From invitation at unyk.com Mon Dec 1 02:30:26 2008 From: invitation at unyk.com (Roberto Rafael Battellini) Date: Mon Dec 1 02:30:45 2008 Subject: [HSF] =?iso-8859-1?q?Invitaci=F3n_personal_de_Roberto_Rafael_Bat?= =?iso-8859-1?q?tellini?= Message-ID: <20081201023026.956550547@unyk.com> Invitaci?n personal de Roberto Rafael Battellini From damle at cableone.net Mon Dec 1 02:59:22 2008 From: damle at cableone.net (Ajit Damle) Date: Mon Dec 1 04:06:09 2008 Subject: [HSF] STS Annual meeting In-Reply-To: <20081201023026.956550547@unyk.com> Message-ID: Any plans for HSF to meet during STS in San Francisco, Jan 09? Ajit Damle From msfirst at gmail.com Mon Dec 1 18:51:12 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Mon Dec 1 18:51:41 2008 Subject: [HSF] Another disaster endocarditis...... Message-ID: OK - you think we could get these problems sorted out. 71 year/old prisoner was found "down" in his cell Intubated by EMS in route. Presumed cause was a large (and I mean large) right MCA CVA with diffuse hemispheric edema. Initial blood cultures positive to MSSA (allergic to PCN) - current set negaitve x1 day Chronic dialysis - surprisingly has a fistula (presumed source) Untreated Hep C (liver numbers OK, but dont know viral titers or HIV status) Recent diagnosis of Gleason (sp?) 9 prostate adenoCA Large vegetation on mitral with severe MR. Thickened aortic valve with mild AI, no obvious AS or signs of infection. Currently intubated on minimal settings (CXR shows diffuse pulm edema) and sedate, but awake follows commands but not moving left side. Obviously needs cath Would like to see him off the vent first - if possible. I favor operate sooner rather than later (i.e. before worse CHF and more complications) - like in the next couple of days. Surprisingly Cardiology want to wait and tune him up??? Plan for MVReplace (tissue obviously) (grafts based upon cath) and probably leave the aortic alone - depending on AI......... or any "mitral reference surgeons" want to accept the transfer and plan a repair? -michael From ebender001 at me.com Mon Dec 1 18:04:53 2008 From: ebender001 at me.com (Edward Bender) Date: Mon Dec 1 19:05:29 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: Message-ID: If he's a "lifer," he may be nearing the end of his sentence. Ed Bender, MD On 12/1/08 5:51 PM, "Michael Firstenberg" wrote: > OK - you think we could get these problems sorted out. > > 71 year/old prisoner was found "down" in his cell > Intubated by EMS in route. > Presumed cause was a large (and I mean large) right MCA CVA with diffuse > hemispheric edema. > Initial blood cultures positive to MSSA (allergic to PCN) - current set > negaitve x1 day > Chronic dialysis - surprisingly has a fistula (presumed source) > Untreated Hep C (liver numbers OK, but dont know viral titers or HIV status) > Recent diagnosis of Gleason (sp?) 9 prostate adenoCA > > Large vegetation on mitral with severe MR. Thickened aortic valve with mild > AI, no obvious AS or signs of infection. > > Currently intubated on minimal settings (CXR shows diffuse pulm edema) and > sedate, but awake follows commands but not moving left side. > > Obviously needs cath > Would like to see him off the vent first - if possible. > > I favor operate sooner rather than later (i.e. before worse CHF and more > complications) - like in the next couple of days. Surprisingly Cardiology > want to wait and tune him up??? > > Plan for MVReplace (tissue obviously) (grafts based upon cath) and probably > leave the aortic alone - depending on AI......... > > > or any "mitral reference surgeons" want to accept the transfer and plan a > repair? > > > -michael > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From msfirst at gmail.com Mon Dec 1 19:42:46 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Mon Dec 1 19:43:24 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: Message-ID: We have the prison contract for the state and typically I dont look up the details (of course available online) - but in this case should it make a difference why he is in jail and for how long? -michael On Dec 1, 2008, at 7:04 PM, Edward Bender wrote: > If he's a "lifer," he may be nearing the end of his sentence. > > Ed Bender, MD > > > On 12/1/08 5:51 PM, "Michael Firstenberg" wrote: > >> OK - you think we could get these problems sorted out. >> >> 71 year/old prisoner was found "down" in his cell >> Intubated by EMS in route. >> Presumed cause was a large (and I mean large) right MCA CVA with >> diffuse >> hemispheric edema. >> Initial blood cultures positive to MSSA (allergic to PCN) - current >> set >> negaitve x1 day >> Chronic dialysis - surprisingly has a fistula (presumed source) >> Untreated Hep C (liver numbers OK, but dont know viral titers or >> HIV status) >> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA >> >> Large vegetation on mitral with severe MR. Thickened aortic valve >> with mild >> AI, no obvious AS or signs of infection. >> >> Currently intubated on minimal settings (CXR shows diffuse pulm >> edema) and >> sedate, but awake follows commands but not moving left side. >> >> Obviously needs cath >> Would like to see him off the vent first - if possible. >> >> I favor operate sooner rather than later (i.e. before worse CHF and >> more >> complications) - like in the next couple of days. Surprisingly >> Cardiology >> want to wait and tune him up??? >> >> Plan for MVReplace (tissue obviously) (grafts based upon cath) and >> probably >> leave the aortic alone - depending on AI......... >> >> >> or any "mitral reference surgeons" want to accept the transfer and >> plan a >> repair? >> >> >> -michael >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 > ----------------------------------------- From ebender001 at me.com Mon Dec 1 18:49:47 2008 From: ebender001 at me.com (Edward Bender) Date: Mon Dec 1 19:53:56 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: Message-ID: Mike: My post wasn't attempting an ethical point, but a medical one. Ed Bender, MD On 12/1/08 6:42 PM, "Michael Firstenberg" wrote: > We have the prison contract for the state and typically I dont look up > the details (of course available online) - but in this case should it > make a difference why he is in jail and for how long? > > > > -michael > > > > On Dec 1, 2008, at 7:04 PM, Edward Bender wrote: > >> If he's a "lifer," he may be nearing the end of his sentence. >> >> Ed Bender, MD >> >> >> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote: >> >>> OK - you think we could get these problems sorted out. >>> >>> 71 year/old prisoner was found "down" in his cell >>> Intubated by EMS in route. >>> Presumed cause was a large (and I mean large) right MCA CVA with >>> diffuse >>> hemispheric edema. >>> Initial blood cultures positive to MSSA (allergic to PCN) - current >>> set >>> negaitve x1 day >>> Chronic dialysis - surprisingly has a fistula (presumed source) >>> Untreated Hep C (liver numbers OK, but dont know viral titers or >>> HIV status) >>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA >>> >>> Large vegetation on mitral with severe MR. Thickened aortic valve >>> with mild >>> AI, no obvious AS or signs of infection. >>> >>> Currently intubated on minimal settings (CXR shows diffuse pulm >>> edema) and >>> sedate, but awake follows commands but not moving left side. >>> >>> Obviously needs cath >>> Would like to see him off the vent first - if possible. >>> >>> I favor operate sooner rather than later (i.e. before worse CHF and >>> more >>> complications) - like in the next couple of days. Surprisingly >>> Cardiology >>> want to wait and tune him up??? >>> >>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and >>> probably >>> leave the aortic alone - depending on AI......... >>> >>> >>> or any "mitral reference surgeons" want to accept the transfer and >>> plan a >>> repair? >>> >>> >>> -michael >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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 > ----------------------------------------- From wftjrtyler at aol.com Mon Dec 1 20:01:16 2008 From: wftjrtyler at aol.com (wftjrtyler@aol.com) Date: Mon Dec 1 20:02:18 2008 Subject: [HSF] Another disaster endocarditis...... Message-ID: i bet this fellow is funded via contract,etc(a convicted criminal) yet millions of Americans are not(non criminals) Tea,Bob ,or Ani please reconcile this paradox to me bill turner In a message dated 12/1/2008 5:53:51 P.M. Central Standard Time, msfirst@gmail.com writes: OK - you think we could get these problems sorted out. 71 year/old prisoner was found "down" in his cell Intubated by EMS in route. Presumed cause was a large (and I mean large) right MCA CVA with diffuse hemispheric edema. Initial blood cultures positive to MSSA (allergic to PCN) - current set negaitve x1 day Chronic dialysis - surprisingly has a fistula (presumed source) Untreated Hep C (liver numbers OK, but dont know viral titers or HIV status) Recent diagnosis of Gleason (sp?) 9 prostate adenoCA Large vegetation on mitral with severe MR. Thickened aortic valve with mild AI, no obvious AS or signs of infection. Currently intubated on minimal settings (CXR shows diffuse pulm edema) and sedate, but awake follows commands but not moving left side. Obviously needs cath Would like to see him off the vent first - if possible. I favor operate sooner rather than later (i.e. before worse CHF and more complications) - like in the next couple of days. Surprisingly Cardiology want to wait and tune him up??? Plan for MVReplace (tissue obviously) (grafts based upon cath) and probably leave the aortic alone - depending on AI......... or any "mitral reference surgeons" want to accept the transfer and plan a repair? -michael _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- **************Life should be easier. So should your homepage. Try the NEW AOL.com. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000002) From msfirst at gmail.com Mon Dec 1 20:01:55 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Mon Dec 1 20:08:23 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: Message-ID: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> I know - but it does raise an ethical question, does it not? Therapy is often withheld or altered for a variety of social/ethical/ economic reasons - for example VADs in prisoners are a bad idea since the follow-up is so poor (not to mention compliance). -michael On Dec 1, 2008, at 7:49 PM, Edward Bender wrote: > Mike: > My post wasn't attempting an ethical point, but a medical one. > Ed Bender, MD > > > On 12/1/08 6:42 PM, "Michael Firstenberg" wrote: > >> We have the prison contract for the state and typically I dont look >> up >> the details (of course available online) - but in this case should it >> make a difference why he is in jail and for how long? >> >> >> >> -michael >> >> >> >> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote: >> >>> If he's a "lifer," he may be nearing the end of his sentence. >>> >>> Ed Bender, MD >>> >>> >>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote: >>> >>>> OK - you think we could get these problems sorted out. >>>> >>>> 71 year/old prisoner was found "down" in his cell >>>> Intubated by EMS in route. >>>> Presumed cause was a large (and I mean large) right MCA CVA with >>>> diffuse >>>> hemispheric edema. >>>> Initial blood cultures positive to MSSA (allergic to PCN) - current >>>> set >>>> negaitve x1 day >>>> Chronic dialysis - surprisingly has a fistula (presumed source) >>>> Untreated Hep C (liver numbers OK, but dont know viral titers or >>>> HIV status) >>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA >>>> >>>> Large vegetation on mitral with severe MR. Thickened aortic valve >>>> with mild >>>> AI, no obvious AS or signs of infection. >>>> >>>> Currently intubated on minimal settings (CXR shows diffuse pulm >>>> edema) and >>>> sedate, but awake follows commands but not moving left side. >>>> >>>> Obviously needs cath >>>> Would like to see him off the vent first - if possible. >>>> >>>> I favor operate sooner rather than later (i.e. before worse CHF and >>>> more >>>> complications) - like in the next couple of days. Surprisingly >>>> Cardiology >>>> want to wait and tune him up??? >>>> >>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and >>>> probably >>>> leave the aortic alone - depending on AI......... >>>> >>>> >>>> or any "mitral reference surgeons" want to accept the transfer and >>>> plan a >>>> repair? >>>> >>>> >>>> -michael >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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@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@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 > ----------------------------------------- From wftjrtyler at aol.com Mon Dec 1 20:10:25 2008 From: wftjrtyler at aol.com (wftjrtyler@aol.com) Date: Mon Dec 1 20:11:28 2008 Subject: [HSF] Another disaster endocarditis...... Message-ID: that is....we(taxpayers) fund the prisoners but........bt In a message dated 12/1/2008 7:04:07 P.M. Central Standard Time, wftjrtyler@aol.com writes: i bet this fellow is funded via contract,etc(a convicted criminal) yet millions of Americans are not(non criminals) Tea,Bob ,or Ani please reconcile this paradox to me bill turner In a message dated 12/1/2008 5:53:51 P.M. Central Standard Time, msfirst@gmail.com writes: OK - you think we could get these problems sorted out. 71 year/old prisoner was found "down" in his cell Intubated by EMS in route. Presumed cause was a large (and I mean large) right MCA CVA with diffuse hemispheric edema. Initial blood cultures positive to MSSA (allergic to PCN) - current set negaitve x1 day Chronic dialysis - surprisingly has a fistula (presumed source) Untreated Hep C (liver numbers OK, but dont know viral titers or HIV status) Recent diagnosis of Gleason (sp?) 9 prostate adenoCA Large vegetation on mitral with severe MR. Thickened aortic valve with mild AI, no obvious AS or signs of infection. Currently intubated on minimal settings (CXR shows diffuse pulm edema) and sedate, but awake follows commands but not moving left side. Obviously needs cath Would like to see him off the vent first - if possible. I favor operate sooner rather than later (i.e. before worse CHF and more complications) - like in the next couple of days. Surprisingly Cardiology want to wait and tune him up??? Plan for MVReplace (tissue obviously) (grafts based upon cath) and probably leave the aortic alone - depending on AI......... or any "mitral reference surgeons" want to accept the transfer and plan a repair? -michael _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- **************Life should be easier. So should your homepage. Try the NEW AOL.com. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom0000000 2) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- **************Life should be easier. So should your homepage. Try the NEW AOL.com. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000002) From ebender001 at me.com Mon Dec 1 19:43:48 2008 From: ebender001 at me.com (Edward Bender) Date: Mon Dec 1 20:48:05 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: Just treat the patient like you would any other stroked out, ventilated, dialysis dependent 71 year old with probable 2 valve endocarditis. He will be near the end of his sentence regardless of whether you feel like you acted ethically or not. If you truly believe that you are fulfilling your duty as a doctor and a human being, then you are acting ethically independent of the process. You could however consider yourself immoral no matter what choice you make. Ed Bender, MD On 12/1/08 7:01 PM, "Michael Firstenberg" wrote: > I know - but it does raise an ethical question, does it not? > > Therapy is often withheld or altered for a variety of social/ethical/ > economic reasons - for example VADs in prisoners are a bad idea since > the follow-up is so poor (not to mention compliance). > > > -michael > > > On Dec 1, 2008, at 7:49 PM, Edward Bender wrote: > >> Mike: >> My post wasn't attempting an ethical point, but a medical one. >> Ed Bender, MD >> >> >> On 12/1/08 6:42 PM, "Michael Firstenberg" wrote: >> >>> We have the prison contract for the state and typically I dont look >>> up >>> the details (of course available online) - but in this case should it >>> make a difference why he is in jail and for how long? >>> >>> >>> >>> -michael >>> >>> >>> >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote: >>> >>>> If he's a "lifer," he may be nearing the end of his sentence. >>>> >>>> Ed Bender, MD >>>> >>>> >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote: >>>> >>>>> OK - you think we could get these problems sorted out. >>>>> >>>>> 71 year/old prisoner was found "down" in his cell >>>>> Intubated by EMS in route. >>>>> Presumed cause was a large (and I mean large) right MCA CVA with >>>>> diffuse >>>>> hemispheric edema. >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current >>>>> set >>>>> negaitve x1 day >>>>> Chronic dialysis - surprisingly has a fistula (presumed source) >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or >>>>> HIV status) >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA >>>>> >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve >>>>> with mild >>>>> AI, no obvious AS or signs of infection. >>>>> >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm >>>>> edema) and >>>>> sedate, but awake follows commands but not moving left side. >>>>> >>>>> Obviously needs cath >>>>> Would like to see him off the vent first - if possible. >>>>> >>>>> I favor operate sooner rather than later (i.e. before worse CHF and >>>>> more >>>>> complications) - like in the next couple of days. Surprisingly >>>>> Cardiology >>>>> want to wait and tune him up??? >>>>> >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and >>>>> probably >>>>> leave the aortic alone - depending on AI......... >>>>> >>>>> >>>>> or any "mitral reference surgeons" want to accept the transfer and >>>>> plan a >>>>> repair? >>>>> >>>>> >>>>> -michael >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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@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@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@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 > ----------------------------------------- From prasannasimha at gmail.com Tue Dec 2 07:25:52 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Dec 1 20:56:21 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: Message-ID: <89c4ed2d0812011755t33dde081ld18f7f9b2234a551@mail.gmail.com> The astatus of a Prisoner is immaterial to treatment.Medical ethics demands that you treat him independently of his Prosoner status. It is for the legal services to decide about his legal status. Prasanna On Tue, Dec 2, 2008 at 6:12 AM, Michael Firstenberg wrote: > We have the prison contract for the state and typically I dont look up the > details (of course available online) - but in this case should it make a > difference why he is in jail and for how long? > > > > -michael > > > > On Dec 1, 2008, at 7:04 PM, Edward Bender wrote: > >> If he's a "lifer," he may be nearing the end of his sentence. >> >> Ed Bender, MD >> >> >> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote: >> >>> OK - you think we could get these problems sorted out. >>> >>> 71 year/old prisoner was found "down" in his cell >>> Intubated by EMS in route. >>> Presumed cause was a large (and I mean large) right MCA CVA with diffuse >>> hemispheric edema. >>> Initial blood cultures positive to MSSA (allergic to PCN) - current set >>> negaitve x1 day >>> Chronic dialysis - surprisingly has a fistula (presumed source) >>> Untreated Hep C (liver numbers OK, but dont know viral titers or HIV >>> status) >>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA >>> >>> Large vegetation on mitral with severe MR. Thickened aortic valve with >>> mild >>> AI, no obvious AS or signs of infection. >>> >>> Currently intubated on minimal settings (CXR shows diffuse pulm edema) >>> and >>> sedate, but awake follows commands but not moving left side. >>> >>> Obviously needs cath >>> Would like to see him off the vent first - if possible. >>> >>> I favor operate sooner rather than later (i.e. before worse CHF and more >>> complications) - like in the next couple of days. Surprisingly >>> Cardiology >>> want to wait and tune him up??? >>> >>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and >>> probably >>> leave the aortic alone - depending on AI......... >>> >>> >>> or any "mitral reference surgeons" want to accept the transfer and plan a >>> repair? >>> >>> >>> -michael >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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 > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From Hgrmd at aol.com Mon Dec 1 20:57:29 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Mon Dec 1 20:58:07 2008 Subject: [HSF] Another disaster endocarditis...... Message-ID: Michael, If I operated, I would definitely consider repairing the valve if possible. Just radically debride and see what's left. If the infection is diffuse, then forget about it and replace the valve. However, I've repaired tons of them and only had to reoperate one (about 10 days postop). This particular patient was one of the first ones I ever tried to repair. As far as his insurance status, I don't let that dictate my treatment. Hal **************Life should be easier. So should your homepage. Try the NEW AOL.com. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000002) From msfirst at gmail.com Mon Dec 1 20:52:51 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Mon Dec 1 20:58:54 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: Message-ID: <1CE9F2DC-3147-4C43-8B50-95947783DBBF@gmail.com> Hate to break it to you We pay for it regardless -michael. On Dec 1, 2008, at 8:10 PM, wftjrtyler@aol.com wrote: > that is....we(taxpayers) fund the prisoners but........bt > > > In a message dated 12/1/2008 7:04:07 P.M. Central Standard Time, > wftjrtyler@aol.com writes: > > i bet this fellow is funded via contract,etc(a convicted > criminal) yet > millions of Americans are not(non criminals) Tea,Bob ,or Ani > please > reconcile this paradox to me bill turner > > > In a message dated 12/1/2008 5:53:51 P.M. Central Standard Time, > msfirst@gmail.com writes: > > OK - you think we could get these problems sorted out. > > 71 year/old prisoner was found "down" in his cell > Intubated by EMS in route. > Presumed cause was a large (and I mean large) right MCA CVA with > diffuse > hemispheric edema. > Initial blood cultures positive to MSSA (allergic to PCN) - > current set > negaitve x1 day > Chronic dialysis - surprisingly has a fistula (presumed source) > Untreated Hep C (liver numbers OK, but dont know viral titers or > HIV status) > Recent diagnosis of Gleason (sp?) 9 prostate adenoCA > > Large vegetation on mitral with severe MR. Thickened aortic valve > with mild > AI, no obvious AS or signs of infection. > > Currently intubated on minimal settings (CXR shows diffuse pulm > edema) and > sedate, but awake follows commands but not moving left side. > > Obviously needs cath > Would like to see him off the vent first - if possible. > > I favor operate sooner rather than later (i.e. before worse CHF > and more > complications) - like in the next couple of days. Surprisingly > Cardiology > want to wait and tune him up??? > > Plan for MVReplace (tissue obviously) (grafts based upon cath) and > probably > leave the aortic alone - depending on AI......... > > > or any "mitral reference surgeons" want to accept the transfer and > plan a > repair? > > > -michael > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > > **************Life should be easier. So should your homepage. Try > the NEW > AOL.com. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom0000000 > 2) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > > **************Life should be easier. So should your homepage. Try > the NEW > AOL.com. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000002 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From Hgrmd at aol.com Mon Dec 1 21:00:40 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Mon Dec 1 21:01:16 2008 Subject: [HSF] STS Annual meeting Message-ID: Ajit, Seeing as how I've organized the last 2 HSF STS dinner meetings, I will let someone else have the honor this time. I plan to be in San Francisco and will certainly block out the time if the event is held. Hope to see you there. Hal **************Life should be easier. So should your homepage. Try the NEW AOL.com. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000002) From msfirst at gmail.com Mon Dec 1 21:13:32 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Mon Dec 1 21:39:32 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: <89c4ed2d0812011755t33dde081ld18f7f9b2234a551@mail.gmail.com> References: <89c4ed2d0812011755t33dde081ld18f7f9b2234a551@mail.gmail.com> Message-ID: <35F2CFDC-1F2C-4479-8947-1B510A7DBCBD@gmail.com> We are all gods children But should I operate and thoughts on timing? -michael. On Dec 1, 2008, at 8:55 PM, "Prasanna Simha M" wrote: > The astatus of a Prisoner is immaterial to treatment.Medical ethics > demands that you treat him independently of his Prosoner status. It is > for the legal services to decide about his legal status. > Prasanna > > On Tue, Dec 2, 2008 at 6:12 AM, Michael Firstenberg > wrote: >> We have the prison contract for the state and typically I dont look >> up the >> details (of course available online) - but in this case should it >> make a >> difference why he is in jail and for how long? >> >> >> >> -michael >> >> >> >> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote: >> >>> If he's a "lifer," he may be nearing the end of his sentence. >>> >>> Ed Bender, MD >>> >>> >>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote: >>> >>>> OK - you think we could get these problems sorted out. >>>> >>>> 71 year/old prisoner was found "down" in his cell >>>> Intubated by EMS in route. >>>> Presumed cause was a large (and I mean large) right MCA CVA with >>>> diffuse >>>> hemispheric edema. >>>> Initial blood cultures positive to MSSA (allergic to PCN) - >>>> current set >>>> negaitve x1 day >>>> Chronic dialysis - surprisingly has a fistula (presumed source) >>>> Untreated Hep C (liver numbers OK, but dont know viral titers or >>>> HIV >>>> status) >>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA >>>> >>>> Large vegetation on mitral with severe MR. Thickened aortic >>>> valve with >>>> mild >>>> AI, no obvious AS or signs of infection. >>>> >>>> Currently intubated on minimal settings (CXR shows diffuse pulm >>>> edema) >>>> and >>>> sedate, but awake follows commands but not moving left side. >>>> >>>> Obviously needs cath >>>> Would like to see him off the vent first - if possible. >>>> >>>> I favor operate sooner rather than later (i.e. before worse CHF >>>> and more >>>> complications) - like in the next couple of days. Surprisingly >>>> Cardiology >>>> want to wait and tune him up??? >>>> >>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and >>>> probably >>>> leave the aortic alone - depending on AI......... >>>> >>>> >>>> or any "mitral reference surgeons" want to accept the transfer >>>> and plan a >>>> repair? >>>> >>>> >>>> -michael >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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@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 >> anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From prasannasimha at gmail.com Tue Dec 2 08:26:05 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Dec 1 22:04:28 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: <35F2CFDC-1F2C-4479-8947-1B510A7DBCBD@gmail.com> References: <89c4ed2d0812011755t33dde081ld18f7f9b2234a551@mail.gmail.com> <35F2CFDC-1F2C-4479-8947-1B510A7DBCBD@gmail.com> Message-ID: <89c4ed2d0812011856g72708ea5i94acd73583d4704a@mail.gmail.com> If he is stable fine tuning may be not a bad idea. If he has worsening sttus then go ahead. If antibiotics act , it makes a messy operation simpler. If it doesnt act in a few days going early would be better. Prasanna On Tue, Dec 2, 2008 at 7:43 AM, Michael Firstenberg wrote: > We are all gods children > > But should I operate and thoughts on timing? > > -michael. > > On Dec 1, 2008, at 8:55 PM, "Prasanna Simha M" > wrote: > >> The astatus of a Prisoner is immaterial to treatment.Medical ethics >> demands that you treat him independently of his Prosoner status. It is >> for the legal services to decide about his legal status. >> Prasanna >> >> On Tue, Dec 2, 2008 at 6:12 AM, Michael Firstenberg >> wrote: >>> >>> We have the prison contract for the state and typically I dont look up >>> the >>> details (of course available online) - but in this case should it make a >>> difference why he is in jail and for how long? >>> >>> >>> >>> -michael >>> >>> >>> >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote: >>> >>>> If he's a "lifer," he may be nearing the end of his sentence. >>>> >>>> Ed Bender, MD >>>> >>>> >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote: >>>> >>>>> OK - you think we could get these problems sorted out. >>>>> >>>>> 71 year/old prisoner was found "down" in his cell >>>>> Intubated by EMS in route. >>>>> Presumed cause was a large (and I mean large) right MCA CVA with >>>>> diffuse >>>>> hemispheric edema. >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current set >>>>> negaitve x1 day >>>>> Chronic dialysis - surprisingly has a fistula (presumed source) >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or HIV >>>>> status) >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA >>>>> >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve with >>>>> mild >>>>> AI, no obvious AS or signs of infection. >>>>> >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm edema) >>>>> and >>>>> sedate, but awake follows commands but not moving left side. >>>>> >>>>> Obviously needs cath >>>>> Would like to see him off the vent first - if possible. >>>>> >>>>> I favor operate sooner rather than later (i.e. before worse CHF and >>>>> more >>>>> complications) - like in the next couple of days. Surprisingly >>>>> Cardiology >>>>> want to wait and tune him up??? >>>>> >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and >>>>> probably >>>>> leave the aortic alone - depending on AI......... >>>>> >>>>> >>>>> or any "mitral reference surgeons" want to accept the transfer and plan >>>>> a >>>>> repair? >>>>> >>>>> >>>>> -michael >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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@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 >>> anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From rwmfglycar at aol.com Tue Dec 2 00:37:26 2008 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Tue Dec 2 00:38:07 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: <89c4ed2d0812011856g72708ea5i94acd73583d4704a@mail.gmail.com> References: <89c4ed2d0812011755t33dde081ld18f7f9b2234a551@mail.gmail.com><35F2CFDC-1F2C-4479-8947-1B510A7DBCBD@gmail.com> <89c4ed2d0812011856g72708ea5i94acd73583d4704a@mail.gmail.com> Message-ID: <8CB22573158A30B-1230-18D8@WEBMAIL-MY04.sysops.aol.com> I gather the CNS dominates. The decision to operate is dependent on intense observation. If the CNS is improving you can use cardiac status to guide the urgency and you are right to hope for time to sort out? his different problems, and right to recognise that most of the failures of emergency endocarditis surgery are caused by delay. Obviously you dismiss his prison status as a factor in the decision. Assume he is a friend. The best result you can hope for is a hemiplegic with other fatal diseases. Can he understand these issues. What does he want? No I am not joking. It is his choice.?He is entitled to say "let me die". He may even tell you to go to hell. Bob -----Original Message----- From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Mon, 1 Dec 2008 9:56 pm Subject: Re: [HSF] Another disaster endocarditis...... If he is stable fine tuning may be not a bad idea. If he has worsening sttus then go ahead. If antibiotics act , it makes a messy operation simpler. If it doesnt act in a few days going early would be better. Prasanna On Tue, Dec 2, 2008 at 7:43 AM, Michael Firstenberg wrote: > We are all gods children > > But should I operate and thoughts on timing? > > -michael. > > On Dec 1, 2008, at 8:55 PM, "Prasanna Simha M" > wrote: > >> The astatus of a Prisoner is immaterial to treatment.Medical ethics >> demands that you treat him independently of his Prosoner status. It is >> for the legal services to decide about his legal status. >> Prasanna >> >> On Tue, Dec 2, 2008 at 6:12 AM, Michael Firstenberg >> wrote: >>> >>> We have the prison contract for the state and typically I dont look up >>> the >>> details (of course available online) - but in this case should it make a >>> difference why he is in jail and for how long? >>> >>> >>> >>> -michael >>> >>> >>> >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote: >>> >>>> If he's a "lifer," he may be nearing the end of his sentence. >>>> >>>> Ed Bender, MD >>>> >>>> >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote: >>>> >>>>> OK - you think we could get these problems sorted out. >>>>> >>>>> 71 year/old prisoner was found "down" in his cell >>>>> Intubated by EMS in route. >>>>> Presumed cause was a large (and I mean large) right MCA CVA with >>>>> diffuse >>>>> hemispheric edema. >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current set >>>>> negaitve x1 day >>>>> Chronic dialysis - surprisingly has a fistula (presumed source) >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or HIV >>>>> status) >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA >>>>> >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve with >>>>> mild >>>>> AI, no obvious AS or signs of infection. >>>>> >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm edema) >>>>> and >>>>> sedate, but awake follows commands but not moving left side. >>>>> >>>>> Obviously needs cath >>>>> Would like to see him off the vent first - if possible. >>>>> >>>>> I favor operate sooner rather than later (i.e. before worse CHF and >>>>> more >>>>> complications) - like in the next couple of days. Surprisingly >>>>> Cardiology >>>>> want to wait and tune him up??? >>>>> >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and >>>>> probably >>>>> leave the aortic alone - depending on AI......... >>>>> >>>>> >>>>> or any "mitral reference surgeons" want to accept the transfer and plan >>>>> a >>>>> repair? >>>>> >>>>> >>>>> -michael >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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@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 >>> anddiscl aimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From anianyanwu at hotmail.com Tue Dec 2 09:35:09 2008 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Tue Dec 2 04:35:59 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old I disagree and would suggest that this patients prison status and his sentence is VERY important in making a decision as to how to manage his problem. In saying this I am assuming he has suffered permanent neurological injury. If so regardless of whatever heroic surgery we do his survival is limited if he has to go back to a prison to rehabhilitate from a stroke. Also his personal choice may be that living in a prison is bad enough and that he does not want to live in a prison severely disabled. On the other hand if he were to be released from prison in six months and had good social support then a 'useful' survival may be feasible with his dense hemiplegia. The BMJ published an episode few years back titled ' a good death' with series of ethical and medical articles stating how and why we should strive to provide our patients with a good death. Nature is providing this poor prisoner with a good death and we want to steal it away and ensure he lives to 'suffer' out the rest of his (?life) sentence. As surgeons we must look beyond 'saving life' and operative survival and ask what we are actually achieving for the quality of the life of the person in front of us beyond survival of surgery. While not privy to the whole clinical and social scenario, my inclination would be that this patient should not be operated because as a surgeon you cannot restore HIM to a reasonable quality of life. The prologue suggests that this is a sick terminally ill 71 year old and that the stroke and endocarditis are just the mechanism, rather than a prevantable cause, of death - why do we as heart surgeons find it difficult to accept the concept that patients do die of sickness or refuse to accept death can occur till we spend 500,000 USD of health care resources? For those who will fix the valve, will you also transplant his kidneys, liver and do a robotic prostatectomy at the same time? Where do we stop? Ani > Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another disaster endocarditis......> From: ebender001@me.com> To: OpenHeart-L@lists.hsforum.com> CC: > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old with probable 2 valve endocarditis. He will> be near the end of his sentence regardless of whether you feel like you> acted ethically or not. If you truly believe that you are fulfilling your> duty as a doctor and a human being, then you are acting ethically> independent of the process. You could however consider yourself immoral no> matter what choice you make.> > Ed Bender, MD> > > On 12/1/08 7:01 PM, "Michael Firstenberg" wrote:> > > I know - but it does raise an ethical question, does it not?> > > > Therapy is often withheld or altered for a variety of social/ethical/> > economic reasons - for example VADs in prisoners are a bad idea since> > the follow-up is so poor (not to mention compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM, Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42 PM, "Michael Firstenberg" wrote:> >> > >>> We have the prison contract for the state and typically I dont look> >>> up> >>> the details (of course available online) - but in this case should it> >>> make a difference why he is in jail and for how long?> >>> > >>> > >>> > >>> -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.