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

[Zhandong Zhou]

Steven,

I think you have to sew the valve into the Dacron graft. 

Just wonder how many of you will do a David I in acute dissection. I just did one today as he has 5cm root aneurysm presented with dissection. However, always worried about risk in these sick patients.

Zhandong Zhou


----- Original Message ----- 
From: "Steven Schwartz" <smschwartz at mac.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Thursday, May 01, 2008 1:45 PM
Subject: Re: [HSF] Sympathy anyone.......


> 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
> 
> 
> 
> 
> _______________________________________________
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