July 31, 2020 – When "Iron Man” Yaniv Hadad was brought to a hospital in the north, he was diagnosed as suffering from dehydration. Hadad wanted a second opinion and went to another hospital, which correctly determined that he had a life-threatening tear in his aorta. He was quickly transferred to Rambam, where he underwent immediate surgery to save his life. Yaniv Hadad (43) is a well-known chef and owner of a Rosh Pina restaurant. He maintains a healthy, active lifestyle, and does not smoke or drink. He enjoys competitive and extreme sports, and participated in a grueling Iron Man competition, which combines running a marathon with miles of swimming and cycling. Although Hadad loves the danger and excitement of extreme sports, a series of events recently forced him to confront his own mortality in a completely unexpected way. During a family vacation, Hadad went on a morning run with his son, and began to feel stabbing pains in his upper body. He immediately went to a local hospital, where he was diagnosed as suffering from dehydration. Hadad, however, was not convinced and went to another hospital for a second opinion. There, an alert physician concluded that Hadad's aorta was tearing, a dangerous condition that could rapidly result in death. Hadad’s condition was critical, and he was rushed by ambulance to Rambam Health Care Campus—the only tertiary care Level 1 trauma center in Northern Israel, and the regional referral center. During the journey, he had to be resuscitated four times. "He arrived at Rambam in critical condition, in shock following the resuscitations, and was immediately brought to the operating room," recalls Dr. Oved Cohen, Deputy Director of Rambam's Department of Cardiac Surgery, who performed the surgery. "The diagnosis was an aortic dissection with damage to the aortic valve, which was torn and not operating properly. The extent of the damage was significant, and complex surgery was required to save his life," says Dr. Cohen. The aorta is the main artery that carries oxygenated blood from the heart to the rest of the body. A tear in the aorta can result from hypertension (high blood pressure), as well as from certain genetic and inherited conditions. Rambam's heart surgeons performed a difficult surgery in which they excised the torn and damaged part of the ascending aorta and replaced it with a woven synthetic tube. In addition, they removed the damaged valve and replaced it with a prosthetic valve. The surgeons also had to replace general heart arteries around the damaged portions of the aorta in order to allow for proper functioning of the newly repaired aorta. The surgery lasted for a number of hours, during which time Hadad was connected to a heart-lung machine to maintain the circulation of blood and oxygen throughout his body. Hadad spent the next two weeks at Rambam, much of it in the Intensive Care Unit, recovering from the dramatic surgery. "I had no idea where I was. The last thing I remember is that I arrived at another hospital in great pain," shares Hadad. "When I woke up and saw the sea out of my window, I asked myself—what is going on here?" Hadad is now recovering; he is looking forward to the future, and to returning to at least some of his normal routine. "Yaniv is really not the classic case of what we would expect to see in the operating room," notes Dr. Cohen. "Apparently, we are dealing with a genetic component affecting the strength of connective tissue and blood vessels in the body, making them more susceptible to damage due to stress or physical exertion." "Time is critical in these situations," he explains. "This is a life-threatening condition in which 50% of patients will die within the first 24 hours if they do not receive treatment—it is that dangerous. Yaniv was very lucky to survive this event, given the condition in which he arrived. Even more than that, he emerged from this crisis without any neurological impairment." According to Dr. Cohen, an aortic dissection is a silent killer that strikes without any advance warning. Most cases result from undiagnosed hypertension. "I ask the public, especially those in high-risk categories because they are smokers or diabetics, to have a simple blood pressure test to determine whether there is a problem," urges Dr. Cohen. In the case of a sudden unexplained death, Dr. Cohen recommends that close family members obtain an echocardiogram to determine whether they have an enlarged aorta, to try to avoid further family tragedies. Photo: Yaniv Hadad surrounded by his medical team at Rambam. Photo courtesy of Rambam Health Care Campus
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