> >>>>> Presumed cause was a large (and I mean large) right MCA CVA with> >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1 day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)> >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or> >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>> complications) - like in the next couple of days. Surprisingly> >>>>> Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably> >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> > >>>>> or any "mitral reference surgeons" want to accept the transfer and> >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>> _______________________________________________> >>>>> OpenHeart-L mailing list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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> ----------------------------------------- _________________________________________________________________ Are you a PC?? Upload your PC story and show the world http://clk.atdmt.com/UKM/go/122465942/direct/01/ From msfirst at gmail.com Tue Dec 2 06:38:26 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Tue Dec 2 06:38:51 2008 Subject: [HSF] STS Annual meeting In-Reply-To: References: Message-ID: Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, > Seeing as how I've organized the last 2 HSF STS dinner meetings, I will > let someone else have the honor this time. I plan to be in San Francisco > and > will certainly block out the time if the event is held. Hope to see you > there. > > Hal > **************Life should be easier. So should your homepage. Try the NEW > AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000002 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > From msfirst at gmail.com Tue Dec 2 06:35:37 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Tue Dec 2 06:41:26 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: One of the aspects of this that bothers me about these kinds of cases is that we can "fix" him and get him completely tunes up - as much as modern medicine can - but then we turn him back to the "society" in which he came from and will have no rehab or further support. In particular, I have seem huge neuro improvements in some of the patients that we rehab on our surgical service or that we send to top notch rehab facilities. But, other than that - off to a LTAC or worse and the first time they get a UTI, pneumonia, or whatever and support gets withdrawn (even if they have only been there for a few days). Very painful to see all of that hard work and potential for progress go down the drain. On Tue, Dec 2, 2008 at 4:35 AM, Ani Anyanwu wrote: > > > Just treat the patient like you would any other stroked out, ventilated,> > dialysis dependent 71 year old > > > I disagree and would suggest that this patients prison status and his > sentence is VERY important in making a decision as to how to manage his > problem. In saying this I am assuming he has suffered permanent neurological > injury. If so regardless of whatever heroic surgery we do his survival is > limited if he has to go back to a prison to rehabhilitate from a stroke. > Also his personal choice may be that living in a prison is bad enough and > that he does not want to live in a prison severely disabled. On the other > hand if he were to be released from prison in six months and had good social > support then a 'useful' survival may be feasible with his dense hemiplegia. > The BMJ published an episode few years back titled ' a good death' with > series of ethical and medical articles stating how and why we should strive > to provide our patients with a good death. Nature is providing this poor > prisoner with a good death and we want to steal it away and ensure he lives > to 'suffer' out the rest of his (?life) sentence. > > As surgeons we must look beyond 'saving life' and operative survival and > ask what we are actually achieving for the quality of the life of the person > in front of us beyond survival of surgery. While not privy to the whole > clinical and social scenario, my inclination would be that this patient > should not be operated because as a surgeon you cannot restore HIM to a > reasonable quality of life. The prologue suggests that this is a sick > terminally ill 71 year old and that the stroke and endocarditis are just the > mechanism, rather than a prevantable cause, of death - why do we as heart > surgeons find it difficult to accept the concept that patients do die of > sickness or refuse to accept death can occur till we spend 500,000 USD of > health care resources? For those who will fix the valve, will you also > transplant his kidneys, liver and do a robotic prostatectomy at the same > time? Where do we stop? > > Ani > > > Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another disaster > endocarditis......> From: ebender001@me.com> To: > OpenHeart-L@lists.hsforum.com> CC: > > Just treat the patient like you > would any other stroked out, ventilated,> dialysis dependent 71 year old > with probable 2 valve endocarditis. He will> be near the end of his sentence > regardless of whether you feel like you> acted ethically or not. If you > truly believe that you are fulfilling your> duty as a doctor and a human > being, then you are acting ethically> independent of the process. You could > however consider yourself immoral no> matter what choice you make.> > Ed > Bender, MD> > > On 12/1/08 7:01 PM, "Michael Firstenberg" < > msfirst@gmail.com> wrote:> > > I know - but it does raise an ethical > question, does it not?> > > > Therapy is often withheld or altered for a > variety of social/ethical/> > economic reasons - for example VADs in > prisoners are a bad idea since> > the follow-up is so poor (not to mention > compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM, > Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical > point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42 > PM, "Michael Firstenberg" wrote:> >> > >>> We have the > prison contract for the state and typically I dont look> >>> up> >>> the > details (of course available online) - but in this case should it> >>> make > a difference why he is in jail and for how long?> >>> > >>> > >>> > >>> > -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender > wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his > sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM, > "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you > think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old > prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.> > >>>>> Presumed cause was a large (and I mean large) right MCA CVA with> > >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures > positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1 > day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)> > >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or> > >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate > adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened > aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of > infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows > diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but > not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like > to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate > sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>> > complications) - like in the next couple of days. Surprisingly> >>>>> > Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for > MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably> > >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> > > >>>>> or any "mitral reference surgeons" want to accept the transfer and> > >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>> > _______________________________________________> >>>>> OpenHeart-L mailing > list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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> > ----------------------------------------- > _________________________________________________________________ > Are you a PC? Upload your PC story and show the world > > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > From benjamin.bidstrup at bigpond.com Tue Dec 2 21:43:02 2008 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Tue Dec 2 06:43:45 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: Here is another example of you are damned if you do and damned if you don't. A great question for the ethics section of a final year exam. We must take a step beyond the single organ doctors that we all to often become. If someone cannot look holistically, then who will. There will be no right answer - ever -. Is it money, is it fairness or is it just plain common sense that determines our response. Who knows. Ben Bidstrup FRACS FRCSEd FEBCTS Cardiothoracic Surgeon On 02/12/2008, at 7:35 PM, Ani Anyanwu wrote: > >> Just treat the patient like you would any other stroked out, >> ventilated,> dialysis dependent 71 year old > > > I disagree and would suggest that this patients prison status and > his sentence is VERY important in making a decision as to how to > manage his problem. In saying this I am assuming he has suffered > permanent neurological injury. If so regardless of whatever heroic > surgery we do his survival is limited if he has to go back to a > prison to rehabhilitate from a stroke. Also his personal choice may > be that living in a prison is bad enough and that he does not want > to live in a prison severely disabled. On the other hand if he were > to be released from prison in six months and had good social support > then a 'useful' survival may be feasible with his dense hemiplegia. > The BMJ published an episode few years back titled ' a good death' > with series of ethical and medical articles stating how and why we > should strive to provide our patients with a good death. Nature is > providing this poor prisoner with a good death and we want to steal > it away and ensure he lives to 'suffer' out the rest of his (?life) > sentence. > > As surgeons we must look beyond 'saving life' and operative survival > and ask what we are actually achieving for the quality of the life > of the person in front of us beyond survival of surgery. While not > privy to the whole clinical and social scenario, my inclination > would be that this patient should not be operated because as a > surgeon you cannot restore HIM to a reasonable quality of life. The > prologue suggests that this is a sick terminally ill 71 year old and > that the stroke and endocarditis are just the mechanism, rather than > a prevantable cause, of death - why do we as heart surgeons find it > difficult to accept the concept that patients do die of sickness or > refuse to accept death can occur till we spend 500,000 USD of health > care resources? For those who will fix the valve, will you also > transplant his kidneys, liver and do a robotic prostatectomy at the > same time? Where do we stop? > > Ani > >> Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another >> disaster endocarditis......> From: ebender001@me.com> To: OpenHeart-L@lists.hsforum.com >> > CC: > > Just treat the patient like you would any other stroked >> out, ventilated,> dialysis dependent 71 year old with probable 2 >> valve endocarditis. He will> be near the end of his sentence >> regardless of whether you feel like you> acted ethically or not. If >> you truly believe that you are fulfilling your> duty as a doctor >> and a human being, then you are acting ethically> independent of >> the process. You could however consider yourself immoral no> matter >> what choice you make.> > Ed Bender, MD> > > On 12/1/08 7:01 PM, >> "Michael Firstenberg" wrote:> > > I know - but >> it does raise an ethical question, does it not?> > > > Therapy is >> often withheld or altered for a variety of social/ethical/> > >> economic reasons - for example VADs in prisoners are a bad idea >> since> > the follow-up is so poor (not to mention compliance).> > > >> > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM, Edward Bender >> wrote:> > > >> Mike:> >> My post wasn't attempting an ethical >> point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On >> 12/1/08 6:42 PM, "Michael Firstenberg" wrote:> >> >> > >>> We have the prison contract for the state and typically I >> dont look> >>> up> >>> the details (of course available online) - >> but in this case should it> >>> make a difference why he is in jail >> and for how long?> >>> > >>> > >>> > >>> -michael> >>> > >>> > >>> >> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote:> >>> > >>>> >> If he's a "lifer," he may be nearing the end of his sentence.> >>>> >> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM, >> "Michael Firstenberg" wrote:> >>>> > >>>>> OK - >> you think we could get these problems sorted out.> >>>>> > >>>>> 71 >> year/old prisoner was found "down" in his cell> >>>>> Intubated by >> EMS in route.> >>>>> Presumed cause was a large (and I mean large) >> right MCA CVA with> >>>>> diffuse> >>>>> hemispheric edema.> >>>>> >> Initial blood cultures positive to MSSA (allergic to PCN) - >> current> >>>>> set> >>>>> negaitve x1 day> >>>>> Chronic dialysis - >> surprisingly has a fistula (presumed source)> >>>>> Untreated Hep C >> (liver numbers OK, but dont know viral titers or> >>>>> HIV >> status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate >> adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. >> Thickened aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or >> signs of infection.> >>>>> > >>>>> Currently intubated on minimal >> settings (CXR shows diffuse pulm> >>>>> edema) and> >>>>> sedate, >> but awake follows commands but not moving left side.> >>>>> > >>>>> >> Obviously needs cath> >>>>> Would like to see him off the vent >> first - if possible.> >>>>> > >>>>> I favor operate sooner rather >> than later (i.e. before worse CHF and> >>>>> more> >>>>> >> complications) - like in the next couple of days. Surprisingly> >> >>>>> Cardiology> >>>>> want to wait and tune him up???> >>>>> > >> >>>>> Plan for MVReplace (tissue obviously) (grafts based upon >> cath) and> >>>>> probably> >>>>> leave the aortic alone - depending >> on AI.........> >>>>> > >>>>> > >>>>> or any "mitral reference >> surgeons" want to accept the transfer and> >>>>> plan a> >>>>> >> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>> >> _______________________________________________> >>>>> OpenHeart-L >> mailing list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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 >> > ----------------------------------------- > _________________________________________________________________ > Are you a PC? Upload your PC story and show the world > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From damle at cableone.net Tue Dec 2 06:03:23 2008 From: damle at cableone.net (Ajit Damle) Date: Tue Dec 2 07:10:10 2008 Subject: [HSF] STS Annual meeting In-Reply-To: Message-ID: How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, > Seeing as how I've organized the last 2 HSF STS dinner meetings, I will > let someone else have the honor this time. I plan to be in San Francisco > and > will certainly block out the time if the event is held. Hope to see you > there. > > Hal > **************Life should be easier. So should your homepage. Try the NEW > AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom000000 02 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 ----------------------------------------- From Hgrmd at aol.com Tue Dec 2 07:17:37 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Tue Dec 2 07:18:39 2008 Subject: [HSF] STS Annual meeting Message-ID: Ajit, I will definitely be at the STS. Hal **************Life should be easier. So should your homepage. Try the NEW AOL.com. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000002) From chand.ramaiah at uky.edu Tue Dec 2 07:46:15 2008 From: chand.ramaiah at uky.edu (Ramaiah, Chandrashekar) Date: Tue Dec 2 07:46:45 2008 Subject: [HSF] STS Annual meeting Message-ID: <3ACC54310BF13645A0D12496D7CA94E5F8BC8B37@EX7FM04.ad.uky.edu> I will be there. Chand -----Original Message----- From: Ajit Damle Sent: Tuesday, December 02, 2008 7:10 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, > Seeing as how I've organized the last 2 HSF STS dinner meetings, I will > let someone else have the honor this time. I plan to be in San Francisco > and > will certainly block out the time if the event is held. Hope to see you > there. > > Hal > **************Life should be easier. So should your homepage. Try the NEW > AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom000000 02 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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 ----------------------------------------- From zzhoumd at pol.net Tue Dec 2 08:09:11 2008 From: zzhoumd at pol.net (Zhandong Zhou) Date: Tue Dec 2 08:13:29 2008 Subject: [HSF] Another disaster endocarditis...... Message-ID: <20081202130914.BDTL959.atlmtaow01.cingularme.com@Inbox> Michael, He needs a few days of antibiotics. Doesn't matter if extubated or not, but needs to have infection under control. If hemodynamically not stable, consider to ligate the shunt. It saved some patients in the past for me although nephrologist may not be happy. Zhandong Zhou, MD, PhD St. Joseph Hospital Syracuse, New York 315 423 7192 -----Original Message----- From: Michael Firstenberg Sent: Monday, December 01, 2008 6:51 PM To: openheart-l Subject: [HSF] Another disaster endocarditis...... OK - you think we could get these problems sorted out. 71 year/old prisoner was found "down" in his cell Intubated by EMS in route. Presumed cause was a large (and I mean large) right MCA CVA with diffuse hemispheric edema. Initial blood cultures positive to MSSA (allergic to PCN) - current set negaitve x1 day Chronic dialysis - surprisingly has a fistula (presumed source) Untreated Hep C (liver numbers OK, but dont know viral titers or HIV status) Recent diagnosis of Gleason (sp?) 9 prostate adenoCA Large vegetation on mitral with severe MR. Thickened aortic valve with mild AI, no obvious AS or signs of infection. Currently intubated on minimal settings (CXR shows diffuse pulm edema) and sedate, but awake follows commands but not moving left side. Obviously needs cath Would like to see him off the vent first - if possible. I favor operate sooner rather than later (i.e. before worse CHF and more complications) - like in the next couple of days. Surprisingly Cardiology want to wait and tune him up??? Plan for MVReplace (tissue obviously) (grafts based upon cath) and probably leave the aortic alone - depending on AI......... or any "mitral reference surgeons" want to accept the transfer and plan a repair? -michael _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From ICHFNO at aol.com Tue Dec 2 09:36:14 2008 From: ICHFNO at aol.com (ICHFNO@aol.com) Date: Tue Dec 2 09:34:49 2008 Subject: [HSF] STS Annual meeting Message-ID: I will be there. WNovick In a message dated 12/2/2008 6:48:29 A.M. Central Standard Time, chand.ramaiah@uky.edu writes: I will be there. Chand -----Original Message----- From: Ajit Damle Sent: Tuesday, December 02, 2008 7:10 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, > Seeing as how I've organized the last 2 HSF STS dinner meetings, I will > let someone else have the honor this time. I plan to be in San Francisco > and > will certainly block out the time if the event is held. Hope to see you > there. > > Hal > **************Life should be easier. So should your homepage. Try the NEW > AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom000000 02 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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@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 ----------------------------------------- **************Life should be easier. So should your homepage. Try the NEW AOL.com. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000002) From robertobattellini at hotmail.com Tue Dec 2 17:51:03 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Tue Dec 2 11:51:31 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: <89c4ed2d0812011856g72708ea5i94acd73583d4704a@mail.gmail.com> References: <89c4ed2d0812011755t33dde081ld18f7f9b2234a551@mail.gmail.com> <35F2CFDC-1F2C-4479-8947-1B510A7DBCBD@gmail.com> <89c4ed2d0812011856g72708ea5i94acd73583d4704a@mail.gmail.com> Message-ID: In Leipzig we have the trend to go early, because before 24 Hs of insult the results are better than after.# And the valve must be very very able to repair to accept repair...some of us have done repairs, all ok and after 10 days, the control echo showed new vegetations...(I remember 3 cases in the last 5 years). Roberto> Date: Tue, 2 Dec 2008 08:26:05 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Another disaster endocarditis......> CC: > > If he is stable fine tuning may be not a bad idea. If he has worsening> sttus then go ahead. If antibiotics act , it makes a messy operation> simpler. If it doesnt act in a few days going early would be better.> Prasanna> On Tue, Dec 2, 2008 at 7:43 AM, Michael Firstenberg wrote:> > We are all gods children> >> > But should I operate and thoughts on timing?> >> > -michael.> >> > On Dec 1, 2008, at 8:55 PM, "Prasanna Simha M" > > wrote:> >> >> The astatus of a Prisoner is immaterial to treatment.Medical ethics> >> demands that you treat him independently of his Prosoner status. It is> >> for the legal services to decide about his legal status.> >> Prasanna> >>> >> On Tue, Dec 2, 2008 at 6:12 AM, Michael Firstenberg > >> wrote:> >>>> >>> We have the prison contract for the state and typically I dont look up> >>> the> >>> details (of course available online) - but in this case should it make a> >>> difference why he is in jail and for how long?> >>>> >>>> >>>> >>> -michael> >>>> >>>> >>>> >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote:> >>>> >>>> If he's a "lifer," he may be nearing the end of his sentence.> >>>>> >>>> Ed Bender, MD> >>>>> >>>>> >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote:> >>>>> >>>>> OK - you think we could get these problems sorted out.> >>>>>> >>>>> 71 year/old prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.> >>>>> Presumed cause was a large (and I mean large) right MCA CVA with> >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current set> >>>>> negaitve x1 day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)> >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or HIV> >>>>> status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA> >>>>>> >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve with> >>>>> mild> >>>>> AI, no obvious AS or signs of infection.> >>>>>> >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm edema)> >>>>> and> >>>>> sedate, but awake follows commands but not moving left side.> >>>>>> >>>>> Obviously needs cath> >>>>> Would like to see him off the vent first - if possible.> >>>>>> >>>>> I favor operate sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>> complications) - like in the next couple of days. Surprisingly> >>>>> Cardiology> >>>>> want to wait and tune him up???> >>>>>> >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably> >>>>> leave the aortic alone - depending on AI.........> >>>>>> >>>>>> >>>>> or any "mitral reference surgeons" want to accept the transfer and plan> >>>>> a> >>>>> repair?> >>>>>> >>>>>> >>>>> -michael> >>>>> _______________________________________________> >>>>> OpenHeart-L mailing list> >>>>>> >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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> >>> anddisclaimers posted at:> >>> http://www.hsforum.com/listdisclaim> >>> -----------------------------------------> >>>> >>> >>> >>> >> --> >> Prasanna Simha M> >> _______________________________________________> >> OpenHeart-L mailing list> >>> >> Send postings to:> >> OpenHeart-L@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@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> > anddisclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From robertobattellini at hotmail.com Tue Dec 2 17:54:25 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Tue Dec 2 11:54:53 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: Any, I want to read that article about good death! For myself, of course. Roberto> From: anianyanwu@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec 2008 09:35:09 +0000> > > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old > > > I disagree and would suggest that this patients prison status and his sentence is VERY important in making a decision as to how to manage his problem. In saying this I am assuming he has suffered permanent neurological injury. If so regardless of whatever heroic surgery we do his survival is limited if he has to go back to a prison to rehabhilitate from a stroke. Also his personal choice may be that living in a prison is bad enough and that he does not want to live in a prison severely disabled. On the other hand if he were to be released from prison in six months and had good social support then a 'useful' survival may be feasible with his dense hemiplegia. The BMJ published an episode few years back titled ' a good death' with series of ethical and medical articles stating how and why we should strive to provide our patients with a good death. Nature is providing this poor prisoner with a good death and we want to steal it away and ensure he lives to 'suffer' out the rest of his (?life) sentence.> > As surgeons we must look beyond 'saving life' and operative survival and ask what we are actually achieving for the quality of the life of the person in front of us beyond survival of surgery. While not privy to the whole clinical and social scenario, my inclination would be that this patient should not be operated because as a surgeon you cannot restore HIM to a reasonable quality of life. The prologue suggests that this is a sick terminally ill 71 year old and that the stroke and endocarditis are just the mechanism, rather than a prevantable cause, of death - why do we as heart surgeons find it difficult to accept the concept that patients do die of sickness or refuse to accept death can occur till we spend 500,000 USD of health care resources? For those who will fix the valve, will you also transplant his kidneys, liver and do a robotic prostatectomy at the same time? Where do we stop?> > Ani> > > Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another disaster endocarditis......> From: ebender001@me.com> To: OpenHeart-L@lists.hsforum.com> CC: > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old with probable 2 valve endocarditis. He will> be near the end of his sentence regardless of whether you feel like you> acted ethically or not. If you truly believe that you are fulfilling your> duty as a doctor and a human being, then you are acting ethically> independent of the process. You could however consider yourself immoral no> matter what choice you make.> > Ed Bender, MD> > > On 12/1/08 7:01 PM, "Michael Firstenberg" wrote:> > > I know - but it does raise an ethical question, does it not?> > > > Therapy is often withheld or altered for a variety of social/ethical/> > economic reasons - for example VADs in prisoners are a bad idea since> > the follow-up is so poor (not to mention compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM, Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42 PM, "Michael Firstenberg" wrote:> >> > >>> We have the prison contract for the state and typically I dont look> >>> up> >>> the details (of course available online) - but in this case should it> >>> make a difference why he is in jail and for how long?> >>> > >>> > >>> > >>> -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.> >>>>> Presumed cause was a large (and I mean large) right MCA CVA with> >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1 day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)> >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or> >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>> complications) - like in the next couple of days. Surprisingly> >>>>> Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably> >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> > >>>>> or any "mitral reference surgeons" want to accept the transfer and> >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>> _______________________________________________> >>>>> OpenHeart-L mailing list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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> -----------------------------------------> _________________________________________________________________> Are you a PC? Upload your PC story and show the world > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From prasannasimha at gmail.com Tue Dec 2 22:29:18 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Dec 2 11:59:46 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: <89c4ed2d0812020859y628cc08an304ded117738a6eb@mail.gmail.com> It is a term very common in Indian philosphy - good death and in my language "Olle saavu" (In Kannada) Prasanna On Tue, Dec 2, 2008 at 10:24 PM, Roberto Battellini wrote: > > Any, > > I want to read that article about good death! > > For myself, of course. > > Roberto> From: anianyanwu@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec 2008 09:35:09 +0000> > > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old > > > I disagree and would suggest that this patients prison status and his sentence is VERY important in making a decision as to how to manage his problem. In saying this I am assuming he has suffered permanent neurological injury. If so regardless of whatever heroic surgery we do his survival is limited if he has to go back to a prison to rehabhilitate from a stroke. Also his personal choice may be that living in a prison is bad enough and that he does not want to live in a prison severely disabled. On the other hand if he were to be released from prison in six months and had good social support then a 'useful' survival may be feasible with his dense hemiplegia. The BMJ published an episode few years back titled ' a good death' with series of ethical and medical articles stating how and why we should strive to provide our patients with a good death. Nature is providing this poor prisoner with a good death and we want to steal it away and ensure he lives to 'suffer' out the rest of his (?life) sentence.> > As surgeons we must look beyond 'saving life' and operative survival and ask what we are actually achieving for the quality of the life of the person in front of us beyond survival of surgery. While not privy to the whole clinical and social scenario, my inclination would be that this patient should not be operated because as a surgeon you cannot restore HIM to a reasonable quality of life. The prologue suggests that this is a sick terminally ill 71 year old and that the stroke and endocarditis are just the mechanism, rather than a prevantable cause, of death - why do we as heart surgeons find it difficult to accept the concept that patients do die of sickness or refuse to accept death can occur till we spend 500,000 USD of health care resources? For those who will fix the valve, will you also transplant his kidneys, liver and do a robotic prostatectomy at the same time? Where do we stop?> > Ani> > > Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another disaster endocarditis......> From: ebender001@me.com> To: OpenHeart-L@lists.hsforum.com> CC: > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old with probable 2 valve endocarditis. He will> be near the end of his sentence regardless of whether you feel like you> acted ethically or not. If you truly believe that you are fulfilling your> duty as a doctor and a human being, then you are acting ethically> independent of the process. You could however consider yourself immoral no> matter what choice you make.> > Ed Bender, MD> > > On 12/1/08 7:01 PM, "Michael Firstenberg" wrote:> > > I know - but it does raise an ethical question, does it not?> > > > Therapy is often withheld or altered for a variety of social/ethical/> > economic reasons - for example VADs in prisoners are a bad idea since> > the follow-up is so poor (not to mention compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM, Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42 PM, "Michael Firstenberg" wrote:> >> > >>> We have the prison contract for the state and typically I dont look> >>> up> >>> the details (of course available online) - but in this case should it> >>> make a difference why he is in jail and for how long?> >>> > >>> > >>> > >>> -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.> >>>>> Presumed cause was a large (and I mean large) right MCA CVA with> >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1 day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)> >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or> >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>> complications) - like in the next couple of days. Surprisingly> >>>>> Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably> >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> > >>>>> or any "mitral reference surgeons" want to accept the transfer and> >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>> _______________________________________________> >>>>> OpenHeart-L mailing list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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> -----------------------------------------> _________________________________________________________________> Are you a PC? Upload your PC story and show the world > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From gabiford at hotmail.com Tue Dec 2 17:45:25 2008 From: gabiford at hotmail.com (gabi ford) Date: Tue Dec 2 12:45:53 2008 Subject: [HSF] a good death In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: From: robertobattellini@hotmail.com> I want to read that article about good death!> > For myself, of course. Roberto, Establish a good relationship with a caring primary care physician, tell him (or her) that you want a good death and write that down. And stay out of the hospital as much as possible. ;) Seriously, I can HIGHLY recommend a book I just finished, very short, couple of hours read. Excellent insights for anyone in health care and especially in ICU. It makes you think. "Life and Death in Intensive Care" by Joan Cassell. She is an anthropologist, late 70's, and she studied different ICUs to see and compare how they work. She really gets it. http://www.amazon.com/Life-Death-Intensive-Care-Cassell/dp/1592133363/ref=sr_1_2?ie=UTF8&s=books&qid=1228239381&sr=8-2 And on another evening when you watch the snow pile up in your nice yard, you can read a short story by Kurt Vonnegut Jr, "Fortitude". http://litmed.med.nyu.edu/Annotation?action=view&annid=129 When you get the article about a good death from Ani, please send it to me. For myself, of course. :) Viele Gruesse, Gabi From ecdouville at orclinic.com Tue Dec 2 13:25:58 2008 From: ecdouville at orclinic.com (Douville, Chuck) Date: Tue Dec 2 16:26:50 2008 Subject: [HSF] STS Annual meeting References: Message-ID: Ajit I will be there and would love to join other HSF members. chuckdouville ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Ajit Damle Sent: Tue 12/2/2008 4:03 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, > Seeing as how I've organized the last 2 HSF STS dinner meetings, I will > let someone else have the honor this time. I plan to be in San Francisco > and > will certainly block out the time if the event is held. Hope to see you > there. > > Hal > **************Life should be easier. So should your homepage. Try the NEW > AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom000000 02 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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 ----------------------------------------- From anianyanwu at hotmail.com Tue Dec 2 23:24:37 2008 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Tue Dec 2 18:25:06 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: > One of the aspects of this that bothers me about these kinds of cases is> that we can "fix" him and get him completely tunes up - as much as modern> medicine can - but then we turn him back to the "society" in which he came> from and will have no rehab or further support. Michael Very important points . The idea that if we fix the endocarditis in this patient that he will be the same as any other 71 year old with endocarditis and stroke that we operate on ignores the real issues. We cannot divorce social conditions from medical decisions and overall care. As you say rehab and social conditions are probably as important as the surgery in yielding a successful outcome here - to do the operation and have him back in prison wont fix his disease. Indeed his "society" may itself be the cause of his disease (e.g. hepatitis and endocarditis are more prevalent in prison populations) and if we make no changes to his social condition and expect we have restored health by fixing his heart we will be in for a surprise (as we often see for example when we operate on IV drug users and then turn them back to their society (of drug use)). We must stop thinking of the heart in isolation and look at the whole patient and the environs/conditions he lives in. As a reminder take the WHO definition of health which has not been changed (and for good reason) for over 50 years: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. While this state is unattainable for most - or indeed all - it is a reminder of the vital components to healthy existence. We cannot live in our small world of cardiac surgery and pretend that social conditons do not impact on effect of disease, successfulness of therapy and the level of quality of life restored by the therapy. To operate on his heart without a longer term solution is arguably a disservice to this patient as it will by definition only prolong his bad death. I am less interested to know what interventions are performed on this patient now but more interested to know where he is and what kind of life he is experiencing - if he is alive - in six months (and what kind of life he experienced before death if he is not alive). I suspect either way it will not be a good story. Ani > Date: Tue, 2 Dec 2008 06:35:37 -0500> From: msfirst@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Another disaster endocarditis......> CC: > > One of the aspects of this that bothers me about these kinds of cases is> that we can "fix" him and get him completely tunes up - as much as modern> medicine can - but then we turn him back to the "society" in which he came> from and will have no rehab or further support. In particular, I have seem> huge neuro improvements in some of the patients that we rehab on our> surgical service or that we send to top notch rehab facilities. But, other> than that - off to a LTAC or worse and the first time they get a UTI,> pneumonia, or whatever and support gets withdrawn (even if they have only> been there for a few days). Very painful to see all of that hard work and> potential for progress go down the drain.> > On Tue, Dec 2, 2008 at 4:35 AM, Ani Anyanwu wrote:> > >> > > Just treat the patient like you would any other stroked out, ventilated,>> > dialysis dependent 71 year old> >> >> > I disagree and would suggest that this patients prison status and his> > sentence is VERY important in making a decision as to how to manage his> > problem. In saying this I am assuming he has suffered permanent neurological> > injury. If so regardless of whatever heroic surgery we do his survival is> > limited if he has to go back to a prison to rehabhilitate from a stroke.> > Also his personal choice may be that living in a prison is bad enough and> > that he does not want to live in a prison severely disabled. On the other> > hand if he were to be released from prison in six months and had good social> > support then a 'useful' survival may be feasible with his dense hemiplegia.> > The BMJ published an episode few years back titled ' a good death' with> > series of ethical and medical articles stating how and why we should strive> > to provide our patients with a good death. Nature is providing this poor> > prisoner with a good death and we want to steal it away and ensure he lives> > to 'suffer' out the rest of his (?life) sentence.