[HSF] Sympathy anyone.......

[Steven Schwartz]

Do you use a perimount already in a valve conduit, or have to hand sew  
it together?
I had another dissection on Tuesday, 65 yo hypertensive, able to  
replace just the ascending Ao with a tube graft and resuspend the  
valve. He has extension of the dissection down the the 6.5 cm abd Ao  
aneurysm found incidentally on the CTS for his dissection diagnosis.  
Compromised flow into the celiac and SMA by the dissection, went to  
interventional radiology and had these vessels stented POD #1.
How are others dealing with:
1. valve selection in these patients. We've always used St. Jude valve  
conduits when replacing the root, not wanting to have to deal with a  
failed bioprosthesis.
2. malperfusion problems. Viscera, renals, limbs, etc.
Steve Schwartz

On Apr 30, 2008, at 7:20 PM, Michael Firstenberg wrote:

> 25mm Perimount
>
> I figured that coumadin would be a disaster (his tissues were  
> crap... I am
> going to work him up for a connective tissue disorder), but I never  
> want to
> be in his chest again (dont we always say that?) and I figure  
> Edwards will
> be the most likely company to have a Perc AVR that will fit in one  
> of their
> valves in a few years when he needs a redo......then again, maybe by  
> then I
> will have forgotten how painful it was the first time - although a  
> redo
> maybe not be all that bad (wait a minute... I need my head  
> examined).......
>
> -michael
>
>
> On 4/30/08, zzhoumd at pol.net <zzhoumd at pol.net> wrote:
>>
>>
>> What valve did you give him?
>>
>>
>>
>> Sent via BlackBerry by AT&T
>>
>> -----Original Message-----
>> From: "Michael Firstenberg" <msfirst at gmail.com>
>>
>> Date: Wed, 30 Apr 2008 21:26:16
>> To:OpenHeart-L at lists.hsforum.com <To%3AOpenHeart-L at lists.hsforum.com>
>> Subject: [HSF] Sympathy anyone.......
>>
>>
>> 51 year/old.....presented with 4 day history of chest pain.
>> Tall, thin, long fingers....
>> ST changes on ECG.
>> Concern for AMI
>> Given:
>> ASA
>> High dose Plavix
>> Lovenox
>>
>> taken to cath lab
>>
>> found to have Type A dissection from valvue to iliacs........
>>
>>
>> oh, he also got reopro............
>>
>>
>> it has been a long day.
>>
>>
>> -michael
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Steven M. Schwartz, MD
smschwartz at mac.com