[HSF] yikes..... post aortic dissection distal pseudoaneurysm

[Tea Acuff]

So why does he have SOB and chest pain? 

I would consider giving the patient the beta blockers and myself the scotch, unless of course you have a dilated aorta also in which case i might take both...

tea



----- Original Message ----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, March 25, 2008 2:36:45 PM
Subject: [HSF] yikes..... post aortic dissection distal pseudoaneurysm

I admitted a symptomatic (chest pain and SOB) 62 year/old who had an Type I
repair done in 2002.  Per the patient, he had a very prolonged
post-operative course - including a CVA which left him with a significant
right sided weakness..  At the time, he had a tube graft with resuspension
of the aortic valve, a RCA bypass, and a beveled graft to under the arch.
He now has a moderate size pseudoaneurysm at the isthmus of the underside of
the arch where the graft is attached to the native aorta.  In the OP note
the surgeon describes using a bunch of bioglue in that area to get the
dissected layers back together.  The remainder of his aorta is gently
dilated (~5-6 cm) with a chronic hematoma all the way down to his
bifurcation.

On an echo he has mild to moderate AI with a good EF.

We are currently thinking a stent graft, but not sure there is an
appriopriate landing zone as this is right under the head vessels and there
is not much room between the LCC and LSC.

Unfortunately, none of the open operations/approaches sound good for this
guy.

(left heart bypass, hypothermia - poss circ arrest, TAAA?)


any thoughts or pearls which are not associated with an 110% M&M?


-michael

(one of our experiences vascular surgeons suggested lots of beta-blockers
and a good bottle of scotch)
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