Right Time, Right Place: College Junior Survives Dangerous Aortic Dissection
Last October, high school track star and marathon runner Michael Spinelli was a healthy, busy junior at The Catholic University of America.
On Halloween, the then-20-year-old awoke from a sound sleep with piercing pain in his chest, a tight jaw, and pain down his arm. Minutes later an ambulance was transporting him to a nearby hospital. He was released after a few hours, armed with pain medication and anti-inflammatories. His chest discomfort was attributed to bronchitis.
Days later and in pain again, Michael returned to the hospital. A CT scan was performed, and an alarmed ER doctor had him transported immediately to MedStar Washington Hospital Center.
There, Ezequiel Molina, MD, the cardiac surgeon on call, took one look at the CT images and realized Michael had a dangerous and deadly aortic dissection
that had ruptured.
“If he hadn’t arrived when he did, his condition would surely have been fatal,” says Dr. Molina. “With every hour past the onset of chest pain, the risk of death increases by 1 percent. In cases like Michael’s, 80 percent of patients die without emergency surgery.”
Michael had the more common and very dangerous Type A aortic dissection. Blood had surged through a tear in the ascending aorta and aortic root, causing the two layers of the vessel to separate—the result of pressure on a long-undiagnosed aortic aneurysm.
“When we opened his chest and the pericardium, we could see blood from the leaking dissected aorta had started to accumulate around his heart. A deadly full aortic rupture was imminent,” Dr. Molina adds.
Michael’s body temperature was cooled to 28 degrees Celsius to protect the brain, heart and visceral organs, and the heart-lung machine was stopped. “We replaced the portion of aorta closest to the aortic arch with a permanent fabric graft,” Dr. Molina explains. “This was performed in just 14 minutes to reduce risk of stroke.”
The medical team restarted the heart-lung machine support, and Michael rewarmed, while his aortic root was replaced with a mechanical valve attached to a fabric graft, his coronary arteries were re-implanted and the two grafts connected together. “In essence, Michael has a new aorta that will last forever,” Dr. Molina says.
Michael was out the hospital in just five days. “And while he will have to be monitored routinely and take a blood thinner daily, he should lead a full life,” Dr. Molina says.
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