> >> > As surgeons we must look beyond 'saving life' and operative survival and> > ask what we are actually achieving for the quality of the life of the person> > in front of us beyond survival of surgery. While not privy to the whole> > clinical and social scenario, my inclination would be that this patient> > should not be operated because as a surgeon you cannot restore HIM to a> > reasonable quality of life. The prologue suggests that this is a sick> > terminally ill 71 year old and that the stroke and endocarditis are just the> > mechanism, rather than a prevantable cause, of death - why do we as heart> > surgeons find it difficult to accept the concept that patients do die of> > sickness or refuse to accept death can occur till we spend 500,000 USD of> > health care resources? For those who will fix the valve, will you also> > transplant his kidneys, liver and do a robotic prostatectomy at the same> > time? Where do we stop?> >> > Ani> >> > > Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another disaster> > endocarditis......> From: ebender001@me.com> To:> > OpenHeart-L@lists.hsforum.com> CC: > > Just treat the patient like you> > would any other stroked out, ventilated,> dialysis dependent 71 year old> > with probable 2 valve endocarditis. He will> be near the end of his sentence> > regardless of whether you feel like you> acted ethically or not. If you> > truly believe that you are fulfilling your> duty as a doctor and a human> > being, then you are acting ethically> independent of the process. You could> > however consider yourself immoral no> matter what choice you make.> > Ed> > Bender, MD> > > On 12/1/08 7:01 PM, "Michael Firstenberg" <> > msfirst@gmail.com> wrote:> > > I know - but it does raise an ethical> > question, does it not?> > > > Therapy is often withheld or altered for a> > variety of social/ethical/> > economic reasons - for example VADs in> > prisoners are a bad idea since> > the follow-up is so poor (not to mention> > compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM,> > Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical> > point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42> > PM, "Michael Firstenberg" wrote:> >> > >>> We have the> > prison contract for the state and typically I dont look> >>> up> >>> the> > details (of course available online) - but in this case should it> >>> make> > a difference why he is in jail and for how long?> >>> > >>> > >>> > >>>> > -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender> > wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his> > sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM,> > "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you> > think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old> > prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.>> > >>>>> Presumed cause was a large (and I mean large) right MCA CVA with>> > >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures> > positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1> > day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)>> > >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or>> > >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate> > adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened> > aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of> > infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows> > diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but> > not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like> > to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate> > sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>>> > complications) - like in the next couple of days. Surprisingly> >>>>>> > Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for> > MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably>> > >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> >> > >>>>> or any "mitral reference surgeons" want to accept the transfer and>> > >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>>> > _______________________________________________> >>>>> OpenHeart-L mailing> > list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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>> > -----------------------------------------> > _________________________________________________________________> > Are you a PC? Upload your PC story and show the world> >> > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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> ----------------------------------------- _________________________________________________________________ Are you a PC?? Upload your PC story and show the world http://clk.atdmt.com/UKM/go/122465942/direct/01/ From anianyanwu at hotmail.com Tue Dec 2 23:33:24 2008 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Tue Dec 2 18:33:51 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: Roberto I am overseas and have only limited internet access for cannot provide you with references just now on the 'good death'. However as a starting point I would advise if you are seeking a good death should leave a written instruction that if you are 71 on dialysis, with chronic hepatitits, have a dense stroke and mitral endocarditis that you should not be taken to your hospital or to any cardiac surgeon on HSF (except me of course!) - as they will operate you and you will likely end up experiencing a very bad death over whatever period of extra life your cardiac surgeon's 'success' allows you to experience! Ani > From: robertobattellini@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec 2008 17:54:25 +0100> > > Any,> > I want to read that article about good death!> > For myself, of course.> > Roberto> From: anianyanwu@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec 2008 09:35:09 +0000> > > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old > > > I disagree and would suggest that this patients prison status and his sentence is VERY important in making a decision as to how to manage his problem. In saying this I am assuming he has suffered permanent neurological injury. If so regardless of whatever heroic surgery we do his survival is limited if he has to go back to a prison to rehabhilitate from a stroke. Also his personal choice may be that living in a prison is bad enough and that he does not want to live in a prison severely disabled. On the other hand if he were to be released from prison in six months and had good social support then a 'useful' survival may be feasible with his dense hemiplegia. The BMJ published an episode few years back titled ' a good death' with series of ethical and medical articles stating how and why we should strive to provide our patients with a good death. Nature is providing this poor prisoner with a good death and we want to steal it away and ensure he lives to 'suffer' out the rest of his (?life) sentence.> > As surgeons we must look beyond 'saving life' and operative survival and ask what we are actually achieving for the quality of the life of the person in front of us beyond survival of surgery. While not privy to the whole clinical and social scenario, my inclination would be that this patient should not be operated because as a surgeon you cannot restore HIM to a reasonable quality of life. The prologue suggests that this is a sick terminally ill 71 year old and that the stroke and endocarditis are just the mechanism, rather than a prevantable cause, of death - why do we as heart surgeons find it difficult to accept the concept that patients do die of sickness or refuse to accept death can occur till we spend 500,000 USD of health care resources? For those who will fix the valve, will you also transplant his kidneys, liver and do a robotic prostatectomy at the same time? Where do we stop?> > Ani> > > Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another disaster endocarditis......> From: ebender001@me.com> To: OpenHeart-L@lists.hsforum.com> CC: > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old with probable 2 valve endocarditis. He will> be near the end of his sentence regardless of whether you feel like you> acted ethically or not. If you truly believe that you are fulfilling your> duty as a doctor and a human being, then you are acting ethically> independent of the process. You could however consider yourself immoral no> matter what choice you make.> > Ed Bender, MD> > > On 12/1/08 7:01 PM, "Michael Firstenberg" wrote:> > > I know - but it does raise an ethical question, does it not?> > > > Therapy is often withheld or altered for a variety of social/ethical/> > economic reasons - for example VADs in prisoners are a bad idea since> > the follow-up is so poor (not to mention compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM, Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42 PM, "Michael Firstenberg" wrote:> >> > >>> We have the prison contract for the state and typically I dont look> >>> up> >>> the details (of course available online) - but in this case should it> >>> make a difference why he is in jail and for how long?> >>> > >>> > >>> > >>> -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.> >>>>> Presumed cause was a large (and I mean large) right MCA CVA with> >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1 day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)> >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or> >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>> complications) - like in the next couple of days. Surprisingly> >>>>> Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably> >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> > >>>>> or any "mitral reference surgeons" want to accept the transfer and> >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>> _______________________________________________> >>>>> OpenHeart-L mailing list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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> -----------------------------------------> _________________________________________________________________> Are you a PC? Upload your PC story and show the world > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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> ----------------------------------------- _________________________________________________________________ Get a bird?s eye view of the world with Multimap http://clk.atdmt.com/GBL/go/115454059/direct/01/ From msfirst at gmail.com Tue Dec 2 19:19:13 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Tue Dec 2 19:19:42 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: I just declared him not a surgical candidate - medical management only. hopefully a Higher Being will have mercy in his soul (never did look up why he is in jail). -michael On Tue, Dec 2, 2008 at 6:33 PM, Ani Anyanwu wrote: > > Roberto > > I am overseas and have only limited internet access for cannot provide you > with references just now on the 'good death'. However as a starting point I > would advise if you are seeking a good death should leave a written > instruction that if you are 71 on dialysis, with chronic hepatitits, have a > dense stroke and mitral endocarditis that you should not be taken to your > hospital or to any cardiac surgeon on HSF (except me of course!) - as they > will operate you and you will likely end up experiencing a very bad death > over whatever period of extra life your cardiac surgeon's 'success' allows > you to experience! > > Ani > > > > From: robertobattellini@hotmail.com> To: openheart-l@lists.hsforum.com> > Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec > 2008 17:54:25 +0100> > > Any,> > I want to read that article about good > death!> > For myself, of course.> > Roberto> From: anianyanwu@hotmail.com> > To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster > endocarditis......> Date: Tue, 2 Dec 2008 09:35:09 +0000> > > > Just treat > the patient like you would any other stroked out, ventilated,> dialysis > dependent 71 year old > > > I disagree and would suggest that this patients > prison status and his sentence is VERY important in making a decision as to > how to manage his problem. In saying this I am assuming he has suffered > permanent neurological injury. If so regardless of whatever heroic surgery > we do his survival is limited if he has to go back to a prison to > rehabhilitate from a stroke. Also his personal choice may be that living in > a prison is bad enough and that he does not want to live in a prison > severely disabled. On the other hand if he were to be released from prison > in six months and had good social support then a 'useful' survival may be > feasible with his dense hemiplegia. The BMJ published an episode few years > back titled ' a good death' with series of ethical and medical articles > stating how and why we should strive to provide our patients with a good > death. Nature is providing this poor prisoner with a good death and we want > to steal it away and ensure he lives to 'suffer' out the rest of his (?life) > sentence.> > As surgeons we must look beyond 'saving life' and operative > survival and ask what we are actually achieving for the quality of the life > of the person in front of us beyond survival of surgery. While not privy to > the whole clinical and social scenario, my inclination would be that this > patient should not be operated because as a surgeon you cannot restore HIM > to a reasonable quality of life. The prologue suggests that this is a sick > terminally ill 71 year old and that the stroke and endocarditis are just the > mechanism, rather than a prevantable cause, of death - why do we as heart > surgeons find it difficult to accept the concept that patients do die of > sickness or refuse to accept death can occur till we spend 500,000 USD of > health care resources? For those who will fix the valve, will you also > transplant his kidneys, liver and do a robotic prostatectomy at the same > time? Where do we stop?> > Ani> > > Date: Mon, 1 Dec 2008 19:43:48 -0600> > Subject: Re: [HSF] Another disaster endocarditis......> From: > ebender001@me.com> To: OpenHeart-L@lists.hsforum.com> CC: > > Just treat > the patient like you would any other stroked out, ventilated,> dialysis > dependent 71 year old with probable 2 valve endocarditis. He will> be near > the end of his sentence regardless of whether you feel like you> acted > ethically or not. If you truly believe that you are fulfilling your> duty as > a doctor and a human being, then you are acting ethically> independent of > the process. You could however consider yourself immoral no> matter what > choice you make.> > Ed Bender, MD> > > On 12/1/08 7:01 PM, "Michael > Firstenberg" wrote:> > > I know - but it does raise an > ethical question, does it not?> > > > Therapy is often withheld or altered > for a variety of social/ethical/> > economic reasons - for example VADs in > prisoners are a bad idea since> > the follow-up is so poor (not to mention > compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM, > Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical > point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42 > PM, "Michael Firstenberg" wrote:> >> > >>> We have the > prison contract for the state and typically I dont look> >>> up> >>> the > details (of course available online) - but in this case should it> >>> make > a difference why he is in jail and for how long?> >>> > >>> > >>> > >>> > -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender > wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his > sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM, > "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you > think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old > prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.> > >>>>> Presumed cause was a large (and I mean large) right MCA CVA with> > >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures > positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1 > day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)> > >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or> > >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate > adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened > aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of > infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows > diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but > not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like > to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate > sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>> > complications) - like in the next couple of days. Surprisingly> >>>>> > Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for > MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably> > >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> > > >>>>> or any "mitral reference surgeons" want to accept the transfer and> > >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>> > _______________________________________________> >>>>> OpenHeart-L mailing > list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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> > -----------------------------------------> > _________________________________________________________________> Are you a > PC? Upload your PC story and show the world > > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________> > OpenHeart-L mailing list> > Send postings to:> > OpenHeart-L@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@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> > ----------------------------------------- > _________________________________________________________________ > Get a bird's eye view of the world with Multimap > > http://clk.atdmt.com/GBL/go/115454059/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > From tacuff at swbell.net Tue Dec 2 22:38:28 2008 From: tacuff at swbell.net (Tea Acuff) Date: Wed Dec 3 01:39:59 2008 Subject: [HSF] Another disaster endocarditis...... Message-ID: <9066.73150.qm@web81605.mail.mud.yahoo.com> This quite an interesting discussion with very different alternatives and outcomes depending of the focus of the "problem". Ani's thoughts are salient and more rich in context than his norm, yet provocative as usual. So how does this (analysis) square with population disease based (single category) medicine, Ani? I have some "quotes" or context to share that expounds on this dilemma, if you like. tea ________________________________ From: Ani Anyanwu To: open heart list Sent: Tuesday, December 2, 2008 5:24:37 PM Subject: RE: [HSF] Another disaster endocarditis...... > One of the aspects of this that bothers me about these kinds of cases is> that we can "fix" him and get him completely tunes up - as much as modern> medicine can - but then we turn him back to the "society" in which he came> from and will have no rehab or further support. Michael Very important points . The idea that if we fix the endocarditis in this patient that he will be the same as any other 71 year old with endocarditis and stroke that we operate on ignores the real issues. We cannot divorce social conditions from medical decisions and overall care. As you say rehab and social conditions are probably as important as the surgery in yielding a successful outcome here - to do the operation and have him back in prison wont fix his disease. Indeed his "society" may itself be the cause of his disease (e.g. hepatitis and endocarditis are more prevalent in prison populations) and if we make no changes to his social condition and expect we have restored health by fixing his heart we will be in for a surprise (as we often see for example when we operate on IV drug users and then turn them back to their society (of drug use)). We must stop thinking of the heart in isolation and look at the whole patient and the environs/conditions he lives in. As a reminder take the WHO definition of health which has not been changed (and for good reason) for over 50 years: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. While this state is unattainable for most - or indeed all - it is a reminder of the vital components to healthy existence. We cannot live in our small world of cardiac surgery and pretend that social conditons do not impact on effect of disease, successfulness of therapy and the level of quality of life restored by the therapy. To operate on his heart without a longer term solution is arguably a disservice to this patient as it will by definition only prolong his bad death. I am less interested to know what interventions are performed on this patient now but more interested to know where he is and what kind of life he is experiencing - if he is alive - in six months (and what kind of life he experienced before death if he is not alive).? I suspect either way it will not be a good story. Ani > Date: Tue, 2 Dec 2008 06:35:37 -0500> From: msfirst@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Another disaster endocarditis......> CC: > > One of the aspects of this that bothers me about these kinds of cases is> that we can "fix" him and get him completely tunes up - as much as modern> medicine can - but then we turn him back to the "society" in which he came> from and will have no rehab or further support. In particular, I have seem> huge neuro improvements in some of the patients that we rehab on our> surgical service or that we send to top notch rehab facilities. But, other> than that - off to a LTAC or worse and the first time they get a UTI,> pneumonia, or whatever and support gets withdrawn (even if they have only> been there for a few days). Very painful to see all of that hard work and> potential for progress go down the drain.> > On Tue, Dec 2, 2008 at 4:35 AM, Ani Anyanwu wrote:> > >> > > Just treat the patient like you would any other stroked out, ventilated,>> > dialysis dependent 71 year old> >> >> > I disagree and would suggest that this patients prison status and his> > sentence is VERY important in making a decision as to how to manage his> > problem. In saying this I am assuming he has suffered permanent neurological> > injury. If so regardless of whatever heroic surgery we do his survival is> > limited if he has to go back to a prison to rehabhilitate from a stroke.> > Also his personal choice may be that living in a prison is bad enough and> > that he does not want to live in a prison severely disabled. On the other> > hand if he were to be released from prison in six months and had good social> > support then a 'useful' survival may be feasible with his dense hemiplegia.> > The BMJ published an episode few years back titled ' a good death' with> > series of ethical and medical articles stating how and why we should strive> > to provide our patients with a good death. Nature is providing this poor> > prisoner with a good death and we want to steal it away and ensure he lives> > to 'suffer' out the rest of his (?life) sentence.> >> > As surgeons we must look beyond 'saving life' and operative survival and> > ask what we are actually achieving for the quality of the life of the person> > in front of us beyond survival of surgery. While not privy to the whole> > clinical and social scenario, my inclination would be that this patient> > should not be operated because as a surgeon you cannot restore HIM to a> > reasonable quality of life. The prologue suggests that this is a sick> > terminally ill 71 year old and that the stroke and endocarditis are just the> > mechanism, rather than a prevantable cause, of death - why do we as heart> > surgeons find it difficult to accept the concept that patients do die of> > sickness or refuse to accept death can occur till we spend 500,000 USD of> > health care resources? For those who will fix the valve, will you also> > transplant his kidneys, liver and do a robotic prostatectomy at the same> > time? Where do we stop?> >> > Ani> >> > > Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another disaster> > endocarditis......> From: ebender001@me.com> To:> > OpenHeart-L@lists.hsforum.com> CC: > > Just treat the patient like you> > would any other stroked out, ventilated,> dialysis dependent 71 year old> > with probable 2 valve endocarditis. He will> be near the end of his sentence> > regardless of whether you feel like you> acted ethically or not. If you> > truly believe that you are fulfilling your> duty as a doctor and a human> > being, then you are acting ethically> independent of the process. You could> > however consider yourself immoral no> matter what choice you make.> > Ed> > Bender, MD> > > On 12/1/08 7:01 PM, "Michael Firstenberg" <> > msfirst@gmail.com> wrote:> > > I know - but it does raise an ethical> > question, does it not?> > > > Therapy is often withheld or altered for a> > variety of social/ethical/> > economic reasons - for example VADs in> > prisoners are a bad idea since> > the follow-up is so poor (not to mention> > compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM,> > Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical> > point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42> > PM, "Michael Firstenberg" wrote:> >> > >>> We have the> > prison contract for the state and typically I dont look> >>> up> >>> the> > details (of course available online) - but in this case should it> >>> make> > a difference why he is in jail and for how long?> >>> > >>> > >>> > >>>> > -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender> > wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his> > sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM,> > "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you> > think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old> > prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.>> > >>>>> Presumed cause was a large (and I mean large) right MCA CVA with>> > >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures> > positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1> > day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)>> > >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or>> > >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate> > adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened> > aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of> > infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows> > diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but> > not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like> > to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate> > sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>>> > complications) - like in the next couple of days. Surprisingly> >>>>>> > Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for> > MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably>> > >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> >> > >>>>> or any "mitral reference surgeons" want to accept the transfer and>> > >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>>> > _______________________________________________> >>>>> OpenHeart-L mailing> > list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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>> > -----------------------------------------> > _________________________________________________________________> > Are you a PC? Upload your PC story and show the world> >> > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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> ----------------------------------------- _________________________________________________________________ Are you a PC?? Upload your PC story and show the world http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From robertobattellini at hotmail.com Wed Dec 3 08:20:59 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Dec 3 02:21:48 2008 Subject: [HSF] Another disaster endocarditis...... In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: Thanks Ani, then I need many more years for this good death. Please, back home send me the article references. Roberto> From: anianyanwu@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec 2008 23:33:24 +0000> > > Roberto> > I am overseas and have only limited internet access for cannot provide you with references just now on the 'good death'. However as a starting point I would advise if you are seeking a good death should leave a written instruction that if you are 71 on dialysis, with chronic hepatitits, have a dense stroke and mitral endocarditis that you should not be taken to your hospital or to any cardiac surgeon on HSF (except me of course!) - as they will operate you and you will likely end up experiencing a very bad death over whatever period of extra life your cardiac surgeon's 'success' allows you to experience!> > Ani> > > > From: robertobattellini@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec 2008 17:54:25 +0100> > > Any,> > I want to read that article about good death!> > For myself, of course.> > Roberto> From: anianyanwu@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec 2008 09:35:09 +0000> > > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old > > > I disagree and would suggest that this patients prison status and his sentence is VERY important in making a decision as to how to manage his problem. In saying this I am assuming he has suffered permanent neurological injury. If so regardless of whatever heroic surgery we do his survival is limited if he has to go back to a prison to rehabhilitate from a stroke. Also his personal choice may be that living in a prison is bad enough and that he does not want to live in a prison severely disabled. On the other hand if he were to be released from prison in six months and had good social support then a 'useful' survival may be feasible with his dense hemiplegia. The BMJ published an episode few years back titled ' a good death' with series of ethical and medical articles stating how and why we should strive to provide our patients with a good death. Nature is providing this poor prisoner with a good death and we want to steal it away and ensure he lives to 'suffer' out the rest of his (?life) sentence.> > As surgeons we must look beyond 'saving life' and operative survival and ask what we are actually achieving for the quality of the life of the person in front of us beyond survival of surgery. While not privy to the whole clinical and social scenario, my inclination would be that this patient should not be operated because as a surgeon you cannot restore HIM to a reasonable quality of life. The prologue suggests that this is a sick terminally ill 71 year old and that the stroke and endocarditis are just the mechanism, rather than a prevantable cause, of death - why do we as heart surgeons find it difficult to accept the concept that patients do die of sickness or refuse to accept death can occur till we spend 500,000 USD of health care resources? For those who will fix the valve, will you also transplant his kidneys, liver and do a robotic prostatectomy at the same time? Where do we stop?> > Ani> > > Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another disaster endocarditis......> From: ebender001@me.com> To: OpenHeart-L@lists.hsforum.com> CC: > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old with probable 2 valve endocarditis. He will> be near the end of his sentence regardless of whether you feel like you> acted ethically or not. If you truly believe that you are fulfilling your> duty as a doctor and a human being, then you are acting ethically> independent of the process. You could however consider yourself immoral no> matter what choice you make.> > Ed Bender, MD> > > On 12/1/08 7:01 PM, "Michael Firstenberg" wrote:> > > I know - but it does raise an ethical question, does it not?> > > > Therapy is often withheld or altered for a variety of social/ethical/> > economic reasons - for example VADs in prisoners are a bad idea since> > the follow-up is so poor (not to mention compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM, Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42 PM, "Michael Firstenberg" wrote:> >> > >>> We have the prison contract for the state and typically I dont look> >>> up> >>> the details (of course available online) - but in this case should it> >>> make a difference why he is in jail and for how long?> >>> > >>> > >>> > >>> -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.> >>>>> Presumed cause was a large (and I mean large) right MCA CVA with> >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1 day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)> >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or> >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>> complications) - like in the next couple of days. Surprisingly> >>>>> Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably> >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> > >>>>> or any "mitral reference surgeons" want to accept the transfer and> >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>> _______________________________________________> >>>>> OpenHeart-L mailing list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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> -----------------------------------------> _________________________________________________________________> Are you a PC? Upload your PC story and show the world > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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> -----------------------------------------> _________________________________________________________________> Get a bird?s eye view of the world with Multimap> http://clk.atdmt.com/GBL/go/115454059/direct/01/_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From robertobattellini at hotmail.com Wed Dec 3 08:28:25 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Dec 3 02:29:14 2008 Subject: [HSF] a good death In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: Gabi, you are great! I hope I can see you in some meeting some day, or later in holidays. I have read a book on pioneers of cardiac surgery and the NEJM accepted my review, I am proud!. I send you the Review.I am reading now the history of Lillehei the book "The Maverik"..and so on, he was phantastic! At my age I am turning my readings from scientific to more historical, ethics, medical education and so on. Roberto > From: gabiford@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] a good death> Date: Tue, 2 Dec 2008 17:45:25 +0000> > > From: robertobattellini@hotmail.com> I want to read that article about good death!> > For myself, of course.> > > Roberto,> > Establish a good relationship with a caring primary care physician, tell him (or her) that you want a good death and write that down. And stay out of the hospital as much as possible. ;)> > Seriously, I can HIGHLY recommend a book I just finished, very short, couple of hours read. Excellent insights for anyone in health care and especially in ICU. It makes you think.