[HSF] Aortic Dissection early after AVR with CABG

[Igor Rudez]

Dear friends,
Just to share my recent experience regarding this topic!
Two weeks ago operated on a 63-y.o. lady because of unstable angina. As
usually, I did OPCAB (LIMA to LAD, SVG OM2 jump OM1, SVG to PD) and early
postop course was uneventful. On the night prior to discharge she suffered
from hypertensive attack (systolic BP was over 250 mmHg!!!) which was
treated with i.v. nitrates. She complained about strong pain in her back, we
did MSCT which showed dissection of asc.aorta from aortic valve root till
brachiocephalic trunk with moderate AR (2+). I did not hesitate much, took
her in the OR, replaced ascending aorta (circ arrest time 16 min),
resuspended aortic valve, and reanastomosed venous proximals. There was a
tear in aortic wall originating from the graft for PD which caused
dissection. At the end of surgery I checked graft flows and all were well.
She is off the ventilator and ready to leave ICU!
Again Tohru, as Hal already said, I would not hesitate too much! In fact, I
would not hesitate at all!
Anyway, good luck!

Igor Rudez


-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Hgrmd at aol.com
Sent: Thursday, May 15, 2008 1:14 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Aortic Dissection early after AVR with CABG


Tohru,
  I would operate know.  It will be much more difficult to do in  a month.  
The natural history of this lesion is not favorable.
  BTW, great seeing you in NY.
 
Hal



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