Hossein Dehghani: My initial feeling when I took the pictures and the whole vessel shut down was honestly, “Oh my gosh, she's going to die.” My name is Hossein Dehghani. I'm an interventional cardiologist at Adventist Health Glendale. I was on call for cardiology, and a young woman had come to the emergency room with some crushing substernal chest pain.
Amir Saddrzadeh Rafie: She had one of the scariest heart attacks, that was coronary artery dissection.
Hossein Dehghani: Spontaneous spinal coronary dissection is a disease where the normal pressures in the heart actually cause ripping of the wall of the vessel, and this can hinder blood flow. Generally, we do whatever we can to actually leave them alone. You most certainly do not want to go in there and manipulate the walls of a vessel that is already ripping by itself.
Leo Shum: We are one of the best centers in Southern California to take care of these types of disease processes.
Amir Saddrzadeh Rafie: We put them on blood thinner, observe them in the hospital, and we hope that they heal by themselves. But that was not the case for Mary.
Hossein Dehghani: About the end of day two, she began to have significantly crushing chest pain. Now the vessel is actually in the process of, or already has fully shut down, and so we take her to the angiography suite, and at this point, the dissection is quite extensive.
Leo Shum: The blockage was so bad that even I, as an intensivist who doesn't do angiograms, could tell that it was completely blocked.
Amir Saddrzadeh Rafie: They called the surgeon to see if there is any option for the surgery.
Hossein Dehghani: It's genuinely the worst situation you really want to find yourself. And I honestly was praying, “God help us.” This is not going to go well. I remember yelling to my team, “We have 10 minutes, or she's dead.” All of her coronary beds literally dissected within five minutes. I had to essentially reconstruct her whole coronary bed. It felt like a lifetime. I was quite exhausted, and really just didn't know what I'm going to be saying to her husband. Her liver is failing. Her kidneys are failing. We are having a very tough time keeping her blood pressure near where we think is possibly livable. She's on many medications. Two ICU nurses have to be assigned to her.
Leo Shum: Mary continued to worsen, and the decision was made to try and get her to an ECMO center in order to save her life.
Hossein Dehghani: ECMO is essentially like a bypass machine to generate blood pressure and circulate blood to essentially keep them alive. This is one of the places where COVID really depleted the resources where something that we could usually find pretty quickly was just not available.
Amir Saddrzadeh Rafie: She needed ECMO at that point, and USC Medical Center finally showed us the green light.
Hossein Dehghani: For two weeks, she was on ECMO, and thankfully, the heart very slowly started to recover as it had now established blood flow from all the stents and actually went fully back to normal squeeze function, and they were able to transfer her here to Adventist for us to continue to care for her.
Over this time, her kidneys actually also recovered, which was miraculous. She started to work with physical and occupational therapy ever since we essentially put a breathing tube in her. I didn't get to talk to her until she came back to Adventist. I remember going there and hugging her, and she was crying, and I was pretty emotional. And she was saying, “I can't believe I made it, and I'm alive.”
Leo Shum: It was really uplifting.
Amir Saddrzadeh Rafie: I couldn't believe that her heart was pumping as strong as an 18-year-old lady.
Hossein Dehghani: At this point, they're family to me. They actually contacted me to let me know that they were able to get a CT scan of the heart, and they were so happy because all the stents were open, and there was still great blood flow to the heart, which I think at this point, means that she's definitely out of the woods. To this day, I think this is the best work I've ever done, and I think until the day I retire, this will be the best work I've ever done.