[HSF] Acute abdomen plus unstable LM stenosis

[erdinç naseri]

Don,
I agree with Dr. Bidstrup.Why not extend te incision immediately after OPCAB.After as the name implies this is an abdominal emergency.
erdinc> Date: Thu, 6 Dec 2007 18:07:35 +1000> To: OpenHeart-L at lists.hsforum.com> From: benjamin.bidstrup at bigpond.com> Subject: Re: [HSF] Acute abdomen plus unstable LM stenosis> CC: > > >70yr male with unremarkable past history presented with acute > >abdomen and rest angina. ( WCC 20,000 )> >Urgent cath showed subtotal LM, 90% LAD, normal dominant RCA, good > >LV function.> >Balloon placed and emergent cabg ( opcab rima to LAD and lima to OM.)> >Laparotomy next day revealed dead colon which was successfully > >resected but patient fading fast with septic shock despite > >haemofiltration.> >> >Q1. Cause of dead gut in the absence of AF or infarct?> >Q2. Timing of laparotomy : before, during or sooner after cabg?> >Don> >_______________________________________________> >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 anddisclaimers posted at:> >http://www.hsforum.com/listdisclaim> >-----------------------------------------> > Acute abdo - autopsy findings wrt gut vasculature??> > A1. Acute gut problem - endotoxaemia - high output state - angina - > CABG - increasing gut ischaemia - downward spiral. What was lactate > and LDH etc prior to CABG?> A2. OPCAB and extend incision - after all OPCAB is not a big deal - > arteries ischaemia are fixed immediately.> -- > Ben Bidstrup FRACS FRCSEd FEBCTS> Consultant Cardiothoracic Surgeon> _______________________________________________> 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> -----------------------------------------