[HSF] Renal impairment & CABG

Nasser F. Abou'Seada nfaabouseada at gmail.com
Sun Jan 21 13:20:01 EST 2007 

Dear Prasanna 
Ha Ha ... I meant that the mammary gland is supplied by many vessels from
diverse suppliers. so apparently no direct relation to the size of the
mammary a. as many other variables are interfering. in fact, the penetrating
intercostal branches are the ones that tend to be found enlarged in females
compared to males, especially during lactation.
in another word, I'm supporting your opinion. 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Sunday, January 21, 2007 11:23 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Renal impairment & CABG
> 
> That is so but, I don't think that it correlates with breast size by any
> stretch of imagination.
> Prasanna
> 
> Nasser F. Abou'Seada wrote:
> > 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
> >>>   >
> >>>   >
> >>>   >
> >>>   >
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