[HSF] Renal impairment & CABG

[Nasser F. Abou'Seada]

Breast mammary gland is supplied partly by the 2nd- 5th intercostal
arteries, with variations. branches from lateral thoracic artery, Pectoral
branches of thoraco-acromial artery

NFA

> From: prasannasimha
> Shucks,
> I did not realize the breast size was wrt Mammary artery size !!  never
> thought about it that way as one is internal and the other is external
> !! I never thought about a "reciprocal" or "concomitant" relation wrt
> the mammary center.
> Incidentally , Ani, thanks for the article. I sent you a reply email but
> was not sure it reached you.
> Prasanna
> 
> Ani Anyanwu wrote:
> > Nand
> >
> > I have my doubts as to the relevance of breast size to the IMA size. The
IMA is not
> a major source of blood supply to the breast - it is an artery of the
chest wall - and
> she has one. Indeed anatomically men have bigger IMAs and at best they
have only a
> rudimentary mammary gland. We have all seen ladies with massive breasts
and tiny
> IMAs. Even children - who have undeveloped breasts have had IMA used for
grafting,
> which I am sure Tohru has done as scenario more common in Japan.
> >
> > I think we are going into 'superthink' here. Just do operation as you
usually do.
> Don't make this into a special case or some battle that it isn't - there
is little special
> about it. As your compatriot Buxton would say, focus on the main game (and
not on
> minutiae). If you find small IMAs, no big deal-  deal with it as you would
in any other
> CABG case.
> >
> > Best of luck
> >
> > Ani
> >   ----- Original Message -----
> >   From: nand kejriwal<mailto:nkkejriwal at gmail.com>
> >   To:
OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >   Sent: Saturday, January 20, 2007 11:20 PM
> >   Subject: Re: [HSF] Renal impairment & CABG
> >
> >
> >   Tohru
> >
> >   The patient came in today for operation tomorrow. She has bilateral
small
> >   breasts with no nipples on either side. No, the cardiologist did not
shoot
> >   the mammaries and to be honest, I did not think about it either. Well,
if
> >   both the mammaries are small, I shall have to use just the veins. As
they
> >   say, we can not make chicken salad out of chicken shit.
> >
> >   Her heart size is completely normal on CXR. I shall of course look at
the
> >   ventricular septum on TOE in the operating rooms and decide what to
do.
> >
> >   nand
> >
> >   On 1/20/07, Tohru Asai <toruasai at belle.shiga-
> med.ac.jp<mailto:toruasai at belle.shiga-med.ac.jp>> wrote:
> >   >
> >   > > A small perimembranous VSD was detected on echo a
> >   > > few years earlier. It is partly closed by the tricuspid leaflet
and does
> >   > not
> >   > > have significant left to right shunt.
> >   > Nand
> >   > This VSD would be my concern. You know the risk of infection
(endocarditis
> >   > and sepsis) is related to small VSD shunt (jet) during routine HD
period.
> >   > I
> >   > would open the right atrium to close VSD if the heart needs to be
> >   > operated.
> >   >
> >   > Also I am a little bit concerned aplasia of breast and nipple. Which
side?
> >   > Can you be sure the mammary has ordinary size? Did your cardiologist
> >   > demonstrated mammary angio preoperatively, probably not?
> >   >
> >   > Good LV function shunting to low pressure chamber RV may not be as
good as
> >   > you expect, but maybe all right. Just a word of caution in your
mind.
> >   >
> >   > Prasonna said quick in and out.No objection. Many things in short
period
> >   > of
> >   > time, you need to organize the procedure well. I may omit some
distal
> >   > targets. What do you think?
> >   > --
> >   > Tohru Asai
> >   > Shiga University of Medical Science
> >   > Otsu, Japan
> >   >
> >   >
> >   >
> >   >
> >   > _______________________________________________
> >   > OpenHeart-L mailing list
> >   >
> >   > Send postings to:
> >   > OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >   >
> >   > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >   > http://mmp.cjp.com/mailman/listinfo/openheart-
> l<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<http://www.hsforum.com/listdisclaim>
> >   > -----------------------------------------
> >   >
> >   _______________________________________________
> >   OpenHeart-L mailing list
> >
> >   Send postings to:
> >    OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >
> >   To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >   http://mmp.cjp.com/mailman/listinfo/openheart-
> l<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<http://www.hsforum.com/listdisclaim>
> >   -----------------------------------------
> > _______________________________________________
> > 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
> > -----------------------------------------
> >
> >
> _______________________________________________
> 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
> -----------------------------------------