Winter 2002
A Wedding Story

Emergency surgery in the Heart Institute at Bridgeport Hospital saved George Cartwright from death—making one of the happiest days of his life even happier!

It was their youngest son's wedding day—a day that had been months in the planning. The house was full of happy confusion—members of the wedding party, grandchildren, and out-of-town guests all gathered for the big event. Fairfield resident George Cartwright was shaving, and his wife Nan was getting ready to slip on her mother-of-the-groom dress, when suddenly all their plans changed.

"I felt an incredible pain," George says. "It started behind my right eyebrow, and went to the back of my head and all the way down my back. I told my wife, 'I have to lie down.' I felt shaky, sweaty, and sick."

Nan took one look at her husband and knew this was not wedding day jitters. She immediately called 911. The ambulance took George to Norwalk Hospital, where the Cartwrights had long-time friendships with physicians on the staff. In the ambulance, "I just kept thinking, 'Hang on George, you can make it!'" says George. "I don't remember anything after the Saugatuck River Bridge. This was a Saturday, and the next thing I knew it was Wednesday!"

A lot happened to George Cartwright while he was sleeping.

The Norwalk Emergency Department began a series of tests to find out what was wrong. Heart attack? Angina? Each of these had to be ruled out. It soon became clear that this was not going to be easy, and was going to take some time.

The family was torn, but they knew George would want them to go ahead with the long-planned wedding. So Nan hurried home to dress. And while George was being scanned and tested, his son John was married.

Before the reception John and his bride, Michelle Margo Cartwright, stopped at the hospital—in full wedding regalia—a visit George doesn't remember.

At the reception, George's middle son, Andrew, gave the best man's toast, and then took his mother aside to tell her that Norwalk Hospital had called a few minutes earlier. They had finished their evaluation and recognized that George might need emergency open-heart surgery. So, at that moment, George was in an ambulance speeding to The Heart Institute at Bridgeport Hospital, where internationally recognized cardiac surgeon M. Clive Robinson, MD, is chief of Cardiothoracic Surgery.

Bridgeport Hospital's Heart Institute, alerted by the Norwalk Emergency Department, was ready for George. Suspecting an acute aortic dissection, cardiologist Steven Kunkes, MD, quickly began to perform a transesophageal echocardiogram—a scan performed with a small probe placed within the esophagus (the tube that connects mouth and stomach) for a close look at the heart and nearby blood vessels. Using the transesophageal probe, Dr. Kunkes was able to confirm the diagnosis and help Dr. Robinson decide how extensive an operation would be needed.

What Is an Acute Aortic Dissection?
In order to understand what happened to George next, it's important to understand what an acute aortic dissection is.

The inch-wide aorta, the body's largest blood vessel, starts oxygen-rich blood on its journey from the heart to the rest of the body. It runs down through the chest and abdomen, with smaller arteries branching off to carry blood to the brain, stomach, liver, kidneys, intestines, and legs.

The wall of the aorta is made up of three layers: a tough elastic outer coat, a middle layer of muscular tissue, and a thin inner coat. If there is a tear in the inner layer, some of the blood begins to escape, flowing between the layers. This blood separates the layers (called dissection), creating a false channel—like a one-lane side-road running alongside a superhighway. The blood that flows along this side-road can't get out to the body; it remains trapped between the aorta walls. And that is what happened to George.

Unless they receive treatment in time, 60% of patients like George die within 24 hours, according to Dr. Robinson, while 75% die within 48 hours, and if the dissection is left untreated, within 3 months, 90% of patients will die.

George's dissection continued to open like a zipper, spreading up and down the aorta from the starting place. In fact, it reached a total length of 22 inches. He was holding up pretty well, though, since some of his blood was still passing along the aortic superhighway and out to his body.

But just as Dr. Kunkes's echocardiogram confirmed an acute aortic dissection, the "zipper" reached George's heart. There the pressure of blood pulsing along the side road peeled the leaflets of the aortic valve away from the heart.

The aortic valve controls the flow of blood from the upper chamber of the heart into the aorta. It blocks blood from flowing backwards into the heart, and allows the blood to flow out to the body—something like a police officer directing traffic. But now, instead of reaching the body, some of George's blood just sloshed back and forth—and much of it began pouring into the sac that surrounds the heart. This was a dead end. With nowhere to go, the blood began building up in the sac, squeezing the heart so that it couldn't beat effectively. Without emergency surgery, George would die.

He was immediately rushed to the operating room, where Dr. Robinson and his specially trained support team of doctors, nurses, perfusionists, and others were ready for him.

When Dr. Robinson first saw George's heart, "it looked like a squashed plum," he recalls. To save George's life, Dr. Robinson immediately made a small hole in the sac around the heart to drain off the blood. Relieved of the pressure, the heart began to beat more effectively.

Now emergency surgery could begin to patch the tear, direct the blood away from the side road and back onto the superhighway, and repair the aortic valve. First George was cooled to a body temperature of about 65°F. A system was set up so that George's blood would circulate only to his brain, while the rest of the body, preserved by its cool temperature, received no blood. Then Dr. Robinson opened the aorta, found the tear, and removed about two inches of the aorta surrounding the tear. He replaced that section with a two-inch graft—a tube of synthetic material. He next re-attached the leaflets of the aortic valve to the heart so they could resume their traffic-cop function, directing the flow of blood to the body..

Then Dr. Robinson closed up the side-road between the layers of the aorta with special stitches. Once the blood stopped entering the side-road and resumed flowing along the superhighway, the layers of the aorta came back together.

When Dr. Robinson and his team were finished, George was rewarmed, and blood flow was returned to his body. Nine hours after surgery began, he was taken to the recovery area.

Two in One Week!
"An acute aortic dissection is uncommon," says Dr. Robinson. "Most cardiac surgeons may only see five or six such patients a year, and many of the patients don't live long enough to reach the operating room. But George Cartwright was my second successful acute aortic dissection surgery that week." Just two days earlier, Gordon Humphreys, a British citizen working in Stamford, had suffered an acute aortic dissection and had been brought to Bridgeport Hospital and Dr. Robinson.

Nan Cartwright met Gordon's wife, Liz, when they were both visiting their husbands in the Surgical Intensive Care Unit. While their men recovered and gained strength, Nan and Liz became close friends.

George stayed in Bridgeport Hospital for 17 days, receiving exp