[HSF] (no subject)

[Michael Firstenberg]

Ahhh, fun case.....

Perc. AVR?

While I have no doubt you could get him thru whatever operation you  
choose (did they use ice slush the first time?  could make for a fun  
redo?  or could be a "cake walk"....hmmmm).  But, sounds like a job  
for true informed consent - there was a recent report in Annals about  
how few of these patients (who survive there operation) actually ever  
leave a nursing home.  While you may not refuse surgery, potentially  
convincing him that medical management may be his best option.  If he  
"currently" feels well it may be hard to improve on that.......

-michael



> I don't think I would. I would certainly try medicine first and  
> pray for the 4th horseman. Supposedly the onset of CHF carries a  
> 50% two year survival. His age alone carries a 4 year 50% survival.  
> It is not going to be easy in and out.
> tea
>
>
> ----- Original Message ----
> From: prasannasimha <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Saturday, May 12, 2007 11:25:23 AM
> Subject: Re: [HSF] (no subject)
>
>
> Somewhere along the line I missed out the fact that this was a redo  
> (pig
> valve in place).Now that adds to the fun.
> Prasanna
> Douville, Chuck wrote:
>> Hal, in our program in Portland, we would not offer this 86 yo man  
>> with extensive aortic calcification and that level of lv  
>> dysfunction reoperative surgery.
>>
>> -----Original Message-----
>> From: "Hgrmd at aol.com" <Hgrmd at aol.com>
>> To: "OpenHeart-L at lists.hsforum.com" <OpenHeart-L at lists.hsforum.com>
>> Sent: 5/12/07 6:32 AM
>> Subject: [HSF] (no subject)
>>
>> Dear Members,
>>   I need an opinion. We've got an 86 yo man referred to our   
>> service who
>> presented with CHF not requiring intubation.  He's currently on   
>> telemetry.  Cath
>> revealed severe 3VD.  The EF was 15%.  There was  a 27 mm gradient  
>> across a
>> 19yo pig valve that appeared heavily calcified and  stenotic on  
>> TEE.  The root
>> and arch showed extensive calcification, but the  distal aorta was  
>> OK.  He
>> currently feels pretty well.   Surgery?
>> Hal
>>
>>
>>
>> ************************************** See what's free at http:// 
>> www.aol.com.
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