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

[prasannasimha]

Why DES since she was planned for some sort of surgery ?
Incidentally for the PFO occluders, there has been an FDA alert and also 
remember that nearly 30 % of the population has them and so the only 
possible indication is in patients with h/o cryptogenic stroke and 
patients with demonstrated platypnea orthodeoxia (not everyone with a 
lung resection will get it too)- not in everyone with a PFO 
prophylactically.
Prasanna
Michael Firstenberg 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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