[HSF] RE: Timing AVR/Coarctation repair

[Nasser F. Abou'Seada]

Thank you Bob for sharing that precious experience .... I was trained to do
it this way, to my mind, the best way I can do it,

NFA

On 5/10/07, Rwmfglycar at aol.com <Rwmfglycar at aol.com> wrote:
>
> When I had to deal with Ascending Aorta/Aortic Valve pathology and
> Coarctation of the Aorta (as you know there are varieties of this
> congenital
> combination), I always thought it made sense to do the coarctation
> first.  The
> uncertainties inherent in  upper and lower body perfusion are  removed
> once the
> coarctation is fixed. I did use two incisions because I did not  like the
> high
> impedance produced by a long fairly narrow ascending to descending  aorta
> graft;
> The systolic pressure can remain high post op with such a  graft  The last
> case
> I did had aortic stenosis and insufficiency and an  acute ascending aorta
> dissection. I used side clamps on the aorta to  place a short fat graft
> without
> producing any rise in the already  raised upper body pressure. The patient
> did
> have to be turned for the  median sternotomy, but with the downstream
> sequential resistance restored to  near normal, the whole operation became
> more routine,
> Bob
>
>
>
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC