Holbrooke’s Heart Ailment Uncommon, Hard to Diagnose

Holbrooke Undergoes 7 More Hours of Heart Surgery
Richard Holbrooke, the U.S. special envoy to Afghanistan and Pakistan. Photographer: Asad Zaidi/Bloomberg

The torn aorta that led to the death of Richard Holbrooke, the U.S. envoy for Afghanistan and Pakistan, is an uncommon disorder that isn’t always recognized, doctors said.

Holbrooke died today at age 69, at George Washington University Hospital in Washington, according to a member of his staff and a friend. He had been taken to the hospital Dec. 10 after falling ill and spent about 20 hours in surgery on Dec. 11 and seven hours yesterday, family friends said.

A torn aorta affects about 2,000 Americans yearly, and less experienced doctors sometimes have trouble recognizing it, said Deeb Salem, chairman of medicine at Tufts Medical Center in Boston. The aorta, about an inch wide, is the main artery carrying blood from the heart to other organs. A tear is often painful and life-threatening, Salem said in a phone interview.

Patients may suffer a heart attack, stroke, organ damage or paralysis as the tear prevents oxygen-carrying blood from being pumped to other parts of the body, said Duke Cameron, chief of cardiac surgery at Johns Hopkins Hospital in Baltimore.

Research suggests tears may result from a combination of high blood pressure and weak tissue, and they usually strike without warning, Salem, from Tufts, said in a phone interview yesterday. About two-thirds of those who suffer aorta tears have high blood pressure, and many have Marfan syndrome, a genetic condition that weakens the walls of the major arteries.

Extensive Damage

The length of the initial surgery suggested the damage suffered by Holbrooke was extensive, said James Willerson, chief medical officer of the Texas Heart Institute in Houston, in a phone interview yesterday.

The goal of surgery is to repair the site of the tear with a graft that eases the pressure on other parts of the heart, which can cause a second rupture, Willerson said. Surgeons may also have reattached some critical blood vessels that were blocked by the tear, he said.

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.

Heart Sac

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.

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.

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