thoracicAneurysmRepair

thoracicAneurysmRepair - PresentedAug2002...

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Ascending thoracic aneurysm repair  with CPB and circulatory arrest   (case presentation) Darko J. Vodopich MD Antonio Cooper MD MetroHealth Medical Center - CWRU   Department of Anesthesiology Presented Aug 2002
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History • CC: 81 y.o. white male coming to ED after  found in the bathroom.  + LOC, no amnesia.   Responsive on arrival. • C/o stroke like symptoms: • headache,  • confusion,  • left sided weakness,  • unable to turn the head to the left side
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History cont.: • Allergy: Ciprofloxacin, Levaquin • PMHx:  – HTN well controlled on Lisinopril and HCTZ – Type 2 DM well controlled by diet/exercise – Prostate cancer (on Megestrol) – Occasional CP (no AMI in the past) – COPD – PVD
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History cont.: •  PSHx:  – Inguinal hernia repair – Umbilical hernia repair • Past Anesthesia Hx: – GA – No complications with GA
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Physical: HEENT: PEERL, EOMI MP class 1, TMD 5 cm, Mouth opening 4 FB, good neck  mobility, own dentition in a good shape Cor: RRR, S 1 S 2 , no murmurs, no thrill, tones silent, distant  on auscultation Pulmo: decreased sounds bilaterally, no crackles or  wheezing Extremities: no gross abnormalities, left sided weakness Neurological: AOx3, left sided focal signs ASA 5, Case type: Emergency
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Laboratory and studies report: CBC: WBC=8.4, Hb=11, Hct=35, Plt=207 Na=128, K=3.6, HCO 3 - =19, Cl=98, BUN=11, Creat=0.6,  Glu=131 Pt=12.0, PT INR =1.02, PTT=42.9 ECG: NSR~100 BPM, nonspecific S-T changes, no signs  of acute ischaemia ECHO: 19 July 2002: EF 74%, no ischaemic changes Adenosine myocardial perfusion test: 19 July 2002: NSR,  left axis anterior hemiblock, mild S-T changes. No  evidence of ischaemia.  Normal test.
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Ultrasound done in Oberlin hospital: Ascending Thoracic Aorta Intimal flap 45 mm
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Ultrasound done in Oberlin hospital: Aorta Blood in dissection Type A ascending aortic aneurysm
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thoracicAneurysmRepair - PresentedAug2002...

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