[HSF] Too scared to touch.....

[psimha]

Hal,
Please read carefully, In never said anything about critical left mains.
Also if you carefully see what I said I said where is the evidence . 
Some things that we practice need not necessarily be right.

Prasanna
hgrmd at aol.com wrote:
> Don,
>   I agree with you.  If Prasanna wants to send out critical LM's or LAD's hanging by a hair after an MI, that's his business.  Around here, if such patient went home without surgery and boxed, we'd definitely hear about it.
>  
> Hal 
>  
> -----Original Message-----
> From: donross at bigpond.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wed, 2 May 2007 4:40 AM
> Subject: Re: [HSF] Too scared to touch.....
>
>
> When they have LM or TVD + poor LV....... most of my patients. 
> I hope, therefore, you are not trying to put me out of a job? 
> Don 
> On 02/05/2007, at 10:53 AM, prasannasimha wrote: 
>  
>   
>> Where in literature has it been shown that a patient who is stable > after an MI benefits from urgent in house revascularization ? 
>> Prasanna 
>>
>> Donald Ross wrote: 
>>     
>>> Also, one wonders about the not infrequent peri-op AMIs during non->> cardiac surgery that come our way for revascularisation prior to >> discharge. 
>>> Is this unnecessary surgery as well, given it carries the same >> indications as regular coronary surgery? 
>>> Don 
>>> On 01/05/2007, at 10:04 PM, Hgrmd at aol.com wrote: 
>>>
>>>       
>>>> Ajit, 
>>>> I invested the time it took to read all of Prasanna's >>> abstracts. I'm 
>>>> still not convinced that medical therapy with beta-blockers is >>> the way to go for 
>>>> nearly every case. Again, if a stress test in an asymptomatic >>> patient shows 
>>>> a lot of myocardium with reversible ischemia, it would be >>> potentially 
>>>> foolhardy not to cath that patient. Over the years, we've been >>> referred lots of 
>>>> patients with left mains or critical 3vd that were cathed prior >>> to an elective 
>>>> noncardiac procedure (usually carotid, ischemic leg, or AAA). >>> We did the 
>>>> CABG, they eventually got the vascular procedure, and they did >>> fine. I've yet to 
>>>> recall "graft closure" while the subsequent case was done. In >>> light of the 
>>>> problems with DES, the cardiologists are much more likely to use >>> bare metal 
>>>> stents in such scenarios. 
>>>> I do agree that beta blockade, possible Swan, and a competent >>> cardiac 
>>>> anesthesiologist suffice for the vast majority of cardiac >>> patients getting 
>>>> noncardiac surgery. However, there are plenty of asymptomatic >>> cardiac time bombs 
>>>> waiting to explode for those that never cath and treat >>> preemptively. 
>>>> Hal 
>>>>
>>>>
>>>>
>>>> ************************************** See what's free at http://>>> www.aol.com. 
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