[HSF] Any One Had This Complication?

Sun Apr 27 19:45:07 EDT 2008

Hal
A very unfortunate problem. I assume that they ligated the aorta at the infrareal area after taking out the graft. The Ax-fem is good but is usually only a 8mm graft. the flow is adequate but very similar to a coarc. In the chronic state these pt can act just like a coarc and depend on collateral flow to improve their distal, including visceral perfusion. The mammary in coarcs can get really big and supply a lot of blood distally via the inferior epigastrics. I have never seen this complication from taking a mammary but have thought about it. 

Tom Martin
U of Florida
Gainesville

-----Original Message-----
From: Hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Sun, 27 Apr 2008 8:49 am
Subject: [HSF] Any One Had This Complication?

Dear Members,
  Last Friday was a tough day at the office.  First I did a  mitral, 
tricuspid, Cox-maze, CABG x1 on a 72 yo lady.  I then did an AVR,  MVR (heavily 
calcified posterior annulus), tricuspid, CABG x 4, Cox-maze on a 78  yo man.  
His 
past history was notable for the fact that he had an  aorto-enteric fistula 
(previous AAA repair) requiring excision of the graft and  a right 
axillary-bifemoral bypass.  Intraop, I noticed that the LIMA had  unusually 
brisk flow.  
About 4 hours postop, he had a bright red  stool.  NG aspirate nonbloody.  By 
yesterday afternoon, he had begun  to develop abdominal tenderness.  He had a 
lap 
in the early evening.   There was a dead colon requiring resection.  The small 
bowel reportedly  looked ischemic, but viable.  He's much better this 
morning, though he's  now developed ATN.  His heart is working great.  It'll be 
a 
struggle,  but I'm cautiously optimistic he'll make it.  Anybody seen this  
scenario?

Hal

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