[HSF] anomolous circ

[Tea Acuff]

A CTA or MR would be a definitive way to tract the course of the circumflex. However, I have had to reimplant the circumflex from the right which continued posterior to the PA in a 9 yo who would become ischemic with exercise just from the distention of the aorta (and PA?)  with increased flow. Frequently in adults this distribution (of the circ) is small so rountine CABG of this vessel instead of reimplantation is not so rountine and may require exposure in the AV groove or behind a transsected main PA which many of us might not do under other circumstances (eg a small PL distribution with large intermediate). A provocative test for ischemia may be useful to confirm the area(s) of ischemia if positive.

tea


----- Original Message ----
From: Otto Thaning <otto at iafrica.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, August 16, 2007 1:42:18 PM
Subject: Re: [HSF] 25 mm valve


Some advice please on the following:

58 year male presents with progressively severe angina on minimal 
provocation.

He has severe proximal LAD & diagonal stenosis, a completely occluded RCA. 
His Cx is an unobstructed vessel BUTarises from the Right coronary cusp. It 
is not possible to determine its course to the lateral LV wall territory, 
but it is a pristine vessel and has a large lateral wall territory that 
fills well and feeds also a large PDA retrogradely.

I plan to graft the LAD, Diagonal and the PDA. The question is what to do if 
the Cx has a course between the PA and the Ao?

Otto Thaning
Cape Town 

_______________________________________________
OpenHeart-L mailing list

Send postings to:
OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------