[HSF] (no subject)

[Michael Firstenberg]

Hal,

My concern with this young man is that these problems have been  
developing over time (unlike your recent 56 year/old redo who  
developed the infection over a short period of time and probably  
started with a fairly reasonable heart) and as such I wonder how much  
of his heart (not just the LV and RV) is burnt out.  What are the  
results of your eye-ball test?  If I am following the thread, people  
are proposing a mix of mechanical and tissue valves and repairs - yes,  
probably all "doable" but how long with it last?  Is he cachectic?  
severe fluid overload?

In response to the "transplant" question and ease in which it is  
tossed out - this is because I have seen some of these "big wacks" in  
young people who survive their operations and some how get lost to  
follow-up in a system (not that you, Hal, would do this - but someone  
has been watching this kid and I am sure this stuff did not develop  
overnight, right?) or simmer with CHF and marginal functional status  
until they disappear.....  Getting him a transplant - if that is an  
option - may get in plugged into a different system of healthcare  
providers who have a vested (if not selfish) interest in his long term  
survival??

Hey, at least I did not say BiVADS.......


-michael



On Aug 30, 2008, at 1:23 PM, hgrmd at aol.com wrote:

> MIchael,
>  I'm not sure that a transplant is a better deal for this 26 yo   
> man.  His
> EF is 60%, and I'm sure his coronaries are normal.  At worst  you do a
> mechanical Bentall, MVR, TVR, and pulmonary homograft.  Huge   
> operation, but
> definitely doable (3 weeks ago, I successfully did a redo  biologic  
> Bentall,
> mitral/tricuspid repairs, cryomaze on a 56 yo man with an  infected  
> 19 yo St Jude
> composite).  I suspect his projected risk and long  term survival  
> would be better
> than getting him listed, transplanted, and still  alive in 5 years.
>
> Hal
>
>
>
> **************It's only a deal if it's where you want to go. Find  
> your travel
> deal here.
> (http://information.travel.aol.com/deals?ncid=aoltrv00050000000047)
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