[HSF] Ao Wraping, One more question!

[murtaza chishti]

ajit damle

in absence of a connective tissue disorder, AVR would be unnecessary.

murtaza chishti


>From: "Ajit Damle" <damle at cableone.net>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: <OpenHeart-L at lists.hsforum.com>
>Subject: RE: [HSF] Ao Wraping, One more question!
>Date: Fri, 30 Mar 2007 09:44:21 -0500
>
>
>Thank you Igor, Michael, Prasanna, Hal, Ed and Manoj for your thoughtful
>replies.
>
>I do not know what to make of the diameter as a threshold for an operation.
>Is it 4.0, as Igor recommends? In a 19 year old, who has plenty of time to
>plot against us, my threshold would be lower still. But replacing the
>ascending aorta without (or a brief) circulatory arrest is a different deal
>than replacing the arch with a longer circ arrest. I must admit, though,
>that I am astonished every time that patients wake up without a detectable
>neurological deficit!
>
>Part of the reason is the relative ease and absolute success rate of arch
>replacements in low risk patients. I did lose a patient some years ago, who
>I treated with a Cabrol shunt for coronary ostial implantation. I could not
>prove it, but I do think that the shunt somehow (twisted or compressed)
>induced coronary insufficiency. Since then,  I have switched to the 
>Valsalva
>graft and direct coronary implantation, and have been just giddy with
>success.
>
>I had never considered wrapping to be a serious option, but there was a
>recent paper that showed external wrapping was a viable option, and that 
>got
>me thinking.
>
>BTW, I have yet another aortic aneurysm coming up. 52 yr man, non-ischemic
>cardiomyopathy, QRS 110 ms, EF 25-30%, NYHA II, PAP 55/20, new onset A.Fib.
>MR 2+, AI 1+, tricuspid aortic valve, no coronary angiogram yet, Asc Ao 6.1
>cms.(not arch, I think I can do him without, or a brief, circ arrest). My
>plan is to replace the asc aorta, repair mitral, do a maze, excise the LA
>appendage, and CABG if needed. I wonder if I should replace his aortic 
>valve
>as well, because he may be on coumadin anyway and, with his cardiomyopathy 
>I
>may not have the luxury to bring him back in 5-10 years.
>
>What do you think? Too much an operation for this man? Should I replace his
>aortic valve?
>
>Ajit Damle
>Fargo ND
>
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