[HSF] RE: Timing AVR/Coarctation repair
Nasser F. Abou'Seada
nfaabouseada at gmail.com
Thu May 10 22:32:48 EDT 2007
ben
please elaborate
NFA
On 5/10/07, Ben Bidstrup <benjamin.bidstrup at bigpond.com> wrote:
>
> And we all know what follows the fourth horseman.
>
> >No, I think it's the fourth sign of the apocalypse. M.At 04:20 PM
> >5/10/2007, you wrote:
> >>Is having Hal and me in the same room parallel impedances?
> >>tea
> >>
> >>
> >>----- Original Message ----
> >>From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
> >>To: OpenHeart-L at lists.hsforum.com
> >>Sent: Thursday, May 10, 2007 5:21:51 AM
> >>Subject: Re: [HSF] RE: Timing AVR/Coarctation repair
> >>
> >>
> >>More likely a system of parallel resistances (or rather impedances).
> >>
> >>
> >>>Maybe. I certainly am often wrong. The circulatory system is complex
> >>>flow, to which your engineers have alluded. But isn't your
> >>>simplifying point that we are talking resistance instead of,
> >>>presumbly, pressure in a flowing circuit just semantics?
> >>>tea
> >>>
> >>>
> >>>----- Original Message ----
> >>>From: prasannasimha <prasannasimha at gmail.com>
> >>>To: OpenHeart-L at lists.hsforum.com
> >>>Sent: Tuesday, May 8, 2007 8:02:07 PM
> >>>Subject: Re: [HSF] RE: Timing AVR/Coarctation repair
> >>>
> >>>
> >>>And not doing a possible femerotibial will give a lower patency.
> >>>Actually Tea you are mixing apples and oranges because the highest
> >>>"egress flow" for the lower limb is the profunda. So if you have a
> >>>blocked distal femerol or tibial artery but a patent profunda the
> >>>distal resistance is still lower than one with a blocked profunda and
> >>>hence the paradox (which isn't really a paradox) since the thigh muscle
> >>>mass is very much larger,more vascular and of lower resistance. We are
> >>>essentially talking of flow resistances compared to just tubes .
> >>>Prasanna
> >>>Tea Acuff wrote:
> >>>> Clearly one has to have some outflow to a graft, but an
> >>>>aortofemoral is warranted before a distal femtib for two level
> >>>>stenoses.
> >>>> tea
> >>>>
> >>>>
> >>>> ----- Original Message ----
> >>>> From: prasannasimha <prasannasimha at gmail.com>
> >>>> To: OpenHeart-L at lists.hsforum.com
> >>>> Sent: Tuesday, May 8, 2007 10:37:36 AM
> >>>> Subject: Re: [HSF] RE: Timing AVR/Coarctation repair
> >>>>
> >>>>
> >>>> Even there it is still true - if you just improve inflow and do not
> have
> >>>> an egress you will still get nowhere.I think we always check the
> >>>> graftability of the femorals first before doing a an
> aortobifemoral.
> >>>> Prasanna
> >>>> Tea Acuff wrote:
> >>>>
> >>>>> Not a truism. It is opposite for periperal vascular disease.
> >>>>>Always improve inflow first in PVD.
> >>>>> tea
> >>>>>
> >>>>>
> >>>>> ----- Original Message ----
> >>>>> From: prasannasimha <prasannasimha at gmail.com>
> >>>>> To: OpenHeart-L at lists.hsforum.com
> >>>>> Sent: Tuesday, May 8, 2007 6:41:50 AM
> >>>>> Subject: Re: [HSF] RE: Timing AVR/Coarctation repair
> >>>>>
> >>>>>
> >>>>> This is a standard MCh case.
> >>>>> Relieve the distal stenosis first and then you can turn around and
> do an
> >>>>> AVR.
> >>>>> In tandem stenoses -always relieve the distal one first- be it gut
> or
> >>>>> vascular otherwise relieving the proximal one doesn't help.
> >>>>> Prasanna
> >>>>> Antonio Laudito wrote:
> >>>>>
> >>>>>
> >>>>>> Dear Members,
> >>>>>>
> >>>>>> A 50 yr old pt show up to your office with a dx of severe AS (EF
> OK, no
> >>>>>> CAD)and severe coarctation ( MRI with a few mm lumen). What would
> be
> >>>>>> your recomended surgical strategy?
> >>>>>> Thanks
> >>>>>> Antonio Laudito,MD
> >>>>>>
> >>>>>>
> >>>>>>
> >>>>>>>>> hgrmd at aol.com 07/05/07 16:25 >>>
> >>>>>>>>>
> >>>>>>>>>
> >>>>>>>>>
> >>>>>> Dear Members,
> >>>>>> One of the senior members of my group and I were discussing
> >>>>>>the merits
> >>>>>> of using a PA vent versus an LA vent when encountering LV
> distension
> >>>>>> just after releasing the clamp. Typically, it is due to mild or
> >>>>>> moderate AI. Personally, I prefer using the main PA as the vent
> site.
> >>>>>> It's quick and easy, and I've always found that it decompressed
> the LV
> >>>>>> nicely. In contrast, my friend says that it's better to use an
> LV vent
> >>>>>> so as to avoid pulling all of that blood through the capillary
> beds and
> >>>>>> risking acute pulmonary injury. I've never read that, and it
> sounds
> >>>>>> like theoretical crap to me. What do you think?
> >>>>>> Hal
>
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> >>
> >>
> >>--
> >>Ben Bidstrup FRACS FRCSEd FEBCTS
> >>Consultant Cardiothoracic Surgeon
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>
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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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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