Charles Benidt

"The miracle of it is, not only that he lived through the operation, but he's come back to live a normal life again," says Bea Benidt, pictured here with Charles.

Late Monday afternoon on November 3, 2003, Bea Benidt returned home from grocery shopping to find the flashing lights of two ambulances in her driveway. "What happened?" she asked, scrambling from her car as the paramedics rushed to load her husband, Charles, onto a gurney.

Charles had been in the garage, tinkering with his new sports car, when he was felled by a sudden, severe pain in his chest and back. Fortunately, he'd been able to make it to the phone to dial 911.

Bea gave the paramedics the name of a local hospital in Scottsdale, Ariz., where she and Charles normally received medical care, but the paramedics were adamant. "Mayo Clinic Hospital is the closest," they said, "and your husband needs to get there now."

The first concern in the emergency room was whether Charles was having a cardiac event, or problems with circulation to his heart. However, when two electrocardiograms confirmed that Charles was not having a heart attack, critical care physician Dr. Joseph Wood ordered a computerized tomography, or CT, scan of Charles' chest, which clearly revealed the problem: aortic dissection.

"I knew immediately what this was," says Bea, "because just two months earlier, the actor John Ritter had died of the same thing." The mortality rate for aortic dissection is about two percent per hour, meaning that victims run a 50 percent risk of dying with one day of the dissection, and almost all victims are dead within five days.

"First things first"

One reason the mortality rate for aortic dissection is so high is because its symptoms mimic those of a heart attack, and many physicians are unfamiliar with the condition. However, newer diagnostic tools such as CT scans and magnetic resonance image, or MRI, scans can clearly reveal a dissection. For patients with symptoms similar to Charles', "aortic dissection is what one should suspect," says Dr. Richard Helmers, the pulmonary critical care physician who helped oversee Charles' care.

The aorta is the major artery that carries blood from the heart to the rest of the body. About the thickness of a garden hose, it rises from the heart nearly to the neck, and then descends through the chest and abdomen. The aorta has three main components to its wall: an inner layer, a muscular middle layer, and a thin outside layer of connective tissue.

In an aortic dissection, blood permeates the aorta's inner layer, tearing and separating it from the middle layer of the aortic wall, causing terrible pain in the patient's chest and back, and leaving the thin, outer layer as the only tissue keeping the blood inside the aorta. If the outer layer perforates or tears, the patient can bleed to death, or the blood can pool around the heart and prevent it from being able to fill and beat, a quickly fatal condition known as cardiac tamponade.

Charles' CT scan revealed an extensive tear of the aorta from the root of the heart all the way down to his legs. The tear was so significant that it went down onto the heart muscle and through the root where the aorta attaches to the heart. Emergency surgery was needed if Charles was to survive. He was immediately moved out of the emergency ward and into a private room to be prepared for surgery.

"There were thirteen people working on him," Bea recalls. "Dr. Wood, who had been in the emergency room when Chuck was admitted, explained who each doctor was, and their background, and their position at the clinic. He did this just so that I wouldn't be a stranger to all the people that were helping my husband."

The repair of Charles' dissection would be handled by Dr. Patrick DeValeria of Mayo Clinic's Division of Cardiovascular and Thoracic Surgery. "He didn't pull any punches, and I love him for that," Bea says. "He told me privately, 'Either Chuck has this operation in the next two or three hours, or else he's going to die.' And so we did what had to be done. I didn't sit there and cry."

Charles was awake and lucid as he was being prepared for surgery. "He did not know what was wrong with him, and no one was going to tell him," Bea recalls.

Ironically, for several years Charles had known that he had a leaky heart valve, but his doctors had never diagnosed it as a particularly severe problem. Now Charles said to Dr. DeValeria, "While you're in there, why don't you fix that leaky valve."

"Well, first things first," Dr. DeValeria answered.

Major Surgery

By 8 p.m., just a few hours after arriving at Mayo Clinic Hospital, Charles was in the operating room.

Surgical repair of aortic dissection can take five to eight hours, depending on what has to be done. In Charles' case, surgeons had to remove the aorta, take the coronary arteries off, perform a surgical graft, and plug the arteries back into the new graft. This involved replacing the valve and the arch of the aorta, and reattaching his great vessels as the surgery progressed.

Because the dissection goes entirely through the aorta and involves the blood vessels leading to the brain, physicians must also put the patient into a condition known as circulatory arrest. This involves cooling the patient's brain to 60 degrees Fahrenheit to prevent neurological damage, stopping the heart, and removing the blood from the circulatory system, essentially leaving the patient in a state of suspended animation.

"When Dr. DeValeria said they had to drain his blood, I asked, 'All of it?'" Bea recalls. "That shook me to the core."

"The longer one has no circulation, the higher the risk of brain damage," explains Dr. DeValeria. "We use certain techniques to try to protect the brain. And immediately following the operation, you must closely assess the patient's brain function and make sure it's intact."

The actual repair of Charles' dissection lasted about six and a half hours. However, it took nearly an additional four hours to control the bleeding and close the surgery site. "Aortic dissection disrupts the blood's normal clotting ability," Dr. DeValeria explains, "so the bleeding just develops right through the suture holes, because the blood can't even clot those." Making matters worse, Charles had difficult-to-control high blood pressure, which was pushing against the suture line in the aorta.

"This is about as tough an operation as it gets," says Dr. Helmers. At 6:30 a.m., after ten-and-a-half hours in the operating room and 29 pints of reinfused blood, the procedure was complete and Charles was moved to the intensive care unit for close, ongoing care and attention.

Long Recovery

Charles was in intensive care for almost three weeks following surgery. "There was a list of all sorts of things I had to do before I could go home," he recalls. "I had to walk a mile around the hospital. I had to shave myself, and I had to brush my teeth, and do all those things."

"The therapists working on Chuck were very kind," Bea adds. "They walked him and gave him breathing therapy. And I told Chuck, 'Do it.' I know that sounds tough, but I knew how important it was to get him back to normal. I wasn't a standing-around, wringing-my-hands type of person. I helped him when he went to the bathroom, and all kinds of things. When it came to therapy and things like that, I said, 'We've got to do this.'"

"The people at Mayo were kind, personable, and caring," Bea continues. "They were never too busy to care. In fact, sometimes I had breakfast or lunch with the scrub nurses. They were a super supportive cast."

Twenty-six days after the aortic dissection, Charles was released from Mayo Clinic Hospital.

"One of the lucky ones"

"The day after Chuck's surgery," Bea recalls, "the Wall Street Journal ran an article about John Ritter and aortic dissection. It talked about how this is something that many doctors have not seen, so they don't know how to diagnose it. That's why we know Chuck is one of the lucky ones."

"If I'd had this done almost any other place, I'd be dead," Chuck says.

In fact, on national average, only 10 percent of people survive an aortic dissection. However, "patients can have a very good long term outlook," says Dr. DeValeria. One complication that sometimes develops is due to multiple rips in blood vessels deep in the chest or abdomen, which may not heal completely. Therefore, patients who have experienced aortic dissection require ongoing monitoring. Chuck dutifully returns to Mayo Clinic Hospital every six months for a CT scan. "Dr. DeValeria showed us how everything had healed," he says. "I'm doing fine."

"The recovery was a long period," Bea adds. "And there are times when he's still recovering. He's a little slower in his movements." However, Chuck still runs his business, plays golf and cards, walks a mile every day, and drives his sports car, "which he still hasn't figured out," laughs Bea.

"The miracle of it is, not only that he lived through the operation, but he's come back to live a reasonably normal life again," she says.

"It's wonderful," Chuck agrees.