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

[Michael Firstenberg]

Indications for surgery - proximal high grade LAD lesion and a huge infarct
salvaged by lytics.

-michael



On 5/15/07, Nasser F. Abou'Seada <nfaabouseada at gmail.com> wrote:
>
> in a 72 yo, what is the indication of surgery? any reason why not PCI
> / BMS, and PFO device closure? is it really Plavix ? what is the
> nature of the lung mass?  any S&S ?
>
> NFA
>
> On 5/14/07, Michael Firstenberg <msfirst at gmail.com> 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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> --
> Nasser  F.  Abou'Seada,
> MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
> FICS,FISCVS,FSSRCTS,FHMS,MESC
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