Trial Short Case 3

Case Summary

59 year old man

Referred emergently by cardiologist from rooms.

Was seeing cardiologist for an annual review appointment. A routine echo performed in the rooms shows a Type A Dissection

Asymptomatic otherwise

Background:

VF Arrest 2 years ago whilst at soccer. Investigation showed tight 3VCAD. Underwent inpatient CABG with uneventful recovery at another institution.

SVG to PDA

SVG to OM

LIMA to Dx to LAD

LVEF 50% postop

pAF

Hypertension

Dyslipidaemia

Walks 4kms a day. Plays soccer.

Panel Beater. Married. 2 children.

Medications

Metoprolol 50mg bd

Aspirin 100mg

Amlodipine/Valsartan/HCT 10mg/160mg/25mg

Atorvastatin 40mgs daily

Family History

Father died age 60. Thought to be heart related.

Examination

96kgs, 180cms, BMI 29

140/90

AF 75

Median sternotomy scar

HS x 2 NA

Chest clear

Echo

LV EF 60-65%

Normal RV size and function

Dilated aortic root: trans sinus 4.2cm, ascending aorta 6.8cms

Dissection flap in ascending aorta extending to sino tubular junction.

No pericardial effusion.

Mild AR

CTCA: Grafts patent

CTCA: Grafts patent

 

Questions:

  1. Describe the indications for surgery in this situation, including the timing of any intervention

  2. What would you explain to the patient and their family including the risks and likely outcomes?

  3. Describe your operative steps succinctly