عمل جراحي AVR+Septal myectomy+CABG
توسط جناب آقای دکتر فروزان نیا اكو توسط خانم دكتر پاكباز
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*Patient History* (According to patient) Intense waist and flank pain led to hospitalization at Erfan Niayesh Hospital and TBD diagnosis History of hernia surgery 8 years ago Hypertensive Age: 70
*Anatomical Measurements* (According to CTA dated: 12 Nov 2021, Salar sizing date: 14 Nov 2021) TBD starting at the LSA ostium extending to the prox levels of the R EIA, and distal segment of the L EIA bovine arch 37mm dilatation in the aortic isthmus large 14mm entry tear at the LSA ostium another 17mm entry tear in the aortic isthmus FL progresses in the posterior segment of Zone 3 (mild to moderate risk of rTAD) large 25mm Brachio-cephalic trunk (BCT) mild pleural effusion compressed TL in the inferior thoracic aorta up to 5mm celiac, SMA, L accessory renal, and dominant L renal all perfused from TL celiac trunk ostium mildly compressed due to FL compression R renal perfused from FL, but a small intimal membrane fenestration is noted TL nearly collapsed in the L CIA, 26mm dilatation TL compression, and rapid L CIA expansion, is most likely due to multiple large superior entry tears, without equivalently-sized exit tears in the inferior descending aorta
*Proposed Treatment Strategy* Indication for intervention is patient symptoms, and multiple anatomical predictors for progression of pathology to "complicated" TBD status (severe TL compression, rapid L CIA dilatation, mild celiac malperfusion due to FL compression, etc) TEVAR from the BCT with a single 20cm device, LSA coiling to prevent retrograde T2 endoleak, follow up for the celiac and L CIA in post-1-month CTA
*Procedural complexity* rTAD TL cannulation will be difficult; R side femoral access is recommended, but if not successful, then right brachial access may be required for antegrade/snare approach IVUS will be helpful, if available