[HSF] Too scared to touch.....
Nasser F. Abou'Seada
nfaabouseada at gmail.com
Tue May 1 11:20:04 EDT 2007
You've got the guts to do such case dave. I'd follow Hal's opinion by all
means.
NFA
On 4/28/07, David Harris <drdharris at yahoo.co.uk> wrote:
>
> This would be the ideal patient for a hybrid / MIDCAB
> approach. No risk from the sternotomy in obese
> patient. If the MIDCAB is done properly, and I am sure
> your cardiologist is aware of this, the risk will be
> minimal. This is a typical kind of patient we see
> thesedays......we become our worst enemies if we do
> not accept these cases for surgery. The
> (liberal)indications for the CABG in this patient
> should be the same as any other patient. If you do
> this one well via a MIDCAB, the cardiologist will take
> notice and may think twice before stenting the LAD
> next time.
>
> Dave Harris
>
>
> --- Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
> > Actually in this case Michael you do know the other
> > devil. Easy to work out likely scenario if you did
> > operate. How obese is obese here anyway?
> >
> > Ani
> > ----- Original Message -----
> > From: Michael
> > Firstenberg<mailto:msfirst at gmail.com>
> > To:
> >
> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >
> > Sent: Saturday, April 28, 2007 11:01 AM
> > Subject: Re: [HSF] Too scared to touch.....
> >
> >
> > That is a major part of our argument not to
> > operate.
> > She came in with a RCA/RV problem - and that was
> > taken care of.
> > Everyone is just "scared" of the LAD/Cx disease
> > (not that bad though)
> > and thinks that CABG will save everything......
> >
> >
> > resisting the oculo-graft reflex (i.e see
> > blockage - needs graft)
> >
> > the devil you know vs the devil you dont.
> >
> > she needs medical management (I dont even think
> > she came in on beta-
> > blockers/statin/etc)
> >
> >
> > -michael
> >
> >
> >
> > On Apr 28, 2007, at 10:51 AM, Ani Anyanwu wrote:
> >
> > > Michael,
> > >
> > > What would be the indication for surgery at the
> > present time?
> > >
> > > Ani
> > > ----- Original Message -----
> > > From: Michael
> >
> Firstenberg<mailto:msfirst at gmail.com<mailto:msfirst at gmail.com>>
> > > To:
> >
> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart<mailto:
> OpenHeart-L at lists.hsforum.com%3Cmailto:OpenHeart>-
> >
> > > L at lists.hsforum.com<mailto:L at lists.hsforum.com>>
> > > Sent: Saturday, April 28, 2007 10:36 AM
> > > Subject: [HSF] Too scared to touch.....
> > >
> > >
> > > Would anyone do anything different?
> > >
> > > 52 year/old, multiple medical problems (poorly
> > controlled diabetes,
> > > hypertension, high lipids of course - and dont
> > forget obese). Known
> > > brain AVM, cryptogenic cirrhosis with history
> > of varices/bleeding/
> > > blakemore tube (the works, but nothing recent
> > and LFTs/proteins not
> > > too bad) - treated with mesocaval shunt for
> > portal vein
> > > thrombosis in
> > > 1999. Splenic embolization also. Chronic
> > anemia and renal
> > > insufficiency. CT scan of abdomen "suggests
> > carcinomatosis" -
> > > slightly worse over past "couple of years" -
> > but no primary (CA125
> > > elevated to ~60 baseline in our hospital
> > 0-40, already had TAH-BSO
> > > years ago). About six months ago, fell and
> > got a "hairline"
> > > fracture
> > > of left hip - no intervention, but developed a
> > DVT in right leg.
> > > Recently, fell again (may have been near
> > syncope) and broke right
> > > ankle in several places. Admitted to outside
> > hospital after fall,
> > > hypotensive, found to have a troponin of ~20
> > with a moderate RV
> > > infarct. Taken to cath lab for PCI (BMS to
> > occluded right -
> > > interesting as she was on coumadin) - opened
> > up, but also has
> > > significant LAD/Cx disease. Good targets.
> > Cardiology asking for
> > > off-
> > > pump LIMA-LAD and they will do a protected
> > left main stent.
> > > Anesthesia and Ortho doesnt want to fix her
> > ankle until her heart is
> > > taken care of.
> > >
> > > Would anyone operate?
> > >
> > > Cardiology somewhat understanding of our
> > reluctance to "take the
> > > high
> > > potential operative mortality hit" and in fact
> > they are not sure
> > > they
> > > even want to "take the PCI hit". To be
> > honest, we all want to try
> > > and help (not sure of the long term benefit as
> > no one has any
> > > idea of
> > > her long-term prognosis), but no one wants to
> > have a potential CABG
> > > mortality.
> > >
> > > Hal - can I send her to you?
> > >
> > >
> > > -michael
> > >
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> === message truncated ===
>
>
> 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
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