(OT)Re: [HSF] Residual MR

[Michael Firstenberg]

Yes, the only thing in Italian that I remember - it is supposed to wish
someone good luck.


-michael


On 6/4/07, prasannasimha <prasannasimha at gmail.com> wrote:
>
> 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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