From benjamin.bidstrup at bigpond.com Sun Jul 1 09:56:27 2007 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Sat Jun 30 18:57:10 2007 Subject: [HSF] Indigenous ring model X.1 In-Reply-To: References: Message-ID: >Prasanna, > Though it would seem inviting to have this handmade ring to be the answer >in bringing repair to the masses, I would caution readers in more affluent >situations to be very cautious, especially if there is the possibility of >litigation. Many years ago, Cooley famously made flexible rings out >of sectioned >Dacron aortic grafts. However, I don't believe too many surgeons in America >would be so bold. > I still have significant concerns as to the completeness of followup of >these implanted prostheses. Again, if it works well, more power to you. As >for me, I'm not willing to take the risk of an adverse equipment failure >potentially robbing me of my retirement. > >Hal > Hal and Prasanna, Each country has different pressures and rules. This has also changed over time. (All this is stating the bl...ding obvious, I know). With regulatory control as exists in many countries USA and Europe which as we have discussed at length are quite different, the ability to do some things of an 'experimental' nature is no longer possible. However, in the case of Prasanna, his decision making process about these aids to his surgical practice is determined by other factors. So the PM wire annuloplasty would not be acceptable to Hal's system. OK if it worked but get a failure, and his friends from the bottom of the ocean floor will be ruining his retirement plan. We all aspire to high standards for our patients and doing harm intentionally is not an issue. Necessity is the mother of invention, and some have to use what is readily available and of course, affordable. I look at operations I saw being done 25 years ago. To do some of them now would be considered unethical, but many of the procedures we do as part of our normal armamentarium had to be started somewhere, and the limits determined. Many drugs we use routinely would now never get regulatory approval. Blood for example. -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From prasannasimha at gmail.com Sun Jul 1 06:48:37 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sat Jun 30 20:25:57 2007 Subject: [HSF] Indigenous ring model X.1 In-Reply-To: References: Message-ID: <4686F2DD.3060502@gmail.com> Of course Hal, even I would not do the same in your shoes (or would I- I do not know !!).I do not think many would be sitting with a paper rock and scissors doing and well if I got something prefabricated that the patient did not have to pay the earth for why not. Between a repair and an MVR I think I am doing a better service to them by repairing the valves and sending them off to the Hinterland with an indigenous ring be it pericardial/Goretex or whatever. At the end of the day let us not kid our selves - any of the rings especially flexible could have been a piece of shoestring if you look at them.(And that is not my quote) Probably Daniel Unich could get the source of the quote right. Prasanna Hgrmd@aol.com wrote: > Prasanna, > Though it would seem inviting to have this handmade ring to be the answer > in bringing repair to the masses, I would caution readers in more affluent > situations to be very cautious, especially if there is the possibility of > litigation. Many years ago, Cooley famously made flexible rings out of sectioned > Dacron aortic grafts. However, I don't believe too many surgeons in America > would be so bold. > I still have significant concerns as to the completeness of followup of > these implanted prostheses. Again, if it works well, more power to you. As > for me, I'm not willing to take the risk of an adverse equipment failure > potentially robbing me of my retirement. > > Hal > > > > ************************************** See what's free at http://www.aol.com. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > > From benjamin.bidstrup at bigpond.com Sun Jul 1 12:19:49 2007 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Sat Jun 30 21:20:37 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> Message-ID: >To the forum. I know we've covered this type of problem in previous >discussions, but... > >An old patient of mine, 62yo petite diabetic female, unrepentant >smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. >She's been complaining of increasing dyspnea for several months and >referred her back to her cardiologist to investigate. The bottom >line is she has critcal AS with AVA 0.3cms, normal EF, normal >chambers, and all grafts are patent. She just had her left >subclavian stent redone to improve LIMA flow. The problem is she is >now totally calcified from valve through arch and LCCA is occluded >just after the origin. Additionally, she now has a 1.5cm LUL nodule >which lights up on PET. Surprisingly, her PFT is remarkably good but >she always reminds me that she had a difficult post op course from a >pulmonary standpoint. >Any thoughts besides the word NO? >Thanks ahead of time. >Mitch Lirtzman > > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@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 JPFROG -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From prasannasimha at gmail.com Sun Jul 1 07:17:46 2007 From: prasannasimha at gmail.com (psimha) Date: Sat Jun 30 21:43:51 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> Message-ID: <4686F9B2.7050102@sify.com> Mitch do I post your pictures or have you given up ? (You had asked me to wait). Prasanna Mitch Lirtzman wrote: > To the forum. I know we've covered this type of problem in previous > discussions, but... > > An old patient of mine, 62yo petite diabetic female, unrepentant > smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. > She's been complaining of increasing dyspnea for several months and > referred her back to her cardiologist to investigate. The bottom line > is she has critcal AS with AVA 0.3cms, normal EF, normal chambers, and > all grafts are patent. She just had her left subclavian stent redone > to improve LIMA flow. The problem is she is now totally calcified from > valve through arch and LCCA is occluded just after the origin. > Additionally, she now has a 1.5cm LUL nodule which lights up on PET. > Surprisingly, her PFT is remarkably good but she always reminds me > that she had a difficult post op course from a pulmonary standpoint. > Any thoughts besides the word NO? > Thanks ahead of time. > Mitch Lirtzman > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > From prasannasimha at gmail.com Sun Jul 1 08:26:19 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sat Jun 30 21:56:55 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> Message-ID: <468709C3.4080201@gmail.com> Just Plain Frigging Ran Out of Gas Prasanna Nasser F. Abou'Seada wrote: > On 6/30/07, Ben Bidstrup wrote: > > "JPFROG" > > Please explain > > NFA > > > > > > > >> >To the forum. I know we've covered this type of problem in previous >> >discussions, but... >> > >> >An old patient of mine, 62yo petite diabetic female, unrepentant >> >smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. >> >She's been complaining of increasing dyspnea for several months and >> >referred her back to her cardiologist to investigate. The bottom >> >line is she has critcal AS with AVA 0.3cms, normal EF, normal >> >chambers, and all grafts are patent. She just had her left >> >subclavian stent redone to improve LIMA flow. The problem is she is >> >now totally calcified from valve through arch and LCCA is occluded >> >just after the origin. Additionally, she now has a 1.5cm LUL nodule >> >which lights up on PET. Surprisingly, her PFT is remarkably good but >> >she always reminds me that she had a difficult post op course from a >> >pulmonary standpoint. >> >Any thoughts besides the word NO? >> >Thanks ahead of time. >> >Mitch Lirtzman >> > >> > >> >_______________________________________________ >> >OpenHeart-L mailing list >> > >> >Send postings to: >> >OpenHeart-L@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 >> >> >> JPFROG >> >> -- >> Ben Bidstrup FRACS FRCSEd FEBCTS >> Consultant Cardiothoracic Surgeon >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 > ----------------------------------------- > From prasannasimha at gmail.com Sun Jul 1 09:03:07 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sat Jun 30 22:33:43 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <8C9899E2FB48508-1860-AAB2@WEBMAIL-MC03.sysops.aol.com> References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> <8C9899E2FB48508-1860-AAB2@WEBMAIL-MC03.sysops.aol.com> Message-ID: <46871263.2000600@gmail.com> Smoker with ? lung Ca Is the valve replacement worth it ? if worth it then - probably would be a candidate for those percut valves. Why chop her up excessively ? Prasanna tdmartin2000@aol.com wrote: > Need a biopsy of lung lesion and then staging if pos for CA. If no carcinoma or something possibley cureable? and no AI, then an apical aortic conduit would be a consideration along with either a wedge resection or lobectomy. You certainly can replace the entire root, ascending?and arch with reasonable results as long as there is something to sew to either in the distal arch or the prox descending. > > Tom Martin > U of Florida > Gainesville > > > -----Original Message----- > From: Mitch Lirtzman > To: OpenHeart-L@hsforum.com > Sent: Sat, 30 Jun 2007 7:48 pm > Subject: [HSF] Calcified aortic stenosis > > > To the forum. I know we've covered this type of problem in previous discussions, but...? > ? > An old patient of mine, 62yo petite diabetic female, unrepentant smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been complaining of increasing dyspnea for several months and referred her back to her cardiologist to investigate. The bottom line is she has critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She just had her left subclavian stent redone to improve LIMA flow. The problem is she is now totally calcified from valve through arch and LCCA is occluded just after the origin. Additionally, she now has a 1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is remarkably good but she always reminds me that she had a difficult post op course from a pulmonary standpoint.? > Any thoughts besides the word NO?? > Thanks ahead of time.? > Mitch Lirtzman? > ? > _______________________________________________? > OpenHeart-L mailing list? > ? > Send postings to:? > OpenHeart-L@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? > -----------------------------------------? > > > ________________________________________________________________________ > AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > > From benjamin.bidstrup at bigpond.com Sun Jul 1 13:47:56 2007 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Sat Jun 30 22:48:38 2007 Subject: [HSF] [OT] A Star is Born In-Reply-To: References: Message-ID: >i believe this is something everyone will enjoy. i hope you do > > >*http://www.youtube.com/watch?v=i0dzZTPWrSM* >* * >** >** >*NFA* >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@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 >----------------------------------------- You need to look at the final as well. He is amazing what a voice. -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From benjamin.bidstrup at bigpond.com Sun Jul 1 14:33:16 2007 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Sat Jun 30 23:33:52 2007 Subject: [HSF] Operating on Liver Cirrhotics In-Reply-To: <93918.4841.qm@web81601.mail.mud.yahoo.com> References: <93918.4841.qm@web81601.mail.mud.yahoo.com> Message-ID: Factor VIIA. Given pre-emptively when Hemophilia is being treated. It brought about the million dollar TH Replacement. 