[HSF] Ao Wraping

[Igor Rudez]

I think his Ajit's rationale was intention to prevent late dilatation of the
aorta which happens quite often in bicuspid patients. Although patient's
aorta did not reach the treshold mentioned by Prasanna (4,5 cm but for the
age below 60yrs, I keep treshold of 4,0 cm) and it might seem a bit of too
much surgery for the moment, the decision of wrapping the aorta looks quite
appealing to me and surely a better choice than preventive replacment of it.

Igor (from Zagreb, Croatia as well)
;-)



-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Prasanna Simha M
Sent: Friday, March 30, 2007 11:29 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Ao Wraping


One question  w<s that true aneurysamal dilatation or just post stenotic
dilatation ? Does a post stenotic dilatation really require any such
extensive procedure  like aortic replacement especially since it is less
than 4.5 cms. Isn,t that strategy a little bit aggresive Prasanna  from
Zagreb

On 3/30/07, Shahid Malik <smmalik at brain.net.pk> wrote:
>
> 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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-- 
Prasanna Simha M
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