[HSF] Aortic dissection and CPR

[Tea Acuff]

Would we call that (the modern approach) progress?
tea


----- Original Message ----
From: "jbflegejr at aol.com" <jbflegejr at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, September 10, 2007 11:27:52 PM
Subject: Re: [HSF] Aortic dissection and CPR


I have had salvage of two patients who ruptured while on the operating 
table as they were prepared for anesthesia. They had not been induced 
completely but we opened there sternum anyway. One had femoral artery 
cannulation by a colleague, the other I cannulated through the 
ascending aorta as recently described by Curt Tribble. Both had no 
neurologic sequale. In one during the excitement I made the disal 
anastamosis a bit tight in effect causing an ascending aortic 
coarctation and he got hemoytic anemia from intraluminal felt and a 
year or so later I resected the area. If I encounter another case 
needing immediate cannulation, I will cannulate the ascending aorta 
through the LV apex which is quick and works well. I had another 
patient who presented in the ER in shock and with hyperacute ischemic 
ECG changes across the anterior leads. He had been worked up and a 
diagnosis of ascending  aortic aneurysm and aortic insufficiency and 
normal coronary arteries established and operation scheduled for the 
day after Christmas but he came back the day before Christmas and went 
straight to the OR. He had a Type A dissection extending into and 
obstructing the Left coronary. I replaced the ascending aorta which 
relieved the coronary obstruction and replaced the valve with a 
Starr-Edwards valve. This was 35 years ago. About 25 years post op he 
had a CT scan for some reason and the radiologist saw that he had an 
aortic dissection down to the femorals and got rather excited about it 
and sent me the films. I did not recommend treatment. In modern times 
this kind of patient would have an aortic root replacement. John Flege


-----Original Message-----
From: tdmartin2000 at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Mon, 10 Sep 2007 9:06 pm
Subject: Re: [HSF] Aortic dissection and CPR






Most of these pts with sudden deterioration have rupture into their 
pericardium
and are not salvageable. I have attempted on multiple occasions and 
have had 2
that we got out of the OR only to have anoxic cerebral deaths. If they 
have
tamponade, CPR does no good, as you cannot fill. One of the ones we got 
out of
the OR actually had arrest right after induction of anesthesia and we 
were on
pump in under 10 min.



Tom Martin

U of Florida

Gainesville


-----Original Message-----
From: james le <jamesle2007 at yahoo.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Mon, 10 Sep 2007 6:35 am
Subject: [HSF] Aortic dissection and CPR




We recently had a   case of Aortic dissection   transferred from some 
other
hospital for surgery. He had dissection   aorta involving the entire 
aorta along

with severe AR.
   On arrival BP   was 90 systolic, all pulses   palpable and   there 
was no
neurological deficit
   At ER he suddenly developed severe Bradycardia   and   arrested and
resuscitation was unsuccessful. TEE done after death   showed only 
small amount
of pericardial collection.

    During CPR we had   a concern that vigorous massage could rupture 
aorta.
  How can we salvage such patients?

  Percutaneous bypass before we take to OR will help?



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