5K for hip, 995K for VIIa, I bet the comapny loved it! In other areas, no - only if you have more money than sense .IMHO >I presume you are not talking about OPCAB since you did not mention >a diagnosis. >tea > > >----- Original Message ---- >From: Ani Anyanwu >To: OpenHeart-L@lists.hsforum.com >Sent: Saturday, June 30, 2007 8:21:46 PM >Subject: [HSF] Operating on Liver Cirrhotics > > >I would be keen to know approaches members use to reduce the >morbidity or mortality associated with cardiac surgery in patients >with liver cirrhosis. >We have an active liver transplant program and few times a year i >have to operate on patients requiring liver transplant who have >co-existing cardiac problems. These patients seem so unpredictable >and mortality has been high such that on occasion some surgeons have >done the (cardiac) procedure in combination with the liver >transplant. >I would be grateful for any tips on dealing with this difficult >group. Prassana I know has a regime of hepatic infusion of >venodilators - is their logic or data to back this and do others >have experience of this technique? Do people give Factor VII >pre-emptively? >Thanks >Ani >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@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@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 >----------------------------------------- -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From prasannasimha at gmail.com Sun Jul 1 09:57:37 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sat Jun 30 23:54:04 2007 Subject: [HSF] Operating on Liver Cirrhotics In-Reply-To: References: Message-ID: <46871F29.9030500@gmail.com> Ani vasodilator perfusion is more based on theoretical construct of decreased hepatic flow with CPB. It is like TRT its use has to be ultimately be proved.It has been shown that nitrate infusions increases hepatic flow during CPB. Delivering targetted would be better hopefully. Prasanna Ani Anyanwu wrote: > I would be keen to know approaches members use to reduce the morbidity or mortality associated with cardiac surgery in patients with liver cirrhosis. > We have an active liver transplant program and few times a year i have to operate on patients requiring liver transplant who have co-existing cardiac problems. These patients seem so unpredictable and mortality has been high such that on occasion some surgeons have done the (cardiac) procedure in combination with the liver transplant. > I would be grateful for any tips on dealing with this difficult group. Prassana I know has a regime of hepatic infusion of venodilators - is their logic or data to back this and do others have experience of this technique? Do people give Factor VII pre-emptively? > Thanks > Ani > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > > From ebender001 at charter.net Sun Jul 1 00:15:48 2007 From: ebender001 at charter.net (Edward Bender) Date: Sun Jul 1 00:16:21 2007 Subject: [HSF] Congratulation Message-ID: <23128BCC-C4DD-4B94-9ECB-7E93D16CD659@charter.net> Congrats to William Novick. See link: http://www.passion-awards.com/June29th.html Ed Bender, MD From alsadd at ksu.edu.sa Sun Jul 1 10:27:45 2007 From: alsadd at ksu.edu.sa (A) Date: Sun Jul 1 02:26:31 2007 Subject: [HSF] Operating on Liver Cirrhotics In-Reply-To: <46871F29.9030500@gmail.com> Message-ID: <20070701062402.00F3BD5FF0@smtp.ksu.edu.sa> One of the dreaded complications is bleeding that can be so difficult to manage. Over the years I have operated on a handful of such cases and they have done well. I give these patients three doses of IV vitamin K1 given by an MD over a period of ten minutes by the clock. The protocol takes three days to complete. This is beside taking meticulous care when opening and closing etc and the routine preop care. I hope that this helps. Ahmed -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of prasannasimha Sent: Saturday, June 30, 2007 8:28 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Operating on Liver Cirrhotics Ani vasodilator perfusion is more based on theoretical construct of decreased hepatic flow with CPB. It is like TRT its use has to be ultimately be proved.It has been shown that nitrate infusions increases hepatic flow during CPB. Delivering targetted would be better hopefully. Prasanna Ani Anyanwu wrote: > I would be keen to know approaches members use to reduce the morbidity or mortality associated with cardiac surgery in patients with liver cirrhosis. > We have an active liver transplant program and few times a year i have to operate on patients requiring liver transplant who have co-existing cardiac problems. These patients seem so unpredictable and mortality has been high such that on occasion some surgeons have done the (cardiac) procedure in combination with the liver transplant. > I would be grateful for any tips on dealing with this difficult group. Prassana I know has a regime of hepatic infusion of venodilators - is their logic or data to back this and do others have experience of this technique? Do people give Factor VII pre-emptively? > Thanks > Ani > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 ----------------------------------------- From cvteles at gmail.com Sun Jul 1 06:18:45 2007 From: cvteles at gmail.com (Claudia Teles) Date: Sun Jul 1 04:46:00 2007 Subject: [HSF] Operating on Liver Cirrhotics In-Reply-To: <20070701062402.00F3BD5FF0@smtp.ksu.edu.sa> References: <46871F29.9030500@gmail.com> <20070701062402.00F3BD5FF0@smtp.ksu.edu.sa> Message-ID: <4329c7e70707010118v4dc78e49ma9be6e128bc5382f@mail.gmail.com> Dear all, Some clinical considerations. First: it is useful to classify the degree of liver dysfunction before surgery. This can be done with Child Pugh modified score or with scyntillographic methods, which are very accurate in this regard. Second: Nutritional and metabolic improvement can make a difference if you can raise a Class C patient?s dysfunction degree to a class A or B. Third: Don?t rely only in the prothrombin time and INR to evaluate coagulation: some of these patients have active fibrinolysis and this can be a complication in the surgical theatre. Fibrinogen levels, factor V and VII levels, D dimer and Thrombin- Antithrombin complexes serum levels can be useful in this regard, if you don?t have any functional dynamic coagulation evaluation device available (Sono Clot, TEG, ROTEM, etc). Many times, if you improve nutrition, you can ameliorate the coagulation status and immune function of the patient. Hope it helps, Claudia Teles, MD Liver Transpl. 2007 Apr 10;13(7):990-995 [Epub ahead of print][image: Click here to read] Links Early and late outcome of cardiac surgery in patients with liver cirrhosis. *Filsoufi F*, *Salzberg SP*, *Rahmanian PB*, *Schiano TD*, *Elsiesy H*, *Squire A*, *Adams DH* . Department of Cardiothoracic Surgery, Mount Sinai Hospital, New York. Liver cirrhosis is a major risk factor in general surgery. Few studies have reported on the outcome of cardiac surgery in these patients. Herein we report our recent experience in this high-risk patient population according to the Child-Turcotte-Pugh classification and Model for End-Stage Liver Disease (MELD) score. Between January 1998 and December 2004, 27 patients (mean age 58 +/- 10 yr, 20 male) with cirrhosis who underwent cardiac surgery were identified. Patients were in Child-Turcotte-Pugh class A (n = 10), B (n = 11), and C (n = 6) and mean MELD score was 14.2 +/- 4.2. Operative mortality was 26% (n = 7). Stratified mortality according to Child-Turcotte-Pugh class was 11%, 18%, and 67% for class A, B, and C, respectively. No mortality occurred in patients who had revascularization without the use of cardiopulmonary bypass (n = 5). The 1-yr survival was 80%, 45%, and 16% for Child-Turcotte-Pugh class A, B, and C, respectively (P = 0.02). Major postoperative complications occurred in 22%, 56%, and 100% for Child-Turcotte-Pugh class A, B, and C, respectively. Child-Turcotte-Pugh classification was a better predictor of hospital mortality (P = 0.02) compared to MELD score (P = 0.065). In conclusion, our results suggest that cardiac surgery can be performed safely in patients with Child-Turcotte-Pugh class A and selected patients with class B. Operative mortality remains high in class C patients. Careful patient selection is critical in order to improve surgical outcome in patients with cirrhosis. Liver Transpl, 2007. (c) 2007 AASLD. * * * *Curr Treat Options Gastroenterol. 2005 Dec;8(6):473-80.[image: Click here to read] Links Management of the cirrhotic patient that needs surgery. *Bell CL*, *Jeyarajah DR* . Department of Surgery, Methodist Hospital of Dallas, 221 West Colorado Blvd., Pavilion I, Suite 100, Dallas, TX 75208, USA. Conditions that necessitate surgery frequently arise in patients with chronic liver disease and cirrhosis. Because cirrhosis has the ability to cause physiologic derangements in every organ system in the body, clinicians face significant challenges in preoperative preparation of the patient with cirrhosis in order to decrease postoperative morbidity and mortality. Emergent operations add an extra dimension of complexity to the clinical picture, due to limited preoperative time to prepare the patient with cirrhosis for surgery. In cases of severely decompensated cirrhosis, clinicians should have in their armamentarium possible alternatives to surgery that can be used to temporize the emergent nature of the disease and improve patient outcomes. The classification of cirrhotic liver disease by Child and Turcotte was initially utilized to predict mortality in patients undergoing surgically placed shunts for portal hypertensive bleeding. Subsequent studies have pointed to the fact that other general and thoracic surgery procedures can be assigned predicted mortality rates according to a similar classification scheme, the modified Child-Pugh score. Patients with cirrhosis facing surgery should undergo a careful history and physical examination and should be accurately placed into a designated Child-Pugh category. Because the modified Child-Pugh class is the most reliable determinant of postoperative morbidity and mortality, every attempt should be made to upgrade a patient's class in a favorable direction prior to surgery. Patients should be carefully evaluated for the presence of ascites and dietary alterations. In addition, medical management with diuretics should be employed to prevent postoperative ascites leak and possible infectious complications including bacterial peritonitis. Perhaps one of the most feared complications in the patient with cirrhosis facing surgery is hemorrhage. Because the liver is vital in maintenance of coagulation homeostasis, several pharmacologic adjuncts may be administered to correct any coagulopathy in the peri-operative period. Several diseases such as cholelithiasis and peptic ulcer disease are known to be more prevalent in the cirrhotic patient, and clinicians treating these diseases should have a thorough understanding of the pathophysiology of cirrhosis and portal hypertension. Patients with cirrhosis and portal hypertensive bleeding that are considered good surgical candidates (ie, Child-Pugh class A) may benefit from surgical portasystemic shunt in contrast to angiographically placed portacaval shunt (ie, transjugular intrahepatic portosystemic shunt ) due to the lack of durable patency and cost effectiveness in the latter. In patients with cirrhosis awaiting orthotopic liver transplantation, TIPS may be a lifesaving temporizing technique that is utilized as a bridge to transplantation. From Hgrmd at aol.com Sun Jul 1 07:49:43 2007 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Jul 1 06:53:59 2007 Subject: [HSF] Operating on Liver Cirrhotics Message-ID: Dear Claudia and Others, I forgot to tell HSF that the patient I was concerned about last weekend got operated last Tuesday. The surgeon in my group initially tried to do him off pump, but found that the LAD was too deeply buried to dig it out without going on pump. He used bivalrudin. Though a bit bloody, the patient did fine. Hal ************************************** See what's free at http://www.aol.com. From prasannasimha at gmail.com Sun Jul 1 17:48:16 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sun Jul 1 07:18:53 2007 Subject: [HSF] Operating on Liver Cirrhotics In-Reply-To: References: Message-ID: <46878D78.8060205@gmail.com> Thanks for the feedback. It will add to our "local evidence" group data !! Prasanna Hgrmd@aol.com wrote: > Dear Claudia and Others, > I forgot to tell HSF that the patient I was concerned about last weekend > got operated last Tuesday. The surgeon in my group initially tried to do him > off pump, but found that the LAD was too deeply buried to dig it out without > going on pump. He used bivalrudin. Though a bit bloody, the patient did > fine. > Hal > > > > ************************************** See what's free at http://www.aol.com. