[HSF] Fw: Saccular aneurysm of ascending aorta

[Tea Acuff]

Agree with all.
tea


----- Original Message ----
From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, February 11, 2007 7:00:31 PM
Subject: Re: [HSF] Fw: Saccular aneurysm of ascending aorta


Arterial grafting to the coronaries, keep away 
from aorta, then short segment of aortic graft. 
This is no more problematic than a triple graft 
rather than 2. If you are facile with OPCAB do 
the CAB part beating and then a short period of 
CPB  to do the aorta.

What this raises yet again, is the often 
inadequate workup that many of our patients have. 
We are always being chastised about pre op 
investigations, and we are the ones that have to 
deal with the surprises that we sometimes see in 
the OR, not to mention the ones we don't. As the 
patient profile changes so the variety and 
severity of the unexpected. Should we insist on 
MDCT (however many slices you have available), 
echocardiography when awake for the mitral and 
aortic and on table TOE (TEE for the Yanks), 
respiratory function tests etc. for all our 
patients. In the old days we used to do the 
equivalent. I remember assessing oblique Ba 
swallows to ascertain the size of the LA etc. 
With  the rapid expansion of CAB surgery in the 
80s, most were young and otherwise fit and many 
of these investigations were considered by the 
factories and then the payors and hospitals as 
being unnecessary. We have gone full circle now 
and need to do these tests. Not only for the 
lawyers but more importantly for our patients.

>----- Original Message -----
>From: Angela Eguren Maxwell
>To: OpenHeart-L at lists.hsforum.com
>Sent: Saturday, February 10, 2007 5:05 PM
>Subject: Saccular aneurysm of ascending aorta
>
>
>70 year old male, heavy smoker with COPD,  past 
>extensive inferior MI (ECG and echocardiographic 
>findings), progressive angina pectoris. EF 28%. 
>Severe proximal stenosis of LAD, RCA occluded. 
>Both with good runoff. Non-significant stenoses 
>of CX.
>Patient went in for surgery yesterday. Planned 
>off-pump left IMA to LAD, saphenous vein to PDA. 
>On opening the pericardium, we found a 3x 3 cm 
>saccular dilation on the anterior aspect of the 
>ascending aorta, not seen on preop aortogram. 
>We decided to proceed with the operation. We did 
>not have the possibility of an epiaortic duplex 
>scan. Patient was extubated on completion of the 
>procedure . This afternoon he will be leaving 
>the ICU due to his good and uneventful recovery. 
>We would like to ask the members of the Forum 
>what would have been the course of action in 
>everybody's opinion :
>1) LIMA to LAD only.
>2) LIMA to LAD/ PDA arterial grafting with aortic no-touch technique
>3) CABG (LIMA-LAD/ saphenous vein to PDA) + 
>aortic resection (partial/total) or plasty.
>
>Also, On pump for aortic exploration 
>with/without cardiac arrest & hypothermia or 
>off-pump side clamp and patch plasty? Or any 
>other combination?
>
>Our surgical team would like to hear your 
>opinions. I will describe our in-situ decision 
>and findings in another mail, since we'd like to 
>know what  each one of you would do  with the 
>data we had in hand.
>Thanks very much for your input.
>Angela Eguren Maxwell
>Attachment converted: Absolute 
>Genius:Photo_020907_002.jpg (JPEG/«IC») 
>(00691E06)
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--
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon
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