[HSF] Leaking thoraco-abdominal aneurysm.

[Tdmartin2000]

Some how I missed this thread. If she is not a stent candidate and you say the aorta is not clampable due to calcification at the prox descending then replacement of the entire thoracic aorta is a option. We reported our technique of doing it all through a sternotomy several yrs ago and Nik Kouchoukos in St Louis also has reported on this. It is something that probably should be referred to a major aortic center if possible.

Tom Martin
U of Florida
Gainesville



In a message dated 06/02/07 11:56:14 Eastern Daylight Time, msfirst at gmail.com writes:
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 
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