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > From benjamin.bidstrup at bigpond.com Sun Jul 1 23:17:08 2007 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Sun Jul 1 08:17:58 2007 Subject: [HSF] Operating on Liver Cirrhotics In-Reply-To: <46878D78.8060205@gmail.com> References: <46878D78.8060205@gmail.com> Message-ID: Hal, Which dose protocol did you use? How long did it take for the bleeding to settle down? >Thanks for the feedback. It will add to our "local evidence" group data !! >Prasanna > >Hgrmd@aol.com wrote: >>Dear Claudia and Others, >> I forgot to tell HSF that the patient I was concerned about last >>weekend got operated last Tuesday. The surgeon in my group >>initially tried to do him off pump, but found that the LAD was too >>deeply buried to dig it out without going on pump. He used >>bivalrudin. Though a bit bloody, the patient did fine. >>Hal >> >> >> >>************************************** See what's free at http://www.aol.com. >>_______________________________________________ >>OpenHeart-L mailing list >> >>Send postings to: >> OpenHeart-L@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@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 >----------------------------------------- -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From jbflegejr at aol.com Sun Jul 1 10:32:35 2007 From: jbflegejr at aol.com (jbflegejr@aol.com) Date: Sun Jul 1 09:33:15 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> Message-ID: <8C989FB6B46DA9D-4E4-366E@mblk-d10.sysops.aol.com> Apico-aortic conduit is one possibility. Another could be hypothermic circulatory arrest and replace the valve while arrested, or replace the ascending aorta, clamp the graft and resume circulation and then replace the valve. John Flege -----Original Message----- From: Mitch Lirtzman To: OpenHeart-L@hsforum.com Sent: Sat, 30 Jun 2007 7:48 pm Subject: [HSF] Calcified aortic stenosis To the forum. I know we've covered this type of problem in previous discussions, but...? ? An old patient of mine, 62yo petite diabetic female, unrepentant smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been complaining of increasing dyspnea for several months and referred her back to her cardiologist to investigate. The bottom line is she has critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She just had her left subclavian stent redone to improve LIMA flow. The problem is she is now totally calcified from valve through arch and LCCA is occluded just after the origin. Additionally, she now has a 1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is remarkably good but she always reminds me that she had a difficult post op course from a pulmonary standpoint.? Any thoughts besides the word NO?? Thanks ahead of time.? Mitch Lirtzman? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@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? -----------------------------------------? ________________________________________________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. =0 From Hgrmd at aol.com Sun Jul 1 10:52:34 2007 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Jul 1 09:53:10 2007 Subject: [HSF] Operating on Liver Cirrhotics Message-ID: Ben, I'm not sure which protocol he used. He's a lurker on HSF, so I'm sure he used one of the couple that were provided. The bottom line was the patient didn't have to go back for bleeding, and he's close to being discharged. Many thanks to all who responded. Hal ************************************** See what's free at http://www.aol.com. From prasannasimha at gmail.com Sun Jul 1 20:33:26 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sun Jul 1 10:29:50 2007 Subject: (OT)Re: [HSF] Operating on Liver Cirrhotics In-Reply-To: References: Message-ID: <4687B42E.2090707@gmail.com> People in your team lurk !! (Or do you not allow them to speak !!!) ;-) :-) :-D O:-) Prasanna Hgrmd@aol.com wrote: > Ben, > I'm not sure which protocol he used. He's a lurker on HSF, so I'm sure he > used one of the couple that were provided. The bottom line was the patient > didn't have to go back for bleeding, and he's close to being discharged. > Many thanks to all who responded. > Hal > > > > ************************************** See what's free at http://www.aol.com. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > From Hgrmd at aol.com Sun Jul 1 11:33:56 2007 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Jul 1 10:38:12 2007 Subject: (OT)Re: [HSF] Operating on Liver Cirrhotics Message-ID: Prasanna, Two other surgeons in my group say they get HSF. Neither one has ever contributed. I wish they would. What can I say? Believe me, they realize the benefit of HSF for managing difficult cases. Hal ************************************** See what's free at http://www.aol.com. From Michael.Crittenden at va.gov Sun Jul 1 11:51:13 2007 From: Michael.Crittenden at va.gov (Crittenden, Michael) Date: Sun Jul 1 10:51:47 2007 Subject: [HSF] Congratulation In-Reply-To: <23128BCC-C4DD-4B94-9ECB-7E93D16CD659@charter.net> References: <23128BCC-C4DD-4B94-9ECB-7E93D16CD659@charter.net> Message-ID: <4130F1CC8938984AA557B3A0CB875D66043914C2@VHAV01MSGA1.v01.med.va.gov> Here here! -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Edward Bender Sent: Sunday, July 01, 2007 12:16 AM To: OpenHeart-L@lists.hsforum.com Subject: [HSF] Congratulation Congrats to William Novick. See link: http://www.passion-awards.com/June29th.html Ed Bender, MD _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From TSalerno at med.miami.edu Sun Jul 1 12:30:47 2007 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Sun Jul 1 11:31:15 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <8C989FB6B46DA9D-4E4-366E@mblk-d10.sysops.aol.com> Message-ID: I have done three of such patients with porcelain aortas in the last few yearas. In each case, I was able to find a place in the distal aorta to cannulate, and a soft spot where a cross-clamp could be applied after systemic flow was decreased. None of the patients had neurological problems after surgery, although the operation was rather tedious. Tomas -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of jbflegejr@aol.com Sent: Sunday, July 01, 2007 9:33 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Calcified aortic stenosis Apico-aortic conduit is one possibility. Another could be hypothermic circulatory arrest and replace the valve while arrested, or replace the ascending aorta, clamp the graft and resume circulation and then replace the valve. John Flege -----Original Message----- From: Mitch Lirtzman To: OpenHeart-L@hsforum.com Sent: Sat, 30 Jun 2007 7:48 pm Subject: [HSF] Calcified aortic stenosis To the forum. I know we've covered this type of problem in previous discussions, but...? ? An old patient of mine, 62yo petite diabetic female, unrepentant smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been complaining of increasing dyspnea for several months and referred her back to her cardiologist to investigate. The bottom line is she has critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She just had her left subclavian stent redone to improve LIMA flow. The problem is she is now totally calcified from valve through arch and LCCA is occluded just after the origin. Additionally, she now has a 1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is remarkably good but she always reminds me that she had a difficult post op course from a pulmonary standpoint.? Any thoughts besides the word NO?? Thanks ahead of time.? Mitch Lirtzman? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@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? -----------------------------------------? ________________________________________________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. =0 _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From Hgrmd at aol.com Sun Jul 1 12:42:48 2007 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Jul 1 11:47:07 2007 Subject: [HSF] Calcified aortic stenosis Message-ID: Tomas, Quite frankly, if you are able to cannulate centrally and crossclamp, I'm not sure that qualifies as a true "porcelain" aorta. Difficult-yes, porcelain-no. An aorta with dense circumferential calcium has to be handled with peripheral cannulation and construction of the distal anastamosis with an open technique. The other increasingly attractive alternative is aortic valve bypass. Hal ************************************** See what's free at http://www.aol.com. From prasannasimha at gmail.com Sun Jul 1 22:20:56 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sun Jul 1 12:18:48 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: References: Message-ID: <4687CD60.10406@gmail.com> Central to a "porcelain" aorta - unclampability. Cannulation may or may not be possible - say in the arch may be possible at times Prasanna Hgrmd@aol.com wrote: > Tomas, > Quite frankly, if you are able to cannulate centrally and crossclamp, I'm > not sure that qualifies as a true "porcelain" aorta. Difficult-yes, > porcelain-no. An aorta with dense circumferential calcium has to be handled with > peripheral cannulation and construction of the distal anastamosis with an open > technique. The other increasingly attractive alternative is aortic valve > bypass. > > Hal > > > > ************************************** See what's free at http://www.aol.com. