[HSF] SVR via left thoracotomy

[Tea Acuff]

I think a more interesting question (and you may too after the case) is what was going on 7 years ago. Patent Lima with early edema? Lima to an early no (out) flow revascularization? Closed Lima that recannulized?
Tea


----- Original Message ----
From: Edward Bender <ebender001 at charter.net>
To: OpenHeart-L <OpenHeart-L at hsforum.com>
Sent: Friday, October 13, 2006 6:55:11 PM
Subject: [HSF] SVR via left thoracotomy


I was asked to see an 83 year old female with class 3-4 CHF,  
orthopnea, moderate pulmonary hypertension.  CABG 8 years ago (LIMA  
to LAD, SVG to RCA).  Postop anterior MI.  Taken to cath lab on post- 
op day one and was found to have occluded LIMA at point of insertion  
to LAD and no distal perfusion.  Nothing was done at that time except  
medical therapy.  Since her symptoms of heart failure have progressed  
dramatically over the past 4-6 months, she underwent cath showing a  
large LV apical aneurysm, the mid and basal parts of the heart have a  
regional ejection fraction of 80% (mostly ejecting into the LV  
aneurysm), cardiac index of 1.6.  Interestingly, her LIMA graft is  
widely patent, filling a large LAD that wraps around the apex, with a  
95% proximal LAD stenosis.  The right graft looks great.  I think she  
would greatly benefit from resection of her aneurysm.  She is thin  
and frail, and I would like to do this without a sternotomy.  I would  
be interested in experiences of the members with a left thoracotomy,  
warm, beating technique or any other approaches.  Although she is  
quite small, I am confident that she can be cannulated peripherally  
without difficulty (I usually use a 17Fr biomedicus arterial and the  
small heartport venous).  Any pitfalls, bad experiences, good  
experiences?

Thanks,

Ed Bender, MD
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