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Race to save the life of man with tear in the body's largest blood vessel

What began as a normal morning for Mickey Gardner, 59, turned into a race to save his life.  He describes his symptoms of aortic dissection as feeling like "someone was tearing out my heart through my mouth."

One weekday afternoon, Gardner was making a sandwich in his kitchen when he was knocked to the floor by a tearing sensation in his chest from his collarbone to his waist. The pain continued for 30 to 40 seconds, then it was gone.

He immediately called his wife Elaine and told her his left arm and leg were numb, but he wasn't slurring his speech and could still think clearly. Within 20 minutes, they were at Piedmont Fayette's emergency department.

Aortic dissection symptoms mimic stroke symptoms

"Someone came out, met us and took him straight back," says Elaine. "Everything happened so fast from there."

Medical staff took Gardner's blood pressure and ran an electrocardiogram (EKG) that showed his heart's electrical activity.

"Mickey came to us complaining of losing feeling to his left leg and feeling like the leg didn't belong to him and wouldn't 'listen' to what he wanted it to do," says Dong Trang, D.O., an emergency physician at Piedmont Fayette. "When I examined Mickey, he had weakness and subjective numbness, but I also noticed his leg was kind of cold."

Dr. Trang knew stroke symptoms were similar to those of other conditions, so he asked Gardner follow-up questions, including if he had experienced chest pain. That's when Gardner remembered the brief, but severe, pain he felt in the kitchen. Dr. Trang told Gardner to let him know if any of his symptoms changed.

"Moments later, I said, 'Hey Dr. Trang, I got feeling back in my leg. I can move it now,'" says Gardner. "He said, 'Well, that's not right.' I said, 'What do you mean that's not right? That's good, right?'"

Diagnosing aortic dissection

Because Gardner regained feeling in his leg so quickly, Dr. Trang immediately knew it wasn't a heart attack or a stroke. He ordered a CT scan, which detected an extensive, type A aortic dissection. This means there was a tear from the root of the aorta all the way down to the groin.

"It's very important to catch that, to know that it was an aortic aneurysm rather than a stroke because if we had given stroke treatment, it would have potentially killed [him] in the process," says Dr. Trang.

Emergency surgery at Piedmont Atlanta

"I remember Dr. Trang coming down the hall and he's talking to someone," says Elaine. "Mickey said, 'Who are you talking to?' He said, 'I'm talking to your surgeon. We're looking at your CT scan.' I was amazed. They're discussing his surgery and they're getting ready for him downtown [at Piedmont Atlanta]. At that point, I knew it was a big deal. They don't just life flight you for nothing."

"At one point, I asked Dr. Trang, 'How serious is this?" He said, 'You've got about a one in four chance of not being on the helicopter when it lands,'" remembers Gardner. "I thought, 'Whoa, this is serious.'"

As the team prepared the helicopter, Elaine held Gardner's hand.

"I looked at him and said, 'Just come back to me,'" she says. "I had that feeling I needed to let go and let them do what they needed to do."

Emergency aortic dissection repair surgery at Piedmont

Dr. Trang told Gardner he would go immediately into surgery when he arrived at Piedmont Atlanta.

"In cardiac surgery, there are very few emergencies," says Federico Milla, M.D., Gardner's cardiac surgeon. "Aortic dissection is one of them."

When the aorta contains blood, but gets torn, sometimes its inner layer will close off. This can lead to inadequate blood flow to an organ or body part, which is known as ischemia. If this happens to cerebral circulation, or blood flow to the brain, it can cause a stroke.

"People can present with paralysis and that's mainly because of loss of blood flow," says Dr. Milla, explaining why Gardner temporarily lost feeling in his leg.

Successful aortic repair surgery

"The goal is to get people as soon as we find out about them into the OR as quickly as possible," says Dr. Milla.

Piedmont is a Level I Cardiovascular Center and has resources in place to handle emergencies like Gardner's any time of day.  

"The great thing about our Level I program is that we've taken the initiative to make it a very safe and effective program where we have resources in place even at 2 a.m.," says Allene Harrison, cardiovascular program coordinator. "We have both cardiothoracic surgery and vascular surgery that can handle any type of aortic emergency patient."

Full recovery from aortic dissection

"The good news is if you can get them into the OR in a timely manner and you're not waiting too long before you can perfuse their body [supply it with blood], organs typically recover fully," says Dr. Milla. "If there's no neurologic injury in the perioperative period, most people go back to a completely normal lifestyle."

Gardner says he feels healthy again.

"From start to finish, the care couldn't [have been] better," he says. "Two months to the day from when this occurred, I'm back on the court playing racquetball. I'm pretty much back to normal."

According to the American Heart Association, the most common symptom of aortic dissection is sudden and severe chest pain or upper back pain. In the event of any medical emergency, dial 9-1-1 immediately.  

For more information about valve repair surgery at Piedmont, click here.

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