Richard Holbrooke Dies After Suffering Aortic Dissection

Dec. 14, 2010— -- A man powerful enough to end a war died Tuesday of a tiny tear close to his heart.

Special Envoy to Pakistan and Afghanistan Richard Holbrooke died Monday night at the age of 69 after suffering an aortic dissection, a small tear in the largest artery of the body.

Holbrooke was in a meeting with Secretary of State Hillary Clinton last Friday when he gasped and became ill. Although he was reportedly able to walk himself to the elevator, he was rushed to George Washington University Hospital, where he was diagnosed with an aortic dissection and underwent 20 hours of emergency surgery.

Aortic dissections are uncommon but often fatal, even when patients receive prompt medical attention. For patients with the most severe type A dissections, which are tears located next to the heart, the mortality rate is about 20 percent.

"It's an emergency condition that requires surgery, and the surgery itself is high risk," said Dr. Chris Malaisrie, a Northwestern University Medicine cardiac surgeon. "Left untreated, 50 percent die in 48 hours."

Aortic dissection can strike anyone, although it most often affects men in their 50s. It occurs when a small tear in the inner layer of the artery allows blood to flow into the middle layer.

"Once there's a tear and blood starts traveling, it can get bigger and bigger," said Dr. Richard Lee, a cardiac surgeon, also at Northwestern.

The fluid builds up between the layers of issue, with potential to eventually rupture into the body. Some 15,000 people die annually from aortic aneurysms in the chest, a precursor to more severe dissections, according to the Cleveland Clinic.

"This is very severe," said Malaisrie. "I've seen patients just die in front of my eyes. There's nothing you can do about it."