Lars AortaSURGERY
Tuesday February 8, 2005
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Bicuspid Aortic Valve |
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Valve Open |
Valve Closed |
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Snapshots from Echocardiogram |
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Purpose of Web Site www.larsaorta.com
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Reference for doctors who may help this patient
with advice or treatment.
See primarily 1. Lars Aorta History,
2. TTE&TEE 03, 3. CT 03, 9. CT 04, 10. CT 04,
11. TTE 04, and 12. MRI 04. - Explanation for persons close to the patient -- first of all his children -- who may want to understand the problem. See primarily 7. How the Heart Works.
- Source of information perhaps, for others in a similar predicament.
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Clarify the problem and organize the information
for the author.
Teaching is, first of all, teaching yourself.
Dialogue lights the mind -- dispels darkness.
Zip files with recordings of CT scans, MRIs, and Echocardiograms were deleted August 19, 2008. The reports on these exams remain available.
| 1. Lars Aorta History.
How the Aortic Aneurysm and the Bicuspid Aortic Valve were discovered. Subjective health. Blood pressure. Blood lipids. Etc. |
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2. Echocardiogram TTE (transthoracic echo) & TEE (transesophagal echo), June 25, 2003.
To download recordings of the echo as a
self-extracting zip file
(27 MB) R-click here and
select "Save target as ...".
Doubleclick the zip file to extract the recordings. Click
HERE for more detailed instructions.
3. CAT Scan Thorax July 9, 2003.
To download recordings of the CAT scan as a
self-extracting zip file (50 MB) R-click here and
select "Save target as ...".
Doubleclick the zip file to extract the recordings. Click
HERE for more detailed instructions.
4. Emergency Instructions.
What to do if this patient gets acutely ill with chest pain.
5. Aortic Root with
Bicuspid Valve.
Go to this page for an explanation of the two echocardiogram snapshots above.
6. How the Heart Works: Explanation with Focus on the Aortic Valve and the Ascending Aorta.
Go to this page for illustrations of the heart and the big vessels, and for an understanding of the Bicuspid Aortic Valve and the Ascending Aortic Aneurysm of the current patient.
7. Anatomy of Aortic Root with Tricuspid Valve.
8. An Aneurysm Is a Death
Sentence.
We have the power to grant you a pardon.
Should it rupture, it can cause uncontrollable bleeding ...
(Back cover of New York Times Magazine,
Sunday Jan 4th, 2004).
CT chest done in San Diego almost 8 months after previous CT scan in Sweden July 9, 2003.
CT chest done in Lund. No change in the width of the aorta since CT scan 11 months earlier, July 9, 2003. However, in addition, an anomaly of the arteries of the neck is noted: the left and the right carotid arteries emerge from the aorta as a common trunk.
11. Echocardiogram, TTE (transthoracic echo) June 9, 2004
Essentially unchanged findings compared with
previous examination June 25, 2003.
This examination, unlike the examination June 25, 2003, included "M-mode,
Doppler, and colordoppler."
12. MRI Heart + Chest, November 4, 2004
13.
Surgery
Tuesday, February 8th, 2005.
Dr. Sharo S. Raissi, at the Cedars-Sinai Medical Center in Los Angeles, will do the surgery. I am convinced that Dr. Raissi is second to none in performing this procedure which is extremely demanding, much more demanding than typical open heart surgery. Dr. Raissi will do three things:
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Replace the Ascending Aorta with a Dacron tube.
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Repair or replace the Bicuspid Aortic Valve.
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Isolate the Pulmonary Veins by cryoablation to prevent episodes of Atrial Fibrillation (See footnote*)
During typical open-heart surgery blood continues to circulate throughout the body (pumped and oxygenated by a heart-lung machine). The major blood vessels to and from the heart are clamped to prevent the flow of blood into the surgical area: the heart and the lungs. (This is called "cardio-pulmonary by-pass" because the blood by-passes the patient's own heart and lungs; instead it passes through the heart-lung machine, the pump-oxygenator.)
In order to replace the
ascending aorta, circulation is stopped the patient is
taken off the heart-lung machine for up to 40
minutes. For "circulatory arrest" to be safe, particularly for
the brain, the body is cooled to about 12°
Celsius and the head is
packed in ice.
Click
here for description of
Open
Anastomosis with Hypothermic Circulatory Arrest.
