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

Wed May 16 21:36:32 EDT 2007

As opposed to what unquestioned therapies?
tea

----- Original Message ----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, May 16, 2007 9:55:56 PM
Subject: Re: [HSF] Another on vs off pump question......

Incidentally that has been a questionable therapy.
Prasanna

Ben Bidstrup wrote:
> 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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