[HSF] Call me crazy, but......

[prasannasimha]

Theoretically asymptomatic AS with no LV dysfunction is not an 
indication for surgery (whatever the gradient) though I feel that 
position is extreme. Any patient with that significant an AS is 
unresuscitatable in case of an arrest which they are more prone. Also 
extreme hypertrophy makes the surgery riskier.Symptomatic AS with 
gradients above 40 -50 m Hg should be operated.
Prasanna

erdinç naseri wrote:
> Prasanna,
> not for this special case but in general:does the presence or absence of symptoms make any difference in the choice of surgery in very severe AS( >120 mmhg peak gradient,<0.9 cm2)
> erdinc> Date: Sat, 30 Jun 2007 07:14:16 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Call me crazy, but......> CC: > > Is the patient ready for the risk and a prolonged ICU stay .> Prasanna> > Michael Firstenberg wrote:> > how briefly?> > Every consultant - nephrology, GI, neurology says "yes, he is high > > risk, but should be OK......"> >> > Gee, I dont see them putting him on their OR schedule?> >> >> >> >> > On Jun 29, 2007, at 7:00 PM, Tea Acuff wrote:> >> >> I did think about it briefly.> >> tea> >>> >>> >> ----- Original Message ----> >> From: Michael Firstenberg <msfirst at gmail.com>> >> To: OpenHeart-L at lists.hsforum.com> >> Sent: Friday, June 29, 2007 12:31:27 PM> >> Subject: [HSF] Call me crazy, but......> >>> >>> >> would ANYONE even think of operating on this patient?> >>> >> 44 year/old> >> Critical AS - peak gradient ~150, mean ~80 mmHg> >> AVA ~ 0.7 cm2> >> preserved LV function, LV size not too bad> >> Pulmonary hyp
>  ertension, PAP ~70mmHg> >> mild (or so) MR with MAC> >>> >> History of:> >>> >> Failed kidney transplant - report of noncompliance> >> Cirrhosis with ascites - 2006 Denver shunts (x2) placed> >> per patient - EtOH induced> >> Difficulty walking due to swollen joints - not sure why, but not CHF> >> Recent GI bleed - given a couple of units at outside hospital> >> not scoped - told to arrange as outpatient> >> Coronaries clean> >> This admission - new onset of seizure> >> CT/MRI shows something in frontal lobe, but not sure what.> >> HUGE mass on lower back - tissue bx - negative for malignancy> >> most likely lipoma, but unclear if that is the only histology> >> Lytic bone lesions - (Heme/Onc thinks related to dialysis)> >> Parathyroid hormone >1000> >>> >> I have told the primary service - the best thing about him is his heart> >>> >>> >> -michael> >> _______________________________________________> >> OpenHeart-L mailing list> >>> >> Send postings to:> >> OpenHeart-L at lists.
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