[HSF] Severe AS in a frail male patient

Ben Bidstrup benjamin.bidstrup at bigpond.com
Tue Sep 11 18:42:53 EDT 2007 

Yes.

Not to my knowledge. (apart from the old procedure of plombage)
This is really part of a spectrum of operating on 
patients with marginal lung function e.g. lung 
resections.




>Dear Dr. Bidstrup,
>Do you mean volume reducing lung surgery or is 
>there any other way to decrease the lung volume.
>erdinc> Date: Mon, 10 Sep 2007 13:57:05 +1000> 
>To: OpenHeart-L at lists.hsforum.com> From: 
>benjamin.bidstrup at bigpond.com> Subject: RE: 
>[HSF] Severe AS in a frail male patient> CC: > > 
>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 > > > > > > > >> >> 
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>-----------------------------------------> >>> >> >> >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 
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>-- > Ben Bidstrup FRACS FRCSEd FEBCTS> 
>Consultant Cardiothoracic Surgeon> 
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon

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