While working at home one day four years ago, Paul Sugg felt a ripping tear through his chest.
"I fell flat on my face and broke into a cold sweat," he says. "It seemed like a heart attack so I called for help."
He was flown to University of Iowa Hospitals and Clinic. Sugg had suffered an acute aortic dissection of the descending thoracic aorta (a portion of the aorta running into the back of the chest) —a life–threatening splitting (dissection) of the inner layer of the aorta's artery wall. The dissection caused an enlargement of the aorta to about 1.5 inches, twice the normal. Sugg avoided surgery during a 10–day hospital stay.
During a follow–up visit in 2008, Sugg learned that his dissected aorta had doubled in size to over three inches, making emergency surgery unavoidable. Domenico Calcaterra, MD, director of the aortic surgery program performed the repair.
Unfortunately, his problems with aortic dissection were only beginning. Three days later, he returned to UI Hospitals and Clinics with shortness of breath.
A new CT scan revealed a second aortic dissection, this time of his ascending aorta (the portion of the aorta coming off the heart and running behind the sternum). This type of dissection always requires emergency surgery because the risk of death within 48 hours is extremely high. Again Calcaterra was called in to help with success.
"I've lost over 50 pounds since November and my voice isn't the best," he says in a raspy voice. "But I feel a lot better," said Sugg. "I guess you could say I'm a miracle survivor who owes everything to my doctors and to my faith. I'm very grateful!"
There was a time when mowing the yard seemed to be "too much" for Roger Elbert.
"My feet would start to drag after the first half-hour of walking behind my mower," he says. "I'd be really pooped, but I figured that's just my age, I guess."
A discussion with his physician, Hamid Amjadi, DO, an internist at Covenant Clinic in Waterloo, resulted in an echocardiogram. The showed that Elbert had aortic stenosis, a narrowing of the aortic valve that makes it extremely difficult for the heart to pump blood to the rest of the body. Left untreated, it can lead to congestive heart failure, even sudden death. Surgery was needed to replace the partially blocked valve.
"That scared the liver out of me," Elbert says. "So I went back and talked to Dr. Amjadi, and we decided to get a second opinion."
Amjadi referred Elbert to the UI Heart and Vascular Center, where tests confirmed the diagnosis. Elbert was a good candidate for minimally invasive aortic valve replacement (AVR) surgery.
A traditional AVR procedure requires a full sternotomy, in which a vertical incision is made along the entire length of a patient's sternum to split the breastbone in order to gain access to the heart. Minimally invasive AVR involves an upper hemi-sternotomy, with an incision about six to eight centimeters long, notes Robert Saeid Farivar, MD, the UI cardiothoracic surgeon who performed Elbert's AVR surgery.
Farivar and the surgical team successfully accessed Elbert's aorta, where they replaced his calcified heart valve with a new tissue valve. There are some important benefits to this approach, including reduced trauma from surgery, faster recovery, better mobility, a smaller scar, and minimal pain.
Elbert was back home only three days after his surgery. Moreover, he felt "no pain whatsoever" following the procedure. Soon he was back to his normal activities: push-mowing his half-acre yard, digging in his garden, and "gallivanting" around the neighborhood.
Cheri Amelon has no idea if it was an out-of-body experience or just a bad dream. All she remembers is the unnerving sensation of holding her husband's hand while hovering in the air above a woman in distress.
"I just kept saying, "We've got to help that girl!," Amelon says.
"Then I realized that girl was me."
Amelon recalls nothing else from her "sudden death". She experienced cardiac arrest (no heart beat) leading to "clinical death" (no breath, no pulse).
Cardiac arrest is nearly always fatal, Amelon survived and appears to be recovering fully with no long-term memory loss.
Fortunate events led to Amelon's remarkable outcome. John Amelon saved his wife's life by CPR and a "911" call. The 911 call brought paramedics to the Amelon's home, where three jolts from a defibrillator restarted her heart. Following this, Amelon benefitted from Arctic Sun® technology to induce hypothermia.
The Arctic Sun® system pushes cold fluids through hollow pads that hug the patient's body, thus lowering the body temperature and diminishing a damaging inflammatory process that occurs naturally when blood flow is restored.
Steven Hata, MD, medical director of the Surgical Intensive Care Unit, says the cold therapy technique mimics the experiences of people who survive lengthy accidental submersions in frigid water.
"Even if the heart recovers after cardiac arrest, many patients sustain brain damage because of lack of blood flow and oxygen to the brain," Hata explains. "Rapid cooling limits damage to the brain cells so those cells don't go on to die."
In Amelon's case, she emerged from her comatose state and began to recover following induced hypothermia over a 24-hour period. During a two-weeks hospital stay, UI Heart and Vascular Center cardiologists placed a stent to keep open an artery that was 80 percent blocked. They also diagnosed a heart arrhythmia and implanted a defibrillator that will automatically shock her heart should it fail again.
"We feel really fortunate she ended up at University Hospitals," John Amelon says. "It was the best possible place for her to be."
As a seasoned card player, Jess Harris knows a good hand when he sees one.
When it came to heart failure, however, the deck was stacked against him.
"My survival chances were less than 50 percent," he says. "Yet here I am!"
Getting from where he was with heart failure so severe he could only walk a few steps at a time-to where he is today-on the road to recovery-wasn't easy. The retired tax consultant and emergency medicine technician needed special help in the form of a procedure called extracorporeal membrane oxygenation (ECMO).
First used in 1971 and often associated with treating newborn infants with respiratory failure, ECMO allows sick or injured hearts or lungs the opportunity to rest and get better.
In Harris's case, the experts with UI Heart and Vascular Center viewed ECMO as a last-ditch effort to give his heart a temporary boost so he could survive the surgical implantation of a cardiac stent.
Cardiologist John Chase, MD, who evaluated Harris and recommended him for ECMO, noted that the procedure is not a cure. "ECMO is generally used for acute, reversible cardiac or respiratory failure when the risk of death despite conventional treatment is high (50 to 100 percent)," he explains. "The results focus on survival."
ECMO is performed by draining venous blood from the large catheter placed in a vein to the ECMO circuit, removing carbon dioxide and adding oxygen through an artificial lung, and pumping the re-warmed blood back into the circulatory system via a vein (VV ECMO) or artery (VA ECMO).
What begins as poorly oxygenated dark red blood becomes well oxygenated bright red blood.
Supported by ECMO, Harris's heart recovered well enough that he could tolerate the all-important surgical implantation of a life-saving stent.
"I'm feeling pretty good right now," Harris says. "The people who took care of me were absolutely great!"