[HSF] Leaking thoraco-abdominal aneurysm.

[Nasser F. Abou'Seada]

> There was a massive calcified clot/false
> aneurysm/?true aneurysm in the chest, with dense
> adhesion to the lung. We managed to mobilise the lung
> off it while cooling.


considering the presenting history of the patient with haemoptysis ......
did you consider one lung intubation ? .. especially in left lateral
position for thoracotomy incision ? .. was a reason ever figured out for the
causation of haemoptysis ?


We
> managed to get in a 28mm graft with much effort, using
> continuous, plus interrupted pledgetted sutures.


would you elaborate more on your technique here please? what sort of graft
did you use? what type of sutures? could you manage to evert the edge of the
aorta, especially as calcific as you describes ?? or what kind of stitches
did you make ? and was endarterectomy ever needed to be performed ?


The circ arrest time was 40 minutes, the longest ever for
> us, but the calcium did slow us down.


did you use retrograde cerebral perfusion? would you elaborate more on your
techniques for cerebra protection ?


After clamping
> the graft, and cannulating it, we restarted the pump
> and rewarmed. We could then clamp the abdominal aorta,
> and restarted femoral perfusion.


What was your site for abdominal aortic clamp application?


We did the distal
> graft a bit higher than originally planned, as the
> aorta here was veering to the right, and I was worried
> about having to still attach intercostals in this
> area. Here the aorta measured about 30mm. There were
> luckily no significant intercostals higher up.


did you have to do any intercostal artery perfusion ????? .... were you
considering doing any island grafts ???


The heart spontaneously defibrillated with further
> rewarming, and she weaned easily off bypass.




She has since been extubated, and is mobilising well,
> and VERY grateful that her breathing feels better,
> without the usual wheeze! She is neurologically intact
> (we also used CSF drainage).


Well .... congratulations Dear Sir ..... still awaiting the Blomendale !!

NFA