A Look At What Can Lead To A Torn Aorta

Richard Holbrooke — the Obama administration's top envoy to Afghanistan and Pakistan — remains hospitalized in critical but stable condition after surgery to repair a torn aorta. For more on torn aortas, NPR's Melissa Block talks to Dr. Gordon Ewy, director of the University of Arizona Sarver Heart Center.

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MELISSA BLOCK, host:

Richard Holbrooke, the Obama administration's top envoy to Afghanistan and Pakistan, remains hospitalized in very critical but stable condition after surgery to repair a torn aorta. Holbrooke collapsed on Friday morning after meeting with Secretary of State Hillary Clinton, and he's since undergone two lengthy operations at George Washington University Hospital here in Washington.

I'm joined by cardiologist Dr. Gordon Ewy. He is director of the University of Arizona's Sarver Heart Center in Tucson.

And, Dr. Ewy, explain what happens exactly when the aorta tears.

Dr. GORDON EWY (Director, University of Arizona Sarver Heart Center): Well, when it tears, blood from inside of the aorta gets into the walls of the aorta, and then it can rapture out of the aorta, and you lose a lot of blood. Or it can stay in the walls and as it dissects along, it can occlude various arteries from the head to the kidneys, to wherever the tear travels.

BLOCK: And what are the causes of an aortic tear?

Dr. EWY: Well, there are certain inherited conditions that weaken the aorta, and it runs in families. And then there's also conditions like atherosclerosis or high blood pressure that contribute to it.

BLOCK: Mmm. And would this be something that comes on suddenly, or would it be gradually building up over time?

Dr. EWY: Well, it can be very sudden. I mean, you can rapture, tear and leak out into various parts of the body very quickly.

BLOCK: And for somebody experiencing an aortic tear, what would the sensation be? What would it feel like?

Dr. EWY: Usually, it's pain. They describe it as a sort of a ripping, tearing-type pain, but it doesn't have to be. It's just pain.

BLOCK: How common is this? How many people suffer aortic tears?

Dr. EWY: Well, it's maybe 10,000 Americans a year.

BLOCK: What we know about Richard Holbrooke here is that he had two operations. The first one lasted 20 hours through the day Friday and overnight, and then he had a second surgery yesterday called a fenestration that took seven hours. What does that tell you, that timeframe that we're talking about?

Dr. EWY: Well, it tells me that it's a very serious condition. It wasn't a simple tear. I think, that clearly he had a lot of complications, you know? It could have - and this is pure speculation - blocked off some of the arteries that they had to reattach and repair.

And it can be a very simple procedure, where sometimes the dissection is still within the aorta, and they go in and just cut it so that the blood goes back into the aorta, and that's it. Or it can be extremely complicated depending on, you know, where the tear is, whether it affects the heart, the vessels to the head, the vessels to the various parts of the body.

BLOCK: Mmm. And if it were a simple dissection, how long might that take?

Dr. EWY: An hour.

BLOCK: An hour. And...

Dr. EWY: So you know this was not simple.

BLOCK: Hmm. Dr. Ewy, as you think about recovery after a tear like this and surgery like this, what would your concerns be? What would you be looking for?

Dr. EWY: Well, it's very hard to tell because we don't know what vessels or - were involved, and, therefore, what organ is involved. If it involved the carotid, he'd have a stroke. If it involved the renal arteries, he could have kidney failure. If it cut off some of the branches to the chest, it can be a very, very serious problem.

And that's why, you know, of course, anybody that has a family history of that, hypertension or high cholesterol, you know, we monitor the aorta. Once the size of the aorta, particularly the area around in the chest, gets greater than five centimeters, then we start watching them very carefully and try to repair it before it ruptures.

BLOCK: Well, Dr. Ewy, thank you very much for talking with us.

Dr. EWY: Any time.

BLOCK: That's Dr. Gordon Ewy. He's director of the Sarver Heart Center at the University of Arizona in Tucson.

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