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > From tdmartin2000 at aol.com Sun Jul 1 21:08:07 2007 From: tdmartin2000 at aol.com (tdmartin2000@aol.com) Date: Sun Jul 1 20:12:23 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <46871263.2000600@gmail.com> References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> <8C9899E2FB48508-1860-AAB2@WEBMAIL-MC03.sysops.aol.com> <46871263.2000600@gmail.com> Message-ID: <8C98A5433C5DB82-18B0-C78E@FWM-D09.sysops.aol.com> Prasanna A percutaneous valve for calcified aortic stenosis???? From a surgical standpoint, even if I were to replace her root ascending and arch with individual head vessel reimplantation I would say her survival is in the 90%?range with her greatest major morbidity coming from a stroke (5-7%). The question here, in my opinion, is how to deal with the pulm lesion and in what order. Someone on the forum must know the data on the perc valves so far, if so, speak up and educate us. I would think that a calcified aorta with calcific AS in a small female would be hard to do and would be at a significant risk of stroke- maybe more so than with an open procedure. Tom Martin U of Florida Gainesville -----Original Message----- From: prasannasimha To: OpenHeart-L@lists.hsforum.com Sent: Sat, 30 Jun 2007 10:33 pm Subject: Re: [HSF] Calcified aortic stenosis Smoker with ? lung Ca? Is the valve replacement worth it ? if worth it then - probably would be a candidate for those percut valves. Why chop her up excessively ?? Prasanna? tdmartin2000@aol.com wrote:? > Need a biopsy of lung lesion and then staging if pos for CA. If no carcinoma or something possibley cureable? and no AI, then an apical aortic conduit would be a consideration along with either a wedge resection or lobectomy. You certainly can replace the entire root, ascending?and arch with reasonable results as long as there is something to sew to either in the distal arch or the prox descending.? >? > Tom Martin? > U of Florida? > Gainesville? >? >? > -----Original Message-----? > From: Mitch Lirtzman ? > To: OpenHeart-L@hsforum.com? > Sent: Sat, 30 Jun 2007 7:48 pm? > Subject: [HSF] Calcified aortic stenosis? >? >? > To the forum. I know we've covered this type of problem in previous discussions, but...?? > ?? > An old patient of mine, 62yo petite diabetic female, unrepentant smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been complaining of increasing dyspnea for several months and referred her back to her cardiologist to investigate. The bottom line is she has critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She just had her left subclavian stent redone to improve LIMA flow. The problem is she is now totally calcified from valve through arch and LCCA is occluded just after the origin. Additionally, she now has a 1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is remarkably good but she always reminds me that she had a difficult post op course from a pulmonary standpoint.?? > Any thoughts besides the word NO??? > Thanks ahead of time.?? > Mitch Lirtzman?? > ?? > _______________________________________________?? > OpenHeart-L mailing list?? > ?? > Send postings to:?? > OpenHeart-L@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?? > -----------------------------------------?? >? >? > ________________________________________________________________________? > AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.? > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@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@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? -----------------------------------------? ________________________________________________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. From nfaabouseada at gmail.com Sun Jul 1 20:14:49 2007 From: nfaabouseada at gmail.com (Nasser F. Abou'Seada) Date: Sun Jul 1 20:40:13 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: References: Message-ID: is there a definition for an entity called "porcelain aorta"? ..... or else it is rather a spectrum of clinico-histo-pathological manifestations ? and what are thee "definite" criteria ? NFA On 7/1/07, Hgrmd@aol.com wrote: > > Tomas, > Quite frankly, if you are able to cannulate centrally and crossclamp, I'm > not sure that qualifies as a true "porcelain" aorta. Difficult-yes, > porcelain-no. An aorta with dense circumferential calcium has to be > handled with > peripheral cannulation and construction of the distal anastamosis with an > open > technique. The other increasingly attractive alternative is aortic valve > bypass. > > Hal > > > > ************************************** See what's free at > http://www.aol.com. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > From prasannasimha at gmail.com Mon Jul 2 07:23:39 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sun Jul 1 20:54:08 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: References: Message-ID: <46884C93.8080807@gmail.com> "Diffuse circumferential plate like calcification" is a porcelain aorta. >From the surgical perspective an aorta is porcelain when this is involving the whole ascending aorta precluding cannulation or cross clamping of the ascending aorta. (It is like the surgical arch versus the anatomical arch). Prasanna Nasser F. Abou'Seada wrote: > is there a definition for an entity called "porcelain aorta"? ..... or > else > it is rather a spectrum of clinico-histo-pathological manifestations ? > and > what are thee "definite" criteria ? > > NFA > > > On 7/1/07, Hgrmd@aol.com wrote: >> >> Tomas, >> Quite frankly, if you are able to cannulate centrally and >> crossclamp, I'm >> not sure that qualifies as a true "porcelain" aorta. Difficult-yes, >> porcelain-no. An aorta with dense circumferential calcium has to be >> handled with >> peripheral cannulation and construction of the distal anastamosis >> with an >> open >> technique. The other increasingly attractive alternative is aortic >> valve >> bypass. >> >> Hal >> >> >> >> ************************************** See what's free at >> http://www.aol.com. >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 > ----------------------------------------- > > From prasannasimha at gmail.com Mon Jul 2 07:19:22 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sun Jul 1 20:56:54 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <8C98A5433C5DB82-18B0-C78E@FWM-D09.sysops.aol.com> References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> <8C9899E2FB48508-1860-AAB2@WEBMAIL-MC03.sysops.aol.com> <46871263.2000600@gmail.com> <8C98A5433C5DB82-18B0-C78E@FWM-D09.sysops.aol.com> Message-ID: <46884B92.20104@gmail.com> Cribrier's original series and the primary indication for a precut valve was and is Calcific aortic stenosis !! When I asked (and later saw) the videos and angios they demonstrated hsi point of "plastering " of the calcium to the wall.(I really wonder how the blessed thing doesn't embolize etc etc. Prasanna tdmartin2000@aol.com wrote: > Prasanna > > A percutaneous valve for calcified aortic stenosis???? From a surgical standpoint, even if I were to replace her root ascending and arch with individual head vessel reimplantation I would say her survival is in the 90%?range with her greatest major morbidity coming from a stroke (5-7%). The question here, in my opinion, is how to deal with the pulm lesion and in what order. > Someone on the forum must know the data on the perc valves so far, if so, speak up and educate us. I would think that a calcified aorta with calcific AS in a small female would be hard to do and would be at a significant risk of stroke- maybe more so than with an open procedure. > > Tom Martin > U of Florida > Gainesville > > > -----Original Message----- > From: prasannasimha > To: OpenHeart-L@lists.hsforum.com > Sent: Sat, 30 Jun 2007 10:33 pm > Subject: Re: [HSF] Calcified aortic stenosis > > > > Smoker with ? lung Ca? > Is the valve replacement worth it ? if worth it then - probably would be a candidate for those percut valves. Why chop her up excessively ?? > Prasanna? > tdmartin2000@aol.com wrote:? > >> Need a biopsy of lung lesion and then staging if pos for CA. If no carcinoma or something possibley cureable? and no AI, then an apical aortic conduit would be a consideration along with either a wedge resection or lobectomy. You certainly can replace the entire root, ascending?and arch with reasonable results as long as there is something to sew to either in the distal arch or the prox descending.? >> ? >> Tom Martin? >> U of Florida? >> Gainesville? >> ? >> ? >> -----Original Message-----? >> From: Mitch Lirtzman ? >> To: OpenHeart-L@hsforum.com? >> Sent: Sat, 30 Jun 2007 7:48 pm? >> Subject: [HSF] Calcified aortic stenosis? >> ? >> ? >> To the forum. I know we've covered this type of problem in previous discussions, but...?? >> ?? >> An old patient of mine, 62yo petite diabetic female, unrepentant smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been complaining of increasing dyspnea for several months and referred her back to her cardiologist to investigate. The bottom line is she has critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She just had her left subclavian stent redone to improve LIMA flow. The problem is she is now totally calcified from valve through arch and LCCA is occluded just after the origin. Additionally, she now has a 1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is remarkably good but she always reminds me that she had a difficult post op course from a pulmonary standpoint.?? >> Any thoughts besides the word NO??? >> Thanks ahead of time.?? >> Mitch Lirtzman?? >> ?? >> _______________________________________________?? >> OpenHeart-L mailing list?? >> ?? >> Send postings to:?? >> OpenHeart-L@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?? >> -----------------------------------------?? >> ? >> ? >> ________________________________________________________________________? >> AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.? >> _______________________________________________? >> OpenHeart-L mailing list? >> ? >> Send postings to:? >> OpenHeart-L@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@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? > -----------------------------------------? > > > ________________________________________________________________________ > AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > > From anianyanwu at hotmail.com Sun Jul 1 22:31:22 2007 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun Jul 1 21:32:14 2007 Subject: [HSF] Calcified aortic stenosis Message-ID: I recently listened to Dr Borger presenting the liepzig experience and such a patient would be a candidate for transapical valve. Her comorbidity (smoking, reop, unclampable aorta etc) makes her an ideal candidate. I however agree with what you infer that it seems difficult to justify the transapical approach if the surgery can be done open with 10% or less mortality. I think the main reason for doing transapical valves is to compete with the inevitable infringement of transfemoral AVRs by cardiologists. Whether it does the patient good is another question, but closed valve replacement will almost certainly be part of the future. Ani ----- Original Message ----- From: tdmartin2000@aol.com Sent: Sunday, July 01, 2007 8:13 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Calcified aortic stenosis Prasanna A percutaneous valve for calcified aortic stenosis???? From a surgical standpoint, even if I were to replace her root ascending and arch with individual head vessel reimplantation I would say her survival is in the 90%?range with her greatest major morbidity coming from a stroke (5-7%). The question here, in my opinion, is how to deal with the pulm lesion and in what order. Someone on the forum must know the data on the perc valves so far, if so, speak up and educate us. I would think that a calcified aorta with calcific AS in a small female would be hard to do and would be at a significant risk of stroke- maybe more so than with an open procedure. Tom Martin U of Florida Gainesville -----Original Message----- From: prasannasimha To: OpenHeart-L@lists.hsforum.com Sent: Sat, 30 Jun 2007 10:33 pm Subject: Re: [HSF] Calcified aortic stenosis Smoker with ? lung Ca? Is the valve replacement worth it ? if worth it then - probably would be a candidate for those percut valves. Why chop her up excessively ?? Prasanna? tdmartin2000@aol.com wrote:? > Need a biopsy of lung lesion and then staging if pos for CA. If no carcinoma or something possibley cureable? and no AI, then an apical aortic conduit would be a consideration along with either a wedge resection or lobectomy. You certainly can replace the entire root, ascending?and arch with reasonable results as long as there is something to sew to either in the distal arch or the prox descending.? >? > Tom Martin? > U of Florida? > Gainesville? >? >? > -----Original Message-----? > From: Mitch Lirtzman ? > To: OpenHeart-L@hsforum.com? > Sent: Sat, 30 Jun 2007 7:48 pm? > Subject: [HSF] Calcified aortic stenosis? >? >? > To the forum. I know we've covered this type of problem in previous discussions, but...?? > ?? > An old patient of mine, 62yo petite diabetic female, unrepentant smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been complaining of increasing dyspnea for several months and referred her back to her cardiologist to investigate. The bottom line is she has critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She just had her left subclavian stent redone to improve LIMA flow. The problem is she is now totally calcified from valve through arch and LCCA is occluded just after the origin. Additionally, she now has a 1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is remarkably good but she always reminds me that she had a difficult post op course from a pulmonary standpoint.?? > Any thoughts besides the word NO??? > Thanks ahead of time.?? > Mitch Lirtzman?? > ?? > _______________________________________________?? > OpenHeart-L mailing list?? > ?? > Send postings to:?? > OpenHeart-L@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?? > -----------------------------------------?? >? >? > ________________________________________________________________________? > AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.? > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@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@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? -----------------------------------------? ________________________________________________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From anianyanwu at hotmail.com Sun Jul 1 22:34:08 2007 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun Jul 1 21:35:29 2007 Subject: [HSF] Operating on Liver Cirrhotics Message-ID: How do members deal with the massive ascites often associated with this condition? Ignore or drain (and if you drain, when and how much?)