[HSF] The unresolved ascending aorta.

Mon Jun 11 21:08:09 EDT 2007

Thank you Tea
still so naive as it might appear, yet still not answered, whether within
the 80-85%  AUC or within the cut off alpha/2  ...
still ... I'm addressing the unambigious quantitative assessment of a
geometric reality  landmark for a definite " vs probable" indication for
interference .... rather than hunches about a so called "prophylactic ?"
intervention in some unfounded virtual speculations .... !!!

NFA

On 6/11/07, Tea Acuff <tacuff at swbell.net> wrote:
>
> Despite the strong and visceral opinions engendered by bleeding aortas of
> all varieties many unaddressed issues come out of this thread ranging from
> possible prophylactic repair of the as yet still competent aortic valve, to
> repair of thousands (millions?) of asymptomatic patients, and  to your
> seemingly naive question how to measure the size on the aorta. The latter
> answer is often the quiptic "by CT scan", but this dismisses the geometric
> reality that the aorta is an oblique, asymmetric volume spiral viewed
> through an axial reconstruction that is favored by most busy radiologists.
> Unless one does a volume reconstruction to get dimensions in relation to the
> aorta and not the patient (are you still sure about orientation, Bob?) the
> enlargements (and absolute or indexed numbers) noted may all be subject to
> special technical variations. This estimation make not be significant if one
> is on the end of the bell curve but it does point to the problems of strict
> or emphatic
> guidelines in the face of messy reality. However, it may effect large
> number of patients in the middle of the bell curve. And it begs the question
> of the effect of ones orientation to the pathology to the unambiguous
> quantitative description of that pathology which is required if we wish to
> apply science to our art.
>
> As usual I may be plain wrong, but despite that I am paying  attention to
> both the problems about which we argue and the problems with how we set the
> argument.
>
> tea
>
>
>
>
> ----- Original Message ----
> From: Nasser F. Abou'Seada <nfaabouseada at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Monday, June 11, 2007 9:50:32 AM
> Subject: Re: [HSF] The unresolved ascending aorta.
>
>
> Hal
> any reference as to the points of reference for measurements for the
> ascending aorta ?
>
> NFA
>
>
> On 6/10/07, hgrmd at aol.com <hgrmd at aol.com> wrote:
> >
> >
> > Erdinc,
> >
> > I was the onewho mentioned the aortic diameter index. The only time I
> ever
> > read about it was from some paper from the Cleveland Clinic. I suspect
> it
> > was 2.7 cm/m2 for the ascending aorta. Whatever, it is obvious that a
> 5.5cm ascending aorta in an 85 lb grandmother is a much different animal
> than
> > the same aorta in a 6ft 2 inch 250 lb man.
> >
> > Hal
> >
> >
> > -----Original Message-----
> > From: erdinç naseri <enaseri at hotmail.com.tr>
> > To: openheart-l at lists.hsforum.com
> > Sent: Sun, 10 Jun 2007 5:42 am
> > Subject: RE: [HSF] The unresolved ascending aorta.
> >
> >
> >
> >
> >
> > s has been proposed by other members w emust have an aortic diameter
> index
> > and
> > reat the patients accordingly.
> > rdinc
> > To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] The unresolved
> > ascending
> > orta.> Date: Sat, 9 Jun 2007 18:56:45 -0400> From: tdmartin2000 at aol.com>
> > CC: >
> > > The size of the aorta that you replace depends totally on the patient
> > and
> > ot on an exact size. Many other things come into play such as  AGE,
> > omorbidities, pt lifestyle, work, other related cardiac problems that
> > might
> > arrent a sternotomy, and last but not least is what the pt wants after a
> > long
> > etailed discussion of all the options.> > So, I can't put an exact
> number
> > on
> > ize. I would say that a general rule of thumb that I use is at 5 to
> 5.5cmI am
> > erioously thinking of surgical intervention. In the young marfan's whose
> > escending is 2 cm then I talk seriously to them about surgery at 4cm or
> > larger.
> > here is no doubt that an elective operation has much better results than
> > an
> > mergency one and a dissection, even if corrected/salvaged has long term
> > onsequenses. You also have a much better chance of saving the aortic
> valve
> > with
> > n elective procedure.> > Tom Martin> U of Florida> Gainesville> > >
> > ----Original Message-----> From: erdinç naseri <enaseri at hotmail.com.tr>>
> > To:
> > penheart-l at lists.hsforum.com> Sent: Fri, 8 Jun 2007 11:52 pm> Subject:
> RE:
> > HSF] The unresolved ascending aorta.> > > > > > ear Dr.Martin,> or
> > ascending
> > orta and aortic root we still follow the rule of 5.5 cm in > onmarfan
> and
> > 4.5
> > n marfan.This patients measurements are far from these > umbers.Can you
> > comment
> > n this and give any literature references if possible.> rdinc>
> > S:references for
> > ur cardiology colleagues.> To: OpenHeart-L at lists.hsforum.com> > ubject:
> > Re:
> > HSF] The unresolved ascending aorta.> Date: Fri, 8 Jun 2007 > 1:15:22
> > -0400>
> > rom: tdmartin2000 at aol.com> CC: > > 54 and female, fix it now or > ix it
> 2
> > to
> > yrs from now as a redo and hope she doesn't have a dissection > efore
> > then.> >
> > om Martin> U of Florida> Gainesville> > > -----Original > essage----->
> > From:
> > ichael Firstenberg <msfirst at gmail.com>> To: >
> penHeart-L at lists.hsforum.com
> > >
> > ent: Thu, 7 Jun 2007 6:18 pm> Subject: [HSF] The > nresolved ascending
> > aorta.>
> > > I was just referred a healthy 54 year/old who > as found to have
> > moderated
> > R > from a prolopsed posterior leaflet - ok, will > ix that. > But, on a
> > MRA
> > he was found to an asc. aneurysm (3.8 cm at the Sinus > f > valsalva)
> and
> > 4.0cm
> > the level of the PA with a normal arch (the studies > > one do not
> comment
> > on
> > he aortic valve) > Obviously she needs a cath, but I am > nclined to fix
> > the
> > scending aorta > while in there? I do not know her BSA, but > dont think
> > she is
> > ig > > > thoughts? > > > -michael > >
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> --
> Nasser  F.  Abou'Seada,
> MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
> FICS,FISCVS,FSSRCTS,FHMS,MESC
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC