[HSF] LAD ENDARTERECTOMY

[Nasser F. Abou'Seada]

Thank you Tohru 
Me at least, have learnt form your style of writing, articulation of
concepts and formulation of the problem. as one of the silent majority ...
we are lucky to have you with us ... 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of Tohru Asai
> Sent: Sunday, January 14, 2007 10:23 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] LAD ENDARTERECTOMY
> 
> Prasanna
> About postoperative angiograms: It used to be, and may still be routine in
> some japanese centers. We still ask referring cardiologists to do postop
> angiogram. However it is very difficult to raise the rate close to 100%.
It
> does not give patients any benefit, especially those who have moderate to
> severe renal dysfunction and also small risk of cerebral embolism exists
> even with diagnostic catheterization. You can imagine that the country
where
> cardiologists implant stent whatever they see (someone said ) and some
jerk
> interventionalists seriously think CABG indication does not exist. I live
in
> such country.(CABG:PCI ratio 1:10-20 with DES) So patients with diabetic
> nephropathy, hemodialysis are one of our routine and increasing. HD is OK,
> but predialysis patients should not receive these studies.
> 
> Currently MDCT ( we have 16 slice CT which is still good ) is gradually
> replacing postop catheterization. It gives us pretty neat pictures and
> useful information. but it is basically "static image" compared with
> "dynamic image" angiogram. Since I started to do many arterial sequential
> graftings off-pump, I really want to know flow competition status. Angio
> information is just different from MDCT. I can not be 100% satisfied. I
> remember Ani's words, "the onus is on those who undertake these procedures
> to study the patients and provide us with data."
> 
> Thaks to your invitation, I have enjoyed discussion in this weekend. What
a
> tremendous thread! A lot of learning (for me, cardiac surgery and English
> language !) I will try to catch up with members' postings.
> --
> Tohru Asai
> 
> 
> > For Ani's question we may have to ask the Japanese. I think it is their
> > policy to do a routine angigram predischarge in all CABG's. Is that
> > right Tohru. If that is so then we would at least get the acute
> > occlusion rate.
> 
> > Tohru do they do routine predischarge Caths after every coronary in
> > Japan ? I had heard someone saying it and wanted to know if it is a
> > routine practice ?
> > Prasanna
> 
> 
> 
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