[HSF] anomolous RCA

[Tea Acuff]

Let me do the "Hal thing". Show me any data that supports CAB for single vessel RCA disease (of any size much less co-dominate, or even pediatric data not just we can or "should")for a mortality benefit. I am not saying it should never be done, just that we should recommend it for mortality benefit ("reported deaths").
I still think a bare stent is a reasonable if not an elegant solution for this problem.
Tea


----- Original Message ----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, February 6, 2007 6:44:24 PM
Subject: Re: [HSF] anomolous RCA


Yes and the risk associated with that versus not putting a graft is 
supposed to be higher
Prasanna

Tea Acuff wrote:
> Sudden death has been reported with CAB, but not reported very often. I do, however, have personal experience with it.
> tea
>
>
> ----- Original Message ----
> From: prasannasimha <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Tuesday, February 6, 2007 5:52:50 AM
> Subject: Re: [HSF] anomolous RCA
>
>
> Sudden death has been reported even for the RCA.
> Prasanna
> Ramaiah, Chandrashekar wrote:
>   
>> Prasanna,
>> Sudden death has been reported and I have taken care in case of Left Coronary. I do not know if you can say the same for RCA.
>> Hal: You can even do RIMA to RCA with robotic harvesting and without sternotomy but I still say nothing needs to be done in this case.
>> Chand
>>  
>>
>> Chand Ramaiah, MD
>> Director,Heart Transplantation
>> Director, Minimally Invasive Cardiac Surgery
>> University of Kentucky
>>
>> -----Original Message-----
>> From: "prasannasimha" <prasannasimha at gmail.com>
>> To: "OpenHeart-L at lists.hsforum.com" <OpenHeart-L at lists.hsforum.com>
>> Sent: 2/5/07 8:42 PM
>> Subject: Re: [HSF] anomolous RCA
>>
>> An anomalous coronary vessel coursing between the aorta and RCA is known 
>> to cause sudden death during exertion. This is because of PA dilatation 
>> and compression during exercise and is well described in literature.
>> This is an indication for a CABG. Usually a vein graft or a RIMA can be 
>> placed. If placing a RIMA graft it may string but I have seen them open 
>> up when proximal CAD has occurred. Incidentally that is what happened to 
>> Acar's radials over years which actually revived interest in radials.
>> Prasanna
>>
>> Hgrmd at aol.com wrote:
>>   
>>     
>>> Chand,
>>>   I wish I could show you the 64 slice CT scan.  It clearly shows  an RCA 
>>> arising from the left coronary sinus.  It appears to be a string  during its 
>>> course between the left side of the ascending aorta and the right  side of the 
>>> MPA.  Distally, it appears normal caliber and terminates in a  nice PDA.  I don't 
>>> see much of a posterolateral branch, and suspect it is a  codominant system.  
>>> The LM, LAD, and Cx appear unremarkable. The  radiologist interprets the scan 
>>> as an anomolous RCA with a "potentially lethal"  anatomy.  I've referred the 
>>> case to a cardiologist I trust and will get his  opinion regarding the need 
>>> for a cath.  Quite honestly, though I don't have  much experience in 
>>> interpreting 64 slice scans, this appears to be an excellent  study.  The patient has had 
>>> exertional angina that began about a month  ago.  Interestingly, a nuclear 
>>> scan reveals mild anterior  reversibility.  
>>>   My initial plan is to place a RIMA to the RCA and probably close the  RCA 
>>> at its course between the aorta and the PA.  Looks to me that  mobilizing the 
>>> RCA off the left sinus would be a dangerous royal pain. Any other  suggestions?
>>> Hal
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