What Happened To Randy In Medical Jargon

Written by Janell's husband Mike


As a doctor, I was asked to give a medical analysis of what happened to Randy. I was able to talk to his CT surgeon and see his operative report. I'll start from the beginning. Randy was working in Davis County when his aorta suddenly dissected. See Image. Basically, the inner lining of his aorta came loose blocking his coronary arteries and aortic valve; essentially causing a heart attack. It is unknown why Randy had this dissection as he has no known risk factors, but in the lay population it's most commonly caused by hypertension. A dissection such as Randy's is a surgical emergency and most patients don't survive long enough to make it to a hospital. Luckily, Randy did make it to the Davis Hospital despite significantly low blood pressure secondary to his heart attack. He was intubated at the Davis Hospital and a chest CT done at the time showed a Stanford type A dissection from the aortic valve to the aortic arch. He was transported by helicopter to the U of U facility and per oral report underwent cardiac resuscitation twice during that interval. At the U of U he was immediately rushed to surgery where the cardiothoracic surgeon gave him less than a 2% chance of survival to discharge. His subsequent 6 hour surgery involved a three hour cardiopulmonary bypass run and exactly 48 minutes of circulatory arrest where his body and brain temperature were dropped to 15 degrees Celsius. Circulatory arrest means that all systemic blood flow and oxygen exchange was stopped (including no heart-lung bypass machine). His native aortic valve was replaced with a 27 St Jude Mechanical Artificial Valve, his entire ascending aorta was replaced with a synthetic graft, and the origin of his left and right coronary arteries were reconstructed. No saphenous vein grafts were needed. The aortic dissection was successfuly repaired and the only known postoperative sequelae was a stroke to his Left Posterior Inferior Cerebellar Artery causing disequilbrium and dizziness. This was the best possible outcome and the minor stroke will likely reside with time. Randy will have to be on blood thinners for the rest of his life because of the artifical aortic valve. He is also significantly deconditioned secondary to the event, and it will take a minimal of several months if not years for him to return to his former activity level. It is currently unknown how much permanent damage his heart underwent, but he is being followed by a cardiologist. Because Randy had an aortic dissection, his likeliood of having another is significatly higher than the lay population and his blood pressure will have be under strict control for the rest of his life (i.e. under 120/80). Also, the likelihood of direct relatives having an aortic aneurysm is higher than the lay population. I hope this helps answer any questions and am happy to help out in any way that I can in the future.