[HSF] Image of the week

[Prasanna Simha]

Images of a case  50 year old lady with an an ascending aortic aneurysm  
involving the root. STJ (58 mm) on Echo but was 69 mm on table and 
sinuses were dilated but annulus was not dilated . Leaflets were normal 
looking on Echo.
I did not have access to a zero porosity dacron graft and was 
uncomfortable doing a David with a cooked graft and there were issue wrt 
blood products and glue etc. I saw on the HSF website Tom Martins 
Florida Sleeve and it was appealing. I also received some good 
suggestions from Dr Martin and I did the case today. I also placed a 
sleeve on the trimmed ascending aorta (though I had to slit it partly to 
obtain hemostasis  in an inaccessible area of the trimmed suture line 
and resuture it).
There wsa some oozing posteriorly (nonidentifiable) and so I placed a 
vaginal roller pack and bought it out via a stab(Probably would have 
stopped with the tincture of time !! . Patient has bled only 70 ml in 
the last 4 hours.
Planing to remove the pack tomorrow.
Tom Martin made some points wrt the necessity of making the keyholes for 
the coroaries wide to prevent kinking (In fact I did extend the key hole 
s I had some concerns. I also needed to remove one subannular stitch as 
it seemed to buckle the LCC. Releasing it gave better mobility to the 
leaflet.The echo shows trivial AR.
This seems to be a very good method and could also be used to advantage 
in doing a Bentall in cases without a calcific aorta using a valve and 
conduit seperately.
Prasanna
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