In addition to replacing the ascending aorta Dr. Raissi will either repair the Bicuspid Aortic Valve or replace it with a an artificial valve (Carpentier-Edwards PERIMOUNT Pericardial Bioprosthesis) and he will isolate the pulmonary veins by cryoablation in order to prevent episodes of atrial fibrillation which the patient has experienced during the last year.
Whereas
the aorta surgery requires circulatory arrest, the valve surgery and the
pulmonary vein isolation do not. So, the heart-lung machine (the
pump-oxygenator) will be restarted before
the second and third step of the procedure.
(CORRECTION
April 28th: Actually, as explained below, the first step was the pulmonary vein
isolation, the second step the valve replacement, and the third step the
replacement of the ascending aorta.)
Welcome back!
Welcome back some time after the surgery when I hope to be able to tell you about the outcome and perhaps make a web page to describe the procedure better than here.
Section under blue line was added April 28th, almost three months after the surgery.
Thoracic Surgery
Lars, February, 2005
| MRI image November 2004: Shows a widened ascending aorta. |
MRI image March 2005: The ascending aorta has been replaced with a dacron graft. |
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Lars lived his life until his mid 60īs unaware that he had a congenital heart defect. He had an abnormal aortic valve, a bicuspid valve instead of the normal tricuspid valve. This was discovered by chance when a doctor happened to hear a murmur when listening to Lars's heart. CT scans and Echocardiograms revealed not only a Bicuspid Aortic Valve but also a widened ascending aorta, also called an Ascending Aortic Aneurysm. A Bicuspid Aortic Valve is commonly associated with an Ascending Aortic Aneurysm. Lars' aorta measured 51 mm, almost twice the normal width. This meant a risk of sudden death from aortic rupture or dissection.
A bicuspid aortic valve wears down faster than a normal tricuspid aortic valve. Lars valve was getting calcified, narrow, and leaky. It needed replacement, now or within some years.
A third heart problem for Lars that started about a year ago were attacks of irregular heart rhythm, atrial fibrillation. Just a few years ago there was a breakthrough in the treatment of atrial fibrillation when it was discovered that atrial fibrillation is often cured if the pulmonary veins (the veins that carry oxygenated blood from the lungs to the left atrium) are electrically isolated from the rest of the heart. This is called Pulmonary Vein Ablation*.
February 8th, 2005,
Dr. Sharo S. Raissi, at Cedars-Sinai Medical
Center in Los Angeles operated. He did three things:
1. Created a fibrous ring around the pulmonary veins by freezing the heart
tissue with a cold probe.
2. Replaced the bicuspid aortic valve with an artificial valve, a
bovine bioprosthesis**.
3. Replaced the ascending aorta with a dacron graft (a plastic tube).
During the first two procedures Lars was on a heart-lung machine. In other words, the blood bypassed his heart and lungs; it was pumped and oxygenated by the machine.
For the third procedure, the replacement of the ascending aorta, however, the blood circulation had to be completely stopped. Total circulatory arrest requires that the body and, particularly, the brain is cooled down. Lars was cooled down to 11-12° Celsius with his head packed in ice. Before the heart-lung machine is stopped the brain must be completely inactive (no waves at all on the EEG = flat EEG). This total brain inactivity is achieved by the cooling + drugs. The total circulatory arrest for Lars lasted 29 minutes. The maximum that is considered safe for the brain is 40 minutes.
*Pulmonary
Vein Ablation
Atrial fibrillation is usually triggered by signals from the four pulmonary veins. Therefore
isolation of the pulmonary veins, also called Pulmonary Vein Ablation, usually
cures atrial fibrillation. Pulmonary vein ablation is achieved by producing a
circular scar around the pulmonary veins
in this case, by freezing the tissue with a cold probe, a cryoprobe. The
scar blocks any impulses firing from within the pulmonary veins. When the
pulmonary veins are thus disconnected from the rest of the heart muscle atrial
fibrillation is prevented.
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**Pericardial
Aortic Bioprosthesis "The Carpentier-Edwards PERIMOUNT Bioprostheses are constructed from three pieces of bovine (cow) pericardial tissue. Tissue is cut out from a carefully selected region of cow tissue surrounding the heart. The tissue is mounted on a lightweight frame that is covered with a porous, knitted polytetrafluoroethylene (PTFE) cloth. A sewing ring made of molded silicone rubber covered by polytetrafluoroethylene cloth enables the surgeon to sew the valve into the patient." Source:
www.edwards.com,
www.lifeisnow.com |
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