[HSF] Full metal jacket

Mon Dec 10 16:52:18 EST 2007

I like your plain, short description. i like to think that cardiologists haven't really thought about what they do. (if they do??)
I would suggest PCD, percutaneous coronary DEvascularization, or TCD, transcoronary devascularization.

tea

----- Original Message ----
From: David Harris <drdharris at yahoo.co.uk>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, December 10, 2007 5:11:39 PM
Subject: Re: [HSF] Full metal jacket

Today a cardiologist refers me an 84 yr old for a 3
vessel CABG. LAD has 90 lesion, and is dominant, wraps
around the heart. The rest of the vessels are small
and trash. After I tell him I want to do MIDCAB, he
then says he will then decide to stent patient, as I
will not be doing a long lasting operation!!!!

And that was after he listened to Dave Taggard`s
wonderful logic at our local conference last month!! 

Luckily we have another cardiologist that sees the
logic of MIDCAB`s and hybrid procedures, and feeds us
single LAD`s

I just bought the 2008 Guiness Book of records for my
son. The world record for the most accumulated stents
in 1 patient is 34 (in USA!!!). HA HA HA, they should
call it the ``debranching coronary procedure``

Dave Harris

--- Ben Bidstrup <benjamin.bidstrup at bigpond.com>
wrote:

> There is an Australian expression but I am not 
> able to put it into this email. It may offend 
> some, but I suspect not a cardiologist!
> 
> >23 stents !!!
> >Recommendation is to stent the cardiologists middle
> cerebral artery
> >bilaterally .
> >
> >Jokes apart the first major series of full metal
> jackets were after  the
> >''reconstitution of the LAD'' pölicy by the
> Maastricht cardioöogy groups so
> >the Maastricht surgeons would be very knowledgable.
> Probably if the
> >myocardium is viable stent endartrectomy and onlay
> patching with grafting is
> >the only viable option.
> >Post oü LMWH , Plavix and aspirin and to maintain a
> high CO and high
> >diastolic pressure and IABP if required (Idea is a
> high coronary flow will
> >try to decrease one component of Virchow's triad)
> >Prasanna
> >
> >On Dec 9, 2007 4:35 AM, Tohru Asai
> <toruasai at belle.shiga-med.ac.jp> wrote:
> >
> >>  Dear Members
> >>
> >>  67yo diabetic Japanese woman with triple vessel
> disease was recently
> >>  referred to me. She had DOE and chest discomfort
> with light exertion. She
> >>  had multiple stents ( at least 23 stents, mostly
> cypher!!!) in all three
> >>  territories. RCA is occluded at ostium, LAD is
> occluded at the middle and
> >>  Circumflex has 90% stenosis at the just
> proximal. In addition, distal
> >>  targets are quite thin ( distal LAD, PDA...) and
> 1st and 2nd diagonal have
> >>  over 95% stenoses, obtuse marginal is obstructed
> 90% at the beginning. I
> >>  attached 2 still pictures of coronary angiogram.
> >>
> >>  Is this kind of patient more common lately in
> your practice?
> >>  What do you do? operate? What procedure?
> >>  What is your graft chice?
> >>  endarterecromy considered?
> >>  What is your strategy of perioperative
> management of anticoagulation?
> >>  kill a cardiologist?
> >>  any comments, please.
> >>
> >>  I am moderating a cardiologist-cardiac surgeon
> session, named "what is an
> >>  ideal coronary revascularization" next weekend
> in Kyoto. I am going to
> >>  present this case.
> >>
> >>  BTW my series of diabetic 3VD had over 10 times
> higher hospital mortality
> >>  with previous PCI compared to diabetic 3VD
> without PCI.. My junior staff
> >>  is
> >>  writing a paper.
> >>  --
> >>  Tohru Asai
> >>  Shiga, Japan
> >>
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> >
> >
> >
> >--
> >Prasanna Simha M
> >_______________________________________________
> >OpenHeart-L mailing list
> >
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> 
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411            
Fax +27-21-9006412      Mobile +27-83-3309587
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