[HSF] type A aortic dissection

[erdinç naseri]

What is the forum's opinion about the following case:
56 y/O male,4 years ago CABG X 4(lima ,LAD) admitted yesterday with a back 
pain which had begun 15 days ago. CT revealed an ascending aorta of 7 cm and 
type A  AD extending up to left subclavian artery, no dissection of the 
coronaries.TEE confirmed the diagnosis and AI of 2.nd degree,No pericardial 
effusion,EF 35%.ECG showed an old anterolateral infarction.Is coronary angio 
a must?
My plan is as follows:Right axillary artery and femoral vein cannulation 
proceeded by sternotomyon CPB.Revert to R atrial cannulation.İsolate the 
arch vessels and aorta while cooling to 25 degree.Supraclavicular 
preparation of origin of Lima.X clamp+ bull dog Lİma. Open  the aorta and 
give direct ostial hypothermic blood cardioplegia and if posssible make an 
island of the saphenous veins to attahch to the graft later on.Hypothermic 
arrest and ACP for distal anastomosis .Revert to CPB and make the proximal 
anastomosis while warming.
Erdin Naseri


>From: Giulio Rizzoli <giulio.rizzoli at unipd.it>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: Re: [HSF] Type I Dissection
>Date: Sat, 10 Feb 2007 10:39:08 +0100
>
>I saw Swenson at Cleveland Clinic performing hemi-arch repair  at 28°  
>through mini thoracotomy in less than 10 m'. of circulatory arrest. To have 
>this self confidence however is a matter of a huge experience
>                                                                            
>             Giulio Rizzoli
>
>
>At 03.49 10/02/2007, you wrote:
>>Ani,
>>   I don't know of anyone, including your predecessor Dr. Griepp, who
>>advocates doing an open distal anastomosis at 25 C without some sort of  
>>selective
>>perfusion.
>>Hal
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>
>Giulio Rizzoli MD FETCS
>Cardiochirurgia Padova
>tel. 049 821-2408
>fax 049 821-2409
>e-mail giulio.rizzoli at unipd.it
>
>***************************************************************************
>Ich hatte einst ein schönes Vaterland.
>Der Eichenbaum wuchs dort so hoch, die Veilchen nickten sanft.
>Es war ein Traum .... Heinrich Heine
>
>
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