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

[Tea Acuff]

Starting with the new MI, not the end stage ventricle, what percentage of patients do you think have segmental akinesis or marked hypokinesis?  Use whatever qualifiers you like, but quess a number.
tea


----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, May 17, 2007 5:39:07 AM
Subject: Re: [HSF] Another on vs off pump question......


Hal

I agree. However very few patients with ischemic cardiomyopathy have aneurysms. With primary PCI and thrombolysis the incidence of these is low. If a patient has an aneurysm and MR, surgery as you describe will be preferable provided we have reasonable contractility, or expectation of contractility in the lateral or inferior segments. Transplantation is a last resort for the globally dilated ischemic ventricle only and not for a segmental aneurysm or akinesia.

Ani
  ----- Original Message ----- 
  From: Hgrmd at aol.com<mailto:Hgrmd at aol.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Thursday, May 17, 2007 6:26 AM
  Subject: Re: [HSF] Another on vs off pump question......


  Tea,
    I would echo your comments about Ani's evaluation of transplant  patients.  
  Perhaps some of those large anterior aneurysms would be better  treated with 
  surgical ventricular restoration rather than transplantation.   Yesterday, I 
  saw a lady in the office that I had done SVR, CABG, mitral, and  tricuspid 
  repair several months ago.  She went from Class III to I. Her EF  went from 15% 
  preop to 35% on a recent transthoracic echo.  I've still got  the biventricular 
  ICD option should she ever need it.  Tomorrow, I've got a  similar case.  I 
  really need to get a picture of the one tomorrow, because  the calcified 
  anteroapical aneurysm is bigger than the remaining heart.
  Hal



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