[HSF] Aortic Aneurysms and Bicuspid Valves

[Ani Anyanwu]

How would the ST junction be near-normal with an ascending aorta so huge esp when the arch is normal sized? One question to ask is the etiology of such a dilatation. Some would regard this finding in a young patient as indicative of aortic wall disease making the sinuses at risk of aneurysmal formation in the future. I believe in this situation Griepp, who does most of these in my institution, would excise the whole root as well and spare the valve - this would be particularly indicated if (as I suspect) the ST junction is dilated. While in the short term ST dilatation may be corrected by a tube graft, there is by definition some dilatation below the ST junction which could progress in future.

As a side, why did you just not have one CT study as the 64 slice angio can provide all that the CT shows? Now we are sending patients straight for the 64 slice CT so get all the information in one study. I am sure the radiologists don't like this as it is the cardiologists that control the cardiac multislice CTs.

Ani
  ----- Original Message ----- 
  From: DukeB60 at aol.com<mailto:DukeB60 at aol.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Saturday, January 13, 2007 2:28 PM
  Subject: Re: [HSF] Aortic Aneurysms and Bicuspid Valves


  CT shows 10cm ascending aneurysm with ST junction  splayed open but not 
  terribly dilated.  Aorta near normal at beginning of  the arch.  It does not touch 
  the sternum nor does it compress the PA and  doesn't compress the trachea.  
  LVEF 45%, 2+ AI.  Should be a straight  forward tube graft.  Would anyone 
  consider this to be an emergent case that  should be done today or tomorrow simply 
  due to the size of the aneurysm?  I  have scheduled the case for Monday AM but 
  the cards seem to think it should be  done ASAP.  64 slice angio not done yet.
   
  Edward P.  Raines, M.D., J.D.
  BryanLGH Cardiothoracic Surgery
  BryanLGH Medical Center  East
  1600 South 48th Str.
  Lincoln, Nebraska 68506
  Office:  402-481-8430
  Cell: 402-730-9242
  Fax:  402-481-8429
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