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

[Michael Firstenberg]

The plot thickens -
CT scan of chest - no lung mass/nodules/etc
Later that morning she starts having short runs of VT
Gets taken to the Cath lab and a DES is placed in her proximal LAD

OK, now remember she still has mild MR (at least) and LV still has not
recovered from the infarct (not to mention the PFO and bad TR).  I asked the
Cardiologist, a friend, if he is going to study the LV (MRI, pet, etc) and
what are "we" going to do about the MR - which I am sure will get
worse.......

By the way, if I had a huge anterior wall infact from a high grade proximal
LAD lesion, as long as I had two functioning myocytes I would want a LIMA
there - where there is smoke there is fire.  Doesn't that count as
symptomatic (i.e. unstable angina?) coronary disease?

For those of you who would not operate on this (ok, I can see and agree to a
viability study) - but what do you operate on?

-michael


On 5/16/07, Nasser F. Abou'Seada <nfaabouseada at gmail.com> wrote:
>
> "Most cases have some hibernated myocardium to be saved by bypass and
> improve LV function."
> "I would "cool down" for a month,find inducible ischemia and/or viable
> myocardium, then accept for bypass surgery"
>
> Dear Tohru
> I find that perplexing to my mind, hibernation and cooling down for a
> month. is that related to this case ? Would you please care to
> elaborate more ?
>
> NFA
>
> On 5/16/07, Tohru Asai <toruasai at belle.shiga-med.ac.jp> wrote:
> > Michael
> >
> > What is "lytics"? Thrombolytics like TPA?
> > I personally do not agree with Ani. Your patient clearly has LV
> dysfunction
> > with significant large LAD territory. Most cases have some hibernated
> > myocardium to be saved by bypass and improve LV function.
> >
> > I am just wondering whether it is common to have PET study to evaluate
> > viability of myocardium in such cases in US?
> >
> > Another questions: Are there any severe lung diease like advanced
> emphysema
> > or fibrosis?
> >
> > Without watching cath film, I can not be certain. But I would "cool
> down"
> > for a month,find inducible ischemia and/or viable myocardium, then
> accept
> > for bypass surgery maybe with excisional biopsy of lung mass, if
> respiratory
> > med guys agree with me. If closing device is available and reliable, no
> need
> > to open RA during OPCAB.
> > --
> > Tohru Asai
> > Shiga University of Medical Science
> > Otsu, Japan
> >
> >
> >
> >
> >
> > > Indications for surgery - proximal high grade LAD lesion and a huge
> infarct
> > > salvaged by lytics.
> > >
> > > -michael
> >
> >
> > _______________________________________________
> > OpenHeart-L mailing list
> >
> > Send postings to:
> >  OpenHeart-L at lists.hsforum.com
> >
> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> > All messages transmitted by the OpenHeart-L are subject to the policies
> and
> > disclaimers posted at:
> > http://www.hsforum.com/listdisclaim
> > -----------------------------------------
> >
>
>
> --
> Nasser  F.  Abou'Seada,
> MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
> FICS,FISCVS,FSSRCTS,FHMS,MESC
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>