[HSF] Bicuspid aortic valve and dilated ascending aorta

[David Harris]

Another indication, I have found, in borderline cases
is a thin aorta, which will often give you problems
with closure. If I see I am possibly going to have
problems closing the aortotomy, or on the rare
occasion where there is inadequate hemostasis, I will
replace the ascending. This does not add much more
time to the procedure, but there is obviously the
increased risk of infection.

Having worked in a teaching hospital for a while, I
have seen disasters where surgeons could not close the
aortotomy nicely, (in dilated aortas), got it closed
eventually, only to have the patient bleed to death
later.

Dave Harris


--- Tdmartin2000 <tdmartin2000 at aol.com> wrote:

> I think the indications for an asymptomatic (i.e.
> one that has not ruptured or dissected as those are
> usually the only symptoms of ascendings) ascending
> repair depends a lot on the pt. How old are they,
> what are their comorbidities etc. For any non Marfan
> pt that has a tricuspid valve and an ascending
> aneurysm of 5cm or more I will spend at least 45min
> to 1 hr with them drawing pictures and expaining to
> them the natural history of the disease and it's
> risks. I will also explain to them the operation
> necessary to repair their problem along with all the
> risks and benefits. In the end the pt and I will
> review the expected risks and benefits of both
> treatment plans (including the % risk of morbidity
> and mortality of both) and then I let the patient
> make the final decision. 
> 
> Tom Martin
> U of Florida
> Gainesville
> 
> 
> In a message dated 04/28/07 16:43:52 Eastern
> Daylight Time, Hgrmd writes:
> Mitch, 
>  The classic indication for asymptomatic ascending
> aortic aneurysm is  6 cm. 
> However, people seem to be getting progressively
> more  aggressive.  Among 
> others, we need to hear from Drs. Bachet and 
> Martin. 
> Hal 
> 
> 
> 
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Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411             
Fax +27-21-9006412      Mobile +27-83-3309587