[HSF] Another on vs off pump question......

[Michael Firstenberg]

Just got a call from my friendly interventionalist.

72 year/old, multiple medical problems (nothing too bad), but has a "lung
mass" which may need work-up and treatment - so he really does not want to
put a proximal LAD stent in and keep her on Plavix forever.  He asked me to
do an off-pump LIMA to LAD.  Sounds good.  However, since her admission
diagnosis was a anterior wall MI, we are letting her "cool down" (peak
troponin 500 - yikes).  So we got an echo to eval function.  EF~30%, little
AI, little MR, moderate TR, elevated pulmonary pressures..... ok nothing too
bad.  Small PFO.

Question: 1)  Off-pump LIMA-LAD and ignore the PFO
               2)  On-pump LIMA-LAD and close the PFO
               3)  Would anyone touch the tricuspid (sorry dont have the
sizes)
               4)   Let him put in a BMS and a clam-shell to the PFO and
walk away..........


Hate to go on pump just to fix a PFO - but she may get a lung resection at
some point and she already does have some pulm hypertension.

----thoughts/comments?



-michael