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

An innovative aortic replacement operation performed by the Department of Cardio-Surgery 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, waking up in intensive care 10 days later

with some criticisms, 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 the Turin 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 industry. 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,” said Michele Monticone, a banker from Turin who was near Ceva with her family during the carnival holiday. “If I tell my experience today, it is only thanks to Dr. Colucci who operated on me, and to Dr. Vitale, who along with his intensive care colleagues kept me alive with several difficulties.” “I emphasize that in addition to professionalism – says Monticone – I have found a lot of humanity

from everyone: Us and intensive care nurses as well as from the ward, Stefania, Marika, Vilma, Alessandro, Sergio, Fabio and Nadia, just to name a few that suited me not only physically 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 Turin 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 is preparing to intervene in a double aortic dissection”. “If there were signs before then, I did not recognize them – he cares

to emphasize Monticone -: high blood pressure was under control until the period of the pandemic, unfortunately there were no special diseases and controls were

always perfect “. Type A aortic dissection where the inner layer (cassock) of the aortic wall is torn and separated from the middle layer with high risk

of rupture, is an often fatal disease, with a mortality rate of 50% before even arriving at the operating room, while the mortality rate at the operation fluctuates

10 to 25%. “The operation was complex – explains heart surgeon Vincenzo Colucci – although we in Cuneo have performed many operations in recent years.

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

build the aortic arch, the aortic ascending and descending aorta by separately replanting the arteries that supply blood to the brain and the 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 composed of a “normal / standard” section and a distal endovascular stent (endoprosthesis), which “freezes” the dissection in the descending thoracic aorta “. In the postoperative period,

however, there have been the complications that are unfortunately common for this type of inversion.

In fact – as Domenico Vitale explains, the anesthetist in cardio-thoraco-vascular intensive care who participated in the management of the emergency – our patient after aortic surgery faced a very serious lung dysfunction with a significant decrease in oxygenation in blood, which led to some 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 that is, replacing the lung function and thus stabilizing the 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 time, we disconnected the machine – Vitale explains – and restored the pulmonary mechanical ventilation up to the gradual suspension, and then continued the recovery process. An intervention like this – highlights a

the doctor cora – strains the body and complications such as those Monticone experiences in intensive care very often mark the patient’s fate “.

Fate, which fortunately only had 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, together with the family members’ visits, has reactivated the contact with the fundamental reality of the patient in order to cope with the stress of intensive care, which very often causes disorientation,” emphasizes Dr. Vitale. Transferred to the inpatient department and to the rehabilitation center Villa Serena, he returned to his everyday life after just over three months, although the experience marked him and left him with 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 remembers the weeks of intensive treatment 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 hose 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, he adds. 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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