[HSF] Ao Wraping

Fri Mar 30 10:05:46 EDT 2007

Nice answer - gee why dont we all just role over a play dead.
Yes, there will be a role for catheter based interventions and all sorts of
mini access stuff, but standard operations give standard results and until
someone "proves" otherwise.  IMHO and I think the data supports that
operative approaches to his problem will, and should be the standard of care
for a very long time.

John, you can have a community cath jockey knock off your left main with a
perc valve........

-michael

On 3/30/07, John Schor <johnschor at mac.com> wrote:
>
> 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
> >>
> >>
> >> --
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> >>
> >>
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> >
> >
> > --
> > Prasanna Simha M
> > _______________________________________________
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