AW: [HSF] Acute dissection - what now?
Tea Acuff
tacuff at swbell.net
Mon Aug 13 18:11:58 EDT 2007
Of course you are making the point that the "leap frog effect" (all cases should go to high volume centers) has serious flaws from the potential patient side, even if it is superior from the doctor perspective, e.g. Cleveland Clinic has "better results". Such is generally the problem with doctor as authority arguments. More on this idea later.
tea
----- Original Message ----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, August 13, 2007 4:48:30 PM
Subject: AW: [HSF] Acute dissection - what now?
Hal,
my "non arrived "case of Friday was the second dying in the transport in the
last 5 years, only for one surgeon. How many may have died for 10?
One case years ago was in the middle of a hard winter, no helicopter
flights, came from some mountains 200 Km far away, the maximal velocity for
driving was 50...
To night we are operating two Type A simultaneously in 2 OR...(my case is in
reperfusion )
Roberto
-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von hgrmd at aol.com
Gesendet: Sonntag, 12. August 2007 18:27
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: [HSF] Acute dissection - what now?
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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