[HSF] Ao Wraping

[Tdmartin2000]

Personally I would have just replaced his aorta. If it was just a hemiarch your arrest time for something like this should be under 10 minutes and with such a young patient we would have even tried to have him extubated in the room. However, what you did is not unheard of or unreasonable. 

Tom Martin
U of Florida
Gator Land
National Champions



In a message dated 03/30/07 01:32:52 Eastern Daylight Time, damle at cableone.net writes:
I operated on a 19 year old last week to replace his aortic valve. (What a 
treat! A change from my usual 84 yr old dialysis dependent valves and 
CABGs!) 

He was known to have a bicuspid valve. In the past few months, he started to 
become symptomatic (with LV dilatation) so this was a good time to replace 
his valve. He looked Marphanoid, so I had a pre-op CT. That showed, a smooth 
fusiform aneurysm starting in the distal ascending aorta, from 1cm below the 
brachiocephalic takeoff to proximal arch. The diameter was 3.8cms. For 
comparison, the proximal ascending aorta was 2..6 cms and the descending 
Aorta was 2.3 cms. The patient is 6' tall and a BSA of 2.3. I was prepared 
to replace his arch. I am very confident and comfortable replacing aortic 
arches, and touch wood, very lucky. But I had some nagging doubts regarding 
the risk/reward ratio in this man. 

At surgery, to I found that his aortic tissue strength was quite good. I did 
cannulate the undersurface of aortic arch, instead the femoral cannulation I 
had planned (I had the fem artery exposed). I replaced the bi-cuspid valve 
with a 27 Carbomedics. I used a 28 Hemashield graft to externally wrap the 
aorta and sutured it to to the aortic adventitia meticulously, with 
substantial dissection,  from just above the coronary ostia to the take-off 
of brachio-cephalic laterally and well past it medially, past my aortic 
input site. 

Before I did the wrapping,  I may point out  that the aortotomy suture line, 
the cardioplegia and aortic cannula input site, none required any additional 
sutures, indicating that the aortic tissue quality  was good. 

Did I do the right thing? I will have this man under CT surveillance for 
ever, but still................. 


Ajit Damle 
Fargo ND 

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