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Jeanne's Story: Recovery From Aortic Dissection

Contributor: Kim Insua de la Cruz, MD
7 minute read
Jeanne (right) with her husband Ken (left) and their dog Django

About 60 years ago, young Jeanne Pasch had to get stitches after falling during a dodgeball game at school. Until recently, that was the only time she needed care in a hospital.

Her string of good fortune abruptly ended in November 2022, when she began experiencing acute shoulder and back pain one morning. Two ambulance rides—and a diagnosis of aortic dissection—later, she found herself at Brigham and Women's Hospital. There, Kim Insua de la Cruz, MD, Mass General Brigham cardiac surgeon and section chief of aortic surgery at the Brigham, performed an operation that might have saved her life.

"It was the hardest thing I've ever gone through," Jeanne says. "I'm grateful to my doctors, nurses, and everyone else who cared for me. Someone was always there when I needed them, and they were very kind to me, a very needy patient."

Sudden and severe pain

Jeanne, who lives in Dover, Massachusetts, with her husband Ken and their dog Django, is a former dancer who had enjoyed good health for much of her life. In the weeks prior to her health scare, she noticed feeling a bit fatigued during her frequent dog walks. But she wasn't particularly concerned.

The first signs of the shoulder and back pain emerged on November 20. When she went to bed the next evening, the pain was worse. Lightheadedness and dizziness had also become an issue. By the morning of November 22, the pain had become unbearable. Ken called 911, and paramedics arrived soon thereafter.

Jeanne has little memory of the next few hours. Her first stop was Newton-Wellesley Hospital, where a CT scan and blood pressure check revealed she had a type A aortic dissection, a life-threatening emergency.

Diagnosis of aortic dissection

An aortic dissection is a tear in the lining of the aorta, the largest artery in the body. The aorta carries oxygen-rich blood from the heart to all major organs and limbs. A tear allows blood to leak into the artery wall, which then splits into two layers and disrupts blood flow to the organs.

When an aortic dissection is diagnosed, time is of the essence in getting the patient into the operating room. According to Dr. de la Cruz, every hour that passes increases the risk of death by an additional 1 to 2%.

"Over time, the dissection can change shape and size," says Dr. de la Cruz. "If we had waited too long before doing surgery, it could have progressed into a full-on stroke. Once they got that diagnosis and the workup was complete, her doctors advised emergency repair."

Type A dissection repairs are some of the most difficult operations in cardiac surgery. Things evolve rapidly. What you see on a CT scan from a few hours ago may not be what you see anatomically when you operate on the patient. There could be other things you have to repair unexpectedly, so as a surgeon, you always have to be thinking on your feet. And you need an agile and experienced team around you.

Kim Insua de la Cruz, MD
Cardiac Surgeon
Mass General Brigham

Expertise in aortic dissection surgery

Due to the complexity of the case, Jeanne's doctor recommended she be transferred immediately from Newton-Wellesley to the Brigham. She couldn't have ended up in a better place.

Aortic dissection is a relatively rare condition. A study published in the Journal of the American College of Cardiology reported that only 11.43 per 1 million people in the United States have a dissection each year.

Research shows that having significant experience in a surgical procedure leads to better patient outcomes. The American College of Cardiology considers a hospital to have "high-volume expertise" if it completes 14 or more type A aortic dissection repairs a year. Very few hospitals in the United States meet this bar. The Brigham easily clears it, with 35-42 repairs in each of the past few years.

"Type A dissection repairs are some of the most difficult operations in cardiac surgery," Dr. de la Cruz says. "Things evolve rapidly. What you see on a CT scan from a few hours ago may not be what you see anatomically when you operate on the patient. There could be other things you have to repair unexpectedly, so as a surgeon, you always have to be thinking on your feet. And you need an agile and experienced team around you."

Aortic dissection repair can take anywhere from 6 to 22 hours, says Dr. de la Cruz. In Jeanne’s case, it was about 8-and-a-half hours.

A full recovery from aortic dissection

When Jeanne awoke in the intensive care unit (ICU), Dr. de la Cruz's was the first face she saw.

"I just remember being happy to see him. He was patient in explaining what had happened and what the surgery involved," she says. "He came by to see me every morning in the ICU, and his bedside manner couldn't have been better. He was gentle and really seemed to appreciate how traumatic this was for me."

Over the next 10 days at the Brigham, Jeanne started her recovery, including physical therapy. But that was just the beginning of what would be a long road.

"This surgery has a humungous impact on the body physiologically," Dr. de la Cruz says. "You don't just bounce back. So even after recovering in the hospital, the work needs to continue at home. I tell my patients that it can take 3 months, 6 months, a year or more to feel some sense of normalcy again."

A day or two after returning home, Jeanne received her first visit from a nurse from Mass General Brigham Home Care. Over the next 7 weeks, a nurse visited once or twice weekly to take Pasch's blood pressure and monitor her progress.

Over this same period, a physical therapist would also come by. At first, doing any kind of exercise was a struggle for Jeanne. But with some insistent prodding from the therapists, she became progressively stronger and more active.

"I was a dancer until I was 57, and I was very cranky because I couldn't move well," Jeanne says. "But they put up with me. They taught me how to push myself, carefully, and keep moving so I could get better."

Fourteen months after her surgery, Jeanne is doing all the right things: walking on the treadmill, doing yoga, and diligently watching her blood pressure. She's still not back to 100%, but she's optimistic about what the future holds—and thankful for the care she received through Mass General Brigham.

"It's a miracle what they did," she says.

Kim Insua de la Cruz, MD

Contributor

Cardiac Surgeon