[HSF] Acute dissection - what now?

[Prasanna Simha]

There was a study I think  by Hans Borst  wrt waiting and watching for 
neurological recovery in patients with acute dissection,neurological 
injury and above (I think) 80 years) - the idea was whether there was  a 
difference in mortality by letting it play out in this high risk 
group.(I hazily recollect it)
Prasanna
Hgrmd at aol.com wrote:
> Ani,
>   There's a big difference in pursuing a staged procedure after  visually 
> inspecting the dissected aorta versus PCI and pericardiocentesis.   I don't think 
> current imaging techniques would be superior to direct inspection  in 
> deciding if staging the procedure was feasible.
> However, you're right, maybe we should reassess our management.   
> Unfortunately, I suspect it's a lot like the management of post infarction  VSD's.  In 
> the old days, the recommendation was to wait at least 6  weeks for the margins 
> of the VSD to mature.  However, it was eventually  realized (I think by Cooley) 
> that all this did was allow operation for the few  who could survive the 
> gauntlet of expectant management.  I suspect the same  would be operant in 
> expectant management of acute Type I's.  Though I'm  aware of no randomized trial to 
> back up my words, I still believe that the  maximum number of patients with 
> acute Type I's are salvaged with immediate  surgery.
>  
> Hal
>
>
>
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