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

[prasannasimha]

I agree  but that is the AHA standpoint !!
Prasanna

Salerno, Tomas wrote:
> That is an extreme position regarding AS, regardless of gradient...
>
> Tomas
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Tuesday, July 03, 2007 12:03 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Call me crazy, but......
>
> 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.
>>  hsforum.com> >>> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> >> http://mmp.cjp.com/mailman/listinfo/openheart-l> >>> >> All messages transmitted by the OpenHeart-L are subject to the > >> policies and> >> disclaimers posted at:> >> http://www.hsforum.com/listdisclaim> >> -----------------------------------------> >> _______________________________________________> >> OpenHeart-L mailing list> >>> >> Send postings to:> >> OpenHeart-L at lists.hsforum.com> >>> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> >> http://mmp.cjp.com/mailman/listinfo/openheart-l> >>> >> All messages transmitted by the OpenHeart-L are subject to the > >> policies and> >> disclaimers posted at:> >> http://www.hsforum.com/listdisclaim> >> -----------------------------------------> >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or
>>   to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the > > policies anddisclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
>> _______________________________________________
>> OpenHeart-L mailing list
>>
>> Send postings to:
>>  OpenHeart-L at lists.hsforum.com
>>
>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>> http://mmp.cjp.com/mailman/listinfo/openheart-l
>>
>> All messages transmitted by the OpenHeart-L are subject to the policies and 
>> disclaimers posted at:
>> http://www.hsforum.com/listdisclaim
>> -----------------------------------------
>>
>>   
>>     
>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies and 
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies and 
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>
>