? Claudia raised an important issue of nutrition - how do members address this? Thank you Ani ----- Original Message ----- From: A Sent: Sunday, July 01, 2007 2:27 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] Operating on Liver Cirrhotics One of the dreaded complications is bleeding that can be so difficult to manage. Over the years I have operated on a handful of such cases and they have done well. I give these patients three doses of IV vitamin K1 given by an MD over a period of ten minutes by the clock. The protocol takes three days to complete. This is beside taking meticulous care when opening and closing etc and the routine preop care. I hope that this helps. Ahmed -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of prasannasimha Sent: Saturday, June 30, 2007 8:28 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Operating on Liver Cirrhotics Ani vasodilator perfusion is more based on theoretical construct of decreased hepatic flow with CPB. It is like TRT its use has to be ultimately be proved.It has been shown that nitrate infusions increases hepatic flow during CPB. Delivering targetted would be better hopefully. Prasanna Ani Anyanwu wrote: > I would be keen to know approaches members use to reduce the morbidity or mortality associated with cardiac surgery in patients with liver cirrhosis. > We have an active liver transplant program and few times a year i have to operate on patients requiring liver transplant who have co-existing cardiac problems. These patients seem so unpredictable and mortality has been high such that on occasion some surgeons have done the (cardiac) procedure in combination with the liver transplant. > I would be grateful for any tips on dealing with this difficult group. Prassana I know has a regime of hepatic infusion of venodilators - is their logic or data to back this and do others have experience of this technique? Do people give Factor VII pre-emptively? > Thanks > Ani > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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 ----------------------------------------- From prasannasimha at gmail.com Mon Jul 2 08:09:56 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sun Jul 1 21:40:29 2007 Subject: [HSF] Operating on Liver Cirrhotics In-Reply-To: References: Message-ID: <4688576C.4000309@gmail.com> Drain as the ascites causes renal vein compression and falling urine output. Protein management becomes an issue .The oncotic pressure may have to be raised. (If TR settles by repair then usually things become better and the ascites does not re accumulate). One regimen is the one that Nasser posted (Yeast - Honey) regimen as a hepatoprotective agent. Prasanna Ani Anyanwu wrote: > How do members deal with the massive ascites often associated with this condition? Ignore or drain (and if you drain, when and how much?)? > > Claudia raised an important issue of nutrition - how do members address this? > > Thank you > > Ani > > ----- Original Message ----- > From: A > Sent: Sunday, July 01, 2007 2:27 AM > To: OpenHeart-L@lists.hsforum.com > Subject: RE: [HSF] Operating on Liver Cirrhotics > > One of the dreaded complications is bleeding that can be so difficult to > manage. Over the years I have operated on a handful of such cases and they > have done well. I give these patients three doses of IV vitamin K1 given by > an MD over a period of ten minutes by the clock. The protocol takes three > days to complete. This is beside taking meticulous care when opening and > closing etc and the routine preop care. > I hope that this helps. > > Ahmed > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of prasannasimha > Sent: Saturday, June 30, 2007 8:28 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Operating on Liver Cirrhotics > > Ani vasodilator perfusion is more based on theoretical construct of > decreased hepatic flow with CPB. It is like TRT its use has to be > ultimately be proved.It has been shown that nitrate infusions increases > hepatic flow during CPB. Delivering targetted would be better hopefully. > Prasanna > Ani Anyanwu wrote: > >> I would be keen to know approaches members use to reduce the morbidity or >> > mortality associated with cardiac surgery in patients with liver cirrhosis. > > >> We have an active liver transplant program and few times a year i have to >> > operate on patients requiring liver transplant who have co-existing cardiac > problems. These patients seem so unpredictable and mortality has been high > such that on occasion some surgeons have done the (cardiac) procedure in > combination with the liver transplant. > >> I would be grateful for any tips on dealing with this difficult group. >> > Prassana I know has a regime of hepatic infusion of venodilators - is their > logic or data to back this and do others have experience of this technique? > Do people give Factor VII pre-emptively? > >> Thanks >> Ani >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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@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@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 > ----------------------------------------- > > From tacuff at swbell.net Sun Jul 1 20:07:20 2007 From: tacuff at swbell.net (Tea Acuff) Date: Sun Jul 1 22:07:50 2007 Subject: [HSF] Calcified aortic stenosis Message-ID: <791030.99561.qm@web81612.mail.mud.yahoo.com> Tom, Did you ignore the little side comment about pulmonary problems after CAB 6 years ago? Is a redo circ arrest case for root replacement really only 10% in this group (I mean this patient specifically, smoker, dyspnea, small) After all the STS mortality for primary CAB is probably close to 4-5% for her. tea ----- Original Message ---- From: Mitch Lirtzman To: OpenHeart-L@hsforum.com Sent: Saturday, June 30, 2007 6:48:53 PM Subject: [HSF] Calcified aortic stenosis To the forum. I know we've covered this type of problem in previous discussions, but... An old patient of mine, 62yo petite diabetic female, unrepentant smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been complaining of increasing dyspnea for several months and referred her back to her cardiologist to investigate. The bottom line is she has critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She just had her left subclavian stent redone to improve LIMA flow. The problem is she is now totally calcified from valve through arch and LCCA is occluded just after the origin. Additionally, she now has a 1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is remarkably good but she always reminds me that she had a difficult post op course from a pulmonary standpoint. Any thoughts besides the word NO? Thanks ahead of time. Mitch Lirtzman _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From tacuff at swbell.net Sun Jul 1 20:36:20 2007 From: tacuff at swbell.net (Tea Acuff) Date: Sun Jul 1 22:37:48 2007 Subject: [HSF] Congratulation Message-ID: <855816.8695.qm@web81604.mail.mud.yahoo.com> I agree and am still fascinated with Dr. Novick's practice on many levels. Please note that this is not a medicine award but one for "entrepreneurial success". He just "happens" to do it in medicine. We have much to learn from and about Dr. Novick. It is not just passion that makes him a successful entreprenuer. Again my personal congratulations also, Dr. Novick! tea ----- Original Message ---- From: "Crittenden, Michael" To: OpenHeart-L@lists.hsforum.com Sent: Sunday, July 1, 2007 9:51:13 AM Subject: RE: [HSF] Congratulation Here here! -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Edward Bender Sent: Sunday, July 01, 2007 12:16 AM To: OpenHeart-L@lists.hsforum.com Subject: [HSF] Congratulation Congrats to William Novick. See link: http://www.passion-awards.com/June29th.html Ed Bender, MD _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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@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 ----------------------------------------- From prasannasimha at gmail.com Mon Jul 2 09:19:05 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Sun Jul 1 22:56:39 2007 Subject: [HSF] Congratulation In-Reply-To: <855816.8695.qm@web81604.mail.mud.yahoo.com> References: <855816.8695.qm@web81604.mail.mud.yahoo.com> Message-ID: <468867A1.7060201@gmail.com> Unique experience from a unique person. Prasanna Tea Acuff wrote: > I agree and am still fascinated with Dr. Novick's practice on many levels. Please note that this is not a medicine award but one for "entrepreneurial success". He just "happens" to do it in medicine. We have much to learn from and about Dr. Novick. It is not just passion that makes him a successful entreprenuer. > > Again my personal congratulations also, Dr. Novick! > > tea > > > ----- Original Message ---- > From: "Crittenden, Michael" > To: OpenHeart-L@lists.hsforum.com > Sent: Sunday, July 1, 2007 9:51:13 AM > Subject: RE: [HSF] Congratulation > > > Here here! > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Edward > Bender > Sent: Sunday, July 01, 2007 12:16 AM > To: OpenHeart-L@lists.hsforum.com > Subject: [HSF] Congratulation > > Congrats to William Novick. See link: > http://www.passion-awards.com/June29th.html > > Ed Bender, MD > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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 > ----------------------------------------- > > > From drmitch at cox.net Sun Jul 1 23:23:06 2007 From: drmitch at cox.net (Mitch Lirtzman) Date: Sun Jul 1 23:24:30 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <4686F9B2.7050102@sify.com> References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> <4686F9B2.7050102@sify.com> Message-ID: <6.2.1.2.2.20070701222249.0204e390@pop.central.cox.net> Go right ahead. Thanks.At 07:47 PM 6/30/2007, you wrote: >Mitch do I post your pictures or have you given up ? (You had asked me to >wait). >Prasanna >Mitch Lirtzman wrote: >>To the forum. I know we've covered this type of problem in previous >>discussions, but... >> >>An old patient of mine, 62yo petite diabetic female, unrepentant smoker >>2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been >>complaining of increasing dyspnea for several months and referred her >>back to her cardiologist to investigate. The bottom line is she has >>critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts >>are patent. She just had her left subclavian stent redone to improve LIMA >>flow. The problem is she is now totally calcified from valve through arch >>and LCCA is occluded just