[HSF] (no subject)

Sun May 13 14:08:43 EDT 2007

Need a very big Mastercard for that one!

>virtual operation
>virtual patient
>virtual results
>progress in medicine, priceless
>
>tea
>
>
>----- Original Message ----
>From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
>To: OpenHeart-L at lists.hsforum.com
>Sent: Saturday, May 12, 2007 6:19:14 PM
>Subject: Re: [HSF] (no subject)
>
>
>He could have
>1. BiV pacemaker and Defib - to reduce risk of sudden death and increase EF
>2. Perc AVR and perc MV "repair"
>3. Optimize med therapy.
>4. PCI to suitable vessels.
>
>All 'low risk ' stuff for a high risk patient. And it won't screw up
>your figures.
>
>I suspect a long discussion with the patient and a few responsible
>members of the family with the real risks - surviving an operation
>with say 3 months in hospital, and an undefined period in a rehab
>facility, with a 30% chance of brain failure (memory loss or worse),
>will come up with the right answer.
>
>This man shows the natural history of CV disease. In the 21st
>century, we look harder at them for various reasons (or the
>cardiologists do for ??). We are starting to learn why the survival
>curves diverge somewhat. We of course do not know the medical
>conditions of all of those who die of natural causes as there is
>usually no acceptable entry on a death certificate for natural causes
>(JPFROG does not go down well).
>
>With his calcified aorta, calcified valve and calcified coronaries
>and probably calcified mitral annulus, he represents what I learnt in
>pathology a long time ago that calcification is one end stage of
>wearing out.
>
>The LV is secondary to that. What was his LV like 12 months ago? Or
>at the original operation or at any time point postoperatively?
>
>If he were my (now late) father, I would say "come home Dad with the
>tablets." (He threatened me with worse than the 4th Horseman if I had
>anything extraordinary done when he got unwell in his mid 80s.)
>
>
>
>>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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>
>--
>Ben Bidstrup FRACS FRCSEd FEBCTS
>Consultant Cardiothoracic Surgeon
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon