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

[Tea Acuff]

Words are funny constructs. A huge infarct salvaged by lytics is an ambiguous paradox. Something for everyone, but likely somewhere in between. Surely you, Ani, are not saying a LIMA is inappropiate for an isolated LAD, however?
tea


----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, May 15, 2007 7:53:09 PM
Subject: Re: [HSF] Another on vs off pump question......


Michael

Surely this is not an indication for coronary artery bypass surgery? 

Indeed this is the situation where you require collaborating evidence (such as angina or imaging viability) to even show that surgery will be of any value at all.

Ani
  ----- Original Message ----- 
  From: Michael Firstenberg<mailto:msfirst at gmail.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Tuesday, May 15, 2007 2:20 PM
  Subject: Re: [HSF] Another on vs off pump question......


  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<mailto: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<mailto: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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