No one could have predicted Denise Bollin's heart issue. Prior to her diagnosis, her only health concern was a broken ankle, which happened while on a horseback riding trip in Colorado. She had no family history of heart disease, her blood pressure was normal and she ate well and was active. Nothing could have prepared her for the day when a casual lunch quickly escalated into a medical emergency.
Serious, sudden symptoms
On Aug. 22, 2016, Denise was enjoying lunch at a Mexican restaurant with her husband and stepson. During her meal, she experienced a strange sensation.
"I remember thinking to myself that the salsa was pretty hot," Denise recalls.
It didn't take long before it was clear that this feeling was more than heat from a spicy meal. The burning sensation rapidly traveled from her mouth to her throat. Within minutes, the pain intensified – spreading throughout her chest and back.
"I knew I was in trouble," Denise says. "I thought it was a blood clot. It never entered my mind that I had anything wrong with my heart."
A shocking discovery
Denise's husband rushed her to the emergency department at a nearby hospital, and she received a series of tests. A CT scan found that Denise's aorta – the heart's main artery that supplies blood to the body – was tearing apart. This often fatal condition is known as aortic dissection. She was quickly transferred by ambulance to The University of Kansas Health System in Kansas City for high-level care. Because of the urgent nature of her condition, Denise's care team, which included a team of multidisciplinary specialists, was waiting and ready for her arrival.
"I remember being wheeled into the room, and there were probably 15 people in there," Denise says. "That's when I realized how serious it was."
Aortic dissection is rare but not uncommon among a certain population with specific risk factors. Typically, it is seen in men 60-80 years old who have a history of heart issues or high blood pressure. Denise was an unusual case because she did not have any of the typical risk factors. What's more, she was suffering from type A dissection, which is the most dangerous and fatal form. Unlike type B dissection, which begins at the top of the aorta in the back of the chest and can often be controlled with medication, type A dissection is located in the ascending aorta – a busy route through which all blood leaving the heart travels.
"When blood gets inside the wall of the aorta through a small tear, it shears the layers of the aorta apart," says Jeffrey Kramer, MD, a board-certified cardiothoracic surgeon. "It can cause death. It can cause stroke. It can cause many immediately life-threatening problems."
She was able to come through and really didn't have any problems. She was lucky to survive. – Jeffrey Kramer, MDCardiothoracic surgeon
An unexpected complication
Denise was immediately taken to surgery to repair her ascending aorta. The procedure involved replacing the damaged part of her aorta with an artificial graft and repairing the affected blood vessels. This treatment is standard for Denise's particular type of aortic dissection. However, during surgery, an unforeseen complication arose.
"We found that the tear originated in the arch of the aorta, which is not at all common," Dr. Kramer says. "It's right where all of the blood vessels to the brain come. That's a very bad place to have a dissection."
It was uncertain how long Denise's brain had been without oxygen. Dr. Kramer estimated she had a very high chance of permanent neurological impairment.
"Dr. Kramer told my husband how critical it was," Denise says. "They told him, 'We don't know if she'll make it, and if she does, she might not ever be the person she was.'"
Innovative technique saves
Denise's surgery lasted several hours. Dr. Kramer used a surgical technique known as deep hypothermic circulatory arrest while performing an aortic dissection repair. This method involves cooling the body to a very cold temperature and stopping circulation for a period of time.
"Inducing hypothermia will protect the brain and other organs while you fix the defects," Dr. Kramer says. "It's a complicated surgery, but there was no other option."
Dr. Kramer and his team were able to replace Denise's damaged aorta with a polyester patch, known as a Dacron graft, and repair the affected blood vessels. He also reconnected the new graft to the arteries that go to the brain. Thanks to Dr. Kramer's steady hand and surgical precision, and the expertise and skill of his team, Denise awoke from surgery without any neurologic complications.
"She was able to come through and really didn't have any problems," Dr. Kramer says. "She was lucky to survive."
A full recovery
Denise spent the next several days at The University of Kansas Health System under close monitoring. Once she was released, she was able to return home and live normally with some restrictions, such as not lifting more than 15 pounds. It took about 12 weeks, but Denise has since made a complete recovery.
"Right now I feel really normal," Denise says. "I really don't have any restrictions at this point."
Denise will continue to receive follow-up care at The University of Kansas Health System. She takes medications daily and must be diligent about controlling her blood pressure. But other than that, she is free to enjoy her retirement days doing what she loves most: horseback riding and traveling with her husband.
"It's nice to finally feel good again," Denise says. "Dr. Kramer and his team saved my life. It's amazing what they do."
Spreading a message of awareness
Denise survived, in part, because she listened to her heart and took action. Now, she understands the importance of awareness and paying close attention to your body's signals.
"If I were to communicate a lesson learned, I would say, 'Don't ever think that it can't happen to you and listen to your body,'" Denise says. "Before the incident, I don't think I knew what aortic dissection even was. And I would never have thought it would happen to me."
Dr. Kramer echoes these sentiments.
"Most people think that if they take care of themselves and don't have any known heart problems, they're going to be fine. But that's not necessarily the case," he says. "You've got to pay attention to your body. And if you have symptoms, you've got to get care."