[HSF] Ao Wraping

Fri Mar 30 17:02:01 EDT 2007

Post stenotic dilatation occurs along a length . I did not understand .
Prasanna

On 3/30/07, Ajit Damle <damle at cableone.net> wrote:
>
> 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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-- 
Prasanna Simha M