This article originally appeared in Connections, a magazine
published for physicians and the community by UMass Memorial Medical
Complex diseases of the thoracic aorta require care by a dedicated team of
specialists working together to evaluate patients and tailor management plans to
meet specific patients needs.
|Heart and Vascular ICU Nurse Maureen Lynch and Stanley
Tam, MD, visit with a patient as he recovers from a
"Acute type A aortic
dissection is one of the few true emergencies in cardiovascular disease," said
Stanley Tam, MD, chief of cardiothoracic surgery and co-director of the Heart
and Vascular ICU at UMass Memorial Medical Center. An acute aortic dissection is
a tear in the wall of the ascending aorta causing blood to flow between its
inner and outer layers, forcing them apart. Type A describes a dissection
involving the ascending aorta.
"As the dissection migrates toward the heart, it can create acute aortic
insufficiency," Dr. Tam explained. "This dissection may further progress causing
acute cardiac tamponade. Both conditions can lead to fatality."
The mortality rate is estimated to be about one percent per hour from the
onset of symptoms, with a 50 percent mortality rate if the dissection is not
treated within 48 hours, underscoring the urgency of prompt treatment.
"We are working with the region's emergency rooms to inform them of the
protocol for managing these patients," Dr. Tam said, noting that initial
emergency treatment is aimed at pain relief and reducing blood pressure to
prevent progression of the dissection, reduce additional bleeding and prevent
rupture. "Then we need to get patients into our operating room as soon as
possible to resect and replace (with synthetic graft) the torn aorta to prevent
the dissection from moving toward the heart," he continued. "If necessary, we
also repair or replace the aortic valve. If there is a tear in the aortic arch,
we replace that, too, reducing the potential of neurological compromise."
Despite the complexity of this type of surgery, the mortality rate for UMass
Memorial Medical Center is zero since Dr. Tam and his team began performing the
procedure in 2006. (The national mortality rate is 20 percent.) It is an example
of why the Society of Thoracic Surgeons awarded its highest quality designation
- three stars - to the UMass Memorial Cardiac Surgery Program every year since
"We can do this complex operation very well," Dr. Tam stressed. "But we must
get patients here as soon as possible."
For urgent consults: 774-443-2787 (774-4HEARTS)