[HSF] (urgent) Acute dissection/Osler-weber-rendu

[Ben Bidstrup]

OWR leads to bleeding from lesions in the mucosa so he is at 
increased risk of having an episode like that during or after 
surgery. Does heparin increase that risk? Uncertain but probably.
If he is stable I would beta block etc.  and try and wait. However 
downside is risk of acute rupture of dissection etc. But many 
patients have done well after conservative therapy .
Like Hal, I would use aprotinin and also have RVIIa and use it after 
heparin reversal. Evidence for that - none but given the mode of 
action it is likely to help.
Stent graft - some are available.


>OK Guys tell me what to do
>
>elderly man with Osler-weber-rendu syndrome that has had multiple mucosal
>bleeding problems his entire life and has had over 200 u of PRBC's in his life
>that now has an acute type 1 dissection and a HCT of 23 and multiple blood
>antibodies. At present he is about 18 hrs out from his acute event, 
>is clinically
>stable with no pain, BP in the low 100's, mild AI and no pericardial effusion.
>At present our plan is to wait at least till tomorrow in order to get enough
>compatible blood.
>Questions
>1. Operative results??
>2. Risk of bleeding post op from GI, lungs etc?
>3. Any role for medical management only?
>
>Thanks for the prompt responses I know I will get. I have no experience with
>Osler-weber-rendu and cardiac surgery and from calling around not many do.
>
>Tom Martin
>U of Florida
>Gainesville
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon