[HSF] Too scared to touch.....

[Ani Anyanwu]

Michael,

What would be the indication for surgery at the present time?

Ani
  ----- Original Message ----- 
  From: Michael Firstenberg<mailto:msfirst at gmail.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Saturday, April 28, 2007 10:36 AM
  Subject: [HSF] Too scared to touch.....


  Would anyone do anything different?

  52 year/old, multiple medical problems (poorly controlled diabetes,  
  hypertension, high lipids of course - and dont forget obese).  Known  
  brain AVM, cryptogenic cirrhosis with history of varices/bleeding/ 
  blakemore tube (the works, but nothing recent and LFTs/proteins not  
  too bad) - treated with mesocaval shunt for portal vein thrombosis in  
  1999.  Splenic embolization also.  Chronic anemia and renal  
  insufficiency.  CT scan of abdomen "suggests carcinomatosis" -  
  slightly worse over past "couple of years" - but no primary (CA125  
  elevated  to ~60 baseline in our hospital 0-40, already had TAH-BSO  
  years ago).  About six months ago, fell and got a "hairline" fracture  
  of left hip - no intervention, but developed a DVT in right leg.   
  Recently, fell again (may have been near syncope) and broke right  
  ankle in several places.  Admitted to outside hospital after fall,  
  hypotensive, found to have a troponin of ~20 with a moderate RV  
  infarct.  Taken to cath lab for PCI (BMS to occluded right -  
  interesting as she was on coumadin) - opened up,  but also has  
  significant LAD/Cx disease.  Good targets.  Cardiology asking for off- 
  pump LIMA-LAD and they will do a protected left main stent.   
  Anesthesia and Ortho doesnt want to fix her ankle until her heart is  
  taken care of.

  Would anyone operate?

  Cardiology somewhat understanding of our reluctance to "take the high  
  potential operative mortality hit" and in fact they are not sure they  
  even want to "take the PCI hit".  To be honest, we all want to try  
  and help (not sure of the long term benefit as no one has any idea of  
  her long-term prognosis), but no one wants to have a potential CABG  
  mortality.

  Hal - can I send her to you?


  -michael
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