From left, Ismail El-Hamamsy, MD, PhD, Yulia Nurikyan, and Percy Boateng, MD.
A first-time mother received life-saving heart surgery at The Mount Sinai Hospital, thanks to her quick response to her symptoms and knowledge of her family’s health history, says a leader of her surgical team, Ismail El-Hamamsy, MD, PhD, Director of Aortic Surgery, Mount Sinai Health System, and first author of a recent paper on aortic dissection repair during the COVID-19 pandemic.
The patient, Yulia Nurikyan, was 38 weeks pregnant and had not been feeling well, with a backache that she thought was caused by her late-stage pregnancy. In mid-May, in the heat of the COVID-19 pandemic, she woke up at 5 am with a heavy feeling in her throat. She got out of bed for a glass of water, then fainted. Her husband, Antoan, quickly called 911, and an ambulance rushed her to Elmhurst Hospital in Queens.
Ms. Nurikyan told the medical team at Elmhurst that her father had died of an aortic dissection in his 40s, so they ordered a CT scan and other diagnostic tests, which showed that she had a bicuspid aortic valve. This was crucial information. About half of patients with this heart defect develop an aortic aneurysm, an enlargement of the vessel that can lead to aortic dissection. This is a tear in the inner layer of the aorta, the main blood vessel that brings oxygenated blood to the rest of the body. Some people with an aortic dissection feel no pain, but common symptoms are severe sudden pain in the upper back or chest, shortness of breath, and dizziness or fainting.
Ms. Nurikyan underwent an emergency C-section, delivering a baby girl, Livia. She held her daughter for a few minutes, then she was rushed to The Mount Sinai Hospital for emergency heart surgery, since the imaging tests suggested that her aorta was about to rupture, which could have proved fatal.
Yulia and Antoan Nurikyan with baby Livia.
“In cardiac surgery, this situation is at the top of the list of emergencies,” says Dr. El-Hamamsy, who treated Ms. Nurikyan as soon as she arrived. Dr. El-Hamamsy, senior faculty in Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, is an expert in the repair of aortic dissection and recently published a study that found a significant decline in reported cases during the COVID-19 crisis.
In the study, published in May in the Journal of the American College of Cardiology, researchers compiled data on surgical repair of acute Type A aortic dissection in 11 New York City hospitals from January 1, 2018, to April 15, 2020, counting March 1, 2020, as the first day of the COVID-19 pandemic in the city. The study found that these surgical repairs fell 76 percent after the COVID-19 pandemic began—from 12.8 cases per month before the pandemic to 3 cases per month after the pandemic.
The investigators presented several potential reasons for the decline, suggesting, for example, that some aortic dissection patients did not call for help, fearing COVID-19 infection; or busy first responders were delayed in providing aid; or overburdened emergency departments may have missed or delayed diagnoses. The study said, “Although no causal relationship can be firmly established among the drop in type A aortic dissections, the COVID-19 outbreak in New York City, and the increase in at-home deaths since the last week of March 2020, this gives pause for thought.”
Ms. Nurikyan experienced a Type A aortic dissection. In a successful procedure, Dr. El Hamamsy repaired her bicuspid aortic valve, removing some of the injured blood vessel and replacing it with a synthetic graft, working with David H. Adams, MD, the Marie-Josée and Henry R. Kravis Professor and Chair of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, and the Cardiac Surgeon-in-Chief of the Mount Sinai Health System, and Percy Boateng, MD, Assistant Professor of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai.
Ms. Nurikyan’s baby, Livia, had remained at Elmhurst, placed in neonatal intensive care because of fluid in her lungs. Ms. Nurikyan and daughter spent a week at separate hospitals, and her husband could not visit either of them due to safety rules during the pandemic, though the hospitals kept them in touch through video calls. The family was happily reunited on May 23, when Ms. Nurikyan was picked up by her husband and they went together to get Livia. “My baby was the one who got me through it,” she said in an article on her care in the Daily News. She said she was grateful for her healthier heart and for the compassionate and expert care her new family received.
Ms. Nurikyan’s quick response to her symptoms was crucial, Dr. El-Hamamsy says, a point reinforced by the recent study. “It is critical, as we adjust to the pandemic, to balance the public health imperative of social distancing with the individual need to consult in the presence of sudden severe symptoms. Furthermore, additional resources, ranging from telemedicine to numbers of first responders, should be greatly increased,” the study concluded. “This serves as a word of caution for cities yet to experience a surge in COVID-19 cases, as well as for future similar events.”