One of the first things Amy Velisek did when she moved to Colorado to be closer to her newborn twin grandchildren was to buy the book “Hikes Around Fort Collins.” No sooner did she open the book, she learned the adventures she read about could kill her.
An aortic aneurysm is an enlargement of the largest blood vessel of the body, the aorta. Aneurysms can rupture, causing internal bleeding, or they can dissect, which is a tear and separation of the layers of the aorta. Mortality rates for both are high, he said.
Just a matter of time
“Amy was exposed to constant risk going forward,” Guadagnoli said. “Her aneurysm was approaching a dangerous size, and being a very physically active person, she really couldn’t safely do a lot of the things she loved anymore.”
The weakening of the aortic wall can happen for numerous reasons, including genetic diseases or lifestyle factors such as high blood pressure or high cholesterol. Symptoms, however, do not usually arise.
“That’s the problem,” said Dr. Mark Guadagnoli, cardiothoracic surgeon with UCHealth Heart and Vascular Clinic in Loveland. “People walk around with an aneurysm and don’t know it. The only way to detect it is a screening examination.”
The economics of screening tests are difficult and are not covered routinely by insurance. Most insurance does not cover chest examinations — such as an ultrasound, CAT scan or echocardiogram — as part of a health screening. Medicare does cover abdominal ultrasounds to screen for abdominal aneurysms starting at age 65, which Guadagnoli recommends. But chest aneurysms are mostly discovered incidentally on tests done for other reasons, such as to determine a cause for high blood pressure, as was the case with Velisek.
The aorta is like a hydraulic line that comes out of the heart, Guadagnoli explained. Every time the heart beats, it accepts the blood that’s being pumped by stretching and relaxing. “If the heart is the engine, then the aorta is the transmission,” he said. And with roughly 31.5 million heart beats per year, that transmission line is working hard.
An aortic aneurysm occurs when the aorta’s wall begins to weaken and loses elasticity. It then starts to balloon outward; the wall deteriorates and the damaged tissue grows in size, increasing the risk for a rupture or dissection.
Velisek knew of her condition before moving to Colorado and had been monitoring it for a few years. But because the aneurysm had grown, Guadagnoli recommended surgery — and because her aneurysm involved the aortic root but not the valve, she was a candidate for a newer approach to that surgery.
Valve-sparing aortic root procedure (VSAR)
Although it has been in development for many years, the valve-sparing root procedure is still not widely available except for centers performing more complex aortic root surgery, such as UCHealth, according to Guadagnoli.
The aortic valve is contained within the aortic root and are intimately related, he explained. A valve-sparing aortic root procedure preserves the heart valve during the aneurysm repair as opposed to the traditional procedure that sacrifices and replaces the valve. “There is nothing like one’s original equipment,” Guadagnoli said
He stressed that heart valve replacements are lifesaving, when necessary, but when the valve is healthy, then this procedure is a great option.
“She got the best option there is,” he said. “Her aneurysm is repaired, and she has her original heart valve, which should last her the rest of her life.”
Making the decision
It wasn’t that cut and dried for Velisek. She struggled with the thought that she’d electively choose to undergo open-heart surgery. The surgery is challenging, and recovery could potentially take a few months. But the benefits outweighed the risks for Velisek.
More than 98 percent of patients who undergo this surgery electively fully recover, whereas most patients presenting with rupture or dissection are facing a dangerous situation with a high-risk of lethality. And Velisek and her family agreed that doing nothing made them all uneasy. And then there was the fact that she wasn’t allowed to be as active as she’d always been.
“Now my life is being restricted by something that can be fixed,” she recalled thinking.
Her daughter helped her schedule the surgery for four weeks later, on April 16, 2018, at UCHealth Heart and Vascular Center – Medical Center of the Rockies.
The road to recovery
After 10 days in the hospital, Velisek was released and began her recovery with help from many visiting family members and a home nurse who’d visit weekly. After three weeks, she started her recovery program — one hour, three days per week at UCHealth Cardiac Rehabilitation – Harmony Campus in Fort Collins.
She’ll admit that the first day of rehab she was in tears because of her limitations. But now, seven weeks later, she’s ready to take on more.
And she’s opened that hiking book again.