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

Thu May 17 03:23:53 EDT 2007

CBO !

NFA

On 5/16/07, Ben Bidstrup <benjamin.bidstrup at bigpond.com> 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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>
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC