[HSF] Significant MR after previous CABG

[Nasser F. Abou'Seada]

I concur .... good question ...

NFA 

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Wednesday, October 04, 2006 12:30 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Significant MR after previous CABG
> 
> 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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