Audrey Spaulding never felt better. The Northern California native has always kept herself engaged in active hobbies, like kayaking and hiking, even at age 89. But while visiting her daughter, Rita Daniels, in Fountain Valley during the holidays in 2019, Audrey suddenly felt a sharp pain in her chest and found it hard to breathe.

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In the emergency room at Orange Coast Medical Center, doctors informed Audrey that she showed signs of a heart attack, but a computed tomography (CT) scan showed something more severe. Her ascending aorta had developed an aneurysm – a ballooning of the weakened arterial wall – and the innermost layer of that wall had a pinhole tear, a condition known as an intramural hematoma.

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No reservations

Tuan Lam, M.D., cardiothoracic surgeon at Orange Coast Medical Center, was in the midst of his holiday dinner on Christmas Eve when he received the call about Audrey. He immediately drove to the emergency room to see her.

 

“An intramural hematoma is a cardiac surgical emergency that often requires immediate repair, but one can consider conservative management, such as blood pressure control, in a patient of advanced age and deemed high- or prohibitive-risk,” says Dr. Lam. “In Audrey’s case, given her advanced age, we opted to wait.”

 

Just a few days later, a second CT scan showed that the intramural hematoma had progressed to a full aortic dissection with impending rupture. The question became not if, but when, the aorta was going to rupture. Surgery was now the only way to prevent the rupture. After a heartfelt and lengthy discussion with Audrey and her daughter, Rita, Dr. Lam decided that, if they were comfortable with the serious risks involved, he would perform the complex surgery at Orange Coast.

 

“We had no reservations at all,” says Rita. “We knew Mom was in good hands with Dr. Lam and our Orange Coast team.”

 

New Year brings resolution
On January 1, 2020, Rachel Hargrove, M.D., cardiothoracic surgeon at Orange Coast Medical Center, worked with Dr. Lam and the cardiovascular operating room (OR) team to hook Audrey up to the heart-lung machine. The plan was to replace the dissected ascending aorta with a synthetic polyester graft, but they soon discovered another complication: the split now extended into the aortic arch, which supplies blood to the head and upper body. Before replacing the aortic arch, they would need to shut down all blood flow to the brain.