[HSF] Renal impairment & CABG

[Nasser F. Abou'Seada]

Very well said Ani 

NFA

> From: Ani Anyanwu
> 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
>   >