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

[Nasser F. Abou'Seada]

Why could not the Cardiologist insert a stent BMS at first encounter ?
any reason he did not / could not close the PFO as well ?
Interesting case Mike
Thank you for sharing such an argumentative case with us. it served to
expose all the ideas and concepts around the subject.

NFA

On 5/16/07, Michael Firstenberg <msfirst at gmail.com> wrote:
> 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
> > >
> > >
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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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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC