[HSF] LIMA in an octogenarian with a suspicious LUL nodule?

[Tea Acuff]

Sounds like we are back to the two team problem again, different verse.
tea


----- Original Message ----
From: "ebender001 at charter.net" <ebender001 at charter.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, August 8, 2007 3:23:07 PM
Subject: Re: [HSF] LIMA in an octogenarian with a suspicious LUL nodule?


Mike:
Do CABG and remove the LUL solitary pulmonary nodule with a generous wedge resection.  If this is a lung primary, in this age group, I doubt you gain much by doing a lobectomy or by having mediastinal lymph nodes for staging.  If he so desires, and if the heme/onc folks think it appropriate, he could even get adjuvant chemoradioation if the PET is positive in the mediastinum.  If the PET shows extrathoracic spread (such as an adrenal mass) I would do the same thing in an 82 year old who is having a sternotomy.

Ed Bender, MD


---- "Crittenden wrote: 
> Scheduled to operate on an 82 yo with 3VD and moderately reduced EF.
> S/P NSTEMI last week.  Refused CABG originally, now ready for an
> operation.
> 
>  
> 
> Due to age, diffuse CAD and other stigmata of atherosclerosis, elected
> to get thoracic CT to assess ascending aorta-as you might have guessed
> there was a LUL nodule ~1.5 x 1.5 that was NOT seen on plain films.  All
> agree that patient should still have an operation given size of mass and
> no obvious node or extrathoracic involvement.  PET scan being done
> today. FEV1  1.4L thus I believe he would tolerate a LULobectomy.
> 
>  
> 
> My questions are:    
> 
> (1)     Would you not do a LIMA and keep the left pleural space intact
> in this 82 yo male? 
> 
> (2)     Take it down in an extrathoracic fashion?  (BTW, I have never
> liked the way the LIMA lies when done in this fashion?
> 
> (3)     Take it down and cover it somehow to prevent injuring it during
> the LUL?
> 
>  
> 
> Mike Crittenden
> 
>                                     
> 
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