[HSF] Ao Wraping

[Ajit Damle]

I do not think this was post-stenotic dilatation. The ascending was normal
in caliber.

Ajit Damle

-----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 4:29 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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-- 
Prasanna Simha M
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