AW: [HSF] The unresolved ascending aorta.

[erdinç naseri]

Forgot to say ,also one case of iatrogenic acute type II dissection after cardiac cath.
erdinc> From: battr at medizin.uni-leipzig.de> To: OpenHeart-L at lists.hsforum.com> Subject: AW: [HSF] The unresolved ascending aorta.> Date: Fri, 8 Jun 2007 16:23:18 +0200> CC: > > Dear Prasanna,> We have in our Type A series in 10 years more or less -I must ask Mr> Girdauskas which is collecting the data- 40 to 50 iatrogenic dissections,> between cardiologists through their cath, or we in OP (cannula site, needle> vent site, Heartport surgery years ago) or years after aortic valve> replacements or coronary "touching the aorta" in the old times when the> aorta was denudated and a lateral clamp was used(we don´t do do this any> more, and we resect enlarged aortas).> 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 12:37> An: OpenHeart-L at lists.hsforum.com> Betreff: Re: [HSF] The unresolved ascending aorta.> > 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-op.> >> > 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 reconstruction 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 (the> >> > 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.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> >> > -----------------------------------------> >> >> >>> >>> >>> >> -- > >> 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, 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> -----------------------------------------