The human body can tolerate about 30 minutes of total circulatory arrest (no blood flowing in the body) at a core temperature of 18 degrees Celsius without tissue damage. Doctors rarely use this window, and only in extreme cases. This is the story of one patient whose surgery needed it, and then some.
What Was the Case Behind the No Blood in the Body Surgery?
A 45-year-old man from Nagpur, who complained of atypical chest pain and breathlessness, was referred to Dr. Sameet Pathak (Cardio-Thoracic and Vascular Surgeon) at Wockhardt Hospitals by a local physician. The patient was investigated thoroughly and diagnosed with a large pseudoaneurysm (an abnormal swelling) arising from the ascending aorta (the large blood vessel leaving the heart).
The pseudoaneurysm measured 7 cm x 7 cm x 5 cm and was eroding the sternum (breast bone) from below. It was partially filled with an organized blood clot, and its wall was calcified in places. Pulsations from the aorta could be felt over the breast bone.
What Is a Pseudoaneurysm? (Pseudoaneurysm Meaning)
The pseudoaneurysm meaning is simple enough: it’s a “false aneurysm.” In a true aneurysm, all layers of the artery wall bulge outward. In a pseudoaneurysm, the blood leaks through a hole or tear in the vessel wall, and the leaked blood is held in by the tissue surrounding the vessel, not by the artery wall itself. That makes the swelling fragile, and it can rupture.
The usual causes of such swelling of a blood vessel are:
- Atherosclerosis
- Hypertension
- Connective tissue disorders
- Trauma, including injury from earlier surgery or procedures
Why Did This Patient Need Urgent Surgery?
This problem requires urgent surgical intervention, as sudden rupture of this kind of swelling is almost always fatal. The patient and his relatives were therefore counseled about the need for surgery and its possible complications.
Why Couldn’t the Surgeons Open the Chest the Usual Way?
Opening the breast bone is usually the first step in cardiac surgery. In this patient, that wasn’t possible, because the pseudoaneurysm was touching the breast bone from below and could have ruptured instantly.
So the surgery was done using a very special technique called Deep Hypothermic Circulatory Arrest. Here is how it went, step by step:
- Both the femoral artery and vein (the blood vessels in the groin) were cannulated, and the patient was put on the cardiopulmonary bypass machine.
- The core body temperature was cooled gradually from 36 degrees to 18 degrees Celsius. At this temperature, the heart stops beating.
- Once the core temperature reached 18 degrees, circulation was stopped completely, and the whole blood from the patient’s body was drained into the venous reservoir of the heart-lung machine. Practically no blood was flowing in the patient’s body.
Why Doesn’t the Body Get Damaged With No Blood in the Body?
The vital organs are not damaged because the body’s oxygen requirement becomes extremely low when the core temperature is lowered. Cold slows down metabolism, and that buys the surgeon’s time. But this golden period of total circulatory arrest is only about 30 minutes, so the team has to work fast.
As soon as circulation was stopped, the breast bone was split open and all the organized blood clot was removed. The neck of the pseudoaneurysm was identified, and the ascending aorta was repaired immediately using a Dacron patch and Prolene suture. Just before the last stitch was tightened, circulation was restarted from the femoral artery, and the whole aorta was de-aired to avoid an air embolism. The patient was then re-warmed slowly until the optimal core temperature was achieved, and the heart started beating happily again. The total circulatory arrest time was 44 minutes.
How Did the Patient Recover?
Hemodynamically, he made an uneventful recovery, with no bleeding issues. He developed a transient neurological injury, which gradually improved. It has been a year now, and he still comes for regular follow-up and is doing well.
Dr. Pathak said this procedure is very rarely performed, and very few cases like this have been reported in the literature to date. Deep hypothermic circulatory arrest is the only technique by which this kind of high-risk surgery can be managed successfully.
What Symptoms Should Make You See a Heart Doctor?
A pseudoaneurysm or aneurysm of the aorta can be silent for a long time. Warning signs that deserve a prompt check include:
- Chest, back or jaw pain that doesn’t have a clear cause
- Breathlessness on mild effort
- A pulsating lump or unusual pulsation in the chest
- Hoarseness or trouble swallowing in some cases
- Sudden severe chest or back pain (an emergency)
If you have high blood pressure, high cholesterol, a family history of aortic problems, or a past chest injury or heart surgery, regular checkups are worth keeping.
Where Can You Get Care? Hospital in Nagpur
For people looking for a hospital in Nagpur with cardiac and vascular expertise, Wockhardt Hospitals offers a range of heart and vascular services. For more information or treatment, please contact Wockhardt Hospitals.
Frequently Asked Questions
1. What is the pseudoaneurysm meaning in simple words?
A pseudoaneurysm is a “false aneurysm.” Blood leaks out through a tear in the wall of a blood vessel and collects in the tissue next to it. That leaked blood forms a pulsating pocket that is walled off by surrounding tissue, not by the vessel wall. It can grow and rupture, so doctors usually take it seriously.
2. How can there be no blood in the body during surgery?
Surgeons use a technique called deep hypothermic circulatory arrest. The patient is cooled to around 18 degrees Celsius and the blood is drained into a heart-lung machine. At that temperature, the body’s need for oxygen drops sharply. That’s how it protects all the important organs for a limited time.
3. How long can the body survive with no blood flow?
At a core temperature of about 18 degrees Celsius, roughly 30 minutes is generally considered the safe window. Beyond that, the risk of injury to the brain and other organs rises. In this case the circulatory arrest lasted 44 minutes, which is unusual, and the patient had a temporary neurological injury that improved.
4. What causes a pseudoaneurysm of the aorta?
Common causes include atherosclerosis, high blood pressure, connective tissue disorders and trauma. Injury from earlier surgery or medical procedures can also play a part. The exact cause varies from patient to patient, and doctors look for it through scans and tests.
5. Is a pseudoaneurysm dangerous?
It can be, because the swelling has a weak wall and may rupture suddenly. Large ones, like the one in this case, usually need urgent treatment. Smaller ones sometimes get watched with regular scans, depending on size and location. Your doctor will decide what’s appropriate.
6. How is a pseudoaneurysm diagnosed?
An ultrasound, CT scan or MRI can show the swelling, its size and its connection to the vessel. A doctor will also check symptoms and medical history.
7. How rare is this type of surgery?
Very rare. Dr. Pathak noted that very few cases like this have been reported in the medical literature. It needs a highly skilled team and specialized equipment. That is why the surgery is done only at centers with experience in complex cardiac surgery.
