[HSF] Low gradient AS

[Tea Acuff]

Treat the patient, not the numbers, Michael.
;)
tea


----- Original Message ----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, December 30, 2007 12:10:29 PM
Subject: [HSF] Low gradient AS

Not to curse myself, but we are seeing more and more "little old ladies"
with CHF, low EFs, low gradients (relative term), and severe AS (like areas
0.5).  While these are known to be higher risk, has anyone turned anyone
down - and if so what are the true contraindications (besides the usual
failure of the eyeball test).  My take is anything you put in has to be
better than what they have and if you do nothing, then they are toast.

A patient I am working up has a AVA of 0.4 with a peak of 42mmHg and a mean
of 24 mmHg with known CAD (moderate LAD disease from a cath in 2001!).   I
know we can get dobut stress echos and MRI, etc etc and ring up big bills,
but she has already been admitted 3 times with severe CHF problems in the
past 2 months and has an ankle fracture which no one will touch due to her
heart.  I get the sense that if we dont offer something they she may not
make it to the end of the year (yikes - that is in 2 days).



-michael
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