Pre Operative Evaluation
As usual history, examination and special investigations.
Can be divided up into:
Aortic specific questions
Pain, although majority are off course pain free. A large number have long existing back pain, which should be distinguished from the pain of the aneurysm. Beware of metastatic spinal lesions eg prostate in old men.
Cardiac specific questions
Shortness of breath and anginal symptoms secondary to aortic and mitral valve disease and coronary artery disease.
General medical questions
As in any other assessment of a cardiac surgical patient. Particular attention needs to be paid top performance status and respiratory function, especially in patients who may need a thoracotomy as part of their aortic surgery. Any history of stomach ulcers or bleeding diathesis, as this will influence the type of valve replacement or potential for repair that needs performing.
Obviously you examine the patient from head to toe. Specific points in aortic surgery include:
Palpate all pulses, and listen for bruits, particularly carotid and femoral.
Listen for cardiac murmurs, and examine for signs of heart failure.
Examine the lung fields, would they benefit from a chest referral.
Are the legs ok for saphenous vein harvest.
FBC Looking for anaemia, polycythaemia, neutropenia, leukaemia, thrombocytopenia, thrombocytosis.
Clotting Looking for evidence of warfarin therapy, Haemophilia, VonWillibrands, Christmas disease, and Lupus anticoagulant
U&E Looking for renal failure (Calculate GFR, Cockcroft Gault equation), effect of diuretics.
LFTs Looking for effects of alcoholism, right heart failure, even liver metastasis
Glucose Diabetes, a major risk factor for post operative deaths.
Aortic Surgery Echocardiography
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