[HSF] Acute dissection - what now?

[psimha]

Dave,
How did he Tamponade ?
Prasanna
David Harris wrote:
> 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
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