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

[psimha]

Ignore the PFO. You can device close it if it produces problems later.
Prasanna
Michael Firstenberg wrote:
> 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
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