> "Life and Death in Intensive Care" by Joan Cassell. She is an anthropologist, late 70's, and she studied different ICUs to see and compare how they work. She really gets it. > http://www.amazon.com/Life-Death-Intensive-Care-Cassell/dp/1592133363/ref=sr_1_2?ie=UTF8&s=books&qid=1228239381&sr=8-2> > And on another evening when you watch the snow pile up in your nice yard, you can read a short story by Kurt Vonnegut Jr, "Fortitude". http://litmed.med.nyu.edu/Annotation?action=view&annid=129> > When you get the article about a good death from Ani, please send it to me. For myself, of course. :)> > Viele Gruesse,> > Gabi_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From damle at cableone.net Wed Dec 3 07:33:37 2008 From: damle at cableone.net (Ajit Damle) Date: Wed Dec 3 09:03:45 2008 Subject: [HSF] STS Annual meeting In-Reply-To: Message-ID: <5B9582405B3E4032B610CCB5EDAEB9BD@yourg8he5gjrox> So far, Chuck Douville Bill Novak Chand Ramaiah Hal Roberts Ajit Damle If we get a good number, I will arrange a meeting. Ajit Damle -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Douville, Chuck Sent: Tuesday, December 02, 2008 3:26 PM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting Ajit I will be there and would love to join other HSF members. chuckdouville ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Ajit Damle Sent: Tue 12/2/2008 4:03 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, > Seeing as how I've organized the last 2 HSF STS dinner meetings, I will > let someone else have the honor this time. I plan to be in San Francisco > and > will certainly block out the time if the event is held. Hope to see you > there. > > Hal > **************Life should be easier. So should your homepage. Try the NEW > AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom000000 02 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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 ----------------------------------------- From rwmfglycar at aol.com Wed Dec 3 11:37:14 2008 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Wed Dec 3 11:38:20 2008 Subject: [HSF] STS Annual meeting In-Reply-To: <5B9582405B3E4032B610CCB5EDAEB9BD@yourg8he5gjrox> Message-ID: <8CB237C88292DD5-7A4-3EB@WEBMAIL-DG02.sim.aol.com> Ajit I shall be in South Africa and since I have another return trip to the States in February I shall have to miss the STS this year. Hope you have a good meeting Bob -----Original Message----- From: Ajit Damle To: OpenHeart-L@lists.hsforum.com Sent: Wed, 3 Dec 2008 8:33 am Subject: RE: [HSF] STS Annual meeting So far, Chuck Douville Bill Novak Chand Ramaiah Hal Roberts Ajit Damle If we get a good number, I will arrange a meeting. Ajit Damle -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Douville, Chuck Sent: Tuesday, December 02, 2008 3:26 PM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting Ajit I will be there and would love to join other HSF members. chuckdouville ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Ajit Damle Sent: Tue 12/2/2008 4:03 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, > Seeing as how I've organized the last 2 HSF STS dinner meetings, I will > let someone else have the honor this time. I plan to be in San Francisco > and > will certainly block out the time if the event is held. Hope to see you > there. > > Hal > **************Life should be easier. So should your homepage. Try the NEW > AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom000000 02 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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@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 ----------------------------------------- From tacuff at swbell.net Wed Dec 3 13:00:07 2008 From: tacuff at swbell.net (Tea Acuff) Date: Wed Dec 3 16:01:39 2008 Subject: [HSF] STS Annual meeting Message-ID: <612098.6736.qm@web81606.mail.mud.yahoo.com> Depending on when HSF is I should be there. Maybe i should help plan it around my schedule! tea ________________________________ From: Ajit Damle To: OpenHeart-L@lists.hsforum.com Sent: Wednesday, December 3, 2008 7:33:37 AM Subject: RE: [HSF] STS Annual meeting So far, Chuck Douville Bill Novak Chand Ramaiah Hal Roberts Ajit Damle If we get a good number, I will arrange a meeting. Ajit Damle -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Douville, Chuck Sent: Tuesday, December 02, 2008 3:26 PM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting Ajit I will be there and would love to join other HSF members. chuckdouville ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Ajit Damle Sent: Tue 12/2/2008 4:03 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, >? Seeing as how I've organized the last 2 HSF STS dinner meetings, I? will > let someone else have the honor this time.? I plan to be in San? Francisco > and > will certainly block out the time if the event is held.? Hope? to see you > there. > > Hal > **************Life should be easier. So should your homepage. Try the NEW > AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom000000 02 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: >? OpenHeart-L@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@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@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@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 ----------------------------------------- From Barry.Mahon at ccdhb.org.nz Thu Dec 4 11:12:23 2008 From: Barry.Mahon at ccdhb.org.nz (Barry Mahon [CCDHB]) Date: Wed Dec 3 18:00:54 2008 Subject: [HSF] STS Annual meeting In-Reply-To: Message-ID: <2F43DD6CF764A74EB97A82411129920E28FCEB@wn0nteml06.hiq.net.nz> I shall be there. Barry Mahon New Zealand -----Original Message----- From: Ajit Damle [mailto:damle@cableone.net] Sent: Wednesday, 03 December 2008 1:03 a.m. To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, > Seeing as how I've organized the last 2 HSF STS dinner meetings, I > will let someone else have the honor this time. I plan to be in San > Francisco and will certainly block out the time if the event is held. > Hope to see you there. > > Hal > **************Life should be easier. So should your homepage. Try the > NEW AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00 0000 02 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 ----------------------------------------- This email or attachment(s) may contain confidential or legally privileged information intended for the sole use of the addressee(s). Any use, redistribution, disclosure, or reproduction of this message, except as intended, is prohibited. If you received this email in error, please notify the sender and remove all copies of the message, including any attachments. Any views or opinions expressed in this email (unless otherwise stated) may not represent those of Capital & Coast District Health Board. http://www.ccdhb.org.nz (1C_S1) No Viruses were detected in this message. HealthIntelligence eMail Filter Service From laudito at musc.edu Thu Dec 4 00:31:35 2008 From: laudito at musc.edu (Laudito, Antonio) Date: Thu Dec 4 00:35:17 2008 Subject: [HSF] STS Annual meeting In-Reply-To: <5B9582405B3E4032B610CCB5EDAEB9BD@yourg8he5gjrox> References: , <5B9582405B3E4032B610CCB5EDAEB9BD@yourg8he5gjrox> Message-ID: <5BC4E9DEC7D1A245B1290DEFE550A1C0DE810D0DB2@EVS4.clinlan.local> Ajit, I will be in San Fancisco for the STS. Please count me in. Thanks, Antonio Antonio Laudito, MD Email: alaudito@cedarsurg.com "Effort and Courage are not enough without purpose and direction." ________________________________________ From: openheart-l-bounces@lists.hsforum.com [openheart-l-bounces@lists.hsforum.com] On Behalf Of Ajit Damle [damle@cableone.net] Sent: Wednesday, December 03, 2008 8:33 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting So far, Chuck Douville Bill Novak Chand Ramaiah Hal Roberts Ajit Damle If we get a good number, I will arrange a meeting. Ajit Damle -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Douville, Chuck Sent: Tuesday, December 02, 2008 3:26 PM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting Ajit I will be there and would love to join other HSF members. chuckdouville ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Ajit Damle Sent: Tue 12/2/2008 4:03 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: > Ajit, > Seeing as how I've organized the last 2 HSF STS dinner meetings, I will > let someone else have the honor this time. I plan to be in San Francisco > and > will certainly block out the time if the event is held. Hope to see you > there. > > Hal > **************Life should be easier. So should your homepage. Try the NEW > AOL.com. > ( > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom000000 02 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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@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 ----------------------------------------- From jgold1 at bigpond.net.au Thu Dec 4 19:59:00 2008 From: jgold1 at bigpond.net.au (john goldblatt) Date: Thu Dec 4 03:59:36 2008 Subject: [HSF] STS Annual meeting In-Reply-To: <5BC4E9DEC7D1A245B1290DEFE550A1C0DE810D0DB2@EVS4.clinlan.local> References: , <5B9582405B3E4032B610CCB5EDAEB9BD@yourg8he5gjrox> <5BC4E9DEC7D1A245B1290DEFE550A1C0DE810D0DB2@EVS4.clinlan.local> Message-ID: <6754A713-32E2-4C31-AF0D-FF88BE329C4C@bigpond.net.au> Ajit, I too plan to be there & would enjoy meeting up with HSF folk. john goldblatt On 04/12/2008, at 4:31 PM, Laudito, Antonio wrote: > Ajit, > I will be in San Fancisco for the STS. Please count me in. > Thanks, > Antonio > > Antonio Laudito, MD > Email: alaudito@cedarsurg.com > > "Effort and Courage are not enough without purpose and direction." > ________________________________________ > From: openheart-l-bounces@lists.hsforum.com [openheart-l-bounces@lists.hsforum.com > ] On Behalf Of Ajit Damle [damle@cableone.net] > Sent: Wednesday, December 03, 2008 8:33 AM > To: OpenHeart-L@lists.hsforum.com > Subject: RE: [HSF] STS Annual meeting > > So far, > > Chuck Douville > Bill Novak > Chand Ramaiah > Hal Roberts > Ajit Damle > > If we get a good number, I will arrange a meeting. > > Ajit Damle > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of > Douville, Chuck > Sent: Tuesday, December 02, 2008 3:26 PM > To: OpenHeart-L@lists.hsforum.com > Subject: RE: [HSF] STS Annual meeting > > Ajit I will be there and would love to join other HSF members. > chuckdouville > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Ajit Damle > Sent: Tue 12/2/2008 4:03 AM > To: OpenHeart-L@lists.hsforum.com > Subject: RE: [HSF] STS Annual meeting > > > > How many will be going to the meeting? > > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael > Firstenberg > Sent: Tuesday, December 02, 2008 5:38 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] STS Annual meeting > > Hal, > You have been doing such a great job, I vote you take it on fulltime. > > -michael > > On Mon, Dec 1, 2008 at 9:00 PM, wrote: > >> Ajit, >> Seeing as how I've organized the last 2 HSF STS dinner meetings, I >> will >> let someone else have the honor this time. I plan to be in San >> Francisco >> and >> will certainly block out the time if the event is held. Hope to >> see you >> there. >> >> Hal >> **************Life should be easier. So should your homepage. Try >> the NEW >> AOL.com. >> ( >> > http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom000000 > 02 >> ) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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@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@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@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 > ----------------------------------------- From tacuff at swbell.net Thu Dec 4 08:57:37 2008 From: tacuff at swbell.net (Tea Acuff) Date: Thu Dec 4 11:59:07 2008 Subject: [HSF] STS Annual meeting Message-ID: <955057.48820.qm@web81607.mail.mud.yahoo.com> It is fun to see our international colleagues, Barry. We usually ask that they pay for the event. Such an honor! Tea Sent from my iPhone On Dec 3, 2008, at 4:12 PM, "Barry Mahon [CCDHB]" wrote: I shall be there. Barry Mahon New Zealand -----Original Message----- From: Ajit Damle [mailto:damle@cableone.net] Sent: Wednesday, 03 December 2008 1:03 a.m. To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] STS Annual meeting How many will be going to the meeting? -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Tuesday, December 02, 2008 5:38 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] STS Annual meeting Hal, You have been doing such a great job, I vote you take it on fulltime. -michael On Mon, Dec 1, 2008 at 9:00 PM, wrote: Ajit, Seeing as how I've organized the last 2 HSF STS dinner meetings, I will let someone else have the honor this time. I plan to be in San Francisco and will certainly block out the time if the event is held. Hope to see you there. Hal **************Life should be easier. So should your homepage. Try the NEW AOL.com. ( http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00 0000 02 ) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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@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 ----------------------------------------- This email or attachment(s) may contain confidential or legally privileged information intended for the sole use of the addressee(s). Any use, redistribution, disclosure, or reproduction of this message, except as intended, is prohibited. If you received this email in error, please notify the sender and remove all copies of the message, including any attachments. Any views or opinions expressed in this email (unless otherwise stated) may not represent those of Capital & Coast District Health Board. http://www.ccdhb.org.nz (1C_S1) No Viruses were detected in this message. HealthIntelligence eMail Filter Service _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From edman63 at hotmail.com Thu Dec 4 19:50:09 2008 From: edman63 at hotmail.com (edgar manrique) Date: Thu Dec 4 19:50:37 2008 Subject: [HSF] jaundice in pop Message-ID: we have a 39 yo man for aortic and mitral replacement,he was operated 6 days ago and during surgery all things very good but 16 hours after surgery in ICU,extubated, the patient is with jaundice with indirect bilirrubin high and sgot and sgpt and alcaline fosfatasa normal and hepatic and biliar ultrasound is normal. there is haemolysis. In this moment the patient is ok but with jaundice. we need opinios about possible dx and therapy thanks edgar j manrique _________________________________________________________________ Connect to the next generation of MSN Messenger? http://imagine-msn.com/messenger/launch80/default.aspx?locale=en-us&source=wlmailtagline From benjamin.bidstrup at bigpond.com Fri Dec 5 12:49:32 2008 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Thu Dec 4 21:50:15 2008 Subject: [HSF] jaundice in pop In-Reply-To: References: Message-ID: <125A99DB-ECA1-48B2-BFCF-2A3CAD4CBA6D@bigpond.com> Have you got an echo to look at the valves? A leak perhaps. Ben Bidstrup FRACS FRCSEd FEBCTS Cardiothoracic Surgeon On 05/12/2008, at 10:50 AM, edgar manrique wrote: > > we have a 39 yo man for aortic and mitral replacement,he was > operated 6 days ago and during surgery all things very good but 16 > hours after surgery in ICU,extubated, the patient is with jaundice > with indirect bilirrubin high and sgot and sgpt and alcaline > fosfatasa normal and hepatic and biliar ultrasound is normal. there > is haemolysis. In this moment the patient is ok but with jaundice. > we need opinios about possible dx and therapy thanks > edgar j manrique > _________________________________________________________________ > Connect to the next generation of MSN Messenger > http://imagine-msn.com/messenger/launch80/default.aspx?locale=en-us&source=wlmailtagline_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From edman63 at hotmail.com Thu Dec 4 22:13:19 2008 From: edman63 at hotmail.com (edgar manrique) Date: Thu Dec 4 22:14:11 2008 Subject: [HSF] jaundice in pop In-Reply-To: <125A99DB-ECA1-48B2-BFCF-2A3CAD4CBA6D@bigpond.com> References: <125A99DB-ECA1-48B2-BFCF-2A3CAD4CBA6D@bigpond.com> Message-ID: the prosthetic valves are ok, by echo, do you want images ? > From: benjamin.bidstrup@bigpond.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] jaundice in pop> Date: Fri, 5 Dec 2008 12:49:32 +1000> CC: > > Have you got an echo to look at the valves? A leak perhaps.> Ben Bidstrup FRACS FRCSEd FEBCTS> Cardiothoracic Surgeon> > > > On 05/12/2008, at 10:50 AM, edgar manrique wrote:> > >> > we have a 39 yo man for aortic and mitral replacement,he was > > operated 6 days ago and during surgery all things very good but 16 > > hours after surgery in ICU,extubated, the patient is with jaundice > > with indirect bilirrubin high and sgot and sgpt and alcaline > > fosfatasa normal and hepatic and biliar ultrasound is normal. there > > is haemolysis. In this moment the patient is ok but with jaundice. > > we need opinios about possible dx and therapy thanks> > edgar j manrique> > _________________________________________________________________> > Connect to the next generation of MSN Messenger> > http://imagine-msn.com/messenger/launch80/default.aspx?locale=en-us&source=wlmailtagline_______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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> ----------------------------------------- _________________________________________________________________ News, entertainment and everything you care about at Live.com. Get it now! http://www.live.com/getstarted.aspx From edman63 at hotmail.com Thu Dec 4 22:19:29 2008 From: edman63 at hotmail.com (edgar manrique) Date: Thu Dec 4 22:19:58 2008 Subject: [HSF] jaundice in pop In-Reply-To: <125A99DB-ECA1-48B2-BFCF-2A3CAD4CBA6D@bigpond.com> References: <125A99DB-ECA1-48B2-BFCF-2A3CAD4CBA6D@bigpond.com> Message-ID: we used the carpentier edwards magna aortic valve> From: benjamin.bidstrup@bigpond.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] jaundice in pop> Date: Fri, 5 Dec 2008 12:49:32 +1000> CC: > > Have you got an echo to look at the valves? A leak perhaps.> Ben Bidstrup FRACS FRCSEd FEBCTS> Cardiothoracic Surgeon> > > > On 05/12/2008, at 10:50 AM, edgar manrique wrote:> > >> > we have a 39 yo man for aortic and mitral replacement,he was > > operated 6 days ago and during surgery all things very good but 16 > > hours after surgery in ICU,extubated, the patient is with jaundice > > with indirect bilirrubin high and sgot and sgpt and alcaline > > fosfatasa normal and hepatic and biliar ultrasound is normal. there > > is haemolysis. In this moment the patient is ok but with jaundice. > > we need opinios about possible dx and therapy thanks> > edgar j manrique> > _________________________________________________________________> > Connect to the next generation of MSN Messenger> > http://imagine-msn.com/messenger/launch80/default.aspx?locale=en-us&source=wlmailtagline_______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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> ----------------------------------------- _________________________________________________________________ News, entertainment and everything you care about at Live.com. Get it now! http://www.live.com/getstarted.aspx From prasannasimha at gmail.com Fri Dec 5 06:58:33 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Dec 4 22:24:21 2008 Subject: [HSF] jaundice in pop In-Reply-To: References: Message-ID: <89c4ed2d0812041728v72f45e1ao5568b4ede280d643@mail.gmail.com> Hemolysis is present - Is there any paravalvar/valvar leak ? I would start him on Pentoxyfillin and beta blockers , add a small dose of phenobarbitone for enzyme induction but the important thing is to have a good look at the cardiac echo. Did he receive any transfusions ? Prasanna On Fri, Dec 5, 2008 at 6:20 AM, edgar manrique wrote: > > we have a 39 yo man for aortic and mitral replacement,he was operated 6 days ago and during surgery all things very good but 16 hours after surgery in ICU,extubated, the patient is with jaundice with indirect bilirrubin high and sgot and sgpt and alcaline fosfatasa normal and hepatic and biliar ultrasound is normal. there is haemolysis. In this moment the patient is ok but with jaundice. we need opinios about possible dx and therapy thanks > edgar j manrique > _________________________________________________________________ > Connect to the next generation of MSN Messenger > http://imagine-msn.com/messenger/launch80/default.aspx?locale=en-us&source=wlmailtagline_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From edman63 at hotmail.com Thu Dec 4 22:43:39 2008 From: edman63 at hotmail.com (edgar manrique) Date: Thu Dec 4 22:44:30 2008 Subject: [HSF] jaundice in pop In-Reply-To: <89c4ed2d0812041728v72f45e1ao5568b4ede280d643@mail.gmail.com> References: <89c4ed2d0812041728v72f45e1ao5568b4ede280d643@mail.gmail.com> Message-ID: there is not paravalve leak, the last echo-c is ok, we will considerer the pentoxyfillin and BB, thanks, is possible than the prosthetic valve produce hemolysis?> Date: Fri, 5 Dec 2008 06:58:33 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] jaundice in pop> CC: > > Hemolysis is present - Is there any paravalvar/valvar leak ? I would> start him on Pentoxyfillin and beta blockers , add a small dose of> phenobarbitone for enzyme induction but the important thing is to have> a good look at the cardiac echo.> Did he receive any transfusions ?> Prasanna> > On Fri, Dec 5, 2008 at 6:20 AM, edgar manrique wrote:> >> > we have a 39 yo man for aortic and mitral replacement,he was operated 6 days ago and during surgery all things very good but 16 hours after surgery in ICU,extubated, the patient is with jaundice with indirect bilirrubin high and sgot and sgpt and alcaline fosfatasa normal and hepatic and biliar ultrasound is normal. there is haemolysis. In this moment the patient is ok but with jaundice. we need opinios about possible dx and therapy thanks> > edgar j manrique> > _________________________________________________________________> > Connect to the next generation of MSN Messenger> > http://imagine-msn.com/messenger/launch80/default.aspx?locale=en-us&source=wlmailtagline_______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- _________________________________________________________________ Explore the seven wonders of the world http://search.msn.com/results.aspx?q=7+wonders+world&mkt=en-US&form=QBRE From tacuff at swbell.net Thu Dec 4 20:23:05 2008 From: tacuff at swbell.net (Tea Acuff) Date: Thu Dec 4 23:23:36 2008 Subject: [HSF] jaundice in pop Message-ID: <680868.14786.qm@web81601.mail.mud.yahoo.com> is there subaortic turbulence? tea ________________________________ From: edgar manrique To: openheart-l@lists.hsforum.com Sent: Thursday, December 4, 2008 9:43:39 PM Subject: RE: [HSF] jaundice in pop there is not paravalve leak, the last echo-c is ok, we will considerer the pentoxyfillin and BB, thanks, is possible than the prosthetic valve produce hemolysis?> Date: Fri, 5 Dec 2008 06:58:33 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] jaundice in pop> CC: > > Hemolysis is present - Is there any paravalvar/valvar leak ? I would> start him on Pentoxyfillin and beta blockers , add a small dose of> phenobarbitone for enzyme induction but the important thing is to have> a good look at the cardiac echo.> Did he receive any transfusions ?> Prasanna> > On Fri, Dec 5, 2008 at 6:20 AM, edgar manrique wrote:> >> > we have a 39 yo man for aortic and mitral replacement,he was operated 6 days ago and during surgery all things very good but 16 hours after surgery in ICU,extubated, the patient is with jaundice with indirect bilirrubin high and sgot and sgpt and alcaline fosfatasa normal and hepatic and biliar ultrasound is normal. there is haemolysis. In this moment the patient is ok but with jaundice. we need opinios about possible dx and therapy thanks> > edgar j manrique> > _________________________________________________________________> > Connect to the next generation of MSN Messenger> > http://imagine-msn.com/messenger/launch80/default.aspx?locale=en-us&source=wlmailtagline_______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- _________________________________________________________________ Explore the seven wonders of the world http://search.msn.com/results.aspx?q=7+wonders+world&mkt=en-US&form=QBRE_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From tacuff at swbell.net Thu Dec 4 21:15:53 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Dec 5 00:17:22 2008 Subject: [HSF] Another disaster endocarditis...... Message-ID: <768357.44660.qm@web81608.mail.mud.yahoo.com> Ani. I suppose that you are still "dis"connected, if not disinterested by preoccupation. I did run across this interesting?footnote in?"The Wounded Storyteller"?which I think is a dagger to the heart of "population medicine" that bares both?its successes and limitations?in a single sentence: ..(T)he?symptoms that combined patients into populations have become more important than the symptoms?that separate patients as individuals... The author of the book, Arthur Frank, uses the footnote to support his thesis (the solution which?is named in his title) that the modernity use of population has separated the patient from the concrete or real world in the name of the unreal or universal?"truth". In telling?his or her?story, even Bob's "go to hell" the patient reasserts the ethical and real world that belongs to the patient. So we in turn as physicans and eventual patients have a choice as underlined in the tension in this thread. We may stay in our world of medical "truth" (the right medical thing)or deal with the patient in his concrete reality if we can recognize the difference. If not,?we are not moral agents, just arrogant medical colonists either unaware or unwilling to?"recognize"?the country in which we practice. I was going to ask Bob in this context, is there an "inappropiate response" from a patient? Is the "customer" always right, even if he is wrong? tea ________________________________ From: Ani Anyanwu To: open heart list Sent: Tuesday, December 2, 2008 5:33:24 PM Subject: RE: [HSF] Another disaster endocarditis...... Roberto I am overseas and have only limited internet access for cannot provide you with references just now on the 'good death'. However as a starting point I would advise if you are seeking a good death should leave a written instruction that if you are 71 on dialysis, with chronic hepatitits, have a dense stroke and mitral endocarditis that you should not be taken to your? hospital or to any cardiac surgeon on HSF (except me of course!) - as they will operate you and you will likely end up experiencing a very bad death over whatever period of extra life your cardiac surgeon's 'success' allows you to experience! Ani > From: robertobattellini@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec 2008 17:54:25 +0100> > > Any,> > I want to read that article about good death!> > For myself, of course.> > Roberto> From: anianyanwu@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Another disaster endocarditis......> Date: Tue, 2 Dec 2008 09:35:09 +0000> > > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old > > > I disagree and would suggest that this patients prison status and his sentence is VERY important in making a decision as to how to manage his problem. In saying this I am assuming he has suffered permanent neurological injury. If so regardless of whatever heroic surgery we do his survival is limited if he has to go back to a prison to rehabhilitate from a stroke. Also his personal choice may be that living in a prison is bad enough and that he does not want to live in a prison severely disabled. On the other hand if he were to be released from prison in six months and had good social support then a 'useful' survival may be feasible with his dense hemiplegia. The BMJ published an episode few years back titled ' a good death' with series of ethical and medical articles stating how and why we should strive to provide our patients with a good death. Nature is providing this poor prisoner with a good death and we want to steal it away and ensure he lives to 'suffer' out the rest of his (?life) sentence.> > As surgeons we must look beyond 'saving life' and operative survival and ask what we are actually achieving for the quality of the life of the person in front of us beyond survival of surgery. While not privy to the whole clinical and social scenario, my inclination would be that this patient should not be operated because as a surgeon you cannot restore HIM to a reasonable quality of life. The prologue suggests that this is a sick terminally ill 71 year old and that the stroke and endocarditis are just the mechanism, rather than a prevantable cause, of death - why do we as heart surgeons find it difficult to accept the concept that patients do die of sickness or refuse to accept death can occur till we spend 500,000 USD of health care resources? For those who will fix the valve, will you also transplant his kidneys, liver and do a robotic prostatectomy at the same time? Where do we stop?> > Ani> > > Date: Mon, 1 Dec 2008 19:43:48 -0600> Subject: Re: [HSF] Another disaster endocarditis......> From: ebender001@me.com> To: OpenHeart-L@lists.hsforum.com> CC: > > Just treat the patient like you would any other stroked out, ventilated,> dialysis dependent 71 year old with probable 2 valve endocarditis. He will> be near the end of his sentence regardless of whether you feel like you> acted ethically or not. If you truly believe that you are fulfilling your> duty as a doctor and a human being, then you are acting ethically> independent of the process. You could however consider yourself immoral no> matter what choice you make.> > Ed Bender, MD> > > On 12/1/08 7:01 PM, "Michael Firstenberg" wrote:> > > I know - but it does raise an ethical question, does it not?> > > > Therapy is often withheld or altered for a variety of social/ethical/> > economic reasons - for example VADs in prisoners are a bad idea since> > the follow-up is so poor (not to mention compliance).> > > > > > -michael> > > > > > On Dec 1, 2008, at 7:49 PM, Edward Bender wrote:> > > >> Mike:> >> My post wasn't attempting an ethical point, but a medical one.> >> Ed Bender, MD> >> > >> > >> On 12/1/08 6:42 PM, "Michael Firstenberg" wrote:> >> > >>> We have the prison contract for the state and typically I dont look> >>> up> >>> the details (of course available online) - but in this case should it> >>> make a difference why he is in jail and for how long?> >>> > >>> > >>> > >>> -michael> >>> > >>> > >>> > >>> On Dec 1, 2008, at 7:04 PM, Edward Bender wrote:> >>> > >>>> If he's a "lifer," he may be nearing the end of his sentence.> >>>> > >>>> Ed Bender, MD> >>>> > >>>> > >>>> On 12/1/08 5:51 PM, "Michael Firstenberg" wrote:> >>>> > >>>>> OK - you think we could get these problems sorted out.> >>>>> > >>>>> 71 year/old prisoner was found "down" in his cell> >>>>> Intubated by EMS in route.> >>>>> Presumed cause was a large (and I mean large) right MCA CVA with> >>>>> diffuse> >>>>> hemispheric edema.> >>>>> Initial blood cultures positive to MSSA (allergic to PCN) - current> >>>>> set> >>>>> negaitve x1 day> >>>>> Chronic dialysis - surprisingly has a fistula (presumed source)> >>>>> Untreated Hep C (liver numbers OK, but dont know viral titers or> >>>>> HIV status)> >>>>> Recent diagnosis of Gleason (sp?) 9 prostate adenoCA> >>>>> > >>>>> Large vegetation on mitral with severe MR. Thickened aortic valve> >>>>> with mild> >>>>> AI, no obvious AS or signs of infection.> >>>>> > >>>>> Currently intubated on minimal settings (CXR shows diffuse pulm> >>>>> edema) and> >>>>> sedate, but awake follows commands but not moving left side.> >>>>> > >>>>> Obviously needs cath> >>>>> Would like to see him off the vent first - if possible.> >>>>> > >>>>> I favor operate sooner rather than later (i.e. before worse CHF and> >>>>> more> >>>>> complications) - like in the next couple of days. Surprisingly> >>>>> Cardiology> >>>>> want to wait and tune him up???> >>>>> > >>>>> Plan for MVReplace (tissue obviously) (grafts based upon cath) and> >>>>> probably> >>>>> leave the aortic alone - depending on AI.........> >>>>> > >>>>> > >>>>> or any "mitral reference surgeons" want to accept the transfer and> >>>>> plan a> >>>>> repair?> >>>>> > >>>>> > >>>>> -michael> >>>>> _______________________________________________> >>>>> OpenHeart-L mailing list> >>>>> > >>>>> Send postings to:> >>>>> OpenHeart-L@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@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@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@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@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@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> -----------------------------------------> _________________________________________________________________> Are you a PC? Upload your PC story and show the world > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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> ----------------------------------------- _________________________________________________________________ Get a bird?s eye view of the world with Multimap http://clk.atdmt.com/GBL/go/115454059/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From robertobattellini at hotmail.com Fri Dec 5 08:10:21 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri Dec 5 02:10:51 2008 Subject: [HSF] jaundice in pop In-Reply-To: References: Message-ID: We had a case recently with jaundice postop, he hed an haematom compressing the cava and perhaps had liver oedema. First reoperated, then got liver dyalisis. Long time in ICU, did fine. So, do you have a CT? Roberto> From: edman63@hotmail.com> To: openheart-l@lists.hsforum.com> Date: Thu, 4 Dec 2008 19:50:09 -0500> Subject: [HSF] jaundice in pop> > > we have a 39 yo man for aortic and mitral replacement,he was operated 6 days ago and during surgery all things very good but 16 hours after surgery in ICU,extubated, the patient is with jaundice with indirect bilirrubin high and sgot and sgpt and alcaline fosfatasa normal and hepatic and biliar ultrasound is normal. there is haemolysis. In this moment the patient is ok but with jaundice. we need opinios about possible dx and therapy thanks> edgar j manrique> _________________________________________________________________> Connect to the next generation of MSN Messenger > http://imagine-msn.com/messenger/launch80/default.aspx?locale=en-us&source=wlmailtagline_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From Rwmfglycar at aol.com Fri Dec 5 02:49:38 2008 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Fri Dec 5 02:50:11 2008 Subject: [HSF] jaundice in pop Message-ID: This may not be relevant to your case but with double valve replacements there is always the possibility that an aortic valve leak will strike the mitral valve. This is influenced by the angle between the planes of the aortic and mitral annuli. The smaller the angle the more the likelihood of the mitral valve projecting far enough across the outflow tract to be in the way of a regurgitant jet from the aortic valve. I had a case in which I had used two Medtronic Hall valves. The Medtronic Hall has normally a jet though the hole in the center of the disc. In my case this NORMAL jet in the closed valve was meeting the open pyrolytic carbon leaflet of the mitral prosthesis and producing significant hemolysis. If you had quite a small jet coming from the aortic valve it could be striking the cloth covering of one of the struts of the mitral valve causing hemolysis. Because of echo reflections from the two prostheses a small jet might be difficult to see. Perhaps you can show the echocardiographer an example of the valve and where in relation to the aortic valve the mitral struts might be according to how you inserted the valve ( I would presume one strut on each side of the subaortic curtain). A very small jet can cause significant hemolysis if it is striking cloth. Bob **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From Hgrmd at aol.com Fri Dec 5 06:27:16 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Fri Dec 5 06:26:18 2008 Subject: [HSF] jaundice in pop Message-ID: Roberto, Tell us more about the technique of liver dialysis. Hal **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From robertobattellini at hotmail.com Fri Dec 5 16:38:17 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri Dec 5 10:39:07 2008 Subject: [HSF] jaundice in pop-OT l for Hal In-Reply-To: References: Message-ID: Hal, I finished now my second case and I?m preparing for the greatest Party of the Year: Volkmar goes asc Chief to Z?rich where Senning chief was.He gives a great Party. Then we fly to Paris. Next week I?ll try to send a photo of the dyalizer, similar to a Kidney one, but they use very different expensive solutions, with good results. My commented case from last week is OK at station now. Till Paris, Roberto > From: Hgrmd@aol.com> Date: Fri, 5 Dec 2008 06:27:16 -0500> Subject: Re: [HSF] jaundice in pop> To: OpenHeart-L@lists.hsforum.com> CC: > > Roberto,> Tell us more about the technique of liver dialysis.> > Hal> **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From prasannasimha at gmail.com Fri Dec 5 21:15:03 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Dec 5 10:45:32 2008 Subject: [HSF] jaundice in pop-OT l for Hal In-Reply-To: References: Message-ID: <89c4ed2d0812050745m3f92348j3d9e4f9d29836d2c@mail.gmail.com> Is it the mars system ? Convey my congratulations to Volkmar. Prasanna Prasanna On Fri, Dec 5, 2008 at 9:08 PM, Roberto Battellini wrote: > > Hal, > > I finished now my second case and I?m preparing for the greatest Party of the Year: Volkmar goes asc Chief to Z?rich where Senning chief was.He gives a great Party. Then we fly to Paris. Next week I?ll try to send a photo of the dyalizer, similar to a Kidney one, but they use very different expensive solutions, with good results. > > My commented case from last week is OK at station now. > > Till Paris, > > Roberto > >> From: Hgrmd@aol.com> Date: Fri, 5 Dec 2008 06:27:16 -0500> Subject: Re: [HSF] jaundice in pop> To: OpenHeart-L@lists.hsforum.com> CC: > > Roberto,> Tell us more about the technique of liver dialysis.> > Hal> **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From Hgrmd at aol.com Fri Dec 5 14:08:54 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Fri Dec 5 14:09:34 2008 Subject: [HSF] jaundice in pop-OT l for Hal Message-ID: Roberto, Please give my congratulations to Volkmar! As you know, he and I are good friends with a common bond in music and surgery. I know he will represent The Herzzentrum well in Zurich. I leave for the airport in a few minutes. See you in Paris. For other members of HSF, Roberto and I are attending Carpentier's 3 day meeting that starts this Monday. Vanermen, Mohr, Dion, Perrier, Dreyfus, and many others are on the program. I will let you know what I consider the highlights. Hal **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From enaseri at hotmail.com.tr Sat Dec 6 07:45:26 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sat Dec 6 02:45:56 2008 Subject: [HSF] To roberto OT In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: Roberto, I received the self inflatable coronary ostial cannula about 1 month ago and sent you an e-mail to your personal e-mail adress which obviously you haven't received. Thank you erdinc From enaseri at hotmail.com.tr Sat Dec 6 08:17:49 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sat Dec 6 03:18:18 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: References: Message-ID: Opinion requested for the following case: 61 Y/O male ,previous heavy weight wrestler admittted to another hospital with the history of sudden loss of consciousness while driving in a traffic jam ( and so with very low speed).Upon arrival to ER he was diagnosed as having left hemiplegia and unresponsive to verbal stimuli.No idea about brain CT then.A TTE showed multiple intimal flaps in the ascending aorta and the patient was directly transferred to our OR.(BP:60/40).Immediately intubated .TEE:Type A dissection with intrapericardial fluid.Femoral cannulation and opened pericardium.Modified Bentall+ hemiarch replacement +CABG X 1( dissection inside RCA which couldn't be repaired ).Re-explored for bleeding on postop 10.th hour ( bleeding from RCA ostium despite circular surure around it). recovered fast and good . opened eyes on 3.rd day with dense hemiplegia.No fever on 1.st generation cephalosporine. Control brain CT:widespread infarcts all over both hemispheres.on postop 8.th day transferred to normal ward with a large decubitus ulcer and started having fever.Started different ab.s with increasing strength and finally VM+imipen+amikacin for the last 2 weeks with persistent daily fever( 38-39C) which has decreased in duration.( ID recommendation)( postop 40's day) erdinc From benjamin.bidstrup at bigpond.com Sat Dec 6 18:57:49 2008 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Sat Dec 6 03:58:32 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: References: Message-ID: <4AE2BF12-C942-42F1-9690-3FF2F0AE1C34@bigpond.com> Suggest stopping Abs for a few days if there is no obvious source (pressure area). Reculture if fever and inflammatory markers, WCC persist. Consider chest CT to exclude infected haematoma or even just a resolving one which can be the source of fever. Ben Bidstrup FRACS FRCSEd FEBCTS Cardiothoracic Surgeon On 06/12/2008, at 6:17 PM, erdin? naseri wrote: > > Opinion requested for the following case: > 61 Y/O male ,previous heavy weight wrestler admittted to another > hospital with the history of sudden loss of consciousness while > driving in a traffic jam ( and so with very low speed).Upon arrival > to ER he was diagnosed as having left hemiplegia and unresponsive > to verbal stimuli.No idea about brain CT then.A TTE showed > multiple intimal flaps in the ascending aorta and the patient was > directly transferred to our OR.(BP:60/40).Immediately > intubated .TEE:Type A dissection with intrapericardial fluid.Femoral > cannulation and opened pericardium.Modified Bentall+ hemiarch > replacement +CABG X 1( dissection inside RCA which couldn't be > repaired ).Re-explored for bleeding on postop 10.th hour ( bleeding > from RCA ostium despite circular surure around it). recovered fast > and good . opened eyes on 3.rd day with dense hemiplegia.No fever on > 1.st generation cephalosporine. Control brain CT:widespread infarcts > all over both hemispheres.on postop 8.th day transferred to normal > ward with > a large decubitus ulcer and started having fever.Started different > ab.s with increasing strength and finally VM+imipen+amikacin for the > last 2 weeks with persistent daily fever( 38-39C) which has > decreased in duration.( ID recommendation)( postop 40's day) > erdinc > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From rowlesjohn at aol.com Sat Dec 6 16:09:23 2008 From: rowlesjohn at aol.com (rowlesjohn@aol.com) Date: Sat Dec 6 11:06:04 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection Message-ID: <335233804-1228579535-cardhu_decombobulator_blackberry.rim.net-504144339-@bxe277.bisx.prod.on.blackberry> Erdinc It sounds like he has a profound and diffuse brain injury that will be fatal. He may have a graft infection if no other sources are identified. You have already gone the extra mile... What is your endpoint? If it was me or one of my family I would want to end the saga. John Rowles, MD Wenatchee, WA ------Original Message------ From: erdin? naseri Sender: openheart-l-bounces@lists.hsforum.com To: HSF HSF ReplyTo: OpenHeart-L@lists.hsforum.com Subject: [HSF] Fever after surgery for ruptured aortic dissection Sent: Dec 6, 2008 12:17 AM Opinion requested for the following case: 61 Y/O male ,previous heavy weight wrestler admittted to another hospital with the history of sudden loss of consciousness while driving in a traffic jam ( and so with very low speed).Upon arrival to ER he was diagnosed as having left hemiplegia and unresponsive to verbal stimuli.No idea about brain CT then.A TTE showed multiple intimal flaps in the ascending aorta and the patient was directly transferred to our OR.