AW: [HSF] angiogram and Denying CABG

[Tea Acuff]

Agree completely. But my answer is: Sure, but it depends. 

I'll see if I can think up a nonfuzzy quideline unless you beat me to it, Ani.

tea


----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Friday, October 12, 2007 11:29:56 AM
Subject: RE: AW: [HSF] angiogram and Denying CABG


An extension to this question is the differentiation between an ungraftable vessel and a clinically irrelevant vessel. Many a time, surgeons would bypass the latter and boast about our prowess for grafting 0.7mm vessels sometimes doing 5 or 6 such bypasses in a patient with diffuse disease. Though possibly beneficial to the surgeon's ego, it is less certain that bypasses of this nature are beneficial to the patient.

Like all other discussions, that something can be done does not necessarily mean it should be done.

Definition of a poor target would take into account not just the size of a vessel but its size in the context of the rest of the coronary anatomy (including its own proximal feed and distal run-off), the function of the ventricle and even the condition of patient from who the catheter image actually came from (Like cardiologists sometimes we forget these images are from patients - in the UK I worked with a few surgeons who operated on angiograms without ever seeing the patient before or indeed after surgery).

Ani




> Date: Fri, 12 Oct 2007 08:44:32 -0700> From: jamesle2007 at yahoo.com> Subject: Re: AW: [HSF] angiogram and Denying CABG> To: OpenHeart-L at lists.hsforum.com> CC: > > > what is a poor target? it has different meanings for different> surgeons.> should we take any thing less than 1mm by angiogram as poor target?> should the measurement be by computer programmes or simply by eye> balling?> Vessels on the anterior and posterior walls of the heart and the> catheter in the aorta are at a different distance from the camera . Does> it affect the magnification of vessels differently?> > > > > ---------------------------------> Catch up on fall's hot new shows on Yahoo! TV. Watch previews, get listings, and more!> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages
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