[HSF] Leaking thoraco-abdominal aneurysm.

[Timothy Sloan]

Dr. Harris:

I think that replacing the descending thoracic aorta is the primary surgical procedure.  The only reason to add my comments is that on rare occasions with regard to the ascending and arch vessels I have used the Vascutek graft.  They have several "stock" grafts already made with great vessel branches that might work for your case in the second operation (see link http://www.vascutek.com/usa/index1.htm ) .  The company  responds rapidly and have a good graft to sew.

Please keep us informed as to your plans and progress.

Tim Sloan 
----- Original Message ----- 
From: "Michael Firstenberg" <msfirst at gmail.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Saturday, June 02, 2007 8:47 AM
Subject: Re: [HSF] Leaking thoraco-abdominal aneurysm.


> It has been a few days now and I am surprise that no one has chimed in.
> What did you do?
> 
>>From the basics, sounds like the descending to the diaphragm needed acutely
> replaced (with some type of bypass to prevent the heart from hating a cross
> clamp and sew with all of that AI) then attack the rest of the chest.
> 
> I guess another option, if you can get help (i.e. someone who has done it
> before - at least once) is replace the entire thoracic aorta in one
> operation - a real tour de force, but she is young.
> 
> What did or are you doing?
> 
> (I guess another option - the one that I would probably select - is put her
> on a helicopter/airplane to a megacenter - I have Lars Svensson's number on
> speed dial for just such emergencies)
> 
> michael
> 
> 
> On 5/31/07, David Harris <drdharris at yahoo.co.uk> wrote:
>>
>> I have been referred a 32 yr old female patient who
>> was turned down for surgery a year ago. She needed a
>> root, ascending, and arch replacement, with elephant
>> trunk, followed by repair of the descending part which
>> stretches to the diaphragm. She was turned down as the
>> aorta was heavily calcified.
>>
>> She now presents with symptoms from the thoraco,
>> namely dyspnea, chest pain and hemoptysis. The distal
>> half of the descending aorta is surrounded by a large
>> round thrombus / contained leak, measuring 12 cm in
>> diameter. The lumen of the desc aorta measures 5 cm,
>> up to the diaphragm, where it is 3 cm, about 4cm above
>> the celiac.
>>
>> Scan show ascending measuring 5cm, sinuses dilated
>> (there is mild to moderate aortic regurg), arch
>> measures 4cm, there is a neck of 3cm at the isthmus.
>> The aorta is heavily calcified from halfway up the
>> ascending, all the way to the T6 level. The ishmus is
>> spared a bit and is POSSIBLY clampable. A stent would
>> not be possible with peripheral access, as the left
>> subclavian attaches to the aorta at an angle, and is a
>> bit stenotic there, and the descending aorta makes a
>> 90 degree turn at the level of the pulmonary ligament
>> towards the right before bending back towards the
>> left. The left external iliac artery is completely
>> occluded.
>>
>> Any extra tips?(I think I have already made up my mind
>> what to do, but some confirmation, and gleaming pearls
>> would be greatly appreciated)
>>
>> Dave Harris
>>
>> 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
>> -----------------------------------------
>>
> _______________________________________________
> 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
> -----------------------------------------
>