after the origin. Additionally, she now has a >>1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is >>remarkably good but she always reminds me that she had a difficult post >>op course from a pulmonary standpoint. >>Any thoughts besides the word NO? >>Thanks ahead of time. >>Mitch Lirtzman >> >> >>_______________________________________________ >>OpenHeart-L mailing list >> >>Send postings to: >>OpenHeart-L@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@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 >----------------------------------------- From drmitch at cox.net Sun Jul 1 23:28:44 2007 From: drmitch at cox.net (Mitch Lirtzman) Date: Sun Jul 1 23:29:06 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <610700.46284.qm@web81611.mail.mud.yahoo.com> References: <610700.46284.qm@web81611.mail.mud.yahoo.com> Message-ID: <6.2.1.2.2.20070701222818.0200cd30@pop.central.cox.net> Thanks Tea. I'll wait to hear from you. Will you need the TEE?At 09:22 PM 6/30/2007, you wrote: >This is probably the type of so called "not a surgical candidate" that >would be a candidate for a trans apical catther approach for a AVR. If you >agree I will try to get you in line for one. I am not an investigator but >they are doing it in Dallas. >tea > > >----- Original Message ---- >From: Mitch Lirtzman >To: OpenHeart-L@hsforum.com >Sent: Saturday, June 30, 2007 6:48:53 PM >Subject: [HSF] Calcified aortic stenosis > > >To the forum. I know we've covered this type of problem in previous >discussions, but... > >An old patient of mine, 62yo petite diabetic female, unrepentant smoker >2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been >complaining of increasing dyspnea for several months and referred her back >to her cardiologist to investigate. The bottom line is she has critcal AS >with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She >just had her left subclavian stent redone to improve LIMA flow. The problem >is she is now totally calcified from valve through arch and LCCA is >occluded just after the origin. Additionally, she now has a 1.5cm LUL >nodule which lights up on PET. Surprisingly, her PFT is remarkably good but >she always reminds me that she had a difficult post op course from a >pulmonary standpoint. >Any thoughts besides the word NO? >Thanks ahead of time. >Mitch Lirtzman > > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@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@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 >----------------------------------------- From drmitch at cox.net Sun Jul 1 23:32:04 2007 From: drmitch at cox.net (Mitch Lirtzman) Date: Sun Jul 1 23:33:27 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <8C9899E2FB48508-1860-AAB2@WEBMAIL-MC03.sysops.aol.com> References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> <8C9899E2FB48508-1860-AAB2@WEBMAIL-MC03.sysops.aol.com> Message-ID: <6.2.1.2.2.20070701222936.01f8acc8@pop.central.cox.net> There is no mediastinal adenopathy and only the lesion lights up. Remember, she is calcified through the arch. I'll look at the CT again and confirm a " Landing zone" at distal arch or prox DTA.At 09:25 PM 6/30/2007, you wrote: >Need a biopsy of lung lesion and then staging if pos for CA. If no >carcinoma or something possibley cureable? and no AI, then an apical >aortic conduit would be a consideration along with either a wedge >resection or lobectomy. You certainly can replace the entire root, >ascending?and arch with reasonable results as long as there is something >to sew to either in the distal arch or the prox descending. > >Tom Martin >U of Florida >Gainesville > > >-----Original Message----- >From: Mitch Lirtzman >To: OpenHeart-L@hsforum.com >Sent: Sat, 30 Jun 2007 7:48 pm >Subject: [HSF] Calcified aortic stenosis > > >To the forum. I know we've covered this type of problem in previous >discussions, but...? >? >An old patient of mine, 62yo petite diabetic female, unrepentant smoker >2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been >complaining of increasing dyspnea for several months and referred her back >to her cardiologist to investigate. The bottom line is she has critcal AS >with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. >She just had her left subclavian stent redone to improve LIMA flow. The >problem is she is now totally calcified from valve through arch and LCCA >is occluded just after the origin. Additionally, she now has a 1.5cm LUL >nodule which lights up on PET. Surprisingly, her PFT is remarkably good >but she always reminds me that she had a difficult post op course from a >pulmonary standpoint.? >Any thoughts besides the word NO?? >Thanks ahead of time.? >Mitch Lirtzman? >? >_______________________________________________? >OpenHeart-L mailing list? >? >Send postings to:? >OpenHeart-L@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? >-----------------------------------------? > > >________________________________________________________________________ >AOL now offers free email to everyone. Find out more about what's free >from AOL at AOL.com. >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@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 >----------------------------------------- From tacuff at swbell.net Sun Jul 1 21:44:11 2007 From: tacuff at swbell.net (Tea Acuff) Date: Sun Jul 1 23:44:40 2007 Subject: [HSF] Calcified aortic stenosis Message-ID: <148826.64912.qm@web81611.mail.mud.yahoo.com> I'll check if needed and if so I can track you down. tea ----- Original Message ---- From: Mitch Lirtzman To: OpenHeart-L@lists.hsforum.com Sent: Sunday, July 1, 2007 10:28:44 PM Subject: Re: [HSF] Calcified aortic stenosis Thanks Tea. I'll wait to hear from you. Will you need the TEE?At 09:22 PM 6/30/2007, you wrote: >This is probably the type of so called "not a surgical candidate" that >would be a candidate for a trans apical catther approach for a AVR. If you >agree I will try to get you in line for one. I am not an investigator but >they are doing it in Dallas. >tea > > >----- Original Message ---- >From: Mitch Lirtzman >To: OpenHeart-L@hsforum.com >Sent: Saturday, June 30, 2007 6:48:53 PM >Subject: [HSF] Calcified aortic stenosis > > >To the forum. I know we've covered this type of problem in previous >discussions, but... > >An old patient of mine, 62yo petite diabetic female, unrepentant smoker >2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been >complaining of increasing dyspnea for several months and referred her back >to her cardiologist to investigate. The bottom line is she has critcal AS >with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She >just had her left subclavian stent redone to improve LIMA flow. The problem >is she is now totally calcified from valve through arch and LCCA is >occluded just after the origin. Additionally, she now has a 1.5cm LUL >nodule which lights up on PET. Surprisingly, her PFT is remarkably good but >she always reminds me that she had a difficult post op course from a >pulmonary standpoint. >Any thoughts besides the word NO? >Thanks ahead of time. >Mitch Lirtzman > > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@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@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@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 ----------------------------------------- From drmitch at cox.net Sun Jul 1 23:43:23 2007 From: drmitch at cox.net (Mitch Lirtzman) Date: Sun Jul 1 23:44:46 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: References: <8C989FB6B46DA9D-4E4-366E@mblk-d10.sysops.aol.com> Message-ID: <6.2.1.2.2.20070701223844.02063930@pop.central.cox.net> Dr. Salerno, I looked very closely at the CT and the valve/ascending/arch are one continuous white ring. I agree with Hal that axillary cannulation would be doable, though now I'm really considering an apical conduit, too. I'll report back on the rest of her work-up. MItchAt 10:30 AM 7/1/2007, you wrote: >I have done three of such patients with porcelain aortas in the last few >yearas. In each case, I was able to find a place in the distal aorta to >cannulate, and a soft spot where a cross-clamp could be applied after >systemic flow was decreased. None of the patients had neurological >problems after surgery, although the operation was rather tedious. > > >Tomas > >-----Original Message----- >From: openheart-l-bounces@lists.hsforum.com >[mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of jbflegejr@aol.com >Sent: Sunday, July 01, 2007 9:33 AM >To: OpenHeart-L@lists.hsforum.com >Subject: Re: [HSF] Calcified aortic stenosis > >Apico-aortic conduit is one possibility. Another could be hypothermic >circulatory arrest and replace the valve while arrested, or replace the >ascending aorta, clamp the graft and resume circulation and then >replace the valve. John Flege > > >-----Original Message----- >From: Mitch Lirtzman >To: OpenHeart-L@hsforum.com >Sent: Sat, 30 Jun 2007 7:48 pm >Subject: [HSF] Calcified aortic stenosis > > > > > > >To the forum. I know we've covered this type of problem in previous >discussions, but... > > >An old patient of mine, 62yo petite diabetic female, unrepentant smoker >2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been >complaining of increasing dyspnea for several months and referred her >back >to her cardiologist to investigate. The bottom line is she has critcal >AS >with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. >She >just had her left subclavian stent redone to improve LIMA flow. The >problem >is she is now totally calcified from valve through arch and LCCA is >occluded just after the origin. Additionally, she now has a 1.5cm LUL >nodule which lights up on PET. Surprisingly, her PFT is remarkably good >but >she always reminds me that she had a difficult post op course from a >pulmonary standpoint. > >Any thoughts besides the word NO? > >Thanks ahead of time. > >Mitch Lirtzman > > > >_______________________________________________ > >OpenHeart-L mailing list > > >Send postings to: > > OpenHeart-L@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 > >----------------------------------------- > > > > > > >________________________________________________________________________ >AOL now offers free email to everyone. Find out more about what's free >from AOL at AOL.com. >=0 >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@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@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 >----------------------------------------- From TSalerno at med.miami.edu Mon Jul 2 07:00:20 2007 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Mon Jul 2 06:00:51 2007 Subject: [HSF] Calcified aortic stenosis Message-ID: No. Matter how, these are challenging and risky (CNS) cases. Good luick Tomas ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: OpenHeart-L@lists.hsforum.com Sent: Sun Jul 01 23:43:23 2007 Subject: RE: [HSF] Calcified aortic stenosis Dr. Salerno, I looked very closely at the CT and the valve/ascending/arch are one continuous white ring. I agree with Hal that axillary cannulation would be doable, though now I'm really considering an apical conduit, too. I'll report back on the rest of her work-up. MItchAt 10:30 AM 7/1/2007, you wrote: >I have done three of such patients with porcelain aortas in the last few >yearas. In each case, I was able to find a place in the distal aorta to >cannulate, and a soft spot where a cross-clamp could be applied after >systemic flow was decreased. None of the patients had neurological >problems after surgery, although the operation was rather tedious. > > >Tomas > >-----Original Message----- >From: openheart-l-bounces@lists.hsforum.com >[mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of jbflegejr@aol.com >Sent: Sunday, July 01, 2007 9:33 AM >To: OpenHeart-L@lists.hsforum.com >Subject: Re: [HSF] Calcified aortic stenosis > >Apico-aortic conduit is one