AW: AW: [HSF] Acute dissection - what now?- Robert Goetz-History of Cardiac Surgery

Tea Acuff tacuff at swbell.net
Wed Aug 15 13:15:16 EDT 2007 

We look at the awesome pictures of the galaxies and notice that only some swirl in spiral patterns. If we could look at the individual stars (must less planets) of those swirl glaxies, we would find most stars in the swirl. The swirl is perhaps best understood as a harmonic of the interaction of individuals of the system, but some stars are disappearing into the central black hole and others into a different fate accelerating away into space. Populations and individuals do not have the same behavior in any universe except the mind. I am still waiting on a response from Ani as to which is the proper baseline from which to assess harm.

tea 


----- Original Message ----
From: David Harris <drdharris at yahoo.co.uk>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, August 15, 2007 10:26:37 AM
Subject: Re: AW: AW: [HSF] Acute dissection - what now?- Robert Goetz-History of Cardiac Surgery


Another must to read is Vasilii I Kolesov. A surgeon
to remember. Igor E Konstantinov. Tex Heart Inst J
2004; 31(4): 349-358.

While we`re on the topic of the aortic dissection:
My patient woke up 2 days ago, I took him back today.
The aorta still looked strong. The brachiocephalic
interestingly gave origin to both carotids, and was a
nice big vessel to cannulate. I also cannulated
femoral, and could get a clamp between L subclavian,
and brachiocephalic, and clamped brachiocephalic
proximally. I never clamp aorta in dissections, but
the arch looked OK, and dissection was still localised
to ascending. The entry site was a 1cm tear just
above, and to left of right coronary. It had tracked
along greater curve, and re-entry was just before
brachiocephalic. The repair was simple.

I think we need to look at each case individually, and
taylor the needs accordingly. I think we would have
wiped him out if we had attempted formal repair
initially......first give the cat a chance to bounce
back!!

Dave Harris

--- "Dr. Roberto Battellini"
<battr at medizin.uni-leipzig.de> wrote:

> For the residents reading HSF,
> 
> Robert Goetz (Bob knows him as Goetz worked in Cape
> Town), performed the
> first successful clinical coronary artery bypass in
> 1960.
> Read Ann Thorac Surg 2000;69:1966-72, fascinating
> paper by Igor
> Konstantinov.
> Roberto
> 
> -----Ursprüngliche Nachricht-----
> Von: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] Im
> Auftrag von
> Rwmfglycar at aol.com
> Gesendet: Dienstag, 14. August 2007 18:13
> An: OpenHeart-L at lists.hsforum.com
> Betreff: Re: AW: [HSF] Acute dissection - what now?
> 
>  
> In a message dated 8/14/2007 9:54:45 A.M. Eastern
> Daylight Time,  
> Jbflegejr at aol.com writes:
> 
> Myron  Wheat at the University of Florida 30 or 40
> years ago reported on the
> 
> medical treatment of acute aortic dissection, I
> think in the Journal of  
> Thoracic Surgery. He had a fairly large number of
> cases for the time and
> the 
> early 
> mortality was not very high. If I come across the
> reference, I  will post
> it. 
> John Flege
> 
> 
> 
> 
> Myron Wheat's paper was in the context of a very
> high mortality of surgery  
> in acute dissection cases. In 1963 Michael Roman and
> Robert Goetz published
> I  
> think 3 successful cases of urgent surgery done at
> Einstein in the Bronx. 
> There  was quite a flurry of attempts to repeat this
> success with dismal
> results 
> (the initial success was in the nature of a "Black
> Swan").  Wheat then 
> published his unloading therapy the results of which
> were better than
> surgery. A 
> year or two later it was pointed out that the
> natural history of  ascending 
> aortic dissection was worse than descending aortic
> dissection and that
> Wheat's 
> treatment was failing for the ascending cases.The
> reason for this was
> obvious: 
> acute aortic insufficiency, acute coronary
> obstruction and acute  hemorrhage
> 
> into the pericardial cavity were more likely to kill
> the patient than  a 
> hematoma contained by the pleura. At that time the
> idea took hold that
> ascending 
> aortic dissections get emergency surgery and
> descending aortic  dissections
> are 
> started with unloading therapy and closely observed.
>       The rule of thumb stated by Ben works. The 
> missing factor in this 
> debate is knowledge that would enable us to predict 
> outcome, to declare
> with any 
> certainty into which third of the three  outcomes 
> the patient will fall. 
> Obviously the presence of one of the  three
> potentially lethal complications
> is 
> likely to put the patient  into one of the first two
> outcomes. Patient 
> anatomical and biological  variability is wide and
> difficult to measure. (I
> notice 
> Roberto thinking of this  when he mentions the
> thinness of the intimal
> layer). All 
> of us have had the  experience of inaccurate
> prediction. 
>         I had a case with acute  dissection in a
> severely hypertensive
> little 
> old lady. Although she did not  yet have a
> potentially lethal complication, 
> the dissection had tracked from  mid ascending aorta
> back to just above the 
> sinotubular junction.  She was  not making urine. I
> advised emergency
> surgery 
> which she refused. I thought  she could get worse at
> any moment and decided
> to 
> sit with her through the night  titrating her
> therapy.
> She started making urine and was quite stable by the
> morning. I offered her
> 
> surgery again and once again was turned down flat. I
> kept track of her for a
> 
> year. She remained proud of having refused to let
> the doctors meddle with
> her.
> Bob
> 
> 
> 
> ************************************** Get a sneak
> peek of the all-new AOL
> at 
> http://discover.aol.com/memed/aolcom30tour
> _______________________________________________
> 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
-----------------------------------------

More information about the OpenHeart-L mailing list