Rupture of Aorta Called a Result of Extensive Damage to Critical Vessel
Reports of Lucille Ball’s death came as a shock to many, because she appeared to be making a good recovery after undergoing emergency open-heart surgery last week to replace part of her damaged aorta and her aortic valve.
But her heart surgeons said Wednesday that the sudden rupture of her weakened abdominal aorta was a recognized and largely unpreventable consequence of extensive damage to the critical blood vessel, not all of which could be fixed with surgery.
The actress bled to death after the rupture of the aorta, the main blood vessel carrying blood from the heart to the rest of the body, according to the surgeons, Dr. Robert Kass and Dr. Aurelio Chaux.
The aortic blow-out “did not happen because anybody failed to do something,” Chaux said at a crowded press conference Wednesday evening. “We both were shocked and surprised, because of the fact she was doing so well. But this was not totally unexpected.”
Cardiac surgeons have learned that severely ill patients, such as Miss Ball, have a greater chance of surviving after extensive aortic damage if doctors concentrate on repairing key parts of the aorta. If the surgeons had tried to replace the entire aorta, the operation itself would have been far too risky and complicated.
Even with optimal medical care, Miss Ball had “a highly fatal disease,” one heart surgeon said. “These are big, dangerous operations.”
A ruptured abdominal aorta “is not an uncommon mode of death for people with this condition,” said another surgeon, Dr. Gregory Kay of the Hospital of the Good Samaritan in Los Angeles. “There is not a lot you can do about that.”
The 77-year-old actress became ill with severe chest pain and other apparent heart attack symptoms April 18. Her husband, Gary Morton, rushed her to Cedars-Sinai Medical Center.
Physicians quickly performed tests, including an electrocardiogram and a coronary arteriogram, an X-ray study of the inside of the heart and blood vessels.
They diagnosed an “aortic dissection.” In this condition, the wall of the aorta tears, allowing blood to flow into false passages between the three layers of the blood vessel’s wall. It is usually caused by a combination of longstanding high blood pressure and a weakness in the wall of the aorta, which may be related to the fat-like deposits known as atherosclerosis.
Like many aortic dissections, Miss Ball’s appeared to have started in the first part of the aorta, near the heart, and rapidly extended throughout the aorta--from the chest cavity to the abdomen. “Her whole aorta was dissected from her heart into the abdomen, which is 12 to 15 inches at least,” Kass said.
During 6 1/2 hours of emergency surgery, Kass and Chaux, who said they have performed similar surgery hundreds of times, replaced a five-inch segment of the first part of Miss Ball’s aorta and the damaged aortic valve. This was to prevent virtually certain death from bleeding, from a heart attack or from a further tear of the part of the aorta where the dissection began.
The surgeons apparently hoped that further damage to the parts of the aorta that could not be repaired could be prevented with medical therapy, such as blood pressure medications. The goal was to give the fragile aortic wall time to heal.
For about a week, Miss Ball appeared to be progressing as well as could be hoped. There were no indications that anything was about to happen.
“She was sitting, eating and even getting to walk a bit,” said Cedars-Sinai spokesman Ron Wise. Her spirits were “good.”
But early Wednesday morning, disaster struck.
Miss Ball, who had been sleeping, complained of back pain and “lost consciousness at that moment,” Kass said.
Within minutes, Miss Ball’s heart stopped beating--apparently because of the sudden loss of blood into her abdominal cavity.
“The (heart) monitors and the private duty nurse instantly recognized that something catastrophic was happening,” Wise said.
Physicians and nurses worked to resuscitate Miss Ball for 47 minutes before pronouncing her dead at 5:47 a.m.
“She basically had no more blood to pump around,” Kass said. “Even if she had been in the operating room at the time it occurred, we would not have been able to save her.”
AORTIC RUPTURE
On April 18, Lucille Ball had an aortic dissection, a condition in which the main artery supplying blood from the heart to the rest of the body suddenly tears and blood flows into the vessel wall. Surgeons repaired key parts of the damage--the aortic valve and the ascending aorta--but were unable to fix all of it. The actress died after a rupture of the abdominal aorta, part of the damaged blood vessel that could not be repaired.
