[HSF] (no subject)

[murtaza chishti]

dear forum members,

 

seek your opinion regarding the following case:

 

70 year old father of a physician friend was referred for cardiac evaluation prior to  lap chole.

 

He has angina class II and his only risk factor for CAD is hypertention since 1985. Echo study was normal except for moderate diastolic dysfunction.

His coronary angio(via radial) revealed severe TV CAD and was referred to me for Coronary Bypass surgery.

After looking at his Chest film, I asked for  Chest CT which revealed aortic dissection extending from left Subclavian to just above the origin of the Renal Arteries. There is aneurysmal dilatation of the dissected descending aorta(max5-6 cm.)in its proximal half. Distally the false lumen is thrombosed.

On questioning, the patient remembers having had sudden onset ,very severe low back pain lasting three days back in 2004 which was dismissed as " disc". Currently no symptoms attributable to his dissection.

There is no clinical evidence of viscral or limb ischemia or CT evidence of viscral artery compromise. Cr.1.3mg/dl.

 What next?

 

murtaza
 		 	   		  
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