[HSF] Severe AS in a frail male patient

[Ben Bidstrup]

In patients like these, I defy the cardiologist's 
desire to operate yesterday and send at least 4 
if not more weeks getting the lungs right. I use 
a programmes based on the lung volume reduction. 
Optimize bronchodilator, inhaled steroids and 
other agents, exercise and regular measurements 
of peak flow or FEV1.

Antibiotics if indicated.

The extra time is well worth it.

>I have done 2 AVR`s on patients with bronchiectasis,
>and both never came off the ventilator.
>
>I am sure you can buy enough time to get him into a
>better condition, and further check out his lung
>condition. Does he have an active lung infection now?
>TB? What is the CRP? What is the FEV1? If it is less
>than 40%, with bronchiectasis, you are not likely to
>get him off the ventilator, so I would spare your
>resources, and if your waiting lists are like they are
>in the state hospitals in S Africa then why not triage
>and give the OR list to the other, probably almost as
>sick patient that has been waiting almost a year, and
>is about to fall off the perch?
>
>Dave Harris
>--- erdinç naseri <enaseri at hotmail.com.tr> wrote:
>
>>
>>  Dear Dr.Zhou,
>>  Though I did only 3 cases of minimally invasive AVR
>>  throughout my carrier ,my main concern is the
>>  detrimental effects of open heart surgery on
>>  noncardiac organs of this gentelman.
>>  erdinc> From: zzhoumd at pol.net> To:
>>  OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF]
>>  Severe AS in a frail male patient> Date: Fri, 7 Sep
>>  2007 13:09:35 -0400> CC: > > Can you do a mini
>>  invasive valve replacement?> > Z Zhou> > -----
>>  Original Message ----- > From: "psimha"
>>  <prasannasimha at gmail.com>> To:
>>  <OpenHeart-L at lists.hsforum.com>> Sent: Friday,
>>  September 07, 2007 8:09 AM> Subject: Re: [HSF]
>>  Severe AS in a frail male patient> > > Erdinc , you
>>  have a cruel referring cardiologist !!> You may have
>>  to do a bioprosthetic AVR as he has h/o hemoptysis.
>>  If you > need to do it quick in and out and the
>>  minimal necessary surgery.> Prasanna> erdinç naseri
>>  wrote:> > Opinion requested:> > 73 Y/O male very
>>  frail .Admitted with dyspnea and effort intolerance(
>>  can't walk witout help),gave a history of
>>  hemoptysis> > CXR: increased broncovascular
>>  markings,CM,calcification of aortic root very
>>  clearly seen> > Chest CT:bronchiectasis,severe
>>  calcification of aortic valve> > ECG:LVH> > Echo:EF(
>>  sim
>>   pson's) 25%,Aortic gradient 90 mmHg,AR+++,(
>>  leaflets mobility very decreased),MR++> >
>>  CAG:previously stented LAD open> > Cre:2.1 mgr/dl> >
>>  > > treated for lung condition and now it is our
>>  turn.I have got the impression that he won't survive
>>  the operation.> > erdinc > > > > > > > >
>>  _______________________________________________> >
>>  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 transmitted by the OpenHeart-L are
>>  subject to the policies and > > disclaimers posted
>>  at:> > http://www.hsforum.com/listdisclaim> >
>>  -----------------------------------------> >> >> > >
>>  > > _______________________________________________>
>>  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 transmitted by the OpenHeart-L are subject
>>  to the policies and > disclaimers posted at:>
>>  http://www.hsforum.com/listdisclaim>
>>  -----------------------------------------
>>  _______________________________________________
>>  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 transmitted by the OpenHeart-L are
>>  subject to the policies and
>>  disclaimers posted at:
>>  http://www.hsforum.com/listdisclaim
>  > -----------------------------------------
>>
>
>
>Dr. David G. Harris, FCS, MMED,
>Cardiothoracic Surgeon       
>Suite 207                               
>Kuils River Private Hospital,       
>PO Box 1200, Kuils River, 7579, Cape Town, South Africa.           
>Tel +27-21-9006411            
>Fax +27-21-9006412      Mobile +27-83-3309587
>
>_______________________________________________
>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 transmitted by the OpenHeart-L are subject to the policies and
>disclaimers posted at:
>http://www.hsforum.com/listdisclaim
>-----------------------------------------


-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon