[HSF] Pre-discharge Echo/CTs

[Tea Acuff]

The real anomaly is that we doctors and the payers consider imaging a cost and profit center when it is the consequence of the finding from which is therapy and from which benefit is derived for the patient, not the imaging per se. Maybe it has partly to do with our abuse, such as daily CXR, etc as well as the artifical separation of diagnosis and therapy. What good is a diagnosis alone? If it is benign, no other followup is necessary rather than the way we presently do it. That is, we "fixed" it so no further confirmation is required.  Imaging, like the observation that it is, should be the beginning and end of every therapy, ie inclusive not exclusive. Hear that echo with the nature of evidence?


tea


----- Original Message ----
From: "ICHFNO at aol.com" <ICHFNO at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, August 17, 2007 5:11:33 PM
Subject: Re: [HSF] Pre-discharge Echo/CTs


I agree completely with Bob. Let me cite a recent example. We have used a  
variety of techniques to restore RV-PA continuity in children around the world,  
one technique we use in especially small children is to create a tri-leaflet  
valve from their own pericardium (non-fixed). We have about 25 of these 
around  the world in children who recieved them when they were 5 kgs or less, and 
could  now be up to 2 years out. We routinely get discharge echo's, as a 
baseline, then  follow-up echo's when ever the children appear for follow-up. So, we 
are able to  evaluate surgical natural history of these valves. We are in 
Beijing now and  last January we operated on a 3 kg baby with Truncus type 1. The 
child now has  an 80 mmmHg gradient across the valve and this is the first 
one that has acted  this way. Our longest tiny valve (made over a 9 mm Hegar) is 
over 2 years out  and still has a gradient of only 25, others are between 
this and less, so we  know that this particular child in Beijing is an anomaly. 
Without the immediate  discharge echo (which showed a gradient of less than 25) 
we would be in the dark  as to the interval changes.

WNovick



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