(BP:60/40).Immediately intubated .TEE:Type A dissection with intrapericardial fluid.Femoral cannulation and opened pericardium.Modified Bentall+ hemiarch replacement +CABG X 1( dissection inside RCA which couldn't be repaired ).Re-explored for bleeding on postop 10.th hour ( bleeding from RCA ostium despite circular surure around it). recovered fast and good . opened eyes on 3.rd day with dense hemiplegia.No fever on 1.st generation cephalosporine. Control brain CT:widespread infarcts all over both hemispheres.on postop 8.th day transferred to normal ward with a large decubitus ulcer and started having fever.Started different ab.s with increasing strength and finally VM+imipen+amikacin for the last 2 weeks with persistent daily fever( 38-39C) which has decreased in duration.( ID recommendation)( postop 40's day) erdinc _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- Sent from my Verizon Wireless BlackBerry From robertobattellini at hotmail.com Sat Dec 6 19:05:00 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sat Dec 6 13:05:28 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: <335233804-1228579535-cardhu_decombobulator_blackberry.rim.net-504144339-@bxe277.bisx.prod.on.blackberry> References: <335233804-1228579535-cardhu_decombobulator_blackberry.rim.net-504144339-@bxe277.bisx.prod.on.blackberry> Message-ID: Erdinc, You wrote at the end that he was on the 40?s PO day? With that description, if you want to continue the saga, and a neurologist says the patient would be neurologically recuperable, we would do a thorax and Abdomen CT, and if for example an h?matom in mediastinum is found, drain it, and if you suspect the prosthesis is infected but is not bleeding, you can try an omentumplastik. I have done half a dozen of those in infected abdominal aneurysms and in two thoracic, with good results if the prosthesis does not bleed. I would do no more than that. Roberto> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Fever after surgery for ruptured aortic dissection> From: rowlesjohn@aol.com> Date: Sat, 6 Dec 2008 16:09:23 +0000> CC: > > Erdinc> > It sounds like he has a profound and diffuse brain injury that will be fatal. He may have a graft infection if no other sources are identified. You have already gone the extra mile... > > What is your endpoint? If it was me or one of my family I would want to end the saga. > > John Rowles, MD> Wenatchee, WA > ------Original Message------> From: erdin? naseri> Sender: openheart-l-bounces@lists.hsforum.com> To: HSF HSF> ReplyTo: OpenHeart-L@lists.hsforum.com> Subject: [HSF] Fever after surgery for ruptured aortic dissection> Sent: Dec 6, 2008 12:17 AM> > > Opinion requested for the following case:> 61 Y/O male ,previous heavy weight wrestler admittted to another hospital with the history of sudden loss of consciousness while driving in a traffic jam ( and so with very low speed).Upon arrival to ER he was diagnosed as having left hemiplegia and unresponsive to verbal stimuli.No idea about brain CT then.A TTE showed multiple intimal flaps in the ascending aorta and the patient was directly transferred to our OR.(BP:60/40).Immediately intubated .TEE:Type A dissection with intrapericardial fluid.Femoral cannulation and opened pericardium.Modified Bentall+ hemiarch replacement +CABG X 1( dissection inside RCA which couldn't be repaired ).Re-explored for bleeding on postop 10.th hour ( bleeding from RCA ostium despite circular surure around it). recovered fast and good . opened eyes on 3.rd day with dense hemiplegia.No fever on 1.st generation cephalosporine. Control brain CT:widespread infarcts all over both hemispheres.on postop 8.th day transferred to normal ward with a large decubitus ulcer and started having fever.Started different ab.s with increasing strength and finally VM+imipen+amikacin for the last 2 weeks with persistent daily fever( 38-39C) which has decreased in duration.( ID recommendation)( postop 40's day)> erdinc> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> -----------------------------------------> > > Sent from my Verizon Wireless BlackBerry From robertobattellini at hotmail.com Sat Dec 6 19:18:26 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sat Dec 6 13:18:53 2008 Subject: [HSF] To Erdinc OT In-Reply-To: References: <8D3286A9-8108-4820-9E8B-5CF36F9955FA@gmail.com> Message-ID: OK, if you need more, I?ll collect some. Roberto> From: enaseri@hotmail.com.tr> To: openheart-l@lists.hsforum.com> Date: Sat, 6 Dec 2008 07:45:26 +0000> Subject: [HSF] To roberto OT> > > Roberto,> I received the self inflatable coronary ostial cannula about 1 month ago and sent you an e-mail to your personal e-mail adress which obviously you haven't received. Thank you> erdinc> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From prasannasimha at gmail.com Sat Dec 6 23:41:54 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Dec 6 13:20:04 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: References: Message-ID: <89c4ed2d0812061011r28144566n16c445f63db93fe2@mail.gmail.com> I would stop all antibiotics and reculture after a couple of days. How is the bedosre ? Is there any collection around the graft as seen on echo/ CT ? Prasanna On Sat, Dec 6, 2008 at 1:47 PM, erdin? naseri wrote: > > Opinion requested for the following case: > 61 Y/O male ,previous heavy weight wrestler admittted to another hospital with the history of sudden loss of consciousness while driving in a traffic jam ( and so with very low speed).Upon arrival to ER he was diagnosed as having left hemiplegia and unresponsive to verbal stimuli.No idea about brain CT then.A TTE showed multiple intimal flaps in the ascending aorta and the patient was directly transferred to our OR.(BP:60/40).Immediately intubated .TEE:Type A dissection with intrapericardial fluid.Femoral cannulation and opened pericardium.Modified Bentall+ hemiarch replacement +CABG X 1( dissection inside RCA which couldn't be repaired ).Re-explored for bleeding on postop 10.th hour ( bleeding from RCA ostium despite circular surure around it). recovered fast and good . opened eyes on 3.rd day with dense hemiplegia.No fever on 1.st generation cephalosporine. Control brain CT:widespread infarcts all over both hemispheres.on postop 8.th day transferred to normal ward with > a large decubitus ulcer and started having fever.Started different ab.s with increasing strength and finally VM+imipen+amikacin for the last 2 weeks with persistent daily fever( 38-39C) which has decreased in duration.( ID recommendation)( postop 40's day) > erdinc > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From msfirst at gmail.com Sat Dec 6 15:22:18 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Sat Dec 6 15:22:57 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: References: <335233804-1228579535-cardhu_decombobulator_blackberry.rim.net-504144339-@bxe277.bisx.prod.on.blackberry> Message-ID: Did you use a lot of bioglue? That can generate an inflammatory reaction that can mimic an infection. I also agree in stopping the antibiotics or you will start seeing more problems -michael. On Dec 6, 2008, at 1:05 PM, Roberto Battellini wrote: > > Erdinc, > > You wrote at the end that he was on the 40?s PO day? > With that description, if you want to continue the saga, and a > neurologist says the patient would be neurologically recuperable, we > would do a thorax and Abdomen CT, and if for example an h?matom in m > ediastinum is found, drain it, and if you suspect the prosthesis is > infected but is not bleeding, you can try an omentumplastik. I have > done half a dozen of those in infected abdominal aneurysms and in tw > o thoracic, with good results if the prosthesis does not bleed. > I would do no more than that. > Roberto> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Fever > after surgery for ruptured aortic dissection> From: > rowlesjohn@aol.com> Date: Sat, 6 Dec 2008 16:09:23 +0000> CC: > > > Erdinc> > It sounds like he has a profound and diffuse brain injury > that will be fatal. He may have a graft infection if no other > sources are identified. You have already gone the extra mile... > > > What is your endpoint? If it was me or one of my family I would want > to end the saga. > > John Rowles, MD> Wenatchee, WA > ------Original > Message------> From: erdin? naseri> Sender: openheart-l-bounces@lists.hsforum.co > m> To: HSF HSF> ReplyTo: OpenHeart-L@lists.hsforum.com> Subject: [HS > F] Fever after surgery for ruptured aortic dissection> Sent: Dec 6, > 2008 12:17 AM> > > Opinion requested for the following case:> 61 Y/O > male ,previous heavy weight wrestler admittted to another hospital > with the history of sudden loss of consciousness while driving in a > traffic jam ( and so with very low speed).Upon arrival to ER he was > diagnosed as having left hemiplegia and unresponsive to verbal stimu > li.No idea about brain CT then.A TTE showed multiple intimal flaps i > n the ascending aorta and the patient was directly transferred to ou > r OR.(BP:60/40).Immediately intubated .TEE:Type A dissection with in > trapericardial fluid.Femoral cannulation and opened pericardium.Modi > fied Bentall+ hemiarch replacement +CABG X 1( dissection inside RCA > which couldn't be repaired ).Re-explored for bleeding on postop 10.t > h hour ( bleeding from RCA ostium despite circular surure around it) > . recovered fast and good . opened eyes on 3.rd day with dense hemip > legia.No fever on 1.st generation cephalosporine. Control brain CT:w > idespread infarcts all over both hemispheres.on postop 8.th day tran > sferred to normal ward with a large decubitus ulcer and started havi > ng fever.Started different ab.s with increasing strength and finally > VM+imipen+amikacin for the last 2 weeks with persistent daily fever > ( 38-39C) which has decreased in duration.( ID recommendation)( post > op 40's day)> erdinc> ______________________________________________ > _> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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 p > olicies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim > > -----------------------------------------> > > Sent from my Verizo > n Wireless BlackBerry_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From enaseri at hotmail.com.tr Sun Dec 7 00:06:28 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sat Dec 6 19:07:18 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: <4AE2BF12-C942-42F1-9690-3FF2F0AE1C34@bigpond.com> References: <4AE2BF12-C942-42F1-9690-3FF2F0AE1C34@bigpond.com> Message-ID: all cultures negative,wbc down to 12000 from 25000 and sedimentation 50 from 120 10 days ago erdinc> From: benjamin.bidstrup@bigpond.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Fever after surgery for ruptured aortic dissection> Date: Sat, 6 Dec 2008 18:57:49 +1000> CC: > > Suggest stopping Abs for a few days if there is no obvious source > (pressure area). Reculture if fever and inflammatory markers, WCC > persist.> > Consider chest CT to exclude infected haematoma or even just a > resolving one which can be the source of fever.> > > Ben Bidstrup FRACS FRCSEd FEBCTS> Cardiothoracic Surgeon> > > > On 06/12/2008, at 6:17 PM, erdin? naseri wrote:> > >> > Opinion requested for the following case:> > 61 Y/O male ,previous heavy weight wrestler admittted to another > > hospital with the history of sudden loss of consciousness while > > driving in a traffic jam ( and so with very low speed).Upon arrival > > to ER he was diagnosed as having left hemiplegia and unresponsive > > to verbal stimuli.No idea about brain CT then.A TTE showed > > multiple intimal flaps in the ascending aorta and the patient was > > directly transferred to our OR.(BP:60/40).Immediately > > intubated .TEE:Type A dissection with intrapericardial fluid.Femoral > > cannulation and opened pericardium.Modified Bentall+ hemiarch > > replacement +CABG X 1( dissection inside RCA which couldn't be > > repaired ).Re-explored for bleeding on postop 10.th hour ( bleeding > > from RCA ostium despite circular surure around it). recovered fast > > and good . opened eyes on 3.rd day with dense hemiplegia.No fever on > > 1.st generation cephalosporine. Control brain CT:widespread infarcts > > all over both hemispheres.on postop 8.th day transferred to normal > > ward with> > a large decubitus ulcer and started having fever.Started different > > ab.s with increasing strength and finally VM+imipen+amikacin for the > > last 2 weeks with persistent daily fever( 38-39C) which has > > decreased in duration.( ID recommendation)( postop 40's day)> > erdinc> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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> ----------------------------------------- From enaseri at hotmail.com.tr Sun Dec 7 00:10:17 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sat Dec 6 19:11:06 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: <335233804-1228579535-cardhu_decombobulator_blackberry.rim.net-504144339-@bxe277.bisx.prod.on.blackberry> References: <335233804-1228579535-cardhu_decombobulator_blackberry.rim.net-504144339-@bxe277.bisx.prod.on.blackberry> Message-ID: John, although he has got diffuse brain infarcts and dense left sided hemiplegia he recovered well and has normal intellectual function.He will need rehabilitation erdinc.. .> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Fever after surgery for ruptured aortic dissection> From: rowlesjohn@aol.com> Date: Sat, 6 Dec 2008 16:09:23 +0000> CC: > > Erdinc> > It sounds like he has a profound and diffuse brain injury that will be fatal. He may have a graft infection if no other sources are identified. You have already gone the extra mile... > > What is your endpoint? If it was me or one of my family I would want to end the saga. > > John Rowles, MD> Wenatchee, WA > ------Original Message------> From: erdin? naseri> Sender: openheart-l-bounces@lists.hsforum.com> To: HSF HSF> ReplyTo: OpenHeart-L@lists.hsforum.com> Subject: [HSF] Fever after surgery for ruptured aortic dissection> Sent: Dec 6, 2008 12:17 AM> > > Opinion requested for the following case:> 61 Y/O male ,previous heavy weight wrestler admittted to another hospital with the history of sudden loss of consciousness while driving in a traffic jam ( and so with very low speed).Upon arrival to ER he was diagnosed as having left hemiplegia and unresponsive to verbal stimuli.No idea about brain CT then.A TTE showed multiple intimal flaps in the ascending aorta and the patient was directly transferred to our OR.(BP:60/40).Immediately intubated .TEE:Type A dissection with intrapericardial fluid.Femoral cannulation and opened pericardium.Modified Bentall+ hemiarch replacement +CABG X 1( dissection inside RCA which couldn't be repaired ).Re-explored for bleeding on postop 10.th hour ( bleeding from RCA ostium despite circular surure around it). recovered fast and good . opened eyes on 3.rd day with dense hemiplegia.No fever on 1.st generation cephalosporine. Control brain CT:widespread infarcts all over both hemispheres.on postop 8.th day transferred to normal ward with a large decubitus ulcer and started having fever.Started different ab.s with increasing strength and finally VM+imipen+amikacin for the last 2 weeks with persistent daily fever( 38-39C) which has decreased in duration.( ID recommendation)( postop 40's day)> erdinc> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> -----------------------------------------> > > Sent from my Verizon Wireless BlackBerry From enaseri at hotmail.com.tr Sun Dec 7 00:13:36 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sat Dec 6 19:14:03 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: References: <335233804-1228579535-cardhu_decombobulator_blackberry.rim.net-504144339-@bxe277.bisx.prod.on.blackberry> Message-ID: Roberto, Normal thoracic Ct .while he ha delevated lipase and amylase levels 2-3 weeks ago we mad e an abd CT for pancreatic pathology and it was compleltely normal. erdinc> From: robertobattellini@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] Fever after surgery for ruptured aortic dissection> Date: Sat, 6 Dec 2008 19:05:00 +0100> > > Erdinc,> > You wrote at the end that he was on the 40?s PO day?> With that description, if you want to continue the saga, and a neurologist says the patient would be neurologically recuperable, we would do a thorax and Abdomen CT, and if for example an h?matom in mediastinum is found, drain it, and if you suspect the prosthesis is infected but is not bleeding, you can try an omentumplastik. I have done half a dozen of those in infected abdominal aneurysms and in two thoracic, with good results if the prosthesis does not bleed.> I would do no more than that.> Roberto> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Fever after surgery for ruptured aortic dissection> From: rowlesjohn@aol.com> Date: Sat, 6 Dec 2008 16:09:23 +0000> CC: > > Erdinc> > It sounds like he has a profound and diffuse brain injury that will be fatal. He may have a graft infection if no other sources are identified. You have already gone the extra mile... > > What is your endpoint? If it was me or one of my family I would want to end the saga. > > John Rowles, MD> Wenatchee, WA > ------Original Message------> From: erdin? naseri> Sender: openheart-l-bounces@lists.hsforum.com> To: HSF HSF> ReplyTo: OpenHeart-L@lists.hsforum.com> Subject: [HSF] Fever after surgery for ruptured aortic dissection> Sent: Dec 6, 2008 12:17 AM> > > Opinion requested for the following case:> 61 Y/O male ,previous heavy weight wrestler admittted to another hospital with the history of sudden loss of consciousness while driving in a traffic jam ( and so with very low speed).Upon arrival to ER he was diagnosed as having left hemiplegia and unresponsive to verbal stimuli.No idea about brain CT then.A TTE showed multiple intimal flaps in the ascending aorta and the patient was directly transferred to our OR.(BP:60/40).Immediately intubated .TEE:Type A dissection with intrapericardial fluid.Femoral cannulation and opened pericardium.Modified Bentall+ hemiarch replacement +CABG X 1( dissection inside RCA which couldn't be repaired ).Re-explored for bleeding on postop 10.th hour ( bleeding from RCA ostium despite circular surure around it). recovered fast and good . opened eyes on 3.rd day with dense hemiplegia.No fever on 1.st generation cephalosporine. Control brain CT:widespread infarcts all over both hemispheres.on postop 8.th day transferred to normal ward with a large decubitus ulcer and started having fever.Started different ab.s with increasing strength and finally VM+imipen+amikacin for the last 2 weeks with persistent daily fever( 38-39C) which has decreased in duration.( ID recommendation)( postop 40's day)> erdinc> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> -----------------------------------------> > > Sent from my Verizon Wireless BlackBerry_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From enaseri at hotmail.com.tr Sun Dec 7 00:15:02 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sat Dec 6 19:15:19 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: <89c4ed2d0812061011r28144566n16c445f63db93fe2@mail.gmail.com> References: <89c4ed2d0812061011r28144566n16c445f63db93fe2@mail.gmail.com> Message-ID: bed sore better compared to weeks before .Normal TTE and CT erdinc> Date: Sat, 6 Dec 2008 23:41:54 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Fever after surgery for ruptured aortic dissection> CC: > > I would stop all antibiotics and reculture after a couple of days. How> is the bedosre ? Is there any collection around the graft as seen on> echo/ CT ?> Prasanna> > On Sat, Dec 6, 2008 at 1:47 PM, erdin? naseri wrote:> >> > Opinion requested for the following case:> > 61 Y/O male ,previous heavy weight wrestler admittted to another hospital with the history of sudden loss of consciousness while driving in a traffic jam ( and so with very low speed).Upon arrival to ER he was diagnosed as having left hemiplegia and unresponsive to verbal stimuli.No idea about brain CT then.A TTE showed multiple intimal flaps in the ascending aorta and the patient was directly transferred to our OR.(BP:60/40).Immediately intubated .TEE:Type A dissection with intrapericardial fluid.Femoral cannulation and opened pericardium.Modified Bentall+ hemiarch replacement +CABG X 1( dissection inside RCA which couldn't be repaired ).Re-explored for bleeding on postop 10.th hour ( bleeding from RCA ostium despite circular surure around it). recovered fast and good . opened eyes on 3.rd day with dense hemiplegia.No fever on 1.st generation cephalosporine. Control brain CT:widespread infarcts all over both hemispheres.on postop 8.th day transferred to normal ward with> > a large decubitus ulcer and started having fever.Started different ab.s with increasing strength and finally VM+imipen+amikacin for the last 2 weeks with persistent daily fever( 38-39C) which has decreased in duration.( ID recommendation)( postop 40's day)> > erdinc> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From enaseri at hotmail.com.tr Sun Dec 7 00:15:42 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sat Dec 6 19:16:10 2008 Subject: [HSF] Fever after surgery for ruptured aortic dissection In-Reply-To: References: <335233804-1228579535-cardhu_decombobulator_blackberry.rim.net-504144339-@bxe277.bisx.prod.on.blackberry> Message-ID: No bioglue erdinc> From: msfirst@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Fever after surgery for ruptured aortic dissection> Date: Sat, 6 Dec 2008 15:22:18 -0500> CC: > > Did you use a lot of bioglue?> That can generate an inflammatory reaction that can mimic an infection.> > I also agree in stopping the antibiotics or you will start seeing more > problems> > -michael.> > On Dec 6, 2008, at 1:05 PM, Roberto Battellini > wrote:> > >> > Erdinc,> >> > You wrote at the end that he was on the 40?s PO day?> > With that description, if you want to continue the saga, and a > > neurologist says the patient would be neurologically recuperable, we > > would do a thorax and Abdomen CT, and if for example an h?matom in m > > ediastinum is found, drain it, and if you suspect the prosthesis is > > infected but is not bleeding, you can try an omentumplastik. I have > > done half a dozen of those in infected abdominal aneurysms and in tw > > o thoracic, with good results if the prosthesis does not bleed.> > I would do no more than that.> > Roberto> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Fever > > after surgery for ruptured aortic dissection> From: > > rowlesjohn@aol.com> Date: Sat, 6 Dec 2008 16:09:23 +0000> CC: > > > > Erdinc> > It sounds like he has a profound and diffuse brain injury > > that will be fatal. He may have a graft infection if no other > > sources are identified. You have already gone the extra mile... > > > > What is your endpoint? If it was me or one of my family I would want > > to end the saga. > > John Rowles, MD> Wenatchee, WA > ------Original > > Message------> From: erdin? naseri> Sender: openheart-l-bounces@lists.hsforum.co > > m> To: HSF HSF> ReplyTo: OpenHeart-L@lists.hsforum.com> Subject: [HS > > F] Fever after surgery for ruptured aortic dissection> Sent: Dec 6, > > 2008 12:17 AM> > > Opinion requested for the following case:> 61 Y/O > > male ,previous heavy weight wrestler admittted to another hospital > > with the history of sudden loss of consciousness while driving in a > > traffic jam ( and so with very low speed).Upon arrival to ER he was > > diagnosed as having left hemiplegia and unresponsive to verbal stimu > > li.No idea about brain CT then.A TTE showed multiple intimal flaps i > > n the ascending aorta and the patient was directly transferred to ou > > r OR.(BP:60/40).Immediately intubated .TEE:Type A dissection with in > > trapericardial fluid.Femoral cannulation and opened pericardium.Modi > > fied Bentall+ hemiarch replacement +CABG X 1( dissection inside RCA > > which couldn't be repaired ).Re-explored for bleeding on postop 10.t > > h hour ( bleeding from RCA ostium despite circular surure around it) > > . recovered fast and good . opened eyes on 3.rd day with dense hemip > > legia.No fever on 1.st generation cephalosporine. Control brain CT:w > > idespread infarcts all over both hemispheres.on postop 8.th day tran > > sferred to normal ward with a large decubitus ulcer and started havi > > ng fever.Started different ab.s with increasing strength and finally > > VM+imipen+amikacin for the last 2 weeks with persistent daily fever > > ( 38-39C) which has decreased in duration.( ID recommendation)( post > > op 40's day)> erdinc> ______________________________________________ > > _> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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 p > > olicies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim > > > -----------------------------------------> > > Sent from my Verizo > > n Wireless BlackBerry_______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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> ----------------------------------------- From Rwmfglycar at aol.com Sun Dec 7 11:08:59 2008 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Sun Dec 7 11:09:35 2008 Subject: [HSF] Another disaster endocarditis...... Message-ID: In a message dated 12/5/2008 12:19:33 A.M. Eastern Standard Time, tacuff@swbell.net writes: I suppose that you are still "dis"connected, if not disinterested by preoccupation. I did run across this interesting footnote in "The Wounded Storyteller" which I think is a dagger to the heart of "population medicine" that bares both its successes and limitations in a single sentence: ..(T)he symptoms that combined patients into populations have become more important than the symptoms that separate patients as individuals... The author of the book, Arthur Frank, uses the footnote to support his thesis (the solution which is named in his title) that the modernity use of population has separated the patient from the concrete or real world in the name of the unreal or universal "truth". In telling his or her story, even Bob's "go to hell" the patient reasserts the ethical and real world that belongs to the patient. So we in turn as physicans and eventual patients have a choice as underlined in the tension in this thread. We may stay in our world of medical "truth" (the right medical thing)or deal with the patient in his concrete reality if we can recognize the difference. If not, we are not moral agents, just arrogant medical colonists either unaware or unwilling to "recognize" the country in which we practice. I was going to ask Bob in this context, is there an "inappropiate response" from a patient? Is the "customer" always right, even if he is wrong? Very nicely put Tea. And thank you for understanding my reply which might have seemed egregiously callous. If we see a patient whose health is on a well established downhill course and offer that patient a treatment to restore him or her to a healthy life and at the same time provide an honest and hopefully accurate assessment of the risks, we believe the appropriate response is to say "yes, show me the optable so I can jump on it". Anybody who goes into our profession is a high energy optimist so a "No" answer always seems inappropriate. There are many reasons for a No answer some of which we can understand and some of which we can spend time on by trying to bring understanding to the patient. Most of us acknowledge that we are not part of a totalitarian machinery and will allow the patient to reach his own understanding of what is appropriate for him.In other words we understand that fear maybe overwhelming or that some circumstance in life has destroyed a will to live. All of this is in the context of one on one interactions. This changes when we think of the individual interacting with society. The control of infectious disease needs totalitarian approaches. Even in the limited context of surgery I will not go the modern route and say that any response is appropriate. Think of teenagers who are intelligent enough to know that an action will harm them and others and go ahead and take it anyway. There are patients who are not teenagers who behave in this way exhibiting what I call willful stupidity. I do describe their responses as inappropriate by which I suppose I mean they do not coincide with my idea of a good world. Bob **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From FONHMD at aol.com Sun Dec 7 11:36:20 2008 From: FONHMD at aol.com (FONHMD@aol.com) Date: Sun Dec 7 11:36:55 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs Message-ID: 5 days ago I repaired the MV of a close family friend of 42 years. She is a 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, thickened as well as all of it's associated chordae. Her preop TEE had "no visible posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a posterior leaflet augmentation with a pericardial strip from just past the P1/P2 junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. Her anterior leaflet had some redundancy, more like a myxomatous valve, and I closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. I added a "full" left atrial Maze(RF), closed the LAA orifice( from a partial lower sternotomy) to try to convert her AF and keep her Coumadin free for a while. My main question, particularly for those who treat/ repair more rheumatic valve disease than we do in the USA, is how long do you expect this type of repair to last? K. Fon Huang, MD Springfield, MO. **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From prasannasimha at gmail.com Sun Dec 7 22:12:27 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Dec 7 11:42:55 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: <89c4ed2d0812070842g426546f9sb2213e68993da1@mail.gmail.com> There is data by both Carpentier and Sampath Kumar available and the results are 70 % 10 year freedom from re replacement.These are younger patients who can have recurrent rheumatic activity. I would keep the patient on 2 weekly long acting penicillin unless you can do penicillin levels and prove that the 3 week level is above the MIC for streptococci. Prasanna On Sun, Dec 7, 2008 at 10:06 PM, wrote: > 5 days ago I repaired the MV of a close family friend of 42 years. She is a > 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, > thickened as well as all of it's associated chordae. Her preop TEE had "no visible > posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a > posterior leaflet augmentation with a pericardial strip from just past the P1/P2 > junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. Her > anterior leaflet had some redundancy, more like a myxomatous valve, and I > closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. I added a > "full" left atrial Maze(RF), closed the LAA orifice( from a partial lower > sternotomy) to try to convert her AF and keep her Coumadin free for a while. > My main question, particularly for those who treat/ repair more > rheumatic valve disease than we do in the USA, is how long do you expect this type of > repair to last? > > K. Fon Huang, MD > Springfield, MO. > **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From ecdouville at orclinic.com Sun Dec 7 08:46:05 2008 From: ecdouville at orclinic.com (Douville, Chuck) Date: Sun Dec 7 11:48:07 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs References: <89c4ed2d0812070842g426546f9sb2213e68993da1@mail.gmail.com> Message-ID: Prasanna, do you mean life long Penicillin, given every two weeks or three weeks depending upon the levels? Prasanna, would you also comment on what percentage of your rheumatic valves you currently repair, approximately? thanks chuckdouville ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M Sent: Sun 12/7/2008 8:42 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Durability - Rheumatic Mitral repairs There is data by both Carpentier and Sampath Kumar available and the results are 70 % 10 year freedom from re replacement.These are younger patients who can have recurrent rheumatic activity. I would keep the patient on 2 weekly long acting penicillin unless you can do penicillin levels and prove that the 3 week level is above the MIC for streptococci. Prasanna On Sun, Dec 7, 2008 at 10:06 PM, wrote: > 5 days ago I repaired the MV of a close family friend of 42 years. She is a > 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, > thickened as well as all of it's associated chordae. Her preop TEE had "no visible > posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a > posterior leaflet augmentation with a pericardial strip from just past the P1/P2 > junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. Her > anterior leaflet had some redundancy, more like a myxomatous valve, and I > closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. I added a > "full" left atrial Maze(RF), closed the LAA orifice( from a partial lower > sternotomy) to try to convert her AF and keep her Coumadin free for a while. > My main question, particularly for those who treat/ repair more > rheumatic valve disease than we do in the USA, is how long do you expect this type of > repair to last? > > K. Fon Huang, MD > Springfield, MO. > **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From zzhoumd at pol.net Sun Dec 7 12:01:41 2008 From: zzhoumd at pol.net (Zhandong Zhou) Date: Sun Dec 7 11:50:47 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs References: <89c4ed2d0812070842g426546f9sb2213e68993da1@mail.gmail.com> Message-ID: <001b01c9588d$7a617490$9801a8c0@domain.local> No many people can reproduce these results. ----- Original Message ----- From: "Prasanna Simha M" To: Sent: Sunday, December 07, 2008 11:42 AM Subject: Re: [HSF] Durability - Rheumatic Mitral repairs > There is data by both Carpentier and Sampath Kumar available and the > results are 70 % 10 year freedom from re replacement.These are younger > patients who can have recurrent rheumatic activity. > I would keep the patient on 2 weekly long acting penicillin unless > you can do penicillin levels and prove that the 3 week level is above > the MIC for streptococci. > Prasanna > > On Sun, Dec 7, 2008 at 10:06 PM, wrote: >> 5 days ago I repaired the MV of a close family friend of 42 years. She >> is a >> 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, >> thickened as well as all of it's associated chordae. Her preop TEE had >> "no visible >> posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a >> posterior leaflet augmentation with a pericardial strip from just past >> the P1/P2 >> junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. >> Her >> anterior leaflet had some redundancy, more like a myxomatous valve, and >> I >> closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. >> I added a >> "full" left atrial Maze(RF), closed the LAA orifice( from a partial >> lower >> sternotomy) to try to convert her AF and keep her Coumadin free for a >> while. >> My main question, particularly for those who treat/ repair more >> rheumatic valve disease than we do in the USA, is how long do you expect >> this type of >> repair to last? >> >> K. Fon Huang, MD >> Springfield, MO. >> **************Make your life easier with all your friends, email, and >> favorite sites in one place. Try it now. >> (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From prasannasimha at gmail.com Sun Dec 7 22:25:04 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Dec 7 11:55:36 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: <001b01c9588d$7a617490$9801a8c0@domain.local> References: <89c4ed2d0812070842g426546f9sb2213e68993da1@mail.gmail.com> <001b01c9588d$7a617490$9801a8c0@domain.local> Message-ID: <89c4ed2d0812070855o7043d25fv8ef82bb243afc7e0@mail.gmail.com> There are two aspects to the problem. One is the type of disease that you deal. Rheumatic disease is a spectrum ranging from calcified valves to minimal fusion with varying mechanisms of regurgitation and stenosis. It is important in any discussion to note these. Incidentally the values that I quoted wrt my personal results refer only to noncalcified valves. Prasanna On Sun, Dec 7, 2008 at 10:31 PM, Zhandong Zhou wrote: > > No many people can reproduce these results. > > > ----- Original Message ----- From: "Prasanna Simha M" > > To: > Sent: Sunday, December 07, 2008 11:42 AM > Subject: Re: [HSF] Durability - Rheumatic Mitral repairs > > >> There is data by both Carpentier and Sampath Kumar available and the >> results are 70 % 10 year freedom from re replacement.These are younger >> patients who can have recurrent rheumatic activity. >> I would keep the patient on 2 weekly long acting penicillin unless >> you can do penicillin levels and prove that the 3 week level is above >> the MIC for streptococci. >> Prasanna >> >> On Sun, Dec 7, 2008 at 10:06 PM, wrote: >>> >>> 5 days ago I repaired the MV of a close family friend of 42 years. She >>> is a >>> 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, >>> thickened as well as all of it's associated chordae. Her preop TEE had >>> "no visible >>> posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a >>> posterior leaflet augmentation with a pericardial strip from just past >>> the P1/P2 >>> junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. >>> Her >>> anterior leaflet had some redundancy, more like a myxomatous valve, and >>> I >>> closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. >>> I added a >>> "full" left atrial Maze(RF), closed the LAA orifice( from a partial >>> lower >>> sternotomy) to try to convert her AF and keep her Coumadin free for a >>> while. >>> My main question, particularly for those who treat/ repair more >>> rheumatic valve disease than we do in the USA, is how long do you expect >>> this type of >>> repair to last? >>> >>> K. Fon Huang, MD >>> Springfield, MO. >>> **************Make your life easier with all your friends, email, and >>> favorite sites in one place. Try it now. >>> >>> (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Dec 7 22:22:31 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Dec 7 12:01:00 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: <89c4ed2d0812070842g426546f9sb2213e68993da1@mail.gmail.com> Message-ID: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com> Yes,especially if the patient comes from an endemic area. My repair rate for rheumatics is now 90 % but this may be a biased population since my referrals would obviously be the more repairable valves. Putting it in perspective , if the infra posterior leaflet triangle is more than 1.5 cms the chance of repair is more than 95 % Prasanna On Sun, Dec 7, 2008 at 10:16 PM, Douville, Chuck wrote: > Prasanna, do you mean life long Penicillin, given every two weeks or three weeks depending upon the levels? Prasanna, would you also comment on what percentage of your rheumatic valves you currently repair, approximately? > thanks chuckdouville > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M > Sent: Sun 12/7/2008 8:42 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Durability - Rheumatic Mitral repairs > > > > There is data by both Carpentier and Sampath Kumar available and the > results are 70 % 10 year freedom from re replacement.These are younger > patients who can have