possibility. Another could be hypothermic >circulatory arrest and replace the valve while arrested, or replace the >ascending aorta, clamp the graft and resume circulation and then >replace the valve. John Flege > > >-----Original Message----- >From: Mitch Lirtzman >To: OpenHeart-L@hsforum.com >Sent: Sat, 30 Jun 2007 7:48 pm >Subject: [HSF] Calcified aortic stenosis > > > > > > >To the forum. I know we've covered this type of problem in previous >discussions, but... > > >An old patient of mine, 62yo petite diabetic female, unrepentant smoker >2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been >complaining of increasing dyspnea for several months and referred her >back >to her cardiologist to investigate. The bottom line is she has critcal >AS >with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. >She >just had her left subclavian stent redone to improve LIMA flow. The >problem >is she is now totally calcified from valve through arch and LCCA is >occluded just after the origin. Additionally, she now has a 1.5cm LUL >nodule which lights up on PET. Surprisingly, her PFT is remarkably good >but >she always reminds me that she had a difficult post op course from a >pulmonary standpoint. > >Any thoughts besides the word NO? > >Thanks ahead of time. > >Mitch Lirtzman > > > >_______________________________________________ > >OpenHeart-L mailing list > > >Send postings to: > > OpenHeart-L@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 > >----------------------------------------- > > > > > > >________________________________________________________________________ >AOL now offers free email to everyone. Find out more about what's free >from AOL at AOL.com. >=0 >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@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@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@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 ----------------------------------------- From battr at medizin.uni-leipzig.de Mon Jul 2 13:31:09 2007 From: battr at medizin.uni-leipzig.de (Dr. Roberto Battellini) Date: Mon Jul 2 06:25:14 2007 Subject: AW: [HSF] Persistence of mammary branches and post CABG angina: whichis the truth? In-Reply-To: <408435.81331.qm@web51410.mail.re2.yahoo.com> References: <002401c7ae9f$3748cee0$b3160a06@HZLPC0679> <408435.81331.qm@web51410.mail.re2.yahoo.com> Message-ID: <022201c7bc94$1ade5ab0$b3160a06@HZLPC0679> Well, you have the 4th case I read upon, another from Donald Ross, so I have to believe it. Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Jorge Rodriguez Campos Gesendet: Freitag, 15. Juni 2007 17:17 An: OpenHeart-L@lists.hsforum.com Betreff: Re: [HSF] Persistence of mammary branches and post CABG angina: whichis the truth? Dear Roberto: I had a case who had 2 years post-op angina with exercise, he had in angio a large lateral thoracic ima branch, he was cured wend a ima branch embolised.- Dr. Jorge Rodriguez Campos "Dr. Roberto Battellini" escribi?: Dear Members, I am revisiting this subject. There are some case reports telling it is truth, but Calafiore insists in the diastolic flow through the IMA and systolic through the branches, so physiologically could not happen. I have the literature from ctsnet.org, what I want is the personal experience and scientific thoughts from our members. EBA, for example, hallo, Tea.. (or literature "not-ctsnet") Roberto _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- __________________________________________________ Correo Yahoo! Espacio para todos tus mensajes, antivirus y antispam ?gratis! Reg?strate ya - http://correo.espanol.yahoo.com/ _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From Hgrmd at aol.com Mon Jul 2 08:19:22 2007 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Mon Jul 2 07:19:55 2007 Subject: [HSF] Calcified aortic stenosis Message-ID: Tom, I've attended several valve meetings over the last 2 years in which the results of percutaneous and transapical aortic valve insertion preliminary results of feasibility studies have been shared. Indeed, these valves are being deployed in cases of porcelain aortas, among other indications. Primarily, they are being used in very elderly patients with an average Euroscore of 25 that have been turned down by 2 cardiac surgeons. In Leipzig, they go the transapical route without use of the pump. This has the advantage of not having the device traverse the arch on its way to the valve. Fred Mohr theorizes that significantly decreases the risk of stroke. In fact, none of his 60 something patients have sustained a stroke thus far. However, the 30 day mortality is 14%, not an insignificant number. I believe a lot of that mortality was in the 1st few cases when they were working out the bugs. They found with oversizing the valve, the incidence of paravalvular leak was nearly eliminated. You can downplay the significance of this new technology at your own peril. I think high volume valve centers will need to learn the procedure. However, more importantly, the indications will have to be controlled so that it is not used in patients who would otherwise be good surgical candidates. Hal ************************************** See what's free at http://www.aol.com. From Hgrmd at aol.com Mon Jul 2 08:21:25 2007 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Mon Jul 2 07:21:44 2007 Subject: [HSF] Calcified aortic stenosis Message-ID: Ani, So far, it does appear to me that the transapical approach will compete well with the retrograde approach due to the fact that the risk of stroke will probably be less. This is by virtue of the fact that the valve assembly doesn't have to traverse the arch. Hal ************************************** See what's free at http://www.aol.com. From Jbflegejr at aol.com Mon Jul 2 10:48:31 2007 From: Jbflegejr at aol.com (Jbflegejr@aol.com) Date: Mon Jul 2 09:52:48 2007 Subject: [HSF] Calcified aortic stenosis Message-ID: When you tap it with a metal instrument and the sound is as if you were striking a coffee mug, it is a porcelain aorta. John Flege ************************************** See what's free at http://www.aol.com. From gabiford at hotmail.com Mon Jul 2 04:56:47 2007 From: gabiford at hotmail.com (gabi ford) Date: Mon Jul 2 10:46:40 2007 Subject: [HSF] picture - not entirely OT Message-ID: On a trip through the Oregon coastal forest today -- lots of Foxglove in bloom. You can still prescribe it. ;) Gabi, RN -------------- next part -------------- A non-text attachment was scrubbed... Name: Digitalis.JPG Type: image/pjpeg Size: 227875 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20070702/9d681aea/Digitalis-0001.bin From prasannasimha at gmail.com Mon Jul 2 21:50:03 2007 From: prasannasimha at gmail.com (prasannasimha) Date: Mon Jul 2 11:20:56 2007 Subject: [HSF] Mitch - aneurysm pictures Message-ID: <468917A3.4060700@gmail.com> Sending the image on behalf of Mitch and I am supposed to make fun of him as per his instructions. (Images came out a bit small). Tea may do the honors !! Prasanna -------------- next part -------------- A non-text attachment was scrubbed... Name: Mitchaneurysm.jpg Type: image/jpeg Size: 122967 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20070702/e8b7b401/Mitchaneurysm-0001.jpg From rwmfglycar at aol.com Mon Jul 2 14:48:41 2007 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Jul 2 13:49:12 2007 Subject: [HSF] Rheumatic mitral valve In-Reply-To: References: Message-ID: <8C98AE85CAA86A6-4AC-E674@webmail-de06.sysops.aol.com> Whether or not to do a commissurotomy for mitral stenosis by any method is entirely pathology dependent. Whether done by balloon, a metallic dilator, trans apically or transseptallym, with or without cardiopulmonary bypass,?the result depends on the pathologic stage of the rheumatic disease. In the early days of closed commissutotomy we learned quite quickly which cases were not suitable for commissurotomy alone.?Since the pathology is progressive the older a patient is the less likely it is thet a commissurotomy will do the job. To attempt a commissurotomy by balloon ?when the pathology is unsuitable does the patient no good and may do harm.?To offer?a balloon in a case unsuitable for commissurotomy?because it ?does not involve a?thoracic incision? is simply stupid. Bob PS? I was at a wonderful family wedding on a sheep farm in Somerset, England. In 4 days there were 384 E mails most with HSF labels. For some of you who may not know, Bob Emery had a serious motorcycle accident riding to the hospital and is now being treated for multiplr fractures. -----Original Message----- From: Ani Anyanwu To: OpenHeart-L@lists.hsforum.com Sent: Thu, 28 Jun 2007 10.18pm Subject: Re: [HSF] Rheumatic mitral valve Sorry Ed I had not read this when sent previous mail. Why don't they offer valvuloplasty? Is it a disbelief in the efficacy of the procedure or a lack of skill to do it? >From the ethical view point, it could be argued that valvuloplasty should be discussed with the patient and the choice given to go elsewhere if the patient chooses percutaneous over surgery? Assuming this patient were 10 years older would you still operate or first seek a percutaneous option? Ani ----- Original Message ----- From: ebender001@charter.net Sent: Wednesday, June 27, 2007 10:11 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] Rheumatic mitral valve Ahmed: LA size is 3.5 cm. Normal coronaries. Our cardiologists do not do balloon valvuloplasty. Ed Bender, MD ---- A wrote: > Dear Ed: > What is the LA size any TR? Coronaries clean? With pure MS no regurgitation > a commisurotomy is all what you probably need to do. > Just wondering if the coronaries are clean and no evidence of clots our > cardiologists would not refer such patients to surgery they will try > percutaneous valvotomy. Wish you luck I am sure that she would do fine in > your hands. > > Ahmed > > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Edward Bender > Sent: Tuesday, June 26, 2007 8:28 PM > To: OpenHeart-L > Subject: [HSF] Rheumatic mitral valve > > I have a 70 year old female with paroxysmal a-fib and mitral stenosis > from rheumatic fever as a child. I plan a maze procedure and mitral > repair. By TEE I am convinced that she can be treated with mitral > commisurotomies. She has very little calcification and no > regurgitation at all. The patient has class 2 symptoms and good LV > function, but she is really bothered by the repeated bouts of a-fib. > My question is whether, upon repairing the valve, she should have a > ring to support her annulus. We rarely get to do these procedures in > the USA, so I wonder what the current thinking is. > > Ed Bender, MD > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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@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 ----------------------------------------- ________________________________________________________________________ Get a FREE AOL Email account with 2GB of storage. Plus, share and store photos and experience exclusively recorded live music Sessions from your favourite artists. Find out more at http://info.aol.co.uk/joinnow/?ncid=548. From rwmfglycar at aol.com Mon Jul 2 15:22:35 2007 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Jul 2 14:27:03 2007 Subject: [HSF] Rheumatic mitral valve In-Reply-To: <468311ED.6080406@gmail.com> References: <468311ED.6080406@gmail.com> Message-ID: <8C98AED1909DEC9-4AC-E809@webmail-de06.sysops.aol.com> I am picking this up while travelling and have got my Email # down from the high 300's to the high 100's. I shall be brief and dogmatic. Insufficiency is due to failed coaptation Rheumatic mitral insufficiency in my experience was most often due to 1) Tissue shrinkage 2) Anterior leaflet chordal elongation (very rarely in acute cases ruptured ant chordae) 3) Annular dilatation as part of ventricular dilatation (and therefor papillary shift)?due to