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

[Ben Bidstrup]

TOE (TEE ) has been on the increase as people with migraines are 
investigated for a PFO as a possible cause !! They then get to the 
interventionalists for a device closure.
What a way to go!

>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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>
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon