Holbrooke's Artery Tear Life Threatening, Painful, Doctors Say
A tear in the aorta, the largest artery leading from the heart, likely was painful and life- threatening for Richard Holbrooke, the U.S. envoy for Pakistan and Afghanistan who underwent two days of surgery to have the blood vessel repaired, doctors said.
Holbrooke, 69, spent about 20 hours in surgery yesterday at George Washington University Hospital in Washington, and seven today, family friends said. The length of the surgery suggests the damage was extensive, said James Willerson, chief medical officer of the Texas Heart Institute in Houston.
About 2,000 cases of torn aortas occur yearly in the U.S., and 90 percent of untreated patients die within two days, said Duke Cameron, chief of cardiac surgery at Johns Hopkins Hospital in Baltimore. The follow up was needed after the first operation was slowed by the failure of his blood to clot, according to friends, who spoke on condition of anonymity.
“The object of surgery is to repair the site of the tear with a background graft” that eases pressure which can cause further ruptures in other parts of the heart, Willerson said in a phone interview yesterday. “They may have needed to reattach some critical blood vessels that were blocked by the tear.”
Without surgery, Holbrooke may have had a heart attack, stroke, organ damage or paralysis as the tear prevents oxygen- carrying blood from being pumped to other organs, Cameron said. Surgery usually takes four to five hours, he said.
High Blood Pressure
Research suggests tears may result from a combination of high blood pressure and weak tissue, Cameron said in a telephone interview yesterday.
Holbrooke was admitted to George Washington University Hospital on Dec 10. Doctors yesterday morning “completed surgery to repair a tear in his aorta,” State Department spokesman Philip J. Crowley said Crowley said in an e-mailed statement. The follow surgery was today, the friends said.
Holbrooke has spent the last two years traveling to Afghanistan and Pakistan, and seeking support from allies to help promote economic development and stabilize the neighboring countries that have been plagued by terrorism. He fell ill on Dec. 10, Crowley said.
“It’s wonderful he survived the surgery,” Willerson said. “Now one has to see whether there’s any injury to the brain. In the best of hands, the risk of dying with the surgery is from 10 to 30 percent.”
Lining Splits
The tear begins when the inner lining of the aorta splits and the vessel’s layers begin to separate, Cameron said. The separation may spread down the aorta and block off other arteries to vital organs, including the brain, kidneys or intestines, which cause the organ damage or stroke, he said.
Sometimes the lining blocks the blood supply to the heart, leading to a heart attack, Cameron said. The actor John Ritter died this way, he said.
The most dangerous outcome of the aortic tear occurs when blood leaks into the sac that surrounds the heart, called the pericardium, Cameron said. Filling the sac with blood reduces the space that allows the heart to beat, which can quickly lead to death, he said.
Doctors treat tears by replacing the upper part of the artery with a plastic tube, made of Dacron, Cameron said. Survivors often need frequent monitoring to make sure the aorta remains healthy, he said.
“It’s very important that people with this condition are treated right away” since patients with minimal damage before surgery can have almost normal life spans, Cameron said.
To contact the reporter on this story: Rob Waters in San Francisco at rwaters5@bloomberg.net; John Lauerman in Boston at jlauerman@bloomberg.net.
To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net.
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