[HSF] Acute dissection - what now?

[hgrmd at aol.com]

Dave,

? I've never seen or heard of staging an acute dissection, but your strategy seems to be working so far.? I suspect if you had tried to fix the whole thing acutely, the patient would have died from RV failure.? Still, I would think it's a small minority of acute Type A dissections that can be staged.? If I'm not mistaken, the mean survival of untreated Type A's is only a couple of days.



Hal


-----Original Message-----
From: David Harris <drdharris at yahoo.co.uk>
To: OpenHeart-L at lists.hsforum.com
Sent: Sun, 12 Aug 2007 12:45 pm
Subject: Re: [HSF] Acute dissection - what now?




Hi Prasannah,

There was no definite site on the aorta, and the aorta
was not thinned out and ready to rupture like I have
usually seen. The adventitia was slightly thickened /
inflamed. There was a small amount of liquid  blood,
and clots, which were around the whole ventricle.
Posterior clots were removed only once we were on
pump.

I took him back on 9 Aug for formal closure of the
chest so we could wean and extubate (I had left the
sternum open to prevent any compression of the RV,
which looked horrid at that stage). By this stage the
RV looked normal, the aorta did not look worse (45mm)
externally, and echo showed no extension of
dissection. He was extubated yesterday, and is still
delirious / confused. Kidneys are working, creat now
330mmol/l. I guess I should plan for later this week?

Dave
--- psimha <prasannasimha at gmail.com> wrote:

> 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
> > _______________________________________________
> > OpenHeart-L mailing list
> >
> > Send postings to:
> >  OpenHeart-L at lists.hsforum.com
> >
> > To UNSUBSCRIBE, to CHANGE email address, or to
> view archives:
> > http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> > All messages transmitted by the OpenHeart-L are
> subject to the policies and 
> > disclaimers posted at:
> > http://www.hsforum.com/listdisclaim
> > -----------------------------------------
> >
> >
> >   
> 
> _______________________________________________
> OpenHeart-L mailing list
> 
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
> 
> To UNSUBSCRIBE, to CHANGE email address, or to view
> archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
> 
> All messages transmitted by the OpenHeart-L are
> subject to the policies and 
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
> 


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
_______________________________________________
OpenHeart-L mailing list

Send postings to:
 OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------


________________________________________________________________________
AOL now offers free email to everyone.  Find out more about what's free from AOL at AOL.com.