The Philippines has a Lady President, so we also have a “First Gentleman” (Hillary take note).

The bad news in the last few days is that the President’s husband has undergone some very risky surgery in Manila.

The early reports was that he had heart surgery, so I assumed that he had a simple “CABG” that in the US we call a “cabbage”. This is, of course, risky surgery, but has become a common procedure, and most people know of those who have had this surgery to bypass a partly blocked artery in the bloodvessels that supply oxygen to the heart muscle. The surgery was bad enough that his wife skipped the “Hero’s day” ceremonies (to commemorate Bataan) on Monday, but most early reports were optimistic.
But today’s story is less optimistic, and as a doc I find it worrysome:he had a “dissecting Aortic Aneurism” and after repair continues to be on a ventillator and on dialysis. An early report of his symptoms are HERE.

The Aorta is the huge artery that goes from the heart to the rest of the body. It is about the size of a garden hose, and comes off the top of the heart and then makes a hairpin turn 180degrees to go to the feet. At the curve, the blood vessels to the brain and arms come off.

There are several types of aneurisms. The most common Aortic aneurism is in the abdomen, where the aorta going to the feet swells up like a baloon.

In the good old days, we saw a lot of aneurisms of the Aorta just above the heart from syphillis (haven’t seen one since medical school 40 years ago, even in Africa, thanks to Penicillin).

But a “dissecting aortic aneurism” is rare, and often missed, or that “blows” so fast that doc’s can’t repair it in time. Actor John Ritter died of one that was diagnosed too late. HERE is an article. Most cases are due to hardening of the arteries (ASCVD) or high blood pressure, but some are from Marfan’s syndrome, a genetic defect where people are tall and doublejointed.

In “dissecting” aortic aneurisms, the blood leaks through the inner layer of the blood vessel in a “false channel” between the lining and the outer layer of connective tissue. This can block the circulation to the body and with time can end up working it’s way all the way through and you bleed to death inside.

In Mike Arroyo’s case, he got sick in Baguio (a mountain town where many spend holidays during the spring hot season), and was flown to Manila for diagnosis and surgery.
So his surgery was not the simple bypass (normal mortality 1-5%) but required replacement of the huge artery coming from his heart which was torn. (“dissecting aortic aneurism). And THAT is big surgery. The heart is just under the sternum (breastbone). You can crack the chest, open it up, and bypass. TO get at the back is a little harder, but you can flip the heart to do it.

To remove an Aortic aneurism, you have to take bypass the huge artery the size of a garden hose, and then usually attach it behind the heart.  You also have to attach all the big bloodvessels that go off the top of it, that supply blood to the brain and the arms.

The reports don’t say if the tear started near the heart or behind the heart, but since Mike’s symptoms were back pain, it was probably behind the heart.

But to repair the blood vessel, you have to open the aorta, and have to keep the brain etc. alive while you’re replacing the damaged blood vessel.

That’s a lot of sewing. They used a heart/lung machine, of course, but also lowered the body temperature that allowed them a little more time. The surgery took six hours in all.

Mr. Arroyo is expected to live, but the opposition has agreed to stop the political attacks on his wife during the critical period. With all of the politics here, nevertheless everyone is related, and no one really wishes bad luck for the President’s husband.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket. 

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