[HSF] Aortic Dissection early after AVR with CABG

[zzhoumd at pol.net]

Tohru,

This most likely happened after surgery because you will know it if it happened during surgery.

By definition, acute phase is 2 weeks. Any dissection more than 2 weeks are defined as chronic which can be managed as aneurysm. At three weeks, the adhesion can be difficult to deal with due to fresh granulation and tissue can be fragile. If your grafts are OK, wait for a while is OK.

If you decided to operate on him, bioglue is very helpful which makes the tissue strong so it can hold the sutures well.

Zhandong Zhou


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-----Original Message-----
From: Tohru Asai <toruasai at belle.shiga-med.ac.jp>

Date: Thu, 15 May 2008 10:07:11 
To:<OpenHeart-L at lists.hsforum.com>
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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