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

[Ani Anyanwu]

How elderly is elderly? Is this man not just dying of his disease? I presume Osler weber rendu of such severity was previously not compatible with long term survival. This man is elderly and has done well dealing with his disease - does he need to go through more? I think sometimes as surgeons we have to accept people are dying and leave them to do so. In him aortic dissection would just be his mechanism of death rather than cause of death. Of course too he may survive without surgery - then if we operate his mechanism of death will be heart surgery. One of my chiefs used to tell me that everyone does not have to die with a scar on his chest.

What does the patient want?

Ani
  ----- Original Message ----- 
  From: Tdmartin2000 at aol.com<mailto:Tdmartin2000 at aol.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Sunday, October 08, 2006 8:32 PM
  Subject: Re: [HSF] (urgent) Acute dissection/Osler-weber-rendu


  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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