The story of the patient who played the violin after a heart operation

An innovative aortic replacement operation performed by the cardio-surgical department at Santa Croce e Carle Hospital in Cuneo saved the life of a 56-year-old man. Arriving in Cuneo under very serious conditions with an aortic dissection, after a first hospitalization in Mondovì, he was operated on March 4 last year by a team led by cardiac surgeon Vincenzo Colucci and anesthesiologist Domenico Vitale. Eight hours in the operating room, the recovery in the intensive care unit, which took place 10 days later with some critical problems, and then a slow return to life, until the total recovery of vital functions completed by a long rehabilitation process in a specialized center in Piossasco, in Turin. the area.

These are some of the numbers that tell the dramatic story, but with a happy ending, about a man who was rescued thanks to doctors representing expertise in their sector. It is the story of a return to life, a near-death experience, which the protagonist tells a few months later with relief and serenity. “Only 10% of the people who suffer from my pathology are saved”says immediately Michele Monticone, a banker from Turin who was near Ceva with her family during the carnival holiday: “If I tell you my experience today, it’s only thanks to Dr. Colucci who operated on me, and to Dr. Vitale, who, along with colleagues in intensive care, kept me alive with several difficulties.”. “I emphasize this in addition to professionalism – says Monticone – I found a lot of humanity in everyone: Us and intensive care nurses as well as on the ward, Stefania, Marika, Vilma, Alessandro, Sergio, Fabio and Nadia, just to name a few who cared not only from a physical point of view but also emotionally. Dr. Vitale, for example, has always given my family members timely information about my physical condition and allowed them to enter the ward, even when they could not. “.

But let’s go in order. On February 28, the unexpected happened to the Torino banker: a sudden illness. He had never had any signs before

so. In Ceva, in the family home, Michele was making a fish-based dish for lunch when she felt a sudden, unbearable pain in her back. One shot. He’s out of breath. In the family, they immediately understand the seriousness, they immediately call 118 and in order not to waste time, they load him into the car to meet the ambulance that will drive him to the nearest hospital, Mondovì.

“The doctors immediately understand the problem, give me an angioTAC and decide to send me immediately to Cuneo, where a specialized team after all the necessary examinations and evaluations prepares to intervene in a double aortic dissection.“. “If there had been any signs before then, I would not have recognized them Monticone would like to emphasize –: high blood pressure was under control until the period of the pandemic, unfortunately there were no special disorders and the controls were always perfect “. Type A aortic dissection, in which the inner layer (cassock) of the aortic wall is torn and separated from the middle layer with a high risk of rupture, is an often fatal disease, with a mortality of 50% before it even reaches the operating room, while the mortality at surgery ranges from 10 to 25%. “The operation was complex – explains heart surgeon Vincenzo Colucci – although we at Cuneo have in recent years carried out many operations of this type in our department. Michele Monticone’s case was special because he had extensive lesions of the thoracic aorta and therefore we had to replace the aortic arch, aortic ascending and descending aorta by separately replanting the arteries that supply blood to the brain and upper limbs. In these cases, especially in young subjects, complete correction of the aortic dissection is indicated with a single operation using new hybrid vascular prostheses with the ‘frozen elephant beak’ technique. A technique involving the insertion of a hybrid vascular prosthesis consisting of a “normal / standard” section and a distal endovascular stent (endoprosthesis) that “freezes” the dissection in the descending thoracic aorta.. In the postoperative period, however, the complications that were unfortunately common for this type of inversion occurred.

“Yes – as explained by Domenico Vitale, cardio-thoraco-vascular intensive care anesthetist, who participated in the management of the emergency –, our patient after aortic surgery, faced a very severe pulmonary dysfunction with a significant decrease in blood oxygenation that led to some episodes of cardiac arrest. With Dr. Colucci we connected it to a machine called ‘veno-venous ECMO’, which takes the blood from a large vein in the body, oxygenates it and through a pump introduces it into the vascular system in such a way that the vicarious, i.e. replace lung function and thus stabilize cardio-respiratory function “. For four days, the patient survived thanks to this machine and this complex procedure that allowed his lungs to regain functionality. “At that point, we took the plug out of the car – Vitale explains – and restored pulmonary mechanical ventilation until gradual suspension, then continued the recovery process. An intervention like this – highlights the doctor again – strains of the organism and complications such as those experienced by Monticone in intensive care very often mark the fate of the patient..

Fate, which fortunately had only positive consequences and fast recovery times. Monticone has resumed breathing autonomously, speaking and controlling movements and has come to pick up the bow and his violin again. “A gesture that, along with family members’ visits, reactivated that contact with the patient’s fundamental reality in order to cope with the stress of intensive care, which very often causes disorientation.”, emphasizes Dr. Vitale. Transferred to the hospital ward and to the rehabilitation center Villa Serena, he returned to his daily life after just over three months, although the experience marked him and left him special memories between dream and reality. “I feel I have overcome this disease as a return to life. I have many confusions and delusions from that period – Monticone is reminiscent of the weeks in the intensive care unit under the influence of morphine -: in my unconscious I also became a woman and the first thing I said to my wife was: ‘ammore’, as I have always called it in a funny way, ‘bring me the tampons’. But not only. I remember seeing myself in the operating room with three kids playing to loosen the snake from my mouth and I start to float so much that they had to close the windows to prevent me from flying out . And still other bizarre things that were said in the days when I returned to life and that were noticed by an aunt of mine. I think it was lucky to be admitted urgently to Cuneo Hospital – adds again –. In other situations, I do not know if I would still be here to tell it. “.

Article published in the newspaper Cuneodice.it in newsagents on Thursday 7 July.

Chiara Carlini

KILE

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