[HSF] Does the LIMA really string?

Wed Jun 6 10:08:28 EDT 2007

you don't WATCH, you don't LOOK
You don't LOOK; you'll not OBSERVE
you don't OBSERVE; you'll never "SEE"

NFA


On 6/6/07, Donald Ross <donross at bigpond.com> wrote:
>
> If you don't observe, you will never see.
>
> On 06/06/2007, at 12:23 PM, Tea Acuff wrote:
>
> > The best way to refine (kill?) a theory from an observation is
> > another observation. Didn't someone caution that this was problematic?
> > tea
> >
> >
> > ----- Original Message ----
> > From: Donald Ross <donross at bigpond.com>
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Monday, June 4, 2007 11:37:38 PM
> > Subject: Re: [HSF] Does the LIMA really string?
> >
> >
> > Noel Mills thought that lysis of SVG valves might reduce the
> > incidence of graft "atheroma" as it was a common observation to see
> > such disease centred around the valves during re-do surgery.
> > He reported using the SVG non-reversed after lysing the valves.
> > I thought it was a good idea and implanted several hundred such
> > grafts. Technically they were appealing especially for skip grafts
> > because they tapered in the correct direction. Over the years however
> > I saw enough of these grafts occlude with classical graft disease to
> > realise that simply hooking the two cusps with a valvulotome probably
> > didn't leave enough of a smooth surface to prevent platelet
> > aggregation and subsequent disease.
> >
> > Here is another theory to ponder upon:
> > If you are an anaortic surgeon and  wish to implant a prophylactic
> > vein graft ( for a 50% lesion not suitable for an arterial graft)
> > then, if you use a SVG T- graft with an intact valve,( from the ima),
> > it  will not cause the ima to suffer from competitive flow back up
> > the SVG from the coronary artery ( with the non-significant
> > obstruction.)
> > Don
> > On 05/06/2007, at 12:45 PM, Tea Acuff wrote:
> >
> >> David,
> >>
> >> Although no one has commented on your mechanism as to how the
> >> valves of RVS cause graft failure and lysis of them without removal
> >> apparently contribute to better longevity, I think your rheological
> >> proposal has merit. I have also wondered the same. Unfortunately, I
> >> do not know how to test for the theory as opposed to the effect. If
> >> and only if it is true, however, it may lead to better insights in
> >> effective CAB. This subject (CAB) despite the sexiness of
> >> endovascular aortic and reparative mitral surgery is likely to
> >> remain the main sustenance of our progenity.
> >> tea
> >>
> >>
> >> ----- Original Message ----
> >> From: David Harris <drdharris at yahoo.co.uk>
> >> To: OpenHeart-L at lists.hsforum.com
> >> Sent: Friday, June 1, 2007 5:18:27 PM
> >> Subject: Re: [HSF] Does the LIMA really string?
> >>
> >>
> >> Many thanks again Prasanna for the picture transfer.
> >> Tha patient had a 60 to 70% proximal LAD lesion. The
> >> LAD was relatively larger than the LIMA. After
> >> injecting (I never do!) the LIMA and clipping it
> >> distally , the flow was not great, and it did not
> >> dilate well. There was a prominant spurt of blood from
> >> the LAD after opening it. I left the bulldog on the
> >> LIMA (proximally) for a while after completing the
> >> graft, and this caused it to dilate nicely. Before
> >> closing the chest the graft looked fine.
> >> I am sure that bidirectional flow in these grafts keep
> >> them open, until the stenosis progresses, and the LIMA
> >> dominates. It would be nice to know exactly how much,
> >> which direction, and relatively during which part of
> >> the cardiac cycle.
> >>
> >> David Harris
> >> --- Donald Ross <donross at bigpond.com> wrote:
> >>
> >>> Thanks for the picture transfer Prasanna.
> >>> David,
> >>> Did you know the status of the LM stenosis at the
> >>> time of the CT?
> >>>
> >>> Also, does anyone have any experience with the
> >>> assessment of ima
> >>> patency using percutaneous doppler or know of an
> >>> authoritative
> >>> reference?
> >>>
> >>> Don
> >>> On 01/06/2007, at 11:27 AM, prasannasimha wrote:
> >>>
> >>>> This is a picture sent by David Harris of a case
> >>> with a small LIMA
> >>>> and left main 50 % (If I remember right). No
> >>> string !!
> >>>> David will complete the description.
> >>>> Prasanna
> >>>> <LIMA to LAD nonstring eml.jpg>
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> >>
> >>
> >> Dr. David G. Harris, FCS, MMED,
> >> Cardiothoracic Surgeon
> >> Suite 207
> >> Kuils River Private Hospital,
> >> PO Box 1200, Kuils River, 7579, Cape Town, South Africa.
> >> Tel +27-21-9006411
> >> Fax +27-21-9006412      Mobile +27-83-3309587
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC