[HSF] Ao Wraping

[Shahid Malik]

Ajit,
Probably difficult to argue your choice of procedure except the comment that he took a 27mm aortic valve.I cannot recall the last time I used this size valve.
Seven yrs ago,I replaced a root in a 22yrs old Marfans(member of a diagnosed-documented family)C.T clearly showed the rest of the arterial tree to be normal,and aneurysm limited to the ascending aorta.Event free surgery and post op course.Post op followed by referring.Three and half yrs later I was told that she suddenly collapsed and died.Survillence by yourself for life is right.
Shahid Malik

On Friday, March 30, 2007 at 08:10:41 AM, OpenHeart-

@lists.hsforum.com wrote:

> Ajit,
> I would have done the same and your patient will do well! Just echo him on 6
> months, and then again every year for follow-up purposes! I am aware that
> there might be some other approaches and comments but...."Every road leads
> to Rome" and "There are many ways to skin a cat"!
> A year ago I posted some pictures of aorta wrapping.
> Good job.
> 
> Igor
> 
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Ajit Damle
> Sent: Friday, March 30, 2007 7:24 AM
> To: OpenHeart-L at lists.hsforum.com
> Cc: 'Manoj Pradhan'
> Subject: [HSF] Ao Wraping
> 
> 
> I operated on a 19 year old last week to replace his aortic valve. (What a
> treat! A change from my usual 84 yr old dialysis dependent valves and
> CABGs!)
> 
> He was known to have a bicuspid valve. In the past few months, he started to
> become symptomatic (with LV dilatation) so this was a good time to replace
> his valve. He looked Marphanoid, so I had a pre-op CT. That showed, a smooth
> fusiform aneurysm starting in the distal ascending aorta, from 1cm below the
> brachiocephalic takeoff to proximal arch. The diameter was 3.8cms. For
> comparison, the proximal ascending aorta was 2..6 cms and the descending
> Aorta was 2.3 cms. The patient is 6' tall and a BSA of 2.3. I was prepared
> to replace his arch. I am very confident and comfortable replacing aortic
> arches, and touch wood, very lucky. But I had some nagging doubts regarding
> the risk/reward ratio in this man.
> 
> At surgery, to I found that his aortic tissue strength was quite good. I did
> cannulate the undersurface of aortic arch, instead the femoral cannulation I
> had planned (I had the fem artery exposed). I replaced the bi-cuspid valve
> with a 27 Carbomedics. I used a 28 Hemashield graft to externally wrap the
> aorta and sutured it to to the aortic adventitia meticulously, with
> substantial dissection,  from just above the coronary ostia to the take-off
> of brachio-cephalic laterally and well past it medially, past my aortic
> input site.
> 
> Before I did the wrapping,  I may point out  that the aortotomy suture line,
> the cardioplegia and aortic cannula input site, none required any additional
> sutures, indicating that the aortic tissue quality  was good.
> 
> Did I do the right thing? I will have this man under CT surveillance for
> ever, but still................. 
> 
> 
> Ajit Damle
> Fargo ND
> 
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e-mail: smmalik at brain.net.pk


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