[HSF] Acute dissection - what now?

[Ben Bidstrup]

It is something 1/3, 1/3, 1/3.
The first third die in a day, the second in a week and the third over 
the next few months.



>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
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>
>
>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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>OpenHeart-L mailing list
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon