[HSF] SBE and the Indications for Surgery

[Tea Acuff]

Ask any drunken sailor for the details. You will likely be under whelmed at their memory. Just look at the pictures again and use your imagination. Imagine that you are not talking to strangers, but someone who know every  point that you are trying to make, and the problems with your sources. Otherwise, my edits are probably all you will get.
tea


----- Original Message ----
From: Prasanna Simha M <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, February 4, 2007 10:35:48 PM
Subject: Re: [HSF] SBE and the Indications for Surgery


But how to get the "gory" details !!!
And Hal must have been a sitting duck to a bunch of drunken sailors waiting
to keel haul him !! Or was it "walking the plank" ?
Prasanna

On 2/5/07, Edward Bender <ebender001 at charter.net> wrote:
>
> There is no need to go off the list for this.  Picture a group of
> surgeons after a few drinks, and then some more drinks.  These
> surgeons are now eating free food.  These surgeons are not driving
> home, have no patients to worry about the next day, and have been
> bludgeoned by the words of the speaker in the not so distant past.
> What would you have done?
>
> Ed Bender, MD
>
>
> On Feb 4, 2007, at 8:39 PM, prasannasimha wrote:
>
> >
> > I am dying to know th e "pressure that was exerted Hal,
> > Please tell me off list !!
> > Prasanna
> > Edward Bender wrote:
> >> Hal:
> >> You know as well as anyone on this list that old literature
> >> poisons current practice.  The classic indications for surgery are
> >> heart failure, embolus, or uncontrolled sepsis.  These were
> >> developed in an era of high mortality rates for valve surgery, not
> >> to mention valve surgery in a septic patient in failure.  Current
> >> literature claims a 10% embolic rate when a vegetation is 15mm or
> >> more diameter.  We also know that there are silent emboli
> >> occurring more frequently.  I would not right off this patient
> >> yet.  Get CT of abdomen (spenic embolus?), aggressive antibiotics,
> >> rehab.  In a couple of weeks she may be salvageable.  The family
> >> will probably do whatever you say, so be careful.  If she does
> >> improve neurologically, proceed without waiting.
> >> Also, be kind to your ID guy. He probably feels bad enough already.
> >>
> >> PS. I give kudos to you stamina under pressure Sunday night.
> >>
> >> Ed Bender, MD
> >>
> >> On Feb 4, 2007, at 4:38 PM, Hgrmd at aol.com wrote:
> >>
> >>> Dear Members,
> >>>   About 3 months ago, I was asked to see an 80 yo fairly frail
> >>> lady  with
> >>> mitral staph SBE.  By the time I saw her, she was afebrile with mild
> >>> leukocytosis.  The coronaries were normal by cath and the EF was
> >>> 50%.   TEE revealed a 15
> >>> mm vegetation on the posterior leaflet with moderate MR.   There
> >>> were no
> >>> overt signs of CHF.   A t the time I suggested surgery  based on
> >>> the large
> >>> vegetation.  I was all set to operate, when, on the day  before,
> >>> the ID doc stepped
> >>> in and emphatically stated that surgery was not  indicated.  He
> >>> felt that
> >>> sepsis appeared to be controlled with anitibiotics  alone and
> >>> that there were no
> >>> indications for surgery.  He also told that to  the patient and
> >>> her son.  I
> >>> backed off and let them have their way.
> >>>   Last Friday, I was reconsulted on this patient.  She had
> >>> represented with
> >>> a large right hemispheric CVA.  She was now blind in the  left
> >>> eye and unable
> >>> to move the left side.  She's screwed.   Transthoracic echo now
> >>> revealed
> >>> severe MR with poor visualization of the  posterior leaflet. The
> >>> family told me
> >>> they wished they had listened to me.   The point is that large
> >>> vegetations alone
> >>> are current indications for surgical  intervention.  Anybody
> >>> disagree?
> >>> Hal
> >>> _______________________________________________
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-- 
Prasanna Simha M
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