[HSF] Acute dissection - what now?

[David Harris]

60 yr old male presents with `acute coronary syndrome`
to physician, inferior infarct pattern.

Cardiac cath done next day. L side normal, RCA
blocked. Aortic valve intact. Aortic dissection then
diagnosed. CT confirms that it extends from RCA to
below brachiocephalic.

Patient then referred to me: dehydrated, obtunded,
creatinine 570mmol/l, anuric. 

Arrests soon after, resuscitated. BP 50 - 60 systolic
for 30 mins. Taken to OR for salvage. Put on pump
(cannulated innominate) to keep him alive. Tamponade
relieved, vein graft on beating heart to prox RCA.
Aorta looks stable (not thinned out - yet)
Weaned with difficulty with IABP.

Now on 40%, ventilated, GCS 10, passing good urine,
creatinine 500. Timing for full repair? Attempt cross
clamp during repair?



Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411             
Fax +27-21-9006412      Mobile +27-83-3309587