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Dallas Hartman: Complex Aortic Dissection

Dallas Hartman | UPMC Heart and Vascular Institute

The Problem: Aortic Dissection and a Series of Strokes

Looking back, Dallas Hartman knows he’s lucky to be alive. The lawyer and admitted former workaholic was just 55 when he looked death in the face — twice — and survived.

Despite chronic high blood pressure and an aneurysm managed by doctors, Dallas had kept a fast pace building a thriving law firm. Long hours in the courtroom and the office were the norm.

It all caught up with him in June 2012.

The car buff was shopping for a new car when he felt a sudden, searing chest pain that extended to his back. The New Wilmington resident called his doctor, who told him to get to the hospital right away.

The Path to UPMC’s Heart and Vascular Institute

At UPMC Jameson’s emergency room, a fast-acting doctor ordered an urgent CT scan.

The image showed that Dallas’ aorta — the main artery that supplies blood from the heart to the body — was tearing apart. This is an often-fatal condition known as an aortic dissection.

Minutes later, Dallas was on his way by chopper to UPMC Shadyside in Pittsburgh for high-level care.

As soon as he got there, Dallas moved into surgery under the care of Thomas Gleason, MD. Dr. Gleason is a cardiothoracic surgeon and co-director of the UPMC Heart and Vascular Institute.

Dr. Gleason spent the next many hours fixing Dallas’ aorta.

“What can you say about someone who saves your life?” asks Dallas. “My chances of survival were slim, but Dr. Gleason never quit. For hours, he focused all his attention on keeping me alive.”

The Solution: Repair of the Dissected Valve and Aorta

An aortic dissection is rare but not uncommon. It mainly affects men who are middle age and older with a history of high blood pressure like Dallas.

It's a life-threatening condition in which a tear forms in the inner layer of the aorta. Blood surging through the tear causes the inner and middle layers of the aorta to split or dissect.

Dallas had the most dangerous form — a type A dissection. The tear was in the ascending aorta, the curved part of the aorta spanning upward from the heart.

During surgery, Dr. Gleason repaired the aortic valve and replaced the ascending aorta with a synthetic graft. Dallas was on a heart and lung machine throughout the long, delicate procedure.

When he finished his work, Dr. Gleason went to the waiting room to talk to Dallas’ wife, Kristina, and their four children.

“He was so kind and gentle,” recalls Kristina. “He took time to stay with us and explain what happened. We were so grateful.”

Back to UPMC After a Stroke

Stroke is one of the major risks of aortic surgery.

Discharged a week after surgery, Dallas was healing quickly at home, walking up to a mile a day. But three weeks later, he had a mini-stroke that doctors treated with blood thinners. Then, just 10 days later, he had a major stroke.

“I was on the porch when I bent over to tie my shoes and sneezed,” says Dallas. “It hurt. I grabbed my chest and toppled over.”

Kristina rushed Dallas to UPMC Jameson’s ER. After consulting with neurologists at UPMC Presbyterian via telemedicine, Dallas was life flighted to Pittsburgh.

A CT scan showed a blockage in the carotid artery had stopped blood flowing to his brain on one side.

“The pressure caused the artery to worsen beyond the original site,” says Kristina. “The right side of his brain wasn’t getting any blood.”

The neurologists who treated Dallas were doubtful he would survive. But they called in Dr. Gleason.

Dr. Gleason told them that, despite how severe and complex the problem, Dallas’ best chance to live was surgery. He needed to replace the carotid artery along with the aorta he already replaced.

Says Kristina, “When I saw Dr. Gleason, I knew he was in good hands.”

The Solution: Double Bypass to the Brain

For three hours, Dr. Gleason performed a delicate double bypass from the ascending aorta to the carotid and other arteries. The bypass restored blood flow to Dallas’ head, neck, arm, and brain.

He then took another hour to carefully inspect the prior repair.

This time, Dallas spent 28 days in the hospital, including three weeks at UPMC Mercy for intensive neurorehabilitation. He had to relearn certain skills and overcome left side neglect — a lack of awareness of one side of his body.

Although Dallas has greatly improved, he still has some mild lingering left side weakness and struggles with concentrating at a high-level.

The Results: Enjoying Life

Today, Dallas says he feels “better than ever.”

His doctors are keeping an eye on the rest of his aorta beyond the one they replaced.

But Dallas is doing all he can to stay healthy. His blood pressure is now a steady 120/80 instead of 230/100. His blood pressure medicine is down from seven to three pills, and he lost more than 50 pounds.

Dallas still spends a few hours a week at his law firm, but no longer argues cases in court. Instead, he works out five days a week and stays busy on his 140-acre farm in Lawrence County. He and Kristina raise Longhorn and Wagyu cattle there.

“I’m enjoying life. These years have been a gift and I feel grateful,” says Dallas.

“Dr. Gleason absolutely saved my life — twice,” adds Dallas. “I got to see my daughter get married and have a baby… watch my youngest son graduate from high school. And I've spent seven more years with my wife. Life is good.”

Dallas' treatment and results may not be representative of similar cases.

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