[HSF] The unresolved ascending aorta.

[erdinç naseri]

Prasanna,
Regarding clamp induced injury I agree with you.During 13 years of cardiac surgery I came across acute dissection in a previously operated patient once. That was a  CABG patient of mine.I posted it in the forum .The openings of the vein grafts were intact and there was an intimal tear above these grafts ( clamp site?).BTW I see at least 1 de novo dissection every 3-4 weeks ( serving a population of about 1 million) and ı am sure that at least 50% of the cases die without any diagnosis.( no routine postmortem study here)
erdinc > Date: Fri, 8 Jun 2007 19:33:03 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] The unresolved ascending aorta.> CC: > > Agreed but then what about clamp induced injury ?> Prasanna> > erdinç naseri wrote:> > Prasanna,> > The reason for a lower incidence of acute dissection<in your practice may be several folds:> > 1.Patients don't live enough to attend medical -surgical treatment.> > 2.Longer life expectancy in the western world.> > 3.Lower a verage BP in the indians> > 4.higher diagnosis of Marfan sd.> > I think the first reason is very important since in the developed countries there is a very wide and well designed system of primary care to this type of patients. This is mostly provided by non physicians and they almost can take the patients to the refferal centers in stable conditions.> > erdinc> Date: Fri, 8 Jun 2007 17:06:37 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] The unresolved ascending aorta.> CC: > > I have one issue - I hear so often of cannulation/clamp dissections but > have seen only one intra op dissection in all these years (I hope I do > not see them again) and am curious - how many other surgeons from India > have seen this ? I am asking because we do not see so many acute > dissections (at least we would hear from our cardiologists even if were > not be able to operate many of them due to "practical" concerns and yet > we do not see many of these ) and I hear that in many centers they see > an acute dissection a week. Could it be related to abnormalities in the > aorta in Caucasians. With my limited experience of Non Indian aortae , > At least I did not see any difference in the quality of the aortae of > Croatians from (East) Indians !!> Prasanna> Michael Firstenberg wrote:> > To all -> > Ed -> > obviously no need to apologize, just did not understand your > > response.> >> > With regards to the indications for the mitral (beside the U.S.A. > > approach> > of "it is abnormal, so lets fix it -since the case is sent to a > > surgeon and> > hey, it is a case?"). The LA is mildly dilated (~4cm) and she has > > exercise> > intollerence and is having arrhythmias (not afib, which I think is in > > part a> > separate issue).> >> > I have not met her yet, but my concern about the ascending is that, > > granted> > the indications are not quite there, but - since I might be there anyhow,> > fixing now adds little additional risk (in theory) vs having to go > > back at> > some other time in the future. I do not know about her aortic valve. Of> > course another option is wait 6 months and repeat the study to see if> > anything is changed since I do not know the natural history of her aortic> > pathology. I would just hate to tell her 2 years from now that she > > needs a> > re-o> > p.> >> > There is also a report of a family history of CAD, so I would not be> > surprise if at 54 she needs a graft or 2. This of course might change> > everything as I would be inclinded to fix the aorta if she were to need> > proximals.> >> > A question though - for these "weak" or "abnormal" aortas is there any> > concern about all of the manipulation that we do during surgery > > altering the> > natural history of the pathology. I have seen several dissections after> > surgery, wish a few having enlarged aortas to begin with - which were not> > fixed (nor should they have been) and I wondered if the cross-clamping,> > cannulating, etc accelerates the process?> >> >> >> > -michael> >> > On 6/8/07, Prasanna Simha M <prasannasimha at gmail.com> wrote:> >>> >> Michael what is the LA size, LVID d and s as you said this is just> >> moderate> >> MR.> >> Prasanna> >> On 6/8/07, Dr. Roberto Battellini <battr at medizin.uni-leipzig.de> wrote:> >> >> >> > We would perform only mitral re> > construction in MIC minithoracotomy.> >> > Roberto> >> >> >> > -----Ursprüngliche Nachricht-----> >> > Von: openheart-l-bounces at lists.hsforum.com> >> > [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von> >> > prasannasimha> >> > Gesendet: Freitag, 8. Juni 2007 02:58> >> > An: OpenHeart-L at lists.hsforum.com> >> > Betreff: Re: [HSF] The unresolved ascending aorta.> >> >> >> > No she needs a heart transplant or a VAD ;-)> >> > Frankly do you all replace 3.8 cm and 4.0 cm aortae ?> >> > Incidentally why is a moderate MR going in for surgery in the first> >> > place ? That by itself is not an indication for surgery.> >> > Prasanna> >> > Michael Firstenberg wrote:> >> > > I was just referred a healthy 54 year/old who was found to have> >> > > moderated MR> >> > > from a prolopsed posterior leaflet - ok, will fix that.> >> > > But, on a MRA she was found to an asc. aneurysm (3.8 cm at the Sinus> >> of> >> > > valsalva) and 4.0cm a the level of the PA with a normal arch (t> > he> >> > studies> >> > > done do not comment on the aortic valve)> >> > > Obviously she needs a cath, but I am inclined to fix the ascending> >> aorta> >> > > while in there? I do not know her BSA, but I dont think she is big> >> > >> >> > >> >> > >> >> > > thoughts?> >> > >> >> > >> >> > >> >> > > -michael> >> > > _______________________________________________> >> > > 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.h> > sforum.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> >> > -----------------------------------------> >> >> >>> >>> >>> >> -- > >> Prasanna Simha M> >> _______________________________________________> >> 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> > -----------------------------------------> >> >> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, t> > o 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> > -----------------------------------------> >> > > > _______________________________________________> 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> -----------------------------------------