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

[Nasser F. Abou'Seada]

Dear Mike
now that the patient had a DES for the PROXIMAL  LAD lesion, with long
term Plavix,
- has there been any change in her LV salvage status or just freedom from VT ?
- is there any improvement / deterioration in her (ischaemic) MR mild degree ?
- Would you consider surgery to correct her "moderate" TR ? .... "how
moderate?"

thank you for sharing a provoking case for different opinions. Please
keep us posted as to her progress.

Yours

NFA

On 5/15/07, Michael Firstenberg <msfirst at gmail.com> wrote:
> Indications for surgery - proximal high grade LAD lesion and a huge infarct
> salvaged by lytics.
>
> -michael
>
>
>
> On 5/15/07, Nasser F. Abou'Seada <nfaabouseada at gmail.com> wrote:
> >
> > in a 72 yo, what is the indication of surgery? any reason why not PCI
> > / BMS, and PFO device closure? is it really Plavix ? what is the
> > nature of the lung mass?  any S&S ?
> >
> > NFA
> >
> > On 5/14/07, Michael Firstenberg <msfirst at gmail.com> wrote:
> > > Just got a call from my friendly interventionalist.
> > >
> > > 72 year/old, multiple medical problems (nothing too bad), but has a
> > "lung
> > > mass" which may need work-up and treatment - so he really does not want
> > to
> > > put a proximal LAD stent in and keep her on Plavix forever.  He asked me
> > to
> > > do an off-pump LIMA to LAD.  Sounds good.  However, since her admission
> > > diagnosis was a anterior wall MI, we are letting her "cool down" (peak
> > > troponin 500 - yikes).  So we got an echo to eval function.  EF~30%,
> > little
> > > AI, little MR, moderate TR, elevated pulmonary pressures..... ok nothing
> > too
> > > bad.  Small PFO.
> > >
> > > Question: 1)  Off-pump LIMA-LAD and ignore the PFO
> > >               2)  On-pump LIMA-LAD and close the PFO
> > >               3)  Would anyone touch the tricuspid (sorry dont have the
> > > sizes)
> > >               4)   Let him put in a BMS and a clam-shell to the PFO and
> > > walk away..........
> > >
> > >
> > > Hate to go on pump just to fix a PFO - but she may get a lung resection
> > at
> > > some point and she already does have some pulm hypertension.
> > >
> > > ----thoughts/comments?
> > >
> > >
> > >
> > > -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