[HSF] (no subject)

[Tohru Asai]

Ashok
I would consider on-pump CABG. I do not consider using in-situ RIMA. I does
not reach distal LAD. I do OPCAB >99%, but pectus is rare contraindication.
If you want to stick to off-pump because of bad aorta, I would consider left
thoracotomy aproach.

On the other hand, mitral repair, ASD, tricuspid valve are much easier in
pectus. Simply because we can see them better. Multivessel OPCAB via
sternotomy is harder.

We have the same situation in patients with previous left lung resection.
These are typical for hearts located in the left chest.

If you want to repair pectus simulteneously, Nuss procedure at the end may
be useful, although I personally have not done yet. However with my
suggestion, a Korean surgeon did it and wrote a case report in HSF a few
years ago.
-- 
Tohru Asai
Shiga University of Medical Science
Otsu, Japan