‘Ticking time bomb’ survives often fatal condition

Robert Ritorto had fallen behind in taking his daily blood pressure medication. But he didn’t encounter what turned out to be the slow and silent consequences until one fateful day.

Like many other weekends, Robert was at his daughter’s volleyball game. That’s when he began experiencing unusual symptoms, including shortness of breath, dizziness and a sharp pain in his chest — a feeling he describes as like nothing he has ever felt before. His wife, Brittany, knew something was wrong and rushed him to the nearest emergency room.

There, Robert was diagnosed with a Type A aortic dissection, which is often fatal without emergency surgery. In fact, about 20% of patients with acute aortic dissection die before reaching the hospital.

Statistically speaking, Robert was in a bad situation.

There are numerous risk factors for aortic dissection, with high blood pressure being a major culprit. Other causes include preexisting aortic aneurysm, connective tissue disorder or bicuspid aortic valve. The use of recreational stimulants, such as cocaine and methamphetamine, also increases risk.

Unfortunately, not every emergency room in San Diego is affiliated with a medical center equipped to handle open-heart surgery. This requires a full heart team with expertise handling the heart-lung machine as well as deep hypothermic circulatory arrest, where the body is cooled to 18º C and circulation is stopped entirely. The emergency room doctor who diagnosed Robert’s aortic dissection began searching for a heart center he could transfer Robert for emergency surgery.

Specialized — and extraordinary — care

That evening, Dr. Alexandra Kharazi, a cardiothoracic surgeon affiliated with Sharp Chula Vista Medical Center, was at home with her family when she received an urgent call from the outside center. After reviewing his CT scan, she knew Robert needed heart surgery immediately.

Dr. Kharazi gathered the details and called the heart team at Sharp Chula Vista to set up. They needed to be ready to go as soon as Robert arrived via ambulance.

According to Dr. Kharazi, Type A aortic dissection treatment involves open-heart surgery to remove the dissected, or torn, portion of the heart’s aorta and reconstruct it using a synthetic tube, called a graft. The condition is more common in males and people over age 60. Robert was only in his 40s.

“He was a ticking time bomb,” says Dr. Kharazi. “We know that without treatment, mortality rate is 1 to 3% an hour during the first 24 hours. What worried me was that his blood pressure was dangerously decreasing as he was brought into the operating room and prepared for surgery.”

Robert’s dropping blood pressure, Dr. Kharazi knew, could lead to progression of the dissection and a possible rupture, when the aorta comes apart. “Time works against us in these cases — we had to work fast to get him on bypass,” she says.

Dr. Kharazi successfully replaced Robert’s aorta. And he was home with his family a week later.

Robert says he now knows that life shouldn’t be taken for granted and to cherish each day. You never know what could happen, he recognizes.

“I was lucky that I made it to Sharp,” Robert says. “I’m now taking my prescribed medication every day, but I’m still on the road to recovery and more aware of my health.”

Sharp Chula Vista Medical Center, Sharp Grossmont Hospital, Sharp Coronado Hospital, and Sharp Memorial Hospital are proud to have been recognized by the American Heart Association and American Stroke Association for meeting the latest research-based standards for resuscitation care with numerous Get With The Guidelines Achievement Awards — forging the way toward longer, healthier lives for patients.