List Archives

Mon Jan 8 22:54:57 GMT 2007

In a message dated 1/8/2007 4:46:49 P.M. Central Standard Time,  
karim at trauma.org writes:

Repeat  CT today shows dissection flap in ascending aorta.  Starts above  left
coronary.  No extension into neck vasculature (yet).
Not visible on initial CT.

BP = 160 systolic -> controlled  with labetalol.

Now what?
Do NOT rely on the CT for a diagnosis.   Motion artifacts in this  area are 
well recognized.    PLEASE do a FORMAL  aortogram.    And then we will 
reconsider.  

Conservative management? - NOT if it is a real injury   -   CPB and repair of 
ascending aorta.  canulate via groin, not  ascending aorta.  

Stent?   NEVER NEVER NEVER to this location

Open repair? Technique?   YES, if this is a real injury, but  CT does NOT 
make the diagnosis.     NO hypothermia,   Just regular CPB,  Clamp and fix it,  
prob primary repair, it may  require a graft.    TOTAL CPB,with bicaval 
canulation, NOT a  single stage catheter in RA.  

k

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