In 2005, I was a healthy 51 year old male.  Just under 6 feet tall weighing in at around 225 pounds.  I had never smoked, drink moderately (most of the time), and exercised 3-5 times a week running 4-5 miles in 45-60 minutes.  I had retired from the Army in 1997 and was working with another federal agency in the Hampton Roads area of Virginia. 

At about 3:00 AM on October 5, 2005, I awoke with a very sharp pain in the middle of my chest.  I stood up and had no relief from the pain so asked my wife to call 911.  Within 30 minutes, I was at the emergency room at Riverside Hospital in Newport News, VA.  Because my blood pressure was so low, they did not administer any medication for heart attack.  About 9:30 AM they performed a heart catheterization and as they were running the catheter up the aorta they found they were going in and out of false lumens.  Luckily, the hospital has a team that trains for aortic dissections and they began operating around 11:00 AM.    

I came out of surgery around 6 or 7 PM, after they had repaired the aortic arch, installing a small (2 cm) Dacron graft.  While I had no heart disease, one of the arteries feeding the heart was so dissected I also received a single bypass before they could restart my heart. It took me about three months to recover and return to work, and like many others have noted, I was unable to find much information on what kind of life I could expect with this dissection.  As a retired military service member I received my follow-on cardiology work at Portsmouth Naval Hospital.  The staff there was excellent and very helpful.  The follow-on MRIs and CAT scans showed that my aortic dissection is from the carotids to the iliac arteries, so both the ascending and descending aorta is dissected.  Additionally, some of the false lumens carried the majority of the blood flow.  Another factor was that my aortic valve was leaking because of the dissection and it was not clear how long it would be, if ever, that additional steps would have to be taken.  Throughout 2006 and into March 2007, I rebuilt my strength walking my neighborhood with some light jogging around the cul de sacs. 

In March 2007, the cardiologists informed me that I was heading for heart failure because of the leaking aortic valve.  They said the aortic chamber of the heart was enlarging very minimally every 3 months, but that it was steady over the preceding 14 months, so much so that my mitral valve had also begun leaking.  They referred me to the surgeon at the hospital and he recommended that I have aortic valve replacement surgery in April or May. 

At this point, I began doing some investigation and found that the hospital where they proposed to do the surgery did roughly 350 valve replacements a year with a very low mortality rate.  However, no one could tell me how many of those operations were on people whose chests had already been cracked by earlier heart surgery.  Consequently, I researched the issue and found that Cleveland Clinic performed in excess of 2,000 valve replacements a year and over 600 of those were on patients who had undergone earlier heart surgery.  Thankfully, I was able to convince Portsmouth Naval Hospital and my primary medical facility to refer me to Cleveland Clinic for assessment and surgery.

In May 2007, my wife and I went to Cleveland Clinic for evaluation for aortic valve replacement surgery.  The cardiologists and surgeon were wonderful.  After a battery of tests they agreed I needed the aortic valve replaced, but also recommended I undergo an elephant trunk procedure.  This procedure is two surgeries.  The first surgery combines the aortic valve replacement with the replacement of much of the ascending aorta and aortic arch with a Dacron graft.  It also leaves a portion of the graft to be extended in the second surgery to replace a portion of the descending aorta.   When I asked why the descending aorta needed replacement the surgeon told me a portion of my descending aorta was distended to roughly twice the normal diameter for my height and weight (6’ and 225 lbs).  That certainly sounded to me like a serious aneurysm waiting to happen. 

I had the first surgery performed on July 9, 2007, and it was a long surgery.  The aortic valve replacement was very successful and the placement of the graft went well.  However, my recovery was quite difficult with an extended stay in ICU.  However, we were out of the hospital on July 21, 2007.  Over the following three months, I recovered and went to cardiac rehabilitation so that I was able to have the second stage of the elephant trunk procedure done on October 27, 2007.  This procedure required the removal of a rib and the deflation of a lung so the surgeons could remove about 5 CM of the descending aorta and replace it with the pre-positioned graft material coming down form the aortic arch. 

This was followed by a short ICU stay and a couple of weeks in the hospital, returning home November 15^th.   I did not have any gout after the second surgery, as I had after the original surgery in 2005 and in July 2007.  Additionally, periods of weakness in my legs after standing, which were prevalent after the July 2007 surgery, disappeared.  Both these observations by me confirmed the surgical team’s observation that when they removed the clamps after the graft was completed they noticed a marked improvement in the perfusion of blood to my legs. 

I returned to cardiac rehabilitation in December 2007 and was able to return to work part time in January 2008.  I am currently back to work full time.  I am able to walk 4-5 miles without undue effort.  In addition, I have begun alternating jogging and walking so that over 20-30 minutes I walk, jog, walk, at 2-3 minute stretches over the entire 20-30 minutes. 

My first cardiology appointment after the valve replacement showed some recovery in heart size, I am scheduled for follow-on echocardiograms, and CAT scans in the next two to three months. 

Medications are relatively minimal, blood thinning for the mechanical aortic valve, blood pressure medications for obvious reasons, and cholesterol and triglyceride medications. 

My surgeon told me that I can lift and carry up to 50 lbs, run, do light weights, swim, bike and do light yard and house work.  As long as I keep it under 50 lbs and don’t do any straining I can resume a fairly normal life.  So far I’ve been able to return to work, drive, do light yard work and house work, use my chainsaw, and exercise 3-4 times a week. 

There have been a few downsides beside the trials and tribulations of two major surgeries.  These include:

1. Some loss of feeling in my right arm on the underside of the forearm (probably arising from the incision on the upper right part of my chest so blood could be circulated bypassing my aorta and heart). 
2. Some loss of feeling in my left breast and around the incision on my left side (where the second part of the elephant trunk surgery occurred). 
3. Loss of the left testicle due to loss of blood flow (either due to the descending aortic repair or the multiple incisions in the groin so blood could be circulated bypassing my aorta and heart). 
4. The original surgery in 2005 resulted in some memory loss – mainly associating names and faces (never a strong suit of mine) and some short-term memory retention issues that have been manageable with judicious note taking.

The upsides have been: 

1. Over two years of quality time with my family. 
2. A sure fire way to cut short insurance sales personnel.
3. A slightly more enhanced desire to not put off things until tomorrow (luckily I always felt that was not a good plan for living a happy, full life and was pretty good about implementing that attitude.)
4. Meeting excellent and dedicated medical personnel who have positively impacted the lives of my family and me. 

I have nothing but praise for the surgical team at Riverside Hospital, who did my 2005 surgery and the staff at the emergency room who have seen me through several visits as we all adjusted to living with a dissection.  Without their outstanding training and efforts, I would not be here today.

I also have been very fortunate to be attended to by one of the finest cardiology clinics I have seen.  The cardiologists and staff at Portsmouth Naval Hospital have diligently followed my progress, worked with me to avoid my being a cardiac cripple, and made a timely diagnosis of my need for the aortic valve replacement. 

Finally, I cannot tell you how much I appreciated the surgical staff at Cleveland Clinic who performed the aortic valve replacement and elephant trunk surgeries.  They did a wonderful job that I am very thankful for receiving.  Also, the nursing staff at Cleveland Clinic were excellent in their care of both me and my family.  In my opinion, Cleveland Clinic deserves its long-standing rating by U.S. News & World Report as the number one heart hospital in the country.

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