Medical Human Story-Episode 52-The Time of the Aorta(2)

 Thoracic Aortic Dissection and the Final Choice of a 78-Year-Old Man


 

Part II: Upon the Stilled Heart

The air in the operating theater is charged with a tension distinct from that of the emergency room. I stood behind the glass of the observation gallery. The wall clock read 5:03 AM. Beneath the massive surgical lights at the center of the room lay a single figure: Park Jung-ho, 78 years old. His diagnosis: Stanford Type A Thoracic Aortic Dissection.

The Incision

Professor Han Do-yoon, a cardiothoracic surgeon, spoke as he donned his gloves. "Is the cardiopulmonary bypass ready?" "Ready, Professor," the anesthesiologist replied.

The monitors flickered with the patient’s vital signs:

  • Heart Rate: 98
  • Blood Pressure: 165/95
  • Oxygen Saturation: 98%

"Let us begin," Han said quietly. Everyone in the room understood the gravity of the moment. A Stanford Type A dissection repair is widely regarded as one of the most formidable challenges in cardiac surgery.

 

Halting the Heart

Professor Han’s voice cut through the silence. "Commence extracorporeal circulation." The pump of the heart-lung machine began to whirl. The machine took over, circulating blood in place of the living organ. Then, Han gave the order: "Prepare for cardiac arrest."

I caught my breath. The anesthesiologist injected the cardioplegic solution. Seconds later, the EKG waveform on the monitor began to sluggishly flatten. Then, it stopped. A long, continuous beep filled the room: ────────. The heart had ceased to beat.

In that moment, the same thought always strikes me: Surgeons may be the only people on earth permitted to stop a human heart. And they do so only for the privilege of making it beat once more.

Opening the Aorta

"Aortic clamp," Han commanded. The metal clamp bit into the massive vessel. He raised the scalpel with steady deliberation and opened the torn aorta. Through the monitor, I watched the internal anatomy reveal itself. The interior of the aorta was already split into two distinct channels:

  • The True Lumen
  • The False Lumen

This was the grim reality of a thoracic aortic dissection. "…This is severe," Han muttered. "How far does the tear extend?" the assistant professor asked. "To the aortic arch." The atmosphere in the room grew even heavier.

The Unforeseen Crisis

Two hours into the procedure, Han suddenly paused. The room fell deathly silent. "There is significant hemorrhaging," he noted. "Blood pressure is crashing," the assistant warned. The anesthesiologist shouted, "Pressure is down to 70!"

I clenched my fists behind the glass. The most terrifying specter of aortic surgery had arrived.

"Prepare for transfusion," Han ordered. "Already underway," the nurse responded. The pressure continued its descent. "It’s at 60," came the report. The air in the theater felt frozen. Yet, Han’s voice remained unnervingly calm. "Stay focused," he said. "We anticipated this possibility."

He removed the damaged section of the aorta and reached for the artificial graft. "We’re going to finish this now."

 

The Vigil

Outside the theater, the daughter sat huddled in a chair. The clock read 7:12 AM. I sat beside her. "…Is it not over yet?" she asked. I shook my head. "Aortic surgery is a marathon." She spoke softly, her voice trembling. "My father… will he make it?" I gave the only answer I could: "We are doing everything in our power."

Resurrection

Five hours in. "Connecting the graft," Professor Han announced. The shredded tissue was gone, replaced by a Dacron graft. At that moment, a single question haunted the room: When this is over, will the man return to us?

"Prepare to restart the heart," Han said. I held my breath. Medication was administered. Seconds ticked by. Then, a spike appeared on the EKG. Thump. And again. Thump. The heart began to beat.

"It's back," I whispered to myself.

But Han was not celebrating. "…It isn't over yet," he cautioned. Aortic surgery does not end when the heart restarts. The true trial often begins afterward. This disease is not merely a matter of one vessel; it disrupts the hemodynamic balance of the entire body.

The Threshold

At 9:18 AM, the doors to the operating suite swung open. Professor Han Do-yoon emerged. The daughter bolted upright. He took a moment to catch his breath before speaking. "…The surgery is complete." Her eyes widened with hope.

"But we cannot rest easy yet," he added slowly. "Why?" she asked, her voice small. "For an aortic dissection patient," he replied, "the first 48 hours post-op are the most critical."

I looked back through the window at the now-quiet operating room. There, the thread of one life and the sleepless vigils of many doctors were intricately woven together. And I knew: this story was far from its end.

 

To be continued!

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