(OT)Re: [HSF] Residual MR

Tue Jun 5 09:12:39 EDT 2007

In bocca de lupo (In the mouth of the wolf)
response
Crepi il lupo ( die wolf)

Supposed to be from "Little red riding hood" - sort of a "break your 
leg" type of thing.
Prasanna
Michael Firstenberg wrote:
> hal
> In boca de lupo
> (i am sure the spelling is off but it is the thought that counts)
>
> michael
>
> Michael Firstenberg <msfirst at gmail.com>
>
> -----Original Message-----
> From: hgrmd at aol.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: 6/4/2007 7:06 PM
> Subject: Re: [HSF] Residual MR
>
>
> Michael,
>
>   There are a lot of emails to respond to today.  However, as I right this, we are leaving the gate for Rome.  I'll keep HSF posted on what I think is valuable from the 3 back to back meetings I'm attending over the next 2 weeks.  Thank God I've got an understanding wife.
>
> Hal
>
>
> -----Original Message-----
> From: Michael Firstenberg <msfirst at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Mon, 4 Jun 2007 12:51 pm
> Subject: Re: [HSF] Residual MR
>
>
>
> then we agree - I knew you would see things my way 
> dont you have real work to do, beside answering all of these emails? 
>  
> :) 
>  
> -michael 
>  
>  
> On 6/4/07, hgrmd at aol.com <hgrmd at aol.com> wrote: 
>   
>>  
>>  
>> Michael, 
>>  
>> That may be, but that doesn't excuse the surgeon from his obligation to 
>> provide the patient with the best care possible. Like I said before, there 
>> are times when you have to bite the bullet and do the case, no matter how 
>> ill prepared are you or your team. However, that should really be for a 
>> minority of cases if you practice in a country with good resources, and you 
>> have a patient with adequate financing. Believe me, I'm not going to try to 
>> transfer some indigent patient to a top notch surgeon. I know from 
>> experience, theyand/or their facilities don't want them. 
>> Hal 
>>  
>>  
>> -----Original Message----- 
>> From: Michael Firstenberg <msfirst at gmail.com> 
>> To: OpenHeart-L at lists.hsforum.com 
>> Sent: Mon, 4 Jun 2007 12:31 pm 
>> Subject: Re: [HSF] Residual MR 
>>  
>>  
>>  
>> Hal, 
>> By no means am I questioning your ability or your obvious top notch team. 
>> But, for people who do not do a lot of these I think it is important to 
>> understand some of the pitfalls - and I think that it part of the problem 
>> for some people who dont do a lot - they dont have good help. 
>>  
>> -michael 
>>  
>> On 6/4/07, hgrmd at aol.com <hgrmd at aol.com> wrote: 
>>     
>>>  
>>>  
>>> Michael, 
>>>  
>>> I guess I'll ignoreyour intimation that I interpret TEE's to suit my 
>>>       
>> ego, 
>>     
>>> and chalk that up to insecurity. I have a dedicated team of cardiac 
>>> anesthesiologists, most of whom are TEE certified, who make the call as 
>>>       
>> to 
>>     
>>> the severity of post repair MRand put it in the chart. The majority of 
>>>       
>> MR is 
>>     
>>> ischemic, and that can be repaired by most surgeons. However, the severe 
>>> MVP, particularly with bileaflet prolapse, is better referred to 
>>>       
>> experienced 
>>     
>>> hands. Don't let your fragile ego or pocketbook get in the way of 
>>>       
>> providing 
>>     
>>> your patients with the best care possible. I don't. 
>>>  
>>> Hal 
>>>  
>>>  
>>> -----Original Message----- 
>>> From: Michael Firstenberg <msfirst at gmail.com> 
>>> To: OpenHeart-L at lists.hsforum.com 
>>> Sent: Mon, 4 Jun 2007 8:55 am 
>>> Subject: Re: [HSF] Residual MR 
>>>  
>>>  
>>>  
>>> I am not disagreeing but there must be a point in which you give up on 
>>> trying to repair and either get out of dodge (and I have seen a few 
>>> patients 
>>> over the years get a staged operation in which after a big operation, 
>>> couple 
>>> of pump runs, go pack to the ICU for a few days and if they are not 
>>> progressing then bring them back for a replacement) or just fight your 
>>>       
>> ego 
>>     
>>> and replace the valve. Hal - you do a lot of valve repairs and have been 
>>> with good results for years and many on this forum perform complex 
>>> reconstructions neocord this pap-transfer that, patches, discussion 
>>> different suture types, but lets face reality we are not all Carpentier 
>>>       
>> or 
>>     
>>> Cosgrove. Trivial/mild MR obvious is better than moderate or a 
>>>       
>> mechanical 
>>     
>>> valve - but who does your TEE? I gave a lecture once to the Edwards 
>>>       
>> people 
>>     
>>> about TEE techniques and without too much difficultly anyone can make MR 
>>> either go away completely or become 3/4+. Part of this is being honest 
>>> with 
>>> yourself at the time of repair. 
>>>  
>>> -michael 
>>>  
>>>  
>>> On 6/4/07, ICHFNO at aol.com <ICHFNO at aol.com> wrote: 
>>>       
>>>>  
>>>> Hal, Michael and others: 
>>>>  
>>>> We perform a number of Mitral repairs around the world in children and 
>>>>         
>> I 
>>     
>>>> would have to echo the fact that when we have repairs where we have 
>>>>         
>> more 
>>     
>>>> than 
>>>> mild in the OR (in places where we have TEE) or the echo on arrival to 
>>>>         
>>> the 
>>>       
>>>> ICU 
>>>> then we find that within 2 years we are re-repairing approximately 60% 
>>>> again. 
>>>> Trivial to mild we have rarely (never say never) re-repaired a valve 
>>>>         
>> in 
>>     
>>>> the 
>>>> last 14 years. 
>>>>  
>>>>  
>>>> William M Novick MD 
>>>> Paul Nemir Professor 
>>>> International Child Health and Surgery 
>>>> University of Tennessee Health Sciences Center 
>>>> Founder and Medical Director 
>>>> International Children's Heart Foundation 
>>>> Memphis, Tennessee 
>>>> _www.babyheart.org_ (http://www.babyheart.org/) 
>>>>  
>>>>  
>>>>  
>>>>  
>>>> ************************************** See what's free at 
>>>> http://www.aol.com. 
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