[HSF] Calcified aortic stenosis

Wed Jul 4 14:08:00 EDT 2007

Exploring all options. M wrote:
>What is wrong with the thought of an apical aortic conduit and a wedge 
>resection if it is that peripheral. You could even do a lobectomy if you 
>thought it necessary.? If indeed the aorta is circumferentially calcfied a 
>root ascending arch is possible but can be extremely difficult 
>particularly when dealing with the distal anastomosis, arch vessels and 
>coronaries. The coronaries can be a real problem and occasionally you have 
>to ligate the orifice and bypass them. Not an impossible situation but can 
>be difficult. An apical aortic conduit is much easier from a technical 
>standpoint.
>
>Tom Martin
>U of Florida
>Gainesville
>
>
>-----Original Message-----
>From: Mitch Lirtzman <drmitch at cox.net>
>To: OpenHeart-L at lists.hsforum.com
>Sent: Mon, 2 Jul 2007 10:19 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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