Two hearts against the clock

Danielle Mincolla's race against time began just after 2 am on September 11, 2024. She was 27 weeks pregnant, lying awake in her bed at an emergency shelter in Rockland, Massachusetts, when something let go deep in her chest.

"I actually heard it," says Danielle, 43. "I couldn't breathe and it felt like my insides were going to explode."

Through the pain, she slowly realized what was happening and the gravity of the situation. Danielle was born with Marfan syndrome — a genetic condition affecting the body’s connective tissue. As a child, she had been diagnosed with an enlarged aorta, a common complication of Marfan that put her at risk of a life-threatening tear known as an aortic dissection.

Throughout her young adulthood and the birth of her two sons, Danielle had monitored her condition with the help of congenital cardiologists from Mass General Brigham. But in 2021, she escaped an abusive marriage, and in the months that followed, her life seemed to unravel: The business she’d been building with her savings collapsed under the weight of the pandemic; mold issues forced her from one rental home; a home invasion led to her eviction from another. At 38, she found herself homeless, separated from her sons, and, for the first time in her life, outside of the medical system.

An unexpected pregnancy in 2024 brought her back under a doctor’s care, and an ultrasound revealed both a blessing and a curse: Danielle was having a girl, her first, but her aorta had grown dangerously large since her last visit to a cardiologist. Out of caution, Danielle was scheduled to be admitted to Brigham and Women's Hospital on September 12. But her body didn't wait.

If she was going to survive and save her baby, she needed emergency care. Danielle packed a bag and made it as far as the front door of the shelter before collapsing. Her vision fading, she handed her unlocked phone to a fellow resident who called 911.

A need for speed

In an average life, the human heart will beat more than 2.5 billion times, with every contraction producing enough force to circulate blood through the 60,000 miles of vessels mapping the body. The bulk of that force is absorbed by the aorta — the cane-shaped vessel that serves as the body’s primary artery. A dissection occurs when a tear forms in the inner wall of the aorta, allowing blood to rush in, separating the layers and creating what is known as a “false channel.” As blood pools in this new space — depriving vital organs of oxygen — pressure builds, and the risk of deadly rupture increases with every passing minute. If left untreated, most patients with aortic dissection die within 48 hours.

“Any delay at all in treatment costs lives,” says Thor Sundt, MD, chief of cardiac surgery for Mass General Brigham.

To save valuable minutes — and lives — the Mass General Brigham Heart and Vascular Institute’s Aortic Center launched a newly streamlined, integrated procedure for transferring and handling patients with aortic dissection. It begins with one guiding principle.

“We just say yes, every time,” Sabe says.

Integrated approach

At South Shore Hospital in Weymouth, a CT scan confirmed Danielle was experiencing an aortic dissection.

“I remember being in a room with what must have been 20 people when they told me, but I wasn’t scared,” Danielle says. “I was just listening to the baby’s heartbeat on the monitor. That’s all I could hear.”

Prior to creation of the Mass General Brigham Heart and Vascular Institute, the South Shore team would have made separate calls to Massachusetts General Hospital and Brigham and Women’s Hospital, and the two institutions, operating on separate but parallel tracks, would do their best to accommodate the transfer. Now, Danielle’s care team made a single call to the Mass General Brigham Patient Transfer and Access Center (PTAC). The PTAC coordinator quickly alerted Sabe, the surgeon on call. Sabe accepted the transfer, quickly assessed capacity to decide where to send Danielle, and mobilized the aortic emergency team — a unified team of experienced cardiac and vascular surgeons, anesthesiologists, nurses, and support staff.

When the ambulance pulled up to the Brigham shortly before 4 am, Danielle bypassed the ER completely and was whisked directly to the OR, where a multidisciplinary team of surgeons and specialists was waiting.

“These are life and death situations and not many places across New England can manage them,” says Matthew Eagleton, MD, chief of vascular surgery. “This approach gets patients with complex urgent and emergent aortic conditions admitted in the shortest period of time.”

Full heart, fresh start

Once Danielle was stabilized, the high-risk maternal fetal medicine team — including Katherine Economy, MD, Danielle’s obstetrician — delivered the baby via cesarean section. Once the uterus was closed, the cardiovascular surgery team placed Danielle on a heart-lung machine to maintain blood flow and oxygen during the complex heart procedure. Over the next 12 hours, Sabe and his colleagues repaired the tear in Danielle’s aorta, replacing part of the damaged section with a synthetic tube.

“Pregnancy with aortic aneurysm is a rare and lethal combination,” Sabe says. “But with our unified call system, increased bandwidth, and surgical and multidisciplinary expertise, we had the pieces in place to give the mother the complex care she needed while protecting her baby. If you are going to have an aortic dissection, this is the safest region in the world to have one. Our expert team is what makes Mass General Brigham so special.”