Spokane heart surgeon Neil Worrall already was home from work and walking his dog by the time he got the call: A patient with a potentially fatal tear in his aorta was being flown to Deaconess Medical Center from the Tri-Cities for emergency surgery.


It was early evening on Wednesday, July 21. It had been a slow day after a hectic week and a half, and Worrall and three other heart surgeons with Northwest Heart & Lung Surgical Associates, of Spokane, had either knocked off for the day or were preparing to do so.


Worrall quickly headed to surgery, but he wouldnt be the only one to do so. Within 45 minutes, two more surgeons had gotten calls about two other patients with the same heart problem, called an aortic dissection, which is a life-threatening condition in which the aortas inner wall splits open. A fourth surgeon, meanwhile, was heading into surgery to save a patient who was suffering a cardiac arrest.


The four heart surgeons since have come to know July 21 as the day of the perfect storm.


That oft-overused analogy, based on the book and movie about a fishing boat lost at sea during an unusually violent storm put in play by several weather events, might well fit the dramatic set of circumstances faced by the four surgeons, their staffs, and the hospitals in which they worked that night.


Chances are slim that four major cardiac events would hit area emergency rooms within an hour, Worrall says.


We usually see about one aortic dissection a month for the entire region, he says. Its almost uniformly a lethal condition.


Cardiac arrest isnt uncommon, but its unusual to have a patient going into surgery while still undergoing cardio-pulmonary resuscitation, Worrall says.


The first aortic-dissection case that evening came to Kootenai Medical Center, where Dr. Leland Siwek, of Spokane, was filling in for a Coeur dAlene surgeon who was on vacation. Siwek promptly prepared for surgery at the Coeur dAlene hospital.


Within minutes, a second aortic-dissection case arrived at KMC, which is able to handle one such procedure at a time, but not two, Siwek says. The second patient had to be flown by helicopter to Sacred Heart Medical Center, in Spokane.


There, Dr. Vern Holbert was summoned to help. He had been on his way to assist colleague Dr. Steven Nisco with a patient at Deaconess who had suffered a major heart attack, had gone into cardiac arrest, and upon whom cardio-pulmonary resuscitation was being administered as he was going into surgery. For Holbert, the aortic dissection at Sacred Heart took precedence.


While Nisco started a heart-catheterization to treat the cardiac-arrest patient at Deaconess, Worrall prepared for emergency surgery elsewhere in the same hospital for the aortic dissection patient from the Tri-Cities. A helicopter carrying that patient was scheduled to arrive at Deaconess any minute.


The harried events started around 5 p.m. New shifts of hospital employees had come on at 3 p.m. at the three facilities, but most of Northwest Heart & Lungs support staff had left for the day.


Worrall says each heart surgery requires eight to 10 people in the operating roomfour to six nurses or technicians, a surgeon, a physicians assistant, a perfusionist (a technician who operates a heart-and-lung machine), and an anesthesiologist.


Deaconess had to call in some people who were off to help.


An aortic dissection typically occurs where pressure on the artery wall from blood flow becomes too high, usually right above the hearts left ventricle, according to the American Heart Association. All three of the aortic dissections that day occurred in that location, called the ascending aorta, Worrall says.


The high blood pressure weakens the arterys inner wall and causes it to tear. When the inner wall splits open, blood forces its way between the arterys walls, making the aorta split further and increasing the chance of the vessel rupturing. A rupture typically will result in swift death.


Many of the victims of an aortic dissection die before making it to a hospital, Worrall says. Those who do make it to the hospital complain of cold sweats and intense chest pain and feel a tearing sensation.


Aortic-dissection surgery involves removing the torn section of the blood vessel and replacing it with a synthetic material.


The surgery often will take six to eight hours to complete.


For those aortic-dissection victims who do make it into surgery, the mortality rate is 15 percent, he says. Ideally, he says, a patient will be in surgery within one hour of the onset of symptoms.


In this case, all three patients survived their surgeries and still were recovering as of last week, Worrall says. All were men between ages of 45 and 65 who otherwise were in reasonably good health.


The heart catheterization procedure, meanwhile, included the placement of a stent to open up a blocked coronary artery. While such stenting procedures are routine, they arent typically used on patients who still are being resuscitated, Worrall says. That patient also survived, though the patient spent two weeks in the hospital.


Worrell says he thinks the events of that hectic evening are an anomaly and not indicative of an increase in occurrence of aortic dissections.


Janice Marich, spokeswoman for Empire Health Services, which operates Deaconess, says such events with good outcomes show the strength of cardiac care in the Inland Northwest.


Whichever hospital they go to, the cardiac care that patients receive is top notch, Marich says. When you have multiple incidents, thats good news.


Aortic dissection occurs most frequently in people in their 50s and 60sa somewhat younger age range than is typical for other heart conditionsand is more common in men than women.


People with high blood pressure are most prone to suffer an aortic dissection, as are those who have or have had an aortic aneurysm, in which the artery wall weakens and becomes dilated.


Last year, the condition came more into public view when comedian and actor John Ritter, one-time star of the Threes Company television series, died of aortic dissection at the age of 54.