[HSF] Ao Wraping

Fri Mar 30 06:05:22 EDT 2007

At 19 yrs of age with bicuspid AoV, I think your choice is very  
reasonable. Besides, if the patient needs more surgery in the future,  
it will be catheter-based (sorry, I couldn't resist).
John

John Schor, MD
PO Box 4445
Cottonwood, AZ 86326

On Mar 30, 2007, at 3:50 AM, Igor Rudez wrote:

> 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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>>
>> e-mail: smmalik at brain.net.pk
>>
>>
>> --
>> Powered by Brain Telecommunication Ltd. http://www.brain.net.pk
>>
>>
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>
>
>
> -- 
> Prasanna Simha M
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