[HSF] Calcified aortic stenosis

Tue Jul 3 17:57:13 EDT 2007

Although Vancover has a center, the only site in the US is Dallas presently. All trans apical approaches are on hold (complete), but thirty more may be available in 60 days. There are trans femoral slots left, but they are randomized, and if your lady is small will not likely be a candidate.

Eight transapical cases were done with one death which occurred when the patient requested to be taken off dialysis due to contrast injury and not wanting chronic dialysis even though stable hemodynamically. Most patients (over 50 were turned down and 10 operated conventially) are not appropiate, but porcelin aorta was present in a couple. Did not ask about stroke.

I did not understand your staging for lysis of adhesions remark, or if I did, I can't believe it. What do you mean?

tea

----- Original Message ----
From: Mitch Lirtzman <drmitch at cox.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, July 2, 2007 9:19:43 PM
Subject: Re: [HSF] Calcified aortic stenosis

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 <prasannasimha at gmail.com>
>To: OpenHeart-L at 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 at 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 <drmitch at cox.net>?
> > To: OpenHeart-L at 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??
> > ??
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