[HSF] Aortic Dissection early after AVR with CABG

[Douville, Chuck]

Tohru, I presented a similiar case to the forum 4 months ago of a frail 78 yr old woman who had an MVR for rheumatic disease and 3 months post op was found to have had an asymptomatic type  A dissection. Tom Martin wisely suggested we observe this 5.8 cm Ascending aorta, given the adhesions present from her previous surgery; it has been 4 additional months now and she continues to do well. On recent CT her aorta remains 5.8 cm. I plan to manage her with beta blockade until 1 year and then re-evaluate. 

________________________________

From: openheart-l-bounces at lists.hsforum.com on behalf of tdmartin2000 at aol.com
Sent: Wed 5/14/2008 7:27 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Aortic Dissection early after AVR with CABG



It's either now or in 6 mo to a yr. At 3 wks it may or may not be really stuck, but it sure will be in 6 mo. At 3 wks I don' t think you are in immediate danger of rupture and should be able to get out 6 mo to a yr if you want. If it is already 5 cm, it will be 6 cm in a yr.

Tom Martin
U of Florida
Gainesville


-----Original Message-----
From: Tohru Asai <toruasai at belle.shiga-med.ac.jp>
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 14 May 2008 9:07 pm
Subject: Re: [HSF] Aortic Dissection early after AVR with CABG



Dear Members
The 73 yo male had underwent AVR(CEP) and double CABG (LITA-LAD, SVG-PDA),
and had shown good recovery. Prior to discharge, we evaluated contrast
enhanced CT to confirm graft patency. The study showed ascending aortic
dissection. Pseudolumen was widely patent from the level of very proximal
ascending to the proximal arch. No clot in the pseudolumen, which occupied
about half the lumen of the mid ascending. Outer dimention of the Aorta was
4.5 to 5.0 cm. Our staff had waited a week to check the size until I came
back from NY. The repeat CT showed the same picture. The patient had never
experienced the dissection-like symptom at all. In OR, there was no sign of
aortic dissection.

What should we do? Operate? Now 3 weeks from the initial surgery.
Any comments are welcome.
--
Tohru Asai
Shiga University of Medical Science
Otsu, Japan



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