[HSF] Significant MR after previous CABG

Wed Oct 4 22:59:50 EDT 2006

We get a preop echo for all cases . Why should you not get Echoes for 
CABG's ?
Prasanna

Michael Firstenberg wrote:
> I have had the debate about pre-op echos on everyone with friends.  I 
> like
> the idea in that you can better plan for the OR, informed consent, better
> pre-op eval (dental eval?  what does the aorta look like if the valve is
> bad).  The other arguement is that "you just figure it out when you get
> there"  (which I hate).  What are the thought plus/minus on pre-op 
> echos for
> CABGs from the group?
>
> michael
>
>
> On 10/4/06, Michael Webb <mwebb at calmedlab.com> wrote:
>>
>>
>>
>> -----Original Message-----
>> From: openheart-l-bounces at lists.hsforum.com
>> [mailto:openheart-l-bounces at lists.hsforum.com]On Behalf Of hgrmd at aol.com
>> Sent: Monday, August 22, 2005 12:52 PM
>> To: OpenHeart-L at lists.hsforum.com
>> Subject: Re: [HSF] Significant MR after previous CABG
>>
>>
>> I don't know about mild MR, but probably moderate.
>> Hal
>>
>> -----Original Message-----
>> From: ASEEM PAWAR <aseem70 at yahoo.com>
>> To: OpenHeart-L at lists.hsforum.com
>> Sent: Mon, 22 Aug 2005 19:05:35 +0100 (BST)
>> Subject: RE: [HSF] Significant MR after previous CABG
>>
>>
>> So, can we now in the light of all the data/insights we have, rightfully
>> ask for
>> the "hand-over" of a CABG+ mild MR patient from the interventionists??
>>
>>              ....aseem
>>
>> "Goldman, Scott" <GoldmanS at MLHS.ORG> wrote:
>> I agree with Mark. We get echos on all CABG pts preop. Our colleages are
>> often
>> only looking to place stents and many pts are inadequitly worked up.
>> MR,AS,AI
>> may br overlooked.
>>
>> Scott
>>
>>
>> -----Original Message-----
>> From: openheart-l-bounces at lists.hsforum.com on behalf of Mark Levinson
>> Sent: Sun 8/21/2005 2:17 AM
>> To: OpenHeart-L at lists.hsforum.com
>> Subject: Re: [HSF] Significant MR after previous CABG
>>
>>
>> On Aug 20, 2005, at 4:18 PM, Hgrmd at aol.com wrote:
>>
>> > Next week, I'm operating on a 64 yo lady for Class III-IV MR. Of
>> > note, she
>> > had an uneventful CABG 2 years ago by another member of my group.
>> > On cath a few
>> > days ago, her 4 grafts are OK and the LV has an EF of 35%. I went
>> > back and
>> > checked the transthoracic echo report from that admission and noted
>> > that the
>> > preop MR was "moderate" with an EF of 40%. My point of discussion
>> > for HSF is
>> > that I operate on this type of scenario atleast once or twice a
>> > month. Unlike
>> > Elefteriades at Yale, I believe that moderate or greater ischemic
>> > MR should be
>> > repaired at the initial surgery. Serrano from Mayo has convincing
>> > data that
>> > even moderate MR adversely impacts the 10 year survival as compared
>> > to CAD
>> > patients with no MR. Obviously, this policy isn't practiced on an
>> > 88 yo. But on
>> > your average patient, you do the patient an incomplete service if
>> > you leave
>> > them with moderate MR after revascularization. My final point is
>> > TEE should be
>> > used on all cases so that this situation can be minimized
>>
>>
>> For the past 2 years, I have asked that every CABG case get a preop
>> echo regardless of symptoms at presentation. MR or AI is often seen
>> and I have learned that if this is not corrected, some will present
>> in the near
>> future for another surgery in the setting of CHF and open grafts.
>>
>> If you use intraoperative TEE routinely, you will see the MR, but then
>> you do not have "informed consent" from the patient to perform a repair.
>> Thus, it is advisable to get routine echos on anyone headed for CABG.
>> The patients want these fixed rather than taking the risk of a second
>> surgery. In the era of routine repairs for MR, these valves do not
>> need
>> to be replaced so the echo is worth the trouble.
>>
>> Mark
>>
>>
>>
>>
>>
>> Mark M. Levinson, MD
>> Founder, Editor-in-Chief,
>> The Heart Surgery Forum
>> WWW:
>> Email:
>> Email:
>>
>>
>>
>>
>>
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