acute rheumatic myocarditis; ?but once the acute myocarditis had recovered isolated?annular dilation without ant chordal elongation or ant /post?leaflet shrinkage was not a cause of mitral incompetence. I did a small study comparing the effective orifice area in degenerative and rheumatic cases in which the annulus had been reduced to the same geometric area by annuloplasty. The EOA was in every case better with degenerative disease. Conclusion is obvious Bob -----Original Message----- From: prasannasimha To: OpenHeart-L@lists.hsforum.com Sent: Thu, 28 Jun 2007 2.42am Subject: Re: [HSF] Rheumatic mitral valve Erdinc , in ehrumatic valvar regurg patients there is commonly annular dilatation. Carpentier's original ring with the 3:4 ratio was designed not for myxomatous but for rheumatic repairs. Having said that pure MS does not require a ring as these cases do not have annular dilatation.? Prasanna? erdin? naseri wrote:? > Dear Igor,? > Though I am not sure whether surgery is an option for this special patient but suppose so: implantation of an annular ring in mitral position will correct annular dilatation and resultant MR. even if she had MR that would be due to chordal fibrosis and shortening with tethering of the leaflets and also leaflet hypomobility due to fibrosis( typical of rheumatic valves).? > In conclusion: > 1. There is no indication for prophylactic implantation of a ring? > 2. Rheumatic MR is not due to annular dilatation( in irreversible phase, LV may dilate leading to annular dilatation)? > erdinc > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@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@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? -----------------------------------------? ________________________________________________________________________ Get a FREE AOL Email account with 2GB of storage. Plus, share and store photos and experience exclusively recorded live music Sessions from your favourite artists. Find out more at http://info.aol.co.uk/joinnow/?ncid=548. From Hgrmd at aol.com Mon Jul 2 20:12:29 2007 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Mon Jul 2 19:13:00 2007 Subject: [HSF] picture - not entirely OT Message-ID: Dear Gabi, Gorgeous. Hal ************************************** See what's free at http://www.aol.com. From drmitch at cox.net Mon Jul 2 22:19:43 2007 From: drmitch at cox.net (Mitch Lirtzman) Date: Mon Jul 2 22:21:16 2007 Subject: [HSF] Calcified aortic stenosis In-Reply-To: <8C98A5433C5DB82-18B0-C78E@FWM-D09.sysops.aol.com> References: <6.2.1.2.2.20070630183505.01db2e00@pop.central.cox.net> <8C9899E2FB48508-1860-AAB2@WEBMAIL-MC03.sysops.aol.com> <46871263.2000600@gmail.com> <8C98A5433C5DB82-18B0-C78E@FWM-D09.sysops.aol.com> Message-ID: <6.2.1.2.2.20070702210323.01db6b88@pop.central.cox.net> I've re-reviewed the CT and PET on this woman. The aorta is totally calcified from valve to the proximal DTA. This includes the coronary ostia and 2 proximal svg sites. The LUL lesion is 1.5cm, close to the surface, and is the only hot spot on PET. There are no mediastinal nodes or other lesions. Clinically, stage 1. Remember, her LCCA is occluded as well. PFT shows normal spirometry except for the 25-75 is ~44%. Normal RV and DLCO~45. I agree with Dr Martin that a percutaneous valve carries a much higher risk of stroke, but as stated, I would like to see the data. The options as I see them are: DHCA w/ Bentall and arch or apical conduit. Remember, this is a re-do. Could she be better served with opening and lysis of adhesions followed by resection the next day, as has been previously discussed? She's coming to see me in two weeks after I get back from Yellowstone. I gotta get some trout fishing under my belt before I lose it. Mitch Lirtzman At 07:08 PM 7/1/2007, you wrote: >Prasanna > >A percutaneous valve for calcified aortic stenosis???? From a surgical >standpoint, even if I were to replace her root ascending and arch with >individual head vessel reimplantation I would say her survival is in the >90%?range with her greatest major morbidity coming from a stroke (5-7%). >The question here, in my opinion, is how to deal with the pulm lesion and >in what order. >Someone on the forum must know the data on the perc valves so far, if so, >speak up and educate us. I would think that a calcified aorta with >calcific AS in a small female would be hard to do and would be at a >significant risk of stroke- maybe more so than with an open procedure. > >Tom Martin >U of Florida >Gainesville > > >-----Original Message----- >From: prasannasimha >To: OpenHeart-L@lists.hsforum.com >Sent: Sat, 30 Jun 2007 10:33 pm >Subject: Re: [HSF] Calcified aortic stenosis > > > >Smoker with ? lung Ca? >Is the valve replacement worth it ? if worth it then - probably would be a >candidate for those percut valves. Why chop her up excessively ?? >Prasanna? >tdmartin2000@aol.com wrote:? > > Need a biopsy of lung lesion and then staging if pos for CA. If no > carcinoma or something possibley cureable? and no AI, then an apical > aortic conduit would be a consideration along with either a wedge > resection or lobectomy. You certainly can replace the entire root, > ascending?and arch with reasonable results as long as there is something > to sew to either in the distal arch or the prox descending.? > >? > > Tom Martin? > > U of Florida? > > Gainesville? > >? > >? > > -----Original Message-----? > > From: Mitch Lirtzman ? > > To: OpenHeart-L@hsforum.com? > > Sent: Sat, 30 Jun 2007 7:48 pm? > > Subject: [HSF] Calcified aortic stenosis? > >? > >? > > To the forum. I know we've covered this type of problem in previous > discussions, but...?? > > ?? > > An old patient of mine, 62yo petite diabetic female, unrepentant smoker > 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been > complaining of increasing dyspnea for several months and referred her > back to her cardiologist to investigate. The bottom line is she has > critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts > are patent. She just had her left subclavian stent redone to improve LIMA > flow. The problem is she is now totally calcified from valve through arch > and LCCA is occluded just after the origin. Additionally, she now has a > 1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is > remarkably good but she always reminds me that she had a difficult post > op course from a pulmonary standpoint.?? > > Any thoughts besides the word NO??? > > Thanks ahead of time.?? > > Mitch Lirtzman?? > > ?? > > _______________________________________________?? > > OpenHeart-L mailing list?? > > ?? > > Send postings to:?? > > OpenHeart-L@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?? > > -----------------------------------------?? > >? > >? > > ________________________________________________________________________? > > AOL now offers free email to everyone. Find out more about what's free > from AOL at AOL.com.? > > _______________________________________________? > > OpenHeart-L mailing list? > >? > > Send postings to:? > > OpenHeart-L@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@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? >-----------------------------------------? > > >________________________________________________________________________ >AOL now offers free email to everyone. Find out more about what's free >from AOL at AOL.com. >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@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 >----------------------------------------- From ICHFNO at aol.com Tue Jul 3 00:13:10 2007 From: ICHFNO at aol.com (ICHFNO@aol.com) Date: Mon Jul 2 23:17:33 2007 Subject: [HSF] Congratulation Message-ID: Tea, Michael, Prasaana and Ed: Thanks for the kind notes. The most interesting part of the award is the reveiw and assessment of the Foundation by the Business School in Lausanne, they will make a critical assessment of our finances, mechanisms, strengths, weaknesses and plans for the future. This Business Assessment will be followed by review by the 50 MBA candidates at the school who will then make Case Studies for us to help us grow. They have also decided to make us their charity of choice for the upcoming release of a new watch, the Double Heart Beat, from which we will receive a portion of the sale of each watch for a year. All in all it was an unbelievable event and result. Hopefully this recognition, donation and assessement will help us to grow and help more children. Sincerely, William M Novick MD Paul Nemir Jr., MD Professor International Child Health and Surgery University of Tennessee Health Sciences Center Founder and Medical Director International Children's Heart Foundation _www.babyheart.org_ (http://www.babyheart.org/) cell 901-438-9413 office 901-869-4243 fax 901-432-4243 home 901-523-2086 ************************************** See what's free at http://www.aol.com. From gabiford at hotmail.com Tue Jul 3 05:00:25 2007 From: gabiford at hotmail.com (gabi ford) Date: Tue Jul 3 00:00:55 2007 Subject: [HSF] picture - not entirely OT In-Reply-To: Message-ID: From: Hgrmd@aol.com > Gorgeous. Thanks, Hal. I hardly ever give digitalis anymore. Some to chronic CHF folks. We don't use it for post open heard a-fib anymore. Now we use Amiodarone (Cordarone) and beta blockers. I liked the little bit of kick the patient got from Dig...and you did not have to worry about hypotension. ;) Gabi From tacuff at swbell.net Mon Jul 2 22:16:31 2007 From: tacuff at swbell.net (Tea Acuff) Date: Tue Jul 3 00:18:04 2007 Subject: [HSF] Rheumatic mitral valve Message-ID: <198060.87807.qm@web81608.mail.mud.yahoo.com> I am sorry to hear about Bob Emery. I will try to send him a note. I will try to send myself a note when ever I get the urge to get a motor cycle. Bob Frater wrote: To offer?a balloon in a case unsuitable for commissurotomy?because it ?does not involve a?thoracic incision? is simply stupid I am glad you have stopped leaving ambiguous clues as to your present feelings. However, I do think that you may have a little palsy in your right index finger which is over the "?" key. ;) tea ----- Original Message ---- From: "rwmfglycar@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Monday, July 2, 2007 12:48:41 PM Subject: Re: [HSF] Rheumatic mitral valve Whether or not to do a commissurotomy for mitral stenosis by any method is entirely pathology dependent. Whether done by balloon, a metallic dilator, trans apically or transseptallym, with or without cardiopulmonary bypass,?the result depends on the pathologic stage of the rheumatic disease. In the early days of closed commissutotomy we learned quite quickly which cases were not suitable for commissurotomy alone.?Since the pathology is progressive the older a patient is the less likely it is thet a commissurotomy will do the job. To attempt a commissurotomy by balloon ?when the pathology is unsuitable does the patient no good and may do harm.?To offer?a balloon in a case unsuitable for commissurotomy?because it ?does not involve a?thoracic incision? is simply stupid. Bob PS? I was at a wonderful family wedding on a sheep farm in Somerset, England. In 4 days there were 384 E mails most with HSF labels. For some of you who may not know, Bob Emery had a serious motorcycle accident riding to the hospital and is now being treated for multiplr fractures. -----Original Message----- From: Ani Anyanwu To: OpenHeart-L@lists.hsforum.com Sent: Thu, 28 Jun 2007 10.18pm Subject: Re: [HSF] Rheumatic mitral valve Sorry Ed I had not read this when sent previous mail. Why don't they offer valvuloplasty? Is it a disbelief in the efficacy of the procedure or a lack of skill to do it? >From the ethical view point, it could be argued that valvuloplasty should be discussed with the patient and the choice given to go elsewhere if the patient chooses percutaneous over surgery? Assuming this patient were 10 years older would you still operat