recurrent rheumatic activity. > I would keep the patient on 2 weekly long acting penicillin unless > you can do penicillin levels and prove that the 3 week level is above > the MIC for streptococci. > Prasanna > > On Sun, Dec 7, 2008 at 10:06 PM, wrote: >> 5 days ago I repaired the MV of a close family friend of 42 years. She is a >> 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, >> thickened as well as all of it's associated chordae. Her preop TEE had "no visible >> posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a >> posterior leaflet augmentation with a pericardial strip from just past the P1/P2 >> junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. Her >> anterior leaflet had some redundancy, more like a myxomatous valve, and I >> closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. I added a >> "full" left atrial Maze(RF), closed the LAA orifice( from a partial lower >> sternotomy) to try to convert her AF and keep her Coumadin free for a while. >> My main question, particularly for those who treat/ repair more >> rheumatic valve disease than we do in the USA, is how long do you expect this type of >> repair to last? >> >> K. Fon Huang, MD >> Springfield, MO. >> **************Make your life easier with all your friends, email, and >> favorite sites in one place. Try it now. >> (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From Rwmfglycar at aol.com Sun Dec 7 12:10:32 2008 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Sun Dec 7 12:11:35 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs Message-ID: In a message dated 12/7/2008 11:49:54 A.M. Eastern Standard Time, ecdouville@orclinic.com writes: On Sun, Dec 7, 2008 at 10:06 PM, wrote: > 5 days ago I repaired the MV of a close family friend of 42 years. She is a > 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, > thickened as well as all of it's associated chordae. Her preop TEE had "no visible > posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a > posterior leaflet augmentation with a pericardial strip from just past the P1/P2 > junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. Her > anterior leaflet had some redundancy, more like a myxomatous valve, and I > closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. I added a > "full" left atrial Maze(RF), closed the LAA orifice( from a partial lower > sternotomy) to try to convert her AF and keep her Coumadin free for a while. > My main question, particularly for those who treat/ repair more > rheumatic valve disease than we do in the USA, is how long do you expect this type of > repair to last? > > K. Fon Huang, MD There is no information on the longterm results of rheumatic insufficiency repair in people in their 60's. My guess is that they are most unlikely to get recurrent rheumatic fever which is good. What pericardium did you use? If fresh autogenous then you have a good chance it will fibrose and shrink within a few years. I did see this happen in a few older patients. Autogenous treated with short glut exposure probably does better as does glut tanned bovine with an anticalcific /antiinflammatory RX. If by "redundancy" you mean some billowing with elongated chordae, this is typical of rheumatic anterior leaflet pathology causing insufficiency. Do you have any idea of the transmitral gradient and cardiac output? When I tried to get my rheumatic results together I always excluded pure tight mitral stenosis cases with pliable leaflets because they do very well and bias the results. The worst are combined stenosis and insufficiency cases, but also bad are pure insufficiency cases with a stiff anterior leaflet. (Positive "bounce back" sign). Bob Bob **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From nfaabouseada at gmail.com Sun Dec 7 12:37:28 2008 From: nfaabouseada at gmail.com (Nasser F Abou'Seada) Date: Sun Dec 7 13:37:59 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: <0FB19F783CFA498AA7BE4F210C45B366@AbouSeadaN> Dear Huang What was the result of the MAZE ? How did it come out of bypass ? .. rhythm I mean ! NFA -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of FONHMD@aol.com Sent: Sunday, December 07, 2008 10:36 AM To: openheart-l@lists.hsforum.com Subject: [HSF] Durability - Rheumatic Mitral repairs 5 days ago I repaired the MV of a close family friend of 42 years. She is a 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, thickened as well as all of it's associated chordae. Her preop TEE had "no visible posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a posterior leaflet augmentation with a pericardial strip from just past the P1/P2 junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. Her anterior leaflet had some redundancy, more like a myxomatous valve, and I closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. I added a "full" left atrial Maze(RF), closed the LAA orifice( from a partial lower sternotomy) to try to convert her AF and keep her Coumadin free for a while. My main question, particularly for those who treat/ repair more rheumatic valve disease than we do in the USA, is how long do you expect this type of repair to last? K. Fon Huang, MD Springfield, MO. **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000 010) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From nfaabouseada at gmail.com Sun Dec 7 12:49:31 2008 From: nfaabouseada at gmail.com (Nasser F Abou'Seada) Date: Sun Dec 7 13:49:58 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: I do share the same concept totally as does Prasanna about Rheumatic Cardiac affection as a wide spectrum of pathology Just wondering about the pathology described in this case of 62 years old lady ... - Were the commissures free of pathology ? .. - Were the the annulus feeling "soft / malleable" or "tough" ? - were the papillary muscles free of pathology ? ... especially those attached to the FIBROTIC chordae of P2 ? - A 25 Duran band was used, .. was the annulus then not widened ? ... it appears the regurgitation was almost due to an isolated P2 pathology ? Bob Do you think such case is purely rheumatic in such age and such LOCALIZED pathology ? your comments are magnificently enriching .. NFA -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of FONHMD@aol.com Sent: Sunday, December 07, 2008 10:36 AM To: openheart-l@lists.hsforum.com Subject: [HSF] Durability - Rheumatic Mitral repairs 5 days ago I repaired the MV of a close family friend of 42 years. She is a 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, thickened as well as all of it's associated chordae. Her preop TEE had "no visible posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a posterior leaflet augmentation with a pericardial strip from just past the P1/P2 junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. Her anterior leaflet had some redundancy, more like a myxomatous valve, and I closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. I added a "full" left atrial Maze(RF), closed the LAA orifice( from a partial lower sternotomy) to try to convert her AF and keep her Coumadin free for a while. My main question, particularly for those who treat/ repair more rheumatic valve disease than we do in the USA, is how long do you expect this type of repair to last? K. Fon Huang, MD Springfield, MO. **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000 010) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From nfaabouseada at gmail.com Sun Dec 7 12:33:37 2008 From: nfaabouseada at gmail.com (Nasser F Abou'Seada) Date: Sun Dec 7 14:05:32 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: " The worst are combined stenosis and insufficiency cases, but also bad are pure insufficiency cases with a stiff anterior leaflet. (Positive "bounce back" sign). Dear Bob Would you elaborate more please ? NFA -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Rwmfglycar@aol.com Sent: Sunday, December 07, 2008 11:11 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Durability - Rheumatic Mitral repairs In a message dated 12/7/2008 11:49:54 A.M. Eastern Standard Time, ecdouville@orclinic.com writes: On Sun, Dec 7, 2008 at 10:06 PM, wrote: > 5 days ago I repaired the MV of a close family friend of 42 years. She is a > 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, > thickened as well as all of it's associated chordae. Her preop TEE had "no visible > posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a > posterior leaflet augmentation with a pericardial strip from just past the P1/P2 > junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. Her > anterior leaflet had some redundancy, more like a myxomatous valve, and I > closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. I added a > "full" left atrial Maze(RF), closed the LAA orifice( from a partial lower > sternotomy) to try to convert her AF and keep her Coumadin free for a while. > My main question, particularly for those who treat/ repair more > rheumatic valve disease than we do in the USA, is how long do you expect this type of > repair to last? > > K. Fon Huang, MD There is no information on the longterm results of rheumatic insufficiency repair in people in their 60's. My guess is that they are most unlikely to get recurrent rheumatic fever which is good. What pericardium did you use? If fresh autogenous then you have a good chance it will fibrose and shrink within a few years. I did see this happen in a few older patients. Autogenous treated with short glut exposure probably does better as does glut tanned bovine with an anticalcific /antiinflammatory RX. If by "redundancy" you mean some billowing with elongated chordae, this is typical of rheumatic anterior leaflet pathology causing insufficiency. Do you have any idea of the transmitral gradient and cardiac output? When I tried to get my rheumatic results together I always excluded pure tight mitral stenosis cases with pliable leaflets because they do very well and bias the results. The worst are combined stenosis and insufficiency cases, but also bad are pure insufficiency cases with a stiff anterior leaflet. (Positive "bounce back" sign). Bob Bob **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000 010) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From nfaabouseada at gmail.com Sun Dec 7 12:31:11 2008 From: nfaabouseada at gmail.com (Nasser F Abou'Seada) Date: Sun Dec 7 16:41:49 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com> References: <89c4ed2d0812070842g426546f9sb2213e68993da1@mail.gmail.com> <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com> Message-ID: " if the infra posterior leaflet triangle is more than 1.5 cms the chance of repair is more than 95 %" Dear Prasanna ... would you extrapolate more !! .... How do you take the measurements ? NFA -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Sunday, December 07, 2008 10:53 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Durability - Rheumatic Mitral repairs Yes,especially if the patient comes from an endemic area. My repair rate for rheumatics is now 90 % but this may be a biased population since my referrals would obviously be the more repairable valves. Putting it in perspective , if the infra posterior leaflet triangle is more than 1.5 cms the chance of repair is more than 95 % Prasanna On Sun, Dec 7, 2008 at 10:16 PM, Douville, Chuck wrote: > Prasanna, do you mean life long Penicillin, given every two weeks or three weeks depending upon the levels? Prasanna, would you also comment on what percentage of your rheumatic valves you currently repair, approximately? > thanks chuckdouville > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M > Sent: Sun 12/7/2008 8:42 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Durability - Rheumatic Mitral repairs > > > > There is data by both Carpentier and Sampath Kumar available and the > results are 70 % 10 year freedom from re replacement.These are younger > patients who can have recurrent rheumatic activity. > I would keep the patient on 2 weekly long acting penicillin unless > you can do penicillin levels and prove that the 3 week level is above > the MIC for streptococci. > Prasanna > > On Sun, Dec 7, 2008 at 10:06 PM, wrote: >> 5 days ago I repaired the MV of a close family friend of 42 years. She is a >> 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, >> thickened as well as all of it's associated chordae. Her preop TEE had "no visible >> posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a >> posterior leaflet augmentation with a pericardial strip from just past the P1/P2 >> junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. Her >> anterior leaflet had some redundancy, more like a myxomatous valve, and I >> closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. I added a >> "full" left atrial Maze(RF), closed the LAA orifice( from a partial lower >> sternotomy) to try to convert her AF and keep her Coumadin free for a while. >> My main question, particularly for those who treat/ repair more >> rheumatic valve disease than we do in the USA, is how long do you expect this type of >> repair to last? >> >> K. Fon Huang, MD >> Springfield, MO. >> **************Make your life easier with all your friends, email, and >> favorite sites in one place. Try it now. >> (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000 010) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From ravi_venkat_in at yahoo.com Mon Dec 8 02:15:26 2008 From: ravi_venkat_in at yahoo.com (venkataraman ravishankar) Date: Mon Dec 8 05:15:54 2008 Subject: [HSF] MAPCAS coiling in cyanotics In-Reply-To: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com> Message-ID: <385894.73992.qm@web30604.mail.mud.yahoo.com> Dear forum members, ? What is the current strategy for MAPCAS coiling in cyanotics? Since most of the diagnosis is echo based? for obvious reasons unless a angio is done one cannot be sure of its presence. Even in those whose angio shows MAPCAs how do we decide which cases actually require preop coiling. In our centre since angio is done for most of the cases we get the coiling done on the morning of surgery but it becomes difficult at times to decide if a particuler collateral requires this procedure. Recently did a TOF case which did not have a preop coiling, after 48 hrs since pressures remained low we took the child to the cath lab and colied two MAPCAs, required peritoneal dialysis even though non ionic contrast was used, but did well and has been discharged. request for comments on this. Col Ravi shankar Military hosp- Cardiothoracic centre Pune? , India --- From enaseri at hotmail.com.tr Mon Dec 8 14:05:17 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Mon Dec 8 09:05:44 2008 Subject: [HSF] TEE in OR In-Reply-To: <385894.73992.qm@web30604.mail.mud.yahoo.com> References: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com> <385894.73992.qm@web30604.mail.mud.yahoo.com> Message-ID: Dear everybody and specially Hal, Finally we got a permenant TEE in OR . Me and the anesthesiologist are trying to learn it by ourselves ( using atlases and etc.). erdinc From dukeb60 at aol.com Mon Dec 8 09:14:24 2008 From: dukeb60 at aol.com (Edward P Raines) Date: Mon Dec 8 10:15:04 2008 Subject: [HSF] TEE in OR In-Reply-To: References: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com> <385894.73992.qm@web30604.mail.mud.yahoo.com> Message-ID: Endric, Go to E-echocardiography.com for a superb atlas of surgical TEE images. Very helpful. We Sent from my iPod On Dec 8, 2008, at 8:05 AM, erdin? naseri wrote: > > Dear everybody and specially Hal, > Finally we got a permenant TEE in OR . Me and the anesthesiologist > are trying to learn it by ourselves ( using atlases and etc.). > erdinc > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From hgrmd at aol.com Mon Dec 8 13:00:54 2008 From: hgrmd at aol.com (hgrmd@aol.com) Date: Mon Dec 8 13:01:42 2008 Subject: [HSF] TEE in OR In-Reply-To: References: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com><385894.73992.qm@web30604.mail.mud.yahoo.com> Message-ID: <8CB27760C570136-1028-55D@WEBMAIL-MC20.sysops.aol.com> Erdinc, ? Congratulations.? Believe me, I have a lot of respect for your ability to do major cardiac cases under suboptimal conditions.? I bet TEE will make you feel much more secure in deairing and evaluating your work. ? BTW, Roberto and I are at the meeting in Paris with Carpentier.? Will write later. Hal -----Original Message----- From: erdin? naseri To: HSF HSF Sent: Mon, 8 Dec 2008 3:05 pm Subject: [HSF] TEE in OR ear everybody and specially Hal, inally we got a permenant TEE in OR . Me and the anesthesiologist are trying o learn it by ourselves ( using atlases and etc.). rdinc ______________________________________________ penHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: ttp://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and isclaimers posted at: ttp://www.hsforum.com/listdisclaim ---------------------------------------- From dukeb60 at aol.com Mon Dec 8 17:55:45 2008 From: dukeb60 at aol.com (Edward P. Raines) Date: Mon Dec 8 17:56:48 2008 Subject: [HSF] TEE in OR In-Reply-To: References: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com><385894.73992.qm@web30604.mail.mud.yahoo.com> Message-ID: <8CB279F3D6A7635-AE0-1785@WEBMAIL-DY29.sysops.aol.com> Erdinc, ???? Go to the site e - echocardiography.com for a superb compilation of TEE images specifically for the OR and cardiac surgery.? I am sure you will find?it to be VERY helpful. ??????????????????????????????????????????????????????????????????????????? Ed Edward P. Raines, M.D., J.D. Director, BryanLGH Cardiothoracic Surgery BryanLGH Medical Center 1500 South 48th Street Suite 601 Lincoln, Nebraska 68506 Office 402-481-8430 Fax 402-481-8429 Cell 402-730-9242 Email Dukeb60@aol.com -----Original Message----- From: erdin? naseri To: HSF HSF Sent: Mon, 8 Dec 2008 8:05 am Subject: [HSF] TEE in OR ear everybody and specially Hal, inally we got a permenant TEE in OR . Me and the anesthesiologist are trying o learn it by ourselves ( using atlases and etc.). rdinc ______________________________________________ penHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: ttp://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and isclaimers posted at: ttp://www.hsforum.com/listdisclaim ---------------------------------------- From prasannasimha at gmail.com Tue Dec 9 07:56:22 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Dec 8 21:26:51 2008 Subject: [HSF] TEE in OR In-Reply-To: References: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com> <385894.73992.qm@web30604.mail.mud.yahoo.com> Message-ID: <89c4ed2d0812081826s327c2ac4nf72fe345144855c8@mail.gmail.com> Good for you Erdinc. Enjoy . We are still fighting (I get a machine on request at present ) There are a lot of resources available on the net. In addition , I would suggest that you take an cadaveric heart (or else an animal heart) and slice it in similar views to get a good orientation. Prasanna Prasanna On Mon, Dec 8, 2008 at 7:35 PM, erdin? naseri wrote: > > Dear everybody and specially Hal, > Finally we got a permenant TEE in OR . Me and the anesthesiologist are trying to learn it by ourselves ( using atlases and etc.). > erdinc > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Tue Dec 9 08:03:10 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Dec 8 21:33:39 2008 Subject: [HSF] HOCM Message-ID: <89c4ed2d0812081833n14f7d24ai7e1d55e380559004@mail.gmail.com> Portrait of the artist as a young man: First HCM clinical diagnosis marks golden anniversary December 8, 2008 | Steve Stiles Boston, MA - "It was the first week after being appointed head of the cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald (Brigham and Women's Hospital, Boston, MA) said about a memorable early episode in his long and distinguished career. The key event, a decade before the advent of echocardiography: the first known diagnosis based solely on clinical signs of what is now called hypertrophic cardiomyopathy (HCM). The diagnostic challenges in that simpler, preelectronic age of cardiology were immense. "In movies about World War I, you see pilots in those very early biplanes, no altimeters, no equipment to guide them. They would recognize when they were over enemy territory, and they shot what they could see. That's how it was. It was a seat-of-the-pants diagnosis." Braunwald related the story to heartwire following a report commemorating the event in the November 15, 2008 American Journal of Cardiology [1], which also pays tribute to the long life of the patient, Claude Brady, of Arlington, VA, who received a new heart in 1989 and is now 71 years old. He said to me, you must have made a mistake. I left the operating room very humbled. "Mr Brady is now healthy and vigorous and has been particularly active in promoting heart transplantation as the founder of two organizations: Transplant Recipients International Organization, Inc (National Capital Chapter), as well as Transplant Awareness, Inc," write the report's authors, who include Braunwald and first author Dr Barry J Maron (Minneapolis Heart Institute Foundation, MN). As Braunwald tells it, one day during his fellowship at the National Heart Institute (NIH), in Bethesda, MD (which later folded into the National Heart, Lung, and Blood Institute), some months before the clinical diagnosis, he observed a pressure gradient in the subaortic area of a different patient's left ventricle during cardiac catheterization. In the late 1950s, that meant only one thing, an obstruction. The patient, diagnosed with congenital (membranous) hypertrophic subaortic stenosis, went to surgery. Later on, he said, the late Dr Andrew G Morrow, chief of surgery there at the time, called Braunwald up to the operating room to show him something unexpected with what should have been a simple operation. "To my chagrin," he said, Morrow showed him how he could put a finger from one hand through the aortic valve and the forefinger from the other hand through the left atrium, so the two could meet in the left ventricle. No obstruction! There shouldn't be a pressure gradient. "And he said to me, you must have made a mistake. I left the operating room very humbled." Braunwald said he later returned to the OR and asked Morrow if, before he closed up the patient's chest, he would check the LV pressure anyway. Then he left again. Sometime later, Morrow pulled him out of the cath lab to tell him that there was, in fact, a gradient of about 100 mm Hg. The two men puzzled over their findings for days but dropped it after a while and moved on. "Then a second case came along about a month later, exactly the same thing. So we knew we had something new" [2]. "And of course we were thrilled," Braunwald said. "This was a paradigm shift in this field, that you could have a gradient without obstruction in a noncontracting heart." In the following months, "a picture of the disorder began to form, in a vague way," he said. "We had a high index of suspicion for young adults who came in with a loud murmur along the left sternal border, murmurs like in a ventricular septal defect, lower down than with the classic aortic-stenosis murmur." This was a paradigm shift in this field, that you could have a gradient without obstruction in a noncontracting heart. Then along came Brady, who presented with exertional dyspnea and fatigue and who reported having a heart murmur first detected when he was 11. "When I examined him, he told me he had a brother and a sister who also had loud heart murmurs since early childhood. And therefore the index of suspicion that he might have this was high." As the commemorative article relates, "Several aunts and uncles had died of heart failure, believed to be due to rheumatic fever. . . . His two siblings had heart murmurs, and many members of his father's family were said to have heart murmurs. Several of these had died suddenly in childhood or during early adult life. Notably, a grade IV/VI midsystolic murmur was heard at the fourth left intercostal space and apex associated with a prominent left ventricular lift. Electrocardiography showed right-axis deviation and incomplete right bundle branch block." "He had the classic physical findings, and so I made the clinical diagnosis, idiopathic hypertrophic subaortic stenosis," Braunwald said, using the name that would eventually be changed to HCM. "Then we did the catheterization." As related by Maron et al, "a peak systolic outflow gradient of 40 mm Hg was recorded between the left ventricular cavity and the subaortic area, confirming the precatheterization diagnosis." The next challenge was to recognize such patients before they go to catheterization and surgery even when their family history is negative. "We spent the next three to five years trying to figure that out." By the time he, Morrow, and others had published a series of about 12 patients in 1960 [3], "we were able to draw a pretty good clinical description." A review of 64 patients followed four years later [4], and in 1968, Braunwald's last year at the NIH, he and his colleagues published reports on the disorder's physiologic effects and treating it with beta blockers and surgery [5,6,7] along with another series of 126 patients [8]. "It was my parting gift. And a year after I left, echocardiography came along and changed everything." Sources -- Prasanna Simha M From FONHMD at aol.com Mon Dec 8 23:36:49 2008 From: FONHMD at aol.com (FONHMD@aol.com) Date: Mon Dec 8 23:37:57 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs Message-ID: Prasanna, Thanks. She lives in northern Arkansas now and has been in the US for ~42 years. Don't you think that suppressive Penicillin would not do much good now? Bob, at least in the OR, the postop MV gradient was only 4mm with normal cardiac output. I wasn't fully prepared for this exact scenario preop. Intraop, I used the Vascuguard bovine pericardial patch. Yes, the anterior leaflet had both excessive tissue billowing and thickening which enhanced the A1/A2 and A2/A3 fissures. I look forward to your wisdom and comments. K. Fon Huang, MD **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From FONHMD at aol.com Mon Dec 8 23:42:27 2008 From: FONHMD at aol.com (FONHMD@aol.com) Date: Mon Dec 8 23:43:03 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs Message-ID: Some intraop clarification: This was mostly P2 pathology. The chords were scarred down to the ventricle/papillary muscles. Remarkably the lateral portions of P1 and P3 and the commissures were thin, pliable and basically normal. The annulus was similar, i.e., P2 portion stiff, while other areas pliable. See the prior comments regarding the anterior leaflet. K. Fon Huang, MD **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From FONHMD at aol.com Mon Dec 8 23:44:40 2008 From: FONHMD at aol.com (FONHMD@aol.com) Date: Mon Dec 8 23:45:14 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs Message-ID: Came out in junctional rhythm like many full Maze operations, has had some intermittent Afib/ NSR. Of course, this is too early to say what the final rhythm will be. K. Fon Huang, MD **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From prasannasimha at gmail.com Tue Dec 9 11:26:15 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Dec 9 00:56:47 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: <89c4ed2d0812082156t475c5b11p6a782ea38b400b03@mail.gmail.com> I am not sure of the strepto status in rural Arkansas. There has been a spate of rheumatic fever of late in the US and that too many with a penicillin resistant strain so I would ask the local physicians in that area about it. The typical rheumatic repairable lesion generally has PML retraction and AML prolapse if there isn't significant commissural fusion. Prasanna On Tue, Dec 9, 2008 at 10:06 AM, wrote: > Prasanna, Thanks. She lives in northern Arkansas now and has been in the US > for ~42 years. Don't you think that suppressive Penicillin would not do > much good now? > Bob, at least in the OR, the postop MV gradient was only 4mm with normal > cardiac output. I wasn't fully prepared for this exact scenario preop. > Intraop, I used the Vascuguard bovine pericardial patch. Yes, the anterior > leaflet had both excessive tissue billowing and thickening which enhanced the > A1/A2 and A2/A3 fissures. I look forward to your wisdom and comments. > > K. Fon Huang, MD > **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Tue Dec 9 11:40:16 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Dec 9 01:10:47 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: <89c4ed2d0812070842g426546f9sb2213e68993da1@mail.gmail.com> <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com> Message-ID: <89c4ed2d0812082210r31475dccj1e20a27e2155b3ea@mail.gmail.com> I will try to send pictures.Basically it is the area subtending the posterior LV wall, PML and the PML chordae in a PLAX view which exposes the triangle at its best. Prasanna On Mon, Dec 8, 2008 at 12:01 AM, Nasser F Abou'Seada wrote: > " if the infra posterior leaflet triangle is > more than 1.5 cms the chance of repair is more than 95 %" > > Dear Prasanna ... would you extrapolate more !! .... How do you take the > measurements ? > > NFA > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M > Sent: Sunday, December 07, 2008 10:53 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Durability - Rheumatic Mitral repairs > > Yes,especially if the patient comes from an endemic area. > My repair rate for rheumatics is now 90 % but this may be a biased > population since my referrals would obviously be the more repairable > valves. > Putting it in perspective , if the infra posterior leaflet triangle is > more than 1.5 cms the chance of repair is more than 95 % > Prasanna > > On Sun, Dec 7, 2008 at 10:16 PM, Douville, Chuck > wrote: >> Prasanna, do you mean life long Penicillin, given every two weeks or three > weeks depending upon the levels? Prasanna, would you also comment on what > percentage of your rheumatic valves you currently repair, approximately? >> thanks chuckdouville >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M >> Sent: Sun 12/7/2008 8:42 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Durability - Rheumatic Mitral repairs >> >> >> >> There is data by both Carpentier and Sampath Kumar available and the >> results are 70 % 10 year freedom from re replacement.These are younger >> patients who can have recurrent rheumatic activity. >> I would keep the patient on 2 weekly long acting penicillin unless >> you can do penicillin levels and prove that the 3 week level is above >> the MIC for streptococci. >> Prasanna >> >> On Sun, Dec 7, 2008 at 10:06 PM, wrote: >>> 5 days ago I repaired the MV of a close family friend of 42 years. She > is a >>> 63 y.o., small lady, BSA~1.5 and had the entire P2 leaflet fibrotic, >>> thickened as well as all of it's associated chordae. Her preop TEE had > "no visible >>> posterior leaflet" with 3+ MR and new onset/diagnosis of Afib. I did a >>> posterior leaflet augmentation with a pericardial strip from just past > the P1/P2 >>> junction to past the P2/P3 junction. Her P1 and P3 was nearly normal. > Her >>> anterior leaflet had some redundancy, more like a myxomatous valve, and > I >>> closed a large A2/A3 fissure. After a 25mm Duran band there was no MR. > I added a >>> "full" left atrial Maze(RF), closed the LAA orifice( from a partial > lower >>> sternotomy) to try to convert her AF and keep her Coumadin free for a > while. >>> My main question, particularly for those who treat/ repair more >>> rheumatic valve disease than we do in the USA, is how long do you expect > this type of >>> repair to last? >>> >>> K. Fon Huang, MD >>> Springfield, MO. >>> **************Make your life easier with all your friends, email, and >>> favorite sites in one place. Try it now. >>> > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000 > 010) >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Tue Dec 9 11:13:05 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Dec 9 01:15:21 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: <89c4ed2d0812082143gd9ddea0o812dea56871b0d4f@mail.gmail.com> That is actually not so common. typically the worst affected areain the posterior leaflet is P3 but then rheumatic mitral disease represets a varying combination of prolapse and retraction so much so that each area (A123 and P123) have to be analyzed individually and each zone is to be attacked independently. Prasanna 10:12 AM, wrote: > Some intraop clarification: This was mostly P2 pathology. The chords were > scarred down to the ventricle/papillary muscles. Remarkably the lateral > portions of P1 and P3 and the commissures were thin, pliable and basically > normal. The annulus was similar, i.e., P2 portion stiff, while other areas > pliable. See the prior comments regarding the anterior leaflet. > > K. Fon Huang, MD > **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From zzhoumd at pol.net Tue Dec 9 04:34:03 2008 From: zzhoumd at pol.net (Zhandong Zhou) Date: Tue Dec 9 04:38:25 2008 Subject: [HSF] TEE in OR Message-ID: <20081209093411.BAQY11530.atlmtaow02.cingularme.com@Inbox> A short training course is very helpful. Zhandong Zhou, MD, PhD St. Joseph Hospital Syracuse, New York 315 423 7192 -----Original Message----- From: erdin? naseri Sent: Monday, December 08, 2008 9:05 AM To: HSF HSF Subject: [HSF] TEE in OR Dear everybody and specially Hal, Finally we got a permenant TEE in OR . Me and the anesthesiologist are trying to learn it by ourselves ( using atlases and etc.). erdinc _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From rwmfglycar at aol.com Tue Dec 9 07:19:44 2008 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Tue Dec 9 07:20:55 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: <8CB280F8D8846D3-490-2C26@MBLK-M02.sysops.aol.com> Great job . The Vascuguard pericardium does not so far as I know have?an anticalcification Rx on it. However at?her age I don't think it will calcify. Even if it thickens and gets stiff, as standard aldehyde tanned pericardium?may do,?it won't matter. The fused?rheumatic posterior leaflet functions as no more than a baffle for the still functional anterior leaflet to meet. Very good that you measured gradient and output in the OR. It was standard for me all my surgical life; you have to be your own quality control?.If the gradient was 4 with a normal cardiac output in the OR, it will be 4 with a normal cardiac output outside the OR. If you had not measured the cardiac output you could not?know whether ?a 4mm gradient was OK or not. If I were extending an anterior leaflet I would use a pericardial patch with an aldehyde blocking?anticalcification treatment on it in the hope that this would lessen the host inflammatory?reaction to unblocked residual aldehydes. (Conflict of Interest; I make and sell such a patch). One thought: after separating the posteriorl eaflet from the annulus you might have seen some thickened 2nd order chordae that you could have cut to enhance posterior leaflet mobility Bob -----Original Message----- From: FONHMD@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Mon, 8 Dec 2008 11:36 pm Subject: Re: [HSF] Durability - Rheumatic Mitral repairs Prasanna, Thanks. She lives in northern Arkansas now and has been in the US for ~42 years. Don't you think that suppressive Penicillin would not do much good now? Bob, at least in the OR, the postop MV gradient was only 4mm with normal cardiac output. I wasn't fully prepared for this exact scenario preop. Intraop, I used the Vascuguard bovine pericardial patch. Yes, the anterior leaflet had both excessive tissue billowing and thickening which enhanced the A1/A2 and A2/A3 fissures. I look forward to your wisdom and comments. K. Fon Huang, MD **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From rwmfglycar at aol.com Tue Dec 9 07:23:05 2008 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Tue Dec 9 07:24:13 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: <8CB281005C41D7F-490-2C4C@MBLK-M02.sysops.aol.com> I made my reply? aboutsecondorder chordae before reading this post. But good post . You have observed and analysed the? pathology Bob -----Original Message----- From: FONHMD@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Mon, 8 Dec 2008 11:42 pm Subject: Re: [HSF] Durability - Rheumatic Mitral repairs Some intraop clarification: This was mostly P2 pathology. The chords were scarred down to the ventricle/papillary muscles. Remarkably the lateral portions of P1 and P3 and the commissures were thin, pliable and basically normal. The annulus was similar, i.e., P2 portion stiff, while other areas pliable. See the prior comments regarding the anterior leaflet. K. Fon Huang, MD **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Tue Dec 9 17:59:24 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Dec 9 07:29:46 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: <8CB280F8D8846D3-490-2C26@MBLK-M02.sysops.aol.com> References: <8CB280F8D8846D3-490-2C26@MBLK-M02.sysops.aol.com> Message-ID: <89c4ed2d0812090429p2f467398nc9114e898c853456@mail.gmail.com> Cutting the posterobala chordae is indeed a very important part and I usually do not have to augment the psoterior leaflet when I am able to divide them. Prasanna On Tue, Dec 9, 2008 at 5:49 PM, wrote: > Great job . > The Vascuguard pericardium does not so far as I know have?an anticalcification Rx on it. However at?her age I don't think it will calcify. Even if it thickens and gets stiff, as standard aldehyde tanned pericardium?may do,?it won't matter. The fused?rheumatic posterior leaflet functions as no more than a baffle for the still functional anterior leaflet to meet. Very good that you measured gradient and output in the OR. It was standard for me all my surgical life; you have to be your own quality control?.If the gradient was 4 with a normal cardiac output in the OR, it will be 4 with a normal cardiac output outside the OR. If you had not measured the cardiac output you could not?know whether ?a 4mm gradient was OK or not. > If I were extending an anterior leaflet I would use a pericardial patch with an aldehyde blocking?anticalcification treatment on it in the hope that this would lessen the host inflammatory?reaction to unblocked residual aldehydes. (Conflict of Interest; I make and sell such a patch). > One thought: after separating the posteriorl eaflet from the annulus you might have seen some thickened 2nd order chordae that you could have cut to enhance posterior leaflet mobility > > Bob > -----Original Message----- > From: FONHMD@aol.com > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 8 Dec 2008 11:36 pm > Subject: Re: [HSF] Durability - Rheumatic Mitral repairs > > > > Prasanna, Thanks. She lives in northern Arkansas now and has been in the US > for ~42 years. Don't you think that suppressive Penicillin would not do > much good now? > Bob, at least in the OR, the postop MV gradient was only 4mm with normal > cardiac output. I wasn't fully prepared for this exact scenario preop. > Intraop, I used the Vascuguard bovine pericardial patch. Yes, the anterior > leaflet had both excessive tissue billowing and thickening which enhanced the > A1/A2 and A2/A3 fissures. I look forward to your wisdom and comments. > > K. Fon Huang, MD > **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From chand.ramaiah at uky.edu Tue Dec 9 08:07:58 2008 From: chand.ramaiah at uky.edu (Ramaiah, Chandrashekar) Date: Tue Dec 9 08:09:28 2008 Subject: [HSF] HOCM In-Reply-To: <89c4ed2d0812081833n14f7d24ai7e1d55e380559004@mail.gmail.com> References: <89c4ed2d0812081833n14f7d24ai7e1d55e380559004@mail.gmail.com> Message-ID: <3ACC54310BF13645A0D12496D7CA94E5F987D280@EX7FM04.ad.uky.edu> Prasanna, I was at the HCM meeting this past weekend. Barry Maron showed us the picture of Mr. Brady. It was a very good meeting. Chand -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Monday, December 08, 2008 9:33 PM To: OpenHeart-L@lists.hsforum.com; Discussion of Critical Care Medicine Subject: [HSF] HOCM Portrait of the artist as a young man: First HCM clinical diagnosis marks golden anniversary December 8, 2008 | Steve Stiles Boston, MA - "It was the first week after being appointed head of the cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald (Brigham and Women's Hospital, Boston, MA) said about a memorable early episode in his long and distinguished career. The key event, a decade before the advent of echocardiography: the first known diagnosis based solely on clinical signs of what is now called hypertrophic cardiomyopathy (HCM). The diagnostic challenges in that simpler, preelectronic age of cardiology were immense. "In movies about World War I, you see pilots in those very early biplanes, no altimeters, no equipment to guide them. They would recognize when they were over enemy territory, and they shot what they could see. That's how it was. It was a seat-of-the-pants diagnosis." Braunwald related the story to heartwire following a report commemorating the event in the November 15, 2008 American Journal of Cardiology [1], which also pays tribute to the long life of the patient, Claude Brady, of Arlington, VA, who received a new heart in 1989 and is now 71 years old. He said to me, you must have made a mistake. I left the operating room very humbled. "Mr Brady is now healthy and vigorous and has been particularly active in promoting heart transplantation as the founder of two organizations: Transplant Recipients International Organization, Inc (National Capital Chapter), as well as Transplant Awareness, Inc," write the report's authors, who include Braunwald and first author Dr Barry J Maron (Minneapolis Heart Institute Foundation, MN). As Braunwald tells it, one day during his fellowship at the National Heart Institute (NIH), in Bethesda, MD (which later folded into the National Heart, Lung, and Blood Institute), some months before the clinical diagnosis, he observed a pressure gradient in the subaortic area of a different patient's left ventricle during cardiac catheterization. In the late 1950s, that meant only one thing, an obstruction. The patient, diagnosed with congenital (membranous) hypertrophic subaortic stenosis, went to surgery. Later on, he said, the late Dr Andrew G Morrow, chief of surgery there at the time, called Braunwald up to the operating room to show him something unexpected with what should have been a simple operation. "To my chagrin," he said, Morrow showed him how he could put a finger from one hand through the aortic valve and the forefinger from the other hand through the left atrium, so the two could meet in the left ventricle. No obstruction! There shouldn't be a pressure gradient. "And he said to me, you must have made a mistake. I left the operating room very humbled." Braunwald said he later returned to the OR and asked Morrow if, before he closed up the patient's chest, he would check the LV pressure anyway. Then he left again. Sometime later, Morrow pulled him out of the cath lab to tell him that there was, in fact, a gradient of about 100 mm Hg. The two men puzzled over their findings for days but dropped it after a while and moved on. "Then a second case came along about a month later, exactly the same thing. So we knew we had something new" [2]. "And of course we were thrilled," Braunwald said. "This was a paradigm shift in this field, that you could have a gradient without obstruction in a noncontracting heart." In the following months, "a picture of the disorder began to form, in a vague way," he said. "We had a high index of suspicion for young adults who came in with a loud murmur along the left sternal border, murmurs like in a ventricular septal defect, lower down than with the classic aortic-stenosis murmur." This was a paradigm shift in this field, that you could have a gradient without obstruction in a noncontracting heart. Then along came Brady, who presented with exertional dyspnea and fatigue and who reported having a heart murmur first detected when he was 11. "When I examined him, he told me he had a brother and a sister who also had loud heart murmurs since early childhood. And therefore the index of suspicion that he might have this was high." As the commemorative article relates, "Several aunts and uncles had died of heart failure, believed to be due to rheumatic fever. . . . His two siblings had heart murmurs, and many members of his father's family were said to have heart murmurs. Several of these had died suddenly in childhood or during early adult life. Notably, a grade IV/VI midsystolic murmur was heard at the fourth left intercostal space and apex associated with a prominent left ventricular lift. Electrocardiography showed right-axis deviation and incomplete right bundle branch block." "He had the classic physical findings, and so I made the clinical diagnosis, idiopathic hypertrophic subaortic stenosis," Braunwald said, using the name that would eventually be changed to HCM. "Then we did the catheterization." As related by Maron et al, "a peak systolic outflow gradient of 40 mm Hg was recorded between the left ventricular cavity and the subaortic area, confirming the precatheterization diagnosis." The next challenge was to recognize such patients before they go to catheterization and surgery even when their family history is negative. "We spent the next three to five years trying to figure that out." By the time he, Morrow, and others had published a series of about 12 patients in 1960 [3], "we were able to draw a pretty good clinical description." A review of 64 patients followed four years later [4], and in 1968, Braunwald's last year at the NIH, he and his colleagues published reports on the disorder's physiologic effects and treating it with beta blockers and surgery [5,6,7] along with another series of 126 patients [8]. "It was my parting gift. And a year after I left, echocardiography came along and changed everything." Sources -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Tue Dec 9 18:52:39 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Dec 9 08:30:30 2008 Subject: [HSF] MAPCAS coiling in cyanotics In-Reply-To: <385894.73992.qm@web30604.mail.mud.yahoo.com> References: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com> <385894.73992.qm@web30604.mail.mud.yahoo.com> Message-ID: <89c4ed2d0812090522naf44e4frcd3413ff90d49e52@mail.gmail.com> Coling of identified MAPCA's just before surgery is the general way. If you have problems with MAPCA's postop they can be embolized. Generally All end to side MAPCA's can be embolized whereas end to end MAPCA's cannot and need to be unifocalized or else embolization will lead to infarction. End to end MAPCA's are usually seen in an atresia situation .64 slice CT may be used in lieu of angiography to demonstrate MAPCA's too. Prasanna On Mon, Dec 8, 2008 at 3:45 PM, venkataraman ravishankar wrote: > Dear forum members, > > What is the current strategy for MAPCAS coiling in cyanotics? > Since most of the diagnosis is echo based for obvious reasons unless a angio is done one cannot be sure of its presence. > Even in those whose angio shows MAPCAs how do we decide which cases actually require preop coiling. > In our centre since angio is done for most of the cases we get the coiling done on the morning of surgery but it becomes difficult at times to decide if a particuler collateral requires this procedure. > Recently did a TOF case which did not have a preop coiling, after 48 hrs since pressures remained low we took the child to the cath lab and colied two MAPCAs, required peritoneal dialysis even though non ionic contrast was used, but did well and has been discharged. > request for comments on this. > Col Ravi shankar > Military hosp- Cardiothoracic centre > Pune , India > > --- > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Tue Dec 9 19:31:20 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Dec 9 09:01:43 2008 Subject: [HSF] HOCM In-Reply-To: <3ACC54310BF13645A0D12496D7CA94E5F987D280@EX7FM04.ad.uky.edu> References: <89c4ed2d0812081833n14f7d24ai7e1d55e380559004@mail.gmail.com> <3ACC54310BF13645A0D12496D7CA94E5F987D280@EX7FM04.ad.uky.edu> Message-ID: <89c4ed2d0812090601i5884619bkcce4643381b67b65@mail.gmail.com> And what did you learn from that meeting ? What is new ? Prasanna On Tue, Dec 9, 2008 at 6:37 PM, Ramaiah, Chandrashekar wrote: > Prasanna, > I was at the HCM meeting this past weekend. Barry Maron showed us the picture of Mr. Brady. It was a very good meeting. > > > Chand > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M > Sent: Monday, December 08, 2008 9:33 PM > To: OpenHeart-L@lists.hsforum.com; Discussion of Critical Care Medicine > Subject: [HSF] HOCM > > Portrait of the artist as a young man: First HCM clinical diagnosis > marks golden anniversary > December 8, 2008 | Steve Stiles > > Boston, MA - "It was the first week after being appointed head of the > cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald > (Brigham and Women's Hospital, Boston, MA) said about a memorable > early episode in his long and distinguished career. The key event, a > decade before the advent of echocardiography: the first known > diagnosis based solely on clinical signs of what is now called > hypertrophic cardiomyopathy (HCM). > > The diagnostic challenges in that simpler, preelectronic age of > cardiology were immense. "In movies about World War I, you see pilots > in those very early biplanes, no altimeters, no equipment to guide > them. They would recognize when they were over enemy territory, and > they shot what they could see. That's how it was. It was a > seat-of-the-pants diagnosis." > > Braunwald related the story to heartwire following a report > commemorating the event in the November 15, 2008 American Journal of > Cardiology [1], which also pays tribute to the long life of the > patient, Claude Brady, of Arlington, VA, who received a new heart in > 1989 and is now 71 years old. > He said to me, you must have made a mistake. I left the operating room > very humbled. > > "Mr Brady is now healthy and vigorous and has been particularly active > in promoting heart transplantation as the founder of two > organizations: Transplant Recipients International Organization, Inc > (National Capital Chapter), as well as Transplant Awareness, Inc," > write the report's authors, who include Braunwald and first author Dr > Barry J Maron (Minneapolis Heart Institute Foundation, MN). > > As Braunwald tells it, one day during his fellowship at the National > Heart Institute (NIH), in Bethesda, MD (which later folded into the > National Heart, Lung, and Blood Institute), some months before the > clinical diagnosis, he observed a pressure gradient in the subaortic > area of a different patient's left ventricle during cardiac > catheterization. In the late 1950s, that meant only one thing, an > obstruction. The patient, diagnosed with congenital (membranous) > hypertrophic subaortic stenosis, went to surgery. > > Later on, he said, the late Dr Andrew G Morrow, chief of surgery there > at the time, called Braunwald up to the operating room to show him > something unexpected with what should have been a simple operation. > "To my chagrin," he said, Morrow showed him how he could put a finger > from one hand through the aortic valve and the forefinger from the > other hand through the left atrium, so the two could meet in the left > ventricle. No obstruction! There shouldn't be a pressure gradient. > > "And he said to me, you must have made a mistake. I left the operating > room very humbled." > > Braunwald said he later returned to the OR and asked Morrow if, before > he closed up the patient's chest, he would check the LV pressure > anyway. Then he left again. > > Sometime later, Morrow pulled him out of the cath lab to tell him that > there was, in fact, a gradient of about 100 mm Hg. > > The two men puzzled over their findings for days but dropped it after > a while and moved on. "Then a second case came along about a month > later, exactly the same thing. So we knew we had something new" [2]. > > "And of course we were thrilled," Braunwald said. "This was a paradigm > shift in this field, that you could have a gradient without > obstruction in a noncontracting heart." > > In the following months, "a picture of the disorder began to form, in > a vague way," he said. "We had a high index of suspicion for young > adults who came in with a loud murmur along the left sternal border, > murmurs like in a ventricular septal defect, lower down than with the > classic aortic-stenosis murmur." > This was a paradigm shift in this field, that you could have a > gradient without obstruction in a noncontracting heart. > > Then along came Brady, who presented with exertional dyspnea and > fatigue and who reported having a heart murmur first detected when he > was 11. "When I examined him, he told me he had a brother and a sister > who also had loud heart murmurs since early childhood. And therefore > the index of suspicion that he might have this was high." > > As the commemorative article relates, "Several aunts and uncles had > died of heart failure, believed to be due to rheumatic fever. . . . > His two siblings had heart murmurs, and many members of his father's > family were said to have heart murmurs. Several of these had died > suddenly in childhood or during early adult life. Notably, a grade > IV/VI midsystolic murmur was heard at the fourth left intercostal > space and apex associated with a prominent left ventricular lift. > Electrocardiography showed right-axis deviation and incomplete right > bundle branch block." > > "He had the classic physical findings, and so I made the clinical > diagnosis, idiopathic hypertrophic subaortic stenosis," Braunwald > said, using the name that would eventually be changed to HCM. "Then we > did the catheterization." > > As related by Maron et al, "a peak systolic outflow gradient of 40 mm > Hg was recorded between the left ventricular cavity and the subaortic > area, confirming the precatheterization diagnosis." > > The next challenge was to recognize such patients before they go to > catheterization and surgery even when their family history is > negative. "We spent the next three to five years trying to figure that > out." By the time he, Morrow, and others had published a series of > about 12 patients in 1960 [3], "we were able to draw a pretty good > clinical description." > > A review of 64 patients followed four years later [4], and in 1968, > Braunwald's last year at the NIH, he and his colleagues published > reports on the disorder's physiologic effects and treating it with > beta blockers and surgery [5,6,7] along with another series of 126 > patients [8]. "It was my parting gift. And a year after I left, > echocardiography came along and changed everything." > Sources > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From anianyanwu at hotmail.com Tue Dec 9 17:35:25 2008 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Tue Dec 9 12:36:15 2008 Subject: [HSF] Interesting article (Myxo Ring) In-Reply-To: References: Message-ID: The plot thickens: http://www.reuters.com/article/domesticNews/idUSTRE4B30GL20081204?feedType=RSS&feedName=domesticNews Apparently the Senate (or specifically Senator Grassley) is now investigating Edwards and the Myxo Ring has disappeared from Edwards USA website and news reports are now saying that device may not have been appropriately FDA approved. Strangely too the IMR ring has disappeared from the website also. Strangely though, the Geoform is still on the website. The question seems to center (as we discussed before though in relation to the Geoform) of the way some devices can be cleared by FDA (without clinical trials or data) because the device is deemed a minor modification of a predicate FDA approved device. If indeed the FDA does claim to have been misled and says that these devices (Myxo ring and IMR ring) have been used without appropriate FDA approval then we can expect a Pandora's box to open... Ani > Date: Wed, 8 Oct 2008 19:43:50 -0500> From: ebender001@me.com> To: OpenHeart-L@hsforum.com> CC: > Subject: [HSF] Interesting article> > http://www.theheart.org/article/909595.do> > Questions raised about Northwestern use of valve device; prominent surgeon> denies wrongdoing> October 7, 2008 | Shelley Wood> > Chicago, IL - Northwestern University is fending off criticism that one of> its star surgeons, Dr Patrick M McCarthy, used a device he invented before> it was formally approved by the FDA, without first telling patients he might> use it. The university, the manufacturer, and McCarthy himself all insist> that the device, known as the Myxo ETlogix annuloplasty ring 5100, was> commercially available at the time. But heartwire has confirmed that the FDA> is investigating the circumstances surrounding its use, and another> cardiologist at Northwestern has come forward saying she believed the device> to be investigational at the time it was used. One of the patients who> received the device is suing McCarthy and Edwards Lifesciences, the> manufacturer of the ring.> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- _________________________________________________________________ Are you a PC?? Upload your PC story and show the world http://clk.atdmt.com/UKM/go/122465942/direct/01/ From enaseri at hotmail.com.tr Tue Dec 9 20:14:52 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Tue Dec 9 15:15:43 2008 Subject: [HSF] TEE in OR In-Reply-To: <8CB279F3D6A7635-AE0-1785@WEBMAIL-DY29.sysops.aol.com> References: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com><385894.73992.qm@web30604.mail.mud.yahoo.com> <8CB279F3D6A7635-AE0-1785@WEBMAIL-DY29.sysops.aol.com> Message-ID: Edward, Though the site you mentioned claims that viewing the images is free ,it requires a subscription and credit card number and so on. erdinc From dukeb60 at aol.com Tue Dec 9 16:06:59 2008 From: dukeb60 at aol.com (Edward P. Raines) Date: Tue Dec 9 16:45:18 2008 Subject: [HSF] TEE in OR In-Reply-To: References: <89c4ed2d0812070852s17d8192g6c289a80ccc110c9@mail.gmail.com><385894.73992.qm@web30604.mail.mud.yahoo.com> <8CB279F3D6A7635-AE0-1785@WEBMAIL-DY29.sysops.aol.com> Message-ID: <8CB28593520D966-13E8-AC@WEBMAIL-DZ01.sysops.aol.com> Erdinc, ???? Two of the founders of e-echocardiography.com work as anesthesiologists at our institution - Dr. Bejot and Dr. Gross.? I just talked with Dr. Gross, who trained with Dr. Stanton Sherman at Harvard, about your concerns.? You are correct that there is a subscription fee for use of the site.? Since the images are from our institution all the physicians here get access for free.? The price varies with the level of access you desire and the syllabus you want.? It also depends upon whether you wish to obtain CME credits.? For the $299 fee you can get 66 hours of CME credit, which in reality is fairly cheap.? You can get limited access for under $70.? Dr. Gross's email address is kgross@jlsi.net if you have any questions regarding the site.? For a department like yours new to TEE I think it would be well worth the cost as the library of images and theory of TEE is extensive.? I have heard Dr. Sherman speak at multiple conferences on TEE and he is superb.? Dr. Gross could give you much more information, however.? Feel free to contact him. ??????????????????????????????????????????????????????????????????????????????????????0 Ed Edward P. Raines, M.D., J.D. Director, BryanLGH Cardiothoracic Surgery BryanLGH Medical Center 1500 South 48th Street Suite 601 Lincoln, Nebraska 68506 Office 402-481-8430 Fax 402-481-8429 Cell 402-730-9242 Email Dukeb60@aol.com -----Original Message----- From: erdin? naseri To: HSF HSF Sent: Tue, 9 Dec 2008 2:14 pm Subject: RE: [HSF] TEE in OR dward, hough the site you mentioned claims that viewing the images is free ,it equires a subscription and credit card number and so on. rdinc ______________________________________________ penHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: ttp://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and isclaimers posted at: ttp://www.hsforum.com/listdisclaim ---------------------------------------- From chand.ramaiah at uky.edu Tue Dec 9 17:05:17 2008 From: chand.ramaiah at uky.edu (Ramaiah, Chandrashekar) Date: Tue Dec 9 17:06:44 2008 Subject: [HSF] HOCM In-Reply-To: <89c4ed2d0812090601i5884619bkcce4643381b67b65@mail.gmail.com> References: <89c4ed2d0812081833n14f7d24ai7e1d55e380559004@mail.gmail.com> <3ACC54310BF13645A0D12496D7CA94E5F987D280@EX7FM04.ad.uky.edu> <89c4ed2d0812090601i5884619bkcce4643381b67b65@mail.gmail.com> Message-ID: <3ACC54310BF13645A0D12496D7CA94E5F987D800@EX7FM04.ad.uky.edu> Prasanna, Take home message... Most patients with HCM at least I risk factor will need discussion of AICD placement for primary prevention (In other countries 2- 3 risk factors). All patients with obstruction (HOCM) with gradients >50 should have referral for surgical myectomy. Extended myectomy is the preferred method with release of papillary muscles, if needed and any mitral placation if necessary. No place for just shaving the top part of the septum off- very high recurrence rates. Dobutamine stress test can be done safely and should be considered to assess severity of obstruction as a provocative test in patients with lower gradients. There is really no role for Alcohol septal ablation, especially in young patients (This was hammered in again and again by all the cardiologists that talked). Alcohol septal ablation may be considered for older patients. Surgical results from major centers were excellent, mortality less than 0.4% and post op gradient of <3mm of Hg. Chand -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Tuesday, December 09, 2008 9:01 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] HOCM And what did you learn from that meeting ? What is new ? Prasanna On Tue, Dec 9, 2008 at 6:37 PM, Ramaiah, Chandrashekar wrote: > Prasanna, > I was at the HCM meeting this past weekend. Barry Maron showed us the picture of Mr. Brady. It was a very good meeting. > > > Chand > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M > Sent: Monday, December 08, 2008 9:33 PM > To: OpenHeart-L@lists.hsforum.com; Discussion of Critical Care Medicine > Subject: [HSF] HOCM > > Portrait of the artist as a young man: First HCM clinical diagnosis > marks golden anniversary > December 8, 2008 | Steve Stiles > > Boston, MA - "It was the first week after being appointed head of the > cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald > (Brigham and Women's Hospital, Boston, MA) said about a memorable > early episode in his long and distinguished career. The key event, a > decade before the advent of echocardiography: the first known > diagnosis based solely on clinical signs of what is now called > hypertrophic cardiomyopathy (HCM). > > The diagnostic challenges in that simpler, preelectronic age of > cardiology were immense. "In movies about World War I, you see pilots > in those very early biplanes, no altimeters, no equipment to guide > them. They would recognize when they were over enemy territory, and > they shot what they could see. That's how it was. It was a > seat-of-the-pants diagnosis." > > Braunwald related the story to heartwire following a report > commemorating the event in the November 15, 2008 American Journal of > Cardiology [1], which also pays tribute to the long life of the > patient, Claude Brady, of Arlington, VA, who received a new heart in > 1989 and is now 71 years old. > He said to me, you must have made a mistake. I left the operating room > very humbled. > > "Mr Brady is now healthy and vigorous and has been particularly active > in promoting heart transplantation as the founder of two > organizations: Transplant Recipients International Organization, Inc > (National Capital Chapter), as well as Transplant Awareness, Inc," > write the report's authors, who include Braunwald and first author Dr > Barry J Maron (Minneapolis Heart Institute Foundation, MN). > > As Braunwald tells it, one day during his fellowship at the National > Heart Institute (NIH), in Bethesda, MD (which later folded into the > National Heart, Lung, and Blood Institute), some months before the > clinical diagnosis, he observed a pressure gradient in the subaortic > area of a different patient's left ventricle during cardiac > catheterization. In the late 1950s, that meant only one thing, an > obstruction. The patient, diagnosed with congenital (membranous) > hypertrophic subaortic stenosis, went to surgery. > > Later on, he said, the late Dr Andrew G Morrow, chief of surgery there > at the time, called Braunwald up to the operating room to show him > something unexpected with what should have been a simple operation. > "To my chagrin," he said, Morrow showed him how he could put a finger > from one hand through the aortic valve and the forefinger from the > other hand through the left atrium, so the two could meet in the left > ventricle. No obstruction! There shouldn't be a pressure gradient. > > "And he said to me, you must have made a mistake. I left the operating > room very humbled." > > Braunwald said he later returned to the OR and asked Morrow if, before > he closed up the patient's chest, he would check the LV pressure > anyway. Then he left again. > > Sometime later, Morrow pulled him out of the cath lab to tell him that > there was, in fact, a gradient of about 100 mm Hg. > > The two men puzzled over their findings for days but dropped it after > a while and moved on. "Then a second case came along about a month > later, exactly the same thing. So we knew we had something new" [2]. > > "And of course we were thrilled," Braunwald said. "This was a paradigm > shift in this field, that you could have a gradient without > obstruction in a noncontracting heart." > > In the following months, "a picture of the disorder began to form, in > a vague way," he said. "We had a high index of suspicion for young > adults who came in with a loud murmur along the left sternal border, > murmurs like in a ventricular septal defect, lower down than with the > classic aortic-stenosis murmur." > This was a paradigm shift in this field, that you could have a > gradient without obstruction in a noncontracting heart. > > Then along came Brady, who presented with exertional dyspnea and > fatigue and who reported having a heart murmur first detected when he > was 11. "When I examined him, he told me he had a brother and a sister > who also had loud heart murmurs since early childhood. And therefore > the index of suspicion that he might have this was high." > > As the commemorative article relates, "Several aunts and uncles had > died of heart failure, believed to be due to rheumatic fever. . . . > His two siblings had heart murmurs, and many members of his father's > family were said to have heart murmurs. Several of these had died > suddenly in childhood or during early adult life. Notably, a grade > IV/VI midsystolic murmur was heard at the fourth left intercostal > space and apex associated with a prominent left ventricular lift. > Electrocardiography showed right-axis deviation and incomplete right > bundle branch block." > > "He had the classic physical findings, and so I made the clinical > diagnosis, idiopathic hypertrophic subaortic stenosis," Braunwald > said, using the name that would eventually be changed to HCM. "Then we > did the catheterization." > > As related by Maron et al, "a peak systolic outflow gradient of 40 mm > Hg was recorded between the left ventricular cavity and the subaortic > area, confirming the precatheterization diagnosis." > > The next challenge was to recognize such patients before they go to > catheterization and surgery even when their family history is > negative. "We spent the next three to five years trying to figure that > out." By the time he, Morrow, and others had published a series of > about 12 patients in 1960 [3], "we were able to draw a pretty good > clinical description." > > A review of 64 patients followed four years later [4], and in 1968, > Braunwald's last year at the NIH, he and his colleagues published > reports on the disorder's physiologic effects and treating it with > beta blockers and surgery [5,6,7] along with another series of 126 > patients [8]. "It was my parting gift. And a year after I left, > echocardiography came along and changed everything." > Sources > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From nfaabouseada at gmail.com Tue Dec 9 16:45:52 2008 From: nfaabouseada at gmail.com (Nasser F. Abou'Seada) Date: Tue Dec 9 17:46:22 2008 Subject: [HSF] Interesting article (Myxo Ring) In-Reply-To: References: Message-ID: very interesting Ani your input, analysis, evaluation and prespective would greatly enrich the way to pick up on it . Festive Greetings NFA On 12/9/08, Ani Anyanwu wrote: > > > The plot thickens: > > > http://www.reuters.com/article/domesticNews/idUSTRE4B30GL20081204?feedType=RSS&feedName=domesticNews > > > Apparently the Senate (or specifically Senator Grassley) is now > investigating Edwards and the Myxo Ring has disappeared from Edwards USA > website and news reports are now saying that device may not have been > appropriately FDA approved. Strangely too the IMR ring has disappeared from > the website also. Strangely though, the Geoform is still on the website. The > question seems to center (as we discussed before though in relation to the > Geoform) of the way some devices can be cleared by FDA (without clinical > trials or data) because the device is deemed a minor modification of a > predicate FDA approved device. > > If indeed the FDA does claim to have been misled and says that these > devices (Myxo ring and IMR ring) have been used without appropriate FDA > approval then we can expect a Pandora's box to open... > > Ani > > > > > Date: Wed, 8 Oct 2008 19:43:50 -0500> From: ebender001@me.com> To: > OpenHeart-L@hsforum.com> CC: > Subject: [HSF] Interesting article> > > http://www.theheart.org/article/909595.do> > Questions raised about > Northwestern use of valve device; prominent surgeon> denies wrongdoing> > October 7, 2008 | Shelley Wood> > Chicago, IL - Northwestern University is > fending off criticism that one of> its star surgeons, Dr Patrick M McCarthy, > used a device he invented before> it was formally approved by the FDA, > without first telling patients he might> use it. The university, the > manufacturer, and McCarthy himself all insist> that the device, known as the > Myxo ETlogix annuloplasty ring 5100, was> commercially available at the > time. But heartwire has confirmed that the FDA> is investigating the > circumstances surrounding its use, and another> cardiologist at Northwestern > has come forward saying she believed the device> to be investigational at > the time it was used. One of the patients who> received the device is suing > McCarthy and Edwards Lifesciences, the> manufacturer of the ring.> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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> > ----------------------------------------- > _________________________________________________________________ > Are you a PC? Upload your PC story and show the world > > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > From msfirst at gmail.com Tue Dec 9 16:58:56 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Tue Dec 9 18:04:52 2008 Subject: [HSF] Interesting article (Myxo Ring) In-Reply-To: References: Message-ID: sounds like we all need to go back to replacing all mitrals with mechanicals. -michael On Tue, Dec 9, 2008 at 12:35 PM, Ani Anyanwu wrote: > > The plot thickens: > > > http://www.reuters.com/article/domesticNews/idUSTRE4B30GL20081204?feedType=RSS&feedName=domesticNews > > > Apparently the Senate (or specifically Senator Grassley) is now > investigating Edwards and the Myxo Ring has disappeared from Edwards USA > website and news reports are now saying that device may not have been > appropriately FDA approved. Strangely too the IMR ring has disappeared from > the website also. Strangely though, the Geoform is still on the website. The > question seems to center (as we discussed before though in relation to the > Geoform) of the way some devices can be cleared by FDA (without clinical > trials or data) because the device is deemed a minor modification of a > predicate FDA approved device. > > If indeed the FDA does claim to have been misled and says that these > devices (Myxo ring and IMR ring) have been used without appropriate FDA > approval then we can expect a Pandora's box to open... > > Ani > > > > > Date: Wed, 8 Oct 2008 19:43:50 -0500> From: ebender001@me.com> To: > OpenHeart-L@hsforum.com> CC: > Subject: [HSF] Interesting article> > > http://www.theheart.org/article/909595.do> > Questions raised about > Northwestern use of valve device; prominent surgeon> denies wrongdoing> > October 7, 2008 | Shelley Wood> > Chicago, IL - Northwestern University is > fending off criticism that one of> its star surgeons, Dr Patrick M McCarthy, > used a device he invented before> it was formally approved by the FDA, > without first telling patients he might> use it. The university, the > manufacturer, and McCarthy himself all insist> that the device, known as the > Myxo ETlogix annuloplasty ring 5100, was> commercially available at the > time. But heartwire has confirmed that the FDA> is investigating the > circumstances surrounding its use, and another> cardiologist at Northwestern > has come forward saying she believed the device> to be investigational at > the time it was used. One of the patients who> received the device is suing > McCarthy and Edwards Lifesciences, the> manufacturer of the ring.> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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> > ----------------------------------------- > _________________________________________________________________ > Are you a PC? Upload your PC story and show the world > > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > From TSalerno at med.miami.edu Tue Dec 9 18:07:53 2008 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Tue Dec 9 18:08:22 2008 Subject: [HSF] Interesting article (Myxo Ring) Message-ID: Without knowing details, and both sides of this story, it is hearbreaking what is being reported on www.google.com Ts ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: OpenHeart-L@lists.hsforum.com Sent: Tue Dec 09 16:58:56 2008 Subject: Re: [HSF] Interesting article (Myxo Ring) sounds like we all need to go back to replacing all mitrals with mechanicals. -michael On Tue, Dec 9, 2008 at 12:35 PM, Ani Anyanwu wrote: > > The plot thickens: > > > http://www.reuters.com/article/domesticNews/idUSTRE4B30GL20081204?feedType=RSS&feedName=domesticNews > > > Apparently the Senate (or specifically Senator Grassley) is now > investigating Edwards and the Myxo Ring has disappeared from Edwards USA > website and news reports are now saying that device may not have been > appropriately FDA approved. Strangely too the IMR ring has disappeared from > the website also. Strangely though, the Geoform is still on the website. The > question seems to center (as we discussed before though in relation to the > Geoform) of the way some devices can be cleared by FDA (without clinical > trials or data) because the device is deemed a minor modification of a > predicate FDA approved device. > > If indeed the FDA does claim to have been misled and says that these > devices (Myxo ring and IMR ring) have been used without appropriate FDA > approval then we can expect a Pandora's box to open... > > Ani > > > > > Date: Wed, 8 Oct 2008 19:43:50 -0500> From: ebender001@me.com> To: > OpenHeart-L@hsforum.com> CC: > Subject: [HSF] Interesting article> > > http://www.theheart.org/article/909595.do> > Questions raised about > Northwestern use of valve device; prominent surgeon> denies wrongdoing> > October 7, 2008 | Shelley Wood> > Chicago, IL - Northwestern University is > fending off criticism that one of> its star surgeons, Dr Patrick M McCarthy, > used a device he invented before> it was formally approved by the FDA, > without first telling patients he might> use it. The university, the > manufacturer, and McCarthy himself all insist> that the device, known as the > Myxo ETlogix annuloplasty ring 5100, was> commercially available at the > time. But heartwire has confirmed that the FDA> is investigating the > circumstances surrounding its use, and another> cardiologist at Northwestern > has come forward saying she believed the device> to be investigational at > the time it was used. One of the patients who> received the device is suing > McCarthy and Edwards Lifesciences, the> manufacturer of the ring.> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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> > ----------------------------------------- > _________________________________________________________________ > Are you a PC? Upload your PC story and show the world > > http://clk.atdmt.com/UKM/go/122465942/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 ----------------------------------------- From DukeB60 at aol.com Tue Dec 9 18:37:05 2008 From: DukeB60 at aol.com (DukeB60@aol.com) Date: Tue Dec 9 18:39:01 2008 Subject: [HSF] HOCM Message-ID: Chand, May I ask who gave the lecture on surgical treatment of HOCM? Ed In a message dated 12/9/2008 4:08:54 P.M. Central Standard Time, chand.ramaiah@uky.edu writes: Prasanna, Take home message... Most patients with HCM at least I risk factor will need discussion of AICD placement for primary prevention (In other countries 2- 3 risk factors). All patients with obstruction (HOCM) with gradients >50 should have referral for surgical myectomy. Extended myectomy is the preferred method with release of papillary muscles, if needed and any mitral placation if necessary. No place for just shaving the top part of the septum off- very high recurrence rates. Dobutamine stress test can be done safely and should be considered to assess severity of obstruction as a provocative test in patients with lower gradients. There is really no role for Alcohol septal ablation, especially in young patients (This was hammered in again and again by all the cardiologists that talked). Alcohol septal ablation may be considered for older patients. Surgical results from major centers were excellent, mortality less than 0.4% and post op gradient of <3mm of Hg. Chand -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Tuesday, December 09, 2008 9:01 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] HOCM And what did you learn from that meeting ? What is new ? Prasanna On Tue, Dec 9, 2008 at 6:37 PM, Ramaiah, Chandrashekar wrote: > Prasanna, > I was at the HCM meeting this past weekend. Barry Maron showed us the picture of Mr. Brady. It was a very good meeting. > > > Chand > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M > Sent: Monday, December 08, 2008 9:33 PM > To: OpenHeart-L@lists.hsforum.com; Discussion of Critical Care Medicine > Subject: [HSF] HOCM > > Portrait of the artist as a young man: First HCM clinical diagnosis > marks golden anniversary > December 8, 2008 | Steve Stiles > > Boston, MA - "It was the first week after being appointed head of the > cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald > (Brigham and Women's Hospital, Boston, MA) said about a memorable > early episode in his long and distinguished career. The key event, a > decade before the advent of echocardiography: the first known > diagnosis based solely on clinical signs of what is now called > hypertrophic cardiomyopathy (HCM). > > The diagnostic challenges in that simpler, preelectronic age of > cardiology were immense. "In movies about World War I, you see pilots > in those very early biplanes, no altimeters, no equipment to guide > them. They would recognize when they were over enemy territory, and > they shot what they could see. That's how it was. It was a > seat-of-the-pants diagnosis." > > Braunwald related the story to heartwire following a report > commemorating the event in the November 15, 2008 American Journal of > Cardiology [1], which also pays tribute to the long life of the > patient, Claude Brady, of Arlington, VA, who received a new heart in > 1989 and is now 71 years old. > He said to me, you must have made a mistake. I left the operating room > very humbled. > > "Mr Brady is now healthy and vigorous and has been particularly active > in promoting heart transplantation as the founder of two > organizations: Transplant Recipients International Organization, Inc > (National Capital Chapter), as well as Transplant Awareness, Inc," > write the report's authors, who include Braunwald and first author Dr > Barry J Maron (Minneapolis Heart Institute Foundation, MN). > > As Braunwald tells it, one day during his fellowship at the National > Heart Institute (NIH), in Bethesda, MD (which later folded into the > National Heart, Lung, and Blood Institute), some months before the > clinical diagnosis, he observed a pressure gradient in the subaortic > area of a different patient's left ventricle during cardiac > catheterization. In the late 1950s, that meant only one thing, an > obstruction. The patient, diagnosed with congenital (membranous) > hypertrophic subaortic stenosis, went to surgery. > > Later on, he said, the late Dr Andrew G Morrow, chief of surgery there > at the time, called Braunwald up to the operating room to show him > something unexpected with what should have been a simple operation. > "To my chagrin," he said, Morrow showed him how he could put a finger > from one hand through the aortic valve and the forefinger from the > other hand through the left atrium, so the two could meet in the left > ventricle. No obstruction! There shouldn't be a pressure gradient. > > "And he said to me, you must have made a mistake. I left the operating > room very humbled." > > Braunwald said he later returned to the OR and asked Morrow if, before > he closed up the patient's chest, he would check the LV pressure > anyway. Then he left again. > > Sometime later, Morrow pulled him out of the cath lab to tell him that > there was, in fact, a gradient of about 100 mm Hg. > > The two men puzzled over their findings for days but dropped it after > a while and moved on. "Then a second case came along about a month > later, exactly the same thing. So we knew we had something new" [2]. > > "And of course we were thrilled," Braunwald said. "This was a paradigm > shift in this field, that you could have a gradient without > obstruction in a noncontracting heart." > > In the following months, "a picture of the disorder began to form, in > a vague way," he said. "We had a high index of suspicion for young > adults who came in with a loud murmur along the left sternal border, > murmurs like in a ventricular septal defect, lower down than with the > classic aortic-stenosis murmur." > This was a paradigm shift in this field, that you could have a > gradient without obstruction in a noncontracting heart. > > Then along came Brady, who presented with exertional dyspnea and > fatigue and who reported having a heart murmur first detected when he > was 11. "When I examined him, he told me he had a brother and a sister > who also had loud heart murmurs since early childhood. And therefore > the index of suspicion that he might have this was high." > > As the commemorative article relates, "Several aunts and uncles had > died of heart failure, believed to be due to rheumatic fever. . . . > His two siblings had heart murmurs, and many members of his father's > family were said to have heart murmurs. Several of these had died > suddenly in childhood or during early adult life. Notably, a grade > IV/VI midsystolic murmur was heard at the fourth left intercostal > space and apex associated with a prominent left ventricular lift. > Electrocardiography showed right-axis deviation and incomplete right > bundle branch block." > > "He had the classic physical findings, and so I made the clinical > diagnosis, idiopathic hypertrophic subaortic stenosis," Braunwald > said, using the name that would eventually be changed to HCM. "Then we > did the catheterization." > > As related by Maron et al, "a peak systolic outflow gradient of 40 mm > Hg was recorded between the left ventricular cavity and the subaortic > area, confirming the precatheterization diagnosis." > > The next challenge was to recognize such patients before they go to > catheterization and surgery even when their family history is > negative. "We spent the next three to five years trying to figure that > out." By the time he, Morrow, and others had published a series of > about 12 patients in 1960 [3], "we were able to draw a pretty good > clinical description." > > A review of 64 patients followed four years later [4], and in 1968, > Braunwald's last year at the NIH, he and his colleagues published > reports on the disorder's physiologic effects and treating it with > beta blockers and surgery [5,6,7] along with another series of 126 > patients [8]. "It was my parting gift. And a year after I left, > echocardiography came along and changed everything." > Sources > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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@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 ----------------------------------------- **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From prasannasimha at gmail.com Wed Dec 10 07:37:36 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Dec 9 21:08:05 2008 Subject: [HSF] HOCM In-Reply-To: <3ACC54310BF13645A0D12496D7CA94E5F987D800@EX7FM04.ad.uky.edu> References: <89c4ed2d0812081833n14f7d24ai7e1d55e380559004@mail.gmail.com> <3ACC54310BF13645A0D12496D7CA94E5F987D280@EX7FM04.ad.uky.edu> <89c4ed2d0812090601i5884619bkcce4643381b67b65@mail.gmail.com> <3ACC54310BF13645A0D12496D7CA94E5F987D800@EX7FM04.ad.uky.edu> Message-ID: <89c4ed2d0812091807n6c057d5asb2bb160bf74e1a5f@mail.gmail.com> Thanks. Prasanna On Wed, Dec 10, 2008 at 3:35 AM, Ramaiah, Chandrashekar wrote: > Prasanna, > Take home message... > Most patients with HCM at least I risk factor will need discussion of AICD placement for primary prevention (In other countries 2- 3 risk factors). > > All patients with obstruction (HOCM) with gradients >50 should have referral for surgical myectomy. > > Extended myectomy is the preferred method with release of papillary muscles, if needed and any mitral placation if necessary. No place for just shaving the top part of the septum off- very high recurrence rates. > > Dobutamine stress test can be done safely and should be considered to assess severity of obstruction as a provocative test in patients with lower gradients. > > There is really no role for Alcohol septal ablation, especially in young patients (This was hammered in again and again by all the cardiologists that talked). Alcohol septal ablation may be considered for older patients. > > Surgical results from major centers were excellent, mortality less than 0.4% and post op gradient of <3mm of Hg. > > Chand > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M > Sent: Tuesday, December 09, 2008 9:01 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] HOCM > > And what did you learn from that meeting ? What is new ? > Prasanna > > On Tue, Dec 9, 2008 at 6:37 PM, Ramaiah, Chandrashekar > wrote: >> Prasanna, >> I was at the HCM meeting this past weekend. Barry Maron showed us the picture of Mr. Brady. It was a very good meeting. >> >> >> Chand >> >> -----Original Message----- >> From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M >> Sent: Monday, December 08, 2008 9:33 PM >> To: OpenHeart-L@lists.hsforum.com; Discussion of Critical Care Medicine >> Subject: [HSF] HOCM >> >> Portrait of the artist as a young man: First HCM clinical diagnosis >> marks golden anniversary >> December 8, 2008 | Steve Stiles >> >> Boston, MA - "It was the first week after being appointed head of the >> cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald >> (Brigham and Women's Hospital, Boston, MA) said about a memorable >> early episode in his long and distinguished career. The key event, a >> decade before the advent of echocardiography: the first known >> diagnosis based solely on clinical signs of what is now called >> hypertrophic cardiomyopathy (HCM). >> >> The diagnostic challenges in that simpler, preelectronic age of >> cardiology were immense. "In movies about World War I, you see pilots >> in those very early biplanes, no altimeters, no equipment to guide >> them. They would recognize when they were over enemy territory, and >> they shot what they could see. That's how it was. It was a >> seat-of-the-pants diagnosis." >> >> Braunwald related the story to heartwire following a report >> commemorating the event in the November 15, 2008 American Journal of >> Cardiology [1], which also pays tribute to the long life of the >> patient, Claude Brady, of Arlington, VA, who received a new heart in >> 1989 and is now 71 years old. >> He said to me, you must have made a mistake. I left the operating room >> very humbled. >> >> "Mr Brady is now healthy and vigorous and has been particularly active >> in promoting heart transplantation as the founder of two >> organizations: Transplant Recipients International Organization, Inc >> (National Capital Chapter), as well as Transplant Awareness, Inc," >> write the report's authors, who include Braunwald and first author Dr >> Barry J Maron (Minneapolis Heart Institute Foundation, MN). >> >> As Braunwald tells it, one day during his fellowship at the National >> Heart Institute (NIH), in Bethesda, MD (which later folded into the >> National Heart, Lung, and Blood Institute), some months before the >> clinical diagnosis, he observed a pressure gradient in the subaortic >> area of a different patient's left ventricle during cardiac >> catheterization. In the late 1950s, that meant only one thing, an >> obstruction. The patient, diagnosed with congenital (membranous) >> hypertrophic subaortic stenosis, went to surgery. >> >> Later on, he said, the late Dr Andrew G Morrow, chief of surgery there >> at the time, called Braunwald up to the operating room to show him >> something unexpected with what should have been a simple operation. >> "To my chagrin," he said, Morrow showed him how he could put a finger >> from one hand through the aortic valve and the forefinger from the >> other hand through the left atrium, so the two could meet in the left >> ventricle. No obstruction! There shouldn't be a pressure gradient. >> >> "And he said to me, you must have made a mistake. I left the operating >> room very humbled." >> >> Braunwald said he later returned to the OR and asked Morrow if, before >> he closed up the patient's chest, he would check the LV pressure >> anyway. Then he left again. >> >> Sometime later, Morrow pulled him out of the cath lab to tell him that >> there was, in fact, a gradient of about 100 mm Hg. >> >> The two men puzzled over their findings for days but dropped it after >> a while and moved on. "Then a second case came along about a month >> later, exactly the same thing. So we knew we had something new" [2]. >> >> "And of course we were thrilled," Braunwald said. "This was a paradigm >> shift in this field, that you could have a gradient without >> obstruction in a noncontracting heart." >> >> In the following months, "a picture of the disorder began to form, in >> a vague way," he said. "We had a high index of suspicion for young >> adults who came in with a loud murmur along the left sternal border, >> murmurs like in a ventricular septal defect, lower down than with the >> classic aortic-stenosis murmur." >> This was a paradigm shift in this field, that you could have a >> gradient without obstruction in a noncontracting heart. >> >> Then along came Brady, who presented with exertional dyspnea and >> fatigue and who reported having a heart murmur first detected when he >> was 11. "When I examined him, he told me he had a brother and a sister >> who also had loud heart murmurs since early childhood. And therefore >> the index of suspicion that he might have this was high." >> >> As the commemorative article relates, "Several aunts and uncles had >> died of heart failure, believed to be due to rheumatic fever. . . . >> His two siblings had heart murmurs, and many members of his father's >> family were said to have heart murmurs. Several of these had died >> suddenly in childhood or during early adult life. Notably, a grade >> IV/VI midsystolic murmur was heard at the fourth left intercostal >> space and apex associated with a prominent left ventricular lift. >> Electrocardiography showed right-axis deviation and incomplete right >> bundle branch block." >> >> "He had the classic physical findings, and so I made the clinical >> diagnosis, idiopathic hypertrophic subaortic stenosis," Braunwald >> said, using the name that would eventually be changed to HCM. "Then we >> did the catheterization." >> >> As related by Maron et al, "a peak systolic outflow gradient of 40 mm >> Hg was recorded between the left ventricular cavity and the subaortic >> area, confirming the precatheterization diagnosis." >> >> The next challenge was to recognize such patients before they go to >> catheterization and surgery even when their family history is >> negative. "We spent the next three to five years trying to figure that >> out." By the time he, Morrow, and others had published a series of >> about 12 patients in 1960 [3], "we were able to draw a pretty good >> clinical description." >> >> A review of 64 patients followed four years later [4], and in 1968, >> Braunwald's last year at the NIH, he and his colleagues published >> reports on the disorder's physiologic effects and treating it with >> beta blockers and surgery [5,6,7] along with another series of 126 >> patients [8]. "It was my parting gift. And a year after I left, >> echocardiography came along and changed everything." >> Sources >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From chand.ramaiah at uky.edu Tue Dec 9 21:09:14 2008 From: chand.ramaiah at uky.edu (Ramaiah, Chandrashekar) Date: Tue Dec 9 21:09:33 2008 Subject: [HSF] HOCM In-Reply-To: Message-ID: Ed, Barry Maron (Univ of Minnesota) talked about Prevention of SCD in HCM (AICD & Surgery) Rick Nishimura (Mayo) talked about Alcohol Septal Ablation, he talked more about the benefits of surgery and very cautious recommending ablation. Daniel Swistel (Surgeon from St. Lukes/Columbia Univ)- Evolution of surgery for HOCM as well as details of extended myectomy, release of Paps and plication. Nick Smedira (Cleveland clinic) Surgical septal myectomy. Chand On 12/9/08 6:37 PM, "DukeB60@aol.com" wrote: Chand, May I ask who gave the lecture on surgical treatment of HOCM? Ed In a message dated 12/9/2008 4:08:54 P.M. Central Standard Time, chand.ramaiah@uky.edu writes: Prasanna, Take home message... Most patients with HCM at least I risk factor will need discussion of AICD placement for primary prevention (In other countries 2- 3 risk factors). All patients with obstruction (HOCM) with gradients >50 should have referral for surgical myectomy. Extended myectomy is the preferred method with release of papillary muscles, if needed and any mitral placation if necessary. No place for just shaving the top part of the septum off- very high recurrence rates. Dobutamine stress test can be done safely and should be considered to assess severity of obstruction as a provocative test in patients with lower gradients. There is really no role for Alcohol septal ablation, especially in young patients (This was hammered in again and again by all the cardiologists that talked). Alcohol septal ablation may be considered for older patients. Surgical results from major centers were excellent, mortality less than 0.4% and post op gradient of <3mm of Hg. Chand -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Tuesday, December 09, 2008 9:01 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] HOCM And what did you learn from that meeting ? What is new ? Prasanna On Tue, Dec 9, 2008 at 6:37 PM, Ramaiah, Chandrashekar wrote: > Prasanna, > I was at the HCM meeting this past weekend. Barry Maron showed us the picture of Mr. Brady. It was a very good meeting. > > > Chand > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M > Sent: Monday, December 08, 2008 9:33 PM > To: OpenHeart-L@lists.hsforum.com; Discussion of Critical Care Medicine > Subject: [HSF] HOCM > > Portrait of the artist as a young man: First HCM clinical diagnosis > marks golden anniversary > December 8, 2008 | Steve Stiles > > Boston, MA - "It was the first week after being appointed head of the > cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald > (Brigham and Women's Hospital, Boston, MA) said about a memorable > early episode in his long and distinguished career. The key event, a > decade before the advent of echocardiography: the first known > diagnosis based solely on clinical signs of what is now called > hypertrophic cardiomyopathy (HCM). > > The diagnostic challenges in that simpler, preelectronic age of > cardiology were immense. "In movies about World War I, you see pilots > in those very early biplanes, no altimeters, no equipment to guide > them. They would recognize when they were over enemy territory, and > they shot what they could see. That's how it was. It was a > seat-of-the-pants diagnosis." > > Braunwald related the story to heartwire following a report > commemorating the event in the November 15, 2008 American Journal of > Cardiology [1], which also pays tribute to the long life of the > patient, Claude Brady, of Arlington, VA, who received a new heart in > 1989 and is now 71 years old. > He said to me, you must have made a mistake. I left the operating room > very humbled. > > "Mr Brady is now healthy and vigorous and has been particularly active > in promoting heart transplantation as the founder of two > organizations: Transplant Recipients International Organization, Inc > (National Capital Chapter), as well as Transplant Awareness, Inc," > write the report's authors, who include Braunwald and first author Dr > Barry J Maron (Minneapolis Heart Institute Foundation, MN). > > As Braunwald tells it, one day during his fellowship at the National > Heart Institute (NIH), in Bethesda, MD (which later folded into the > National Heart, Lung, and Blood Institute), some months before the > clinical diagnosis, he observed a pressure gradient in the subaortic > area of a different patient's left ventricle during cardiac > catheterization. In the late 1950s, that meant only one thing, an > obstruction. The patient, diagnosed with congenital (membranous) > hypertrophic subaortic stenosis, went to surgery. > > Later on, he said, the late Dr Andrew G Morrow, chief of surgery there > at the time, called Braunwald up to the operating room to show him > something unexpected with what should have been a simple operation. > "To my chagrin," he said, Morrow showed him how he could put a finger > from one hand through the aortic valve and the forefinger from the > other hand through the left atrium, so the two could meet in the left > ventricle. No obstruction! There shouldn't be a pressure gradient. > > "And he said to me, you must have made a mistake. I left the operating > room very humbled." > > Braunwald said he later returned to the OR and asked Morrow if, before > he closed up the patient's chest, he would check the LV pressure > anyway. Then he left again. > > Sometime later, Morrow pulled him out of the cath lab to tell him that > there was, in fact, a gradient of about 100 mm Hg. > > The two men puzzled over their findings for days but dropped it after > a while and moved on. "Then a second case came along about a month > later, exactly the same thing. So we knew we had something new" [2]. > > "And of course we were thrilled," Braunwald said. "This was a paradigm > shift in this field, that you could have a gradient without > obstruction in a noncontracting heart." > > In the following months, "a picture of the disorder began to form, in > a vague way," he said. "We had a high index of suspicion for young > adults who came in with a loud murmur along the left sternal border, > murmurs like in a ventricular septal defect, lower down than with the > classic aortic-stenosis murmur." > This was a paradigm shift in this field, that you could have a > gradient without obstruction in a noncontracting heart. > > Then along came Brady, who presented with exertional dyspnea and > fatigue and who reported having a heart murmur first detected when he > was 11. "When I examined him, he told me he had a brother and a sister > who also had loud heart murmurs since early childhood. And therefore > the index of suspicion that he might have this was high." > > As the commemorative article relates, "Several aunts and uncles had > died of heart failure, believed to be due to rheumatic fever. . . . > His two siblings had heart murmurs, and many members of his father's > family were said to have heart murmurs. Several of these had died > suddenly in childhood or during early adult life. Notably, a grade > IV/VI midsystolic murmur was heard at the fourth left intercostal > space and apex associated with a prominent left ventricular lift. > Electrocardiography showed right-axis deviation and incomplete right > bundle branch block." > > "He had the classic physical findings, and so I made the clinical > diagnosis, idiopathic hypertrophic subaortic stenosis," Braunwald > said, using the name that would eventually be changed to HCM. "Then we > did the catheterization." > > As related by Maron et al, "a peak systolic outflow gradient of 40 mm > Hg was recorded between the left ventricular cavity and the subaortic > area, confirming the precatheterization diagnosis." > > The next challenge was to recognize such patients before they go to > catheterization and surgery even when their family history is > negative. "We spent the next three to five years trying to figure that > out." By the time he, Morrow, and others had published a series of > about 12 patients in 1960 [3], "we were able to draw a pretty good > clinical description." > > A review of 64 patients followed four years later [4], and in 1968, > Braunwald's last year at the NIH, he and his colleagues published > reports on the disorder's physiologic effects and treating it with > beta blockers and surgery [5,6,7] along with another series of 126 > patients [8]. "It was my parting gift. And a year after I left, > echocardiography came along and changed everything." > Sources > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > From ebender001 at me.com Tue Dec 9 21:28:44 2008 From: ebender001 at me.com (Edward Bender) Date: Tue Dec 9 22:29:20 2008 Subject: [HSF] Interesting article (Myxo Ring) In-Reply-To: Message-ID: I wanted to use an IMR ring today, but it has disappeared from our shelves also. This is Chicago politics at its best. I believe that this is payback for some untoward deeds or influences by the new Chicago golden boy for cardiac surgery. For any of you who have lived in Chicago, I am sure you can relate to the level of retaliation that can occur by snubbed powers that be. Ed Bender, MD On 12/9/08 11:35 AM, "Ani Anyanwu" wrote: > > The plot thickens: > > http://www.reuters.com/article/domesticNews/idUSTRE4B30GL20081204?feedType=RSS > &feedName=domesticNews > > > Apparently the Senate (or specifically Senator Grassley) is now investigating > Edwards and the Myxo Ring has disappeared from Edwards USA website and news > reports are now saying that device may not have been appropriately FDA > approved. Strangely too the IMR ring has disappeared from the website also. > Strangely though, the Geoform is still on the website. The question seems to > center (as we discussed before though in relation to the Geoform) of the way > some devices can be cleared by FDA (without clinical trials or data) because > the device is deemed a minor modification of a predicate FDA approved device. > > If indeed the FDA does claim to have been misled and says that these devices > (Myxo ring and IMR ring) have been used without appropriate FDA approval then > we can expect a Pandora's box to open... > > Ani > > > >> Date: Wed, 8 Oct 2008 19:43:50 -0500> From: ebender001@me.com> To: >> OpenHeart-L@hsforum.com> CC: > Subject: [HSF] Interesting article> > >> http://www.theheart.org/article/909595.do> > Questions raised about >> Northwestern use of valve device; prominent surgeon> denies wrongdoing> >> October 7, 2008 | Shelley Wood> > Chicago, IL - Northwestern University is >> fending off criticism that one of> its star surgeons, Dr Patrick M McCarthy, >> used a device he invented before> it was formally approved by the FDA, >> without first telling patients he might> use it. The university, the >> manufacturer, and McCarthy himself all insist> that the device, known as the >> Myxo ETlogix annuloplasty ring 5100, was> commercially available at the time. >> But heartwire has confirmed that the FDA> is investigating the circumstances >> surrounding its use, and another> cardiologist at Northwestern has come >> forward saying she believed the device> to be investigational at the time it >> was used. One of the patients who> received the device is suing McCarthy and >> Edwards Lifesciences, the> manufacturer of the ring.> >> _______________________________________________> OpenHeart-L mailing list> > >> Send postings to:> OpenHeart-L@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> >> ----------------------------------------- > _________________________________________________________________ > Are you a PC?? Upload your PC story and show the world > http://clk.atdmt.com/UKM/go/122465942/direct/01/______________________________ > _________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From ecdouville at orclinic.com Tue Dec 9 20:26:50 2008 From: ecdouville at orclinic.com (Douville, Chuck) Date: Tue Dec 9 23:30:24 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs References: <89c4ed2d0812082156t475c5b11p6a782ea38b400b03@mail.gmail.com> Message-ID: Prasanna, how much calcification in the leaflets does it take to dissuade you from rheumatic valve repair? Does it even matter if you are able to correct the restricted leaflet motion? ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M Sent: Mon 12/8/2008 9:56 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Durability - Rheumatic Mitral repairs I am not sure of the strepto status in rural Arkansas. There has been a spate of rheumatic fever of late in the US and that too many with a penicillin resistant strain so I would ask the local physicians in that area about it. The typical rheumatic repairable lesion generally has PML retraction and AML prolapse if there isn't significant commissural fusion. Prasanna On Tue, Dec 9, 2008 at 10:06 AM, wrote: > Prasanna, Thanks. She lives in northern Arkansas now and has been in the US > for ~42 years. Don't you think that suppressive Penicillin would not do > much good now? > Bob, at least in the OR, the postop MV gradient was only 4mm with normal > cardiac output. I wasn't fully prepared for this exact scenario preop. > Intraop, I used the Vascuguard bovine pericardial patch. Yes, the anterior > leaflet had both excessive tissue billowing and thickening which enhanced the > A1/A2 and A2/A3 fissures. I look forward to your wisdom and comments. > > K. Fon Huang, MD > **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From tacuff at swbell.net Tue Dec 9 22:22:46 2008 From: tacuff at swbell.net (Tea Acuff) Date: Wed Dec 10 01:24:18 2008 Subject: [HSF] Interesting article (Myxo Ring) Message-ID: <356686.63722.qm@web81606.mail.mud.yahoo.com> The problem is that there is a silent disconnect between virtually all approval and subsequent use. For many reasons "effective" over site is prospectively impossible if clinical adaptation is an actual goal, life being not even clear in retrospect much less prospectively. We doctors are as a group are incapable of being fair much less honest. We might as well be politicians in the good we claim to do in "protection" of the general well being. Then again some of us actually were politicians with a miserable record to show for it. If we could just?line up for transparency and a little?contrite honesty instead of exalted expertise, not just seeking sanctity with our usual 'conflicts of interest', we might eventually regain trust as a group.?Instead we line up not for insight but our pro and con agendas. I do not see much likely hood of?honest action as we scramble to be seen by the powerful as super regulators with super knowledge of the public needs, however. We need to be aligned with those that suffer as our first allegiance. Let the powerful heal themselves as they will do as they please anyway. The powerful are not, have not,?and never will be our friends or our ascendancy.?Wisdom is not a hammer, but a plea even in medicine. tea ________________________________ From: Edward Bender To: HSF List Sent: Tuesday, December 9, 2008 9:28:44 PM Subject: Re: [HSF] Interesting article (Myxo Ring) I wanted to use an IMR ring today, but it has disappeared from our shelves also.? This is Chicago politics at its best.? I believe that this is payback for some untoward deeds or influences by the new Chicago golden boy for cardiac surgery.? For any of you who have lived in Chicago, I am sure you can relate to the level of retaliation that can occur by snubbed powers that be. Ed Bender, MD On 12/9/08 11:35 AM, "Ani Anyanwu" wrote: > > The plot thickens: >? > http://www.reuters.com/article/domesticNews/idUSTRE4B30GL20081204?feedType=RSS > &feedName=domesticNews >? >? > Apparently the Senate (or specifically Senator Grassley) is now investigating > Edwards and the Myxo Ring has disappeared from Edwards USA website and news > reports are now saying that device may not have been appropriately FDA > approved. Strangely too the IMR ring has disappeared from the website also. > Strangely though, the Geoform is still on the website. The question seems to > center (as we discussed before though in relation to the Geoform) of the way > some devices can be cleared by FDA? (without clinical trials or data) because > the device is deemed a minor modification of a predicate FDA approved device. >? > If indeed the FDA does claim to have been misled and says that these devices > (Myxo ring and IMR ring) have been used without appropriate FDA approval then > we can expect a Pandora's box to open... >? > Ani >? >? >? >> Date: Wed, 8 Oct 2008 19:43:50 -0500> From: ebender001@me.com> To: >> OpenHeart-L@hsforum.com> CC: > Subject: [HSF] Interesting article> > >> http://www.theheart.org/article/909595.do> > Questions raised about >> Northwestern use of valve device; prominent surgeon> denies wrongdoing> >> October 7, 2008 | Shelley Wood> > Chicago, IL - Northwestern University is >> fending off criticism that one of> its star surgeons, Dr Patrick M McCarthy, >> used a device he invented before> it was formally approved by the FDA, >> without first telling patients he might> use it. The university, the >> manufacturer, and McCarthy himself all insist> that the device, known as the >> Myxo ETlogix annuloplasty ring 5100, was> commercially available at the time. >> But heartwire has confirmed that the FDA> is investigating the circumstances >> surrounding its use, and another> cardiologist at Northwestern has come >> forward saying she believed the device> to be investigational at the time it >> was used. One of the patients who> received the device is suing McCarthy and >> Edwards Lifesciences, the> manufacturer of the ring.> >> _______________________________________________> OpenHeart-L mailing list> > >> Send postings to:> OpenHeart-L@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> >> ----------------------------------------- > _________________________________________________________________ > Are you a PC?? Upload your PC story and show the world > http://clk.atdmt.com/UKM/go/122465942/direct/01/______________________________ > _________________ > OpenHeart-L mailing list > > Send postings to: >? OpenHeart-L@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@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 ----------------------------------------- From prasannasimha at gmail.com Wed Dec 10 14:42:25 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Dec 10 04:12:55 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: <89c4ed2d0812082156t475c5b11p6a782ea38b400b03@mail.gmail.com> Message-ID: <89c4ed2d0812100112g7c545258wf04e173e08a3686a@mail.gmail.com> Excisable local calcium is OK . Beyond that I do not repair dominantly regurgitant valves. If the case is for an open mitral valvotomy or is a fixed orifice MR , I am a bit more aggressive and will decalcify the leaflet if I can remove the calcium in toto. I just did such a case this week. Mitral orifice 1.1 cms and with grade III fixe3d orifice MR in a 24 year old man who comes from 500 Kms away from the "hinterland". I could decalcify the calcium and did an open valvotomy and did a localized annuloplasty to correct a coaptation deficiency of the posteromedial commissure (Did not do well with a magic stitch but did well with a limited annuloplasty. I did not put in a ring in this case.) . This resulted in a good valve area and trivial MR. Basically I am loath to repair valves which have anything but minimal excisable and non commissural calcium. I may tolerate posterior leaflet calcification but the scissors are more apt to excise the valve if the anterior leaflet is involved. I will also be more aggressive the younger the patient and in thise in whom anticoagulation is an issue. I did not understand the second part of the question (Does it even matter if you are able to correct the restricted leaflet motion?) Prasanna On Wed, Dec 10, 2008 at 9:56 AM, Douville, Chuck wrote: > Prasanna, how much calcification in the leaflets does it take to dissuade you from rheumatic valve repair? Does it even matter if you are able to correct the restricted leaflet motion? > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M > Sent: Mon 12/8/2008 9:56 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Durability - Rheumatic Mitral repairs > > > > I am not sure of the strepto status in rural Arkansas. There has been > a spate of rheumatic fever of late in the US and that too many with a > penicillin resistant strain so I would ask the local physicians in > that area about it. > The typical rheumatic repairable lesion generally has PML retraction > and AML prolapse if there isn't significant commissural fusion. > Prasanna > > On Tue, Dec 9, 2008 at 10:06 AM, wrote: >> Prasanna, Thanks. She lives in northern Arkansas now and has been in the US >> for ~42 years. Don't you think that suppressive Penicillin would not do >> much good now? >> Bob, at least in the OR, the postop MV gradient was only 4mm with normal >> cardiac output. I wasn't fully prepared for this exact scenario preop. >> Intraop, I used the Vascuguard bovine pericardial patch. Yes, the anterior >> leaflet had both excessive tissue billowing and thickening which enhanced the >> A1/A2 and A2/A3 fissures. I look forward to your wisdom and comments. >> >> K. Fon Huang, MD >> **************Make your life easier with all your friends, email, and >> favorite sites in one place. Try it now. >> (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Wed Dec 10 15:10:39 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Dec 10 04:48:26 2008 Subject: [HSF] HOCM In-Reply-To: <3ACC54310BF13645A0D12496D7CA94E5F987D800@EX7FM04.ad.uky.edu> References: <89c4ed2d0812081833n14f7d24ai7e1d55e380559004@mail.gmail.com> <3ACC54310BF13645A0D12496D7CA94E5F987D280@EX7FM04.ad.uky.edu> <89c4ed2d0812090601i5884619bkcce4643381b67b65@mail.gmail.com> <3ACC54310BF13645A0D12496D7CA94E5F987D800@EX7FM04.ad.uky.edu> Message-ID: <89c4ed2d0812100140h27fa513fm86ca64767674d7c2@mail.gmail.com> Could you highlight a bit more on papillary muscle release . Prasanna On Wed, Dec 10, 2008 at 3:35 AM, Ramaiah, Chandrashekar wrote: > Prasanna, > Take home message... > Most patients with HCM at least I risk factor will need discussion of AICD placement for primary prevention (In other countries 2- 3 risk factors). > > All patients with obstruction (HOCM) with gradients >50 should have referral for surgical myectomy. > > Extended myectomy is the preferred method with release of papillary muscles, if needed and any mitral placation if necessary. No place for just shaving the top part of the septum off- very high recurrence rates. > > Dobutamine stress test can be done safely and should be considered to assess severity of obstruction as a provocative test in patients with lower gradients. > > There is really no role for Alcohol septal ablation, especially in young patients (This was hammered in again and again by all the cardiologists that talked). Alcohol septal ablation may be considered for older patients. > > Surgical results from major centers were excellent, mortality less than 0.4% and post op gradient of <3mm of Hg. > > Chand > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M > Sent: Tuesday, December 09, 2008 9:01 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] HOCM > > And what did you learn from that meeting ? What is new ? > Prasanna > > On Tue, Dec 9, 2008 at 6:37 PM, Ramaiah, Chandrashekar > wrote: >> Prasanna, >> I was at the HCM meeting this past weekend. Barry Maron showed us the picture of Mr. Brady. It was a very good meeting. >> >> >> Chand >> >> -----Original Message----- >> From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M >> Sent: Monday, December 08, 2008 9:33 PM >> To: OpenHeart-L@lists.hsforum.com; Discussion of Critical Care Medicine >> Subject: [HSF] HOCM >> >> Portrait of the artist as a young man: First HCM clinical diagnosis >> marks golden anniversary >> December 8, 2008 | Steve Stiles >> >> Boston, MA - "It was the first week after being appointed head of the >> cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald >> (Brigham and Women's Hospital, Boston, MA) said about a memorable >> early episode in his long and distinguished career. The key event, a >> decade before the advent of echocardiography: the first known >> diagnosis based solely on clinical signs of what is now called >> hypertrophic cardiomyopathy (HCM). >> >> The diagnostic challenges in that simpler, preelectronic age of >> cardiology were immense. "In movies about World War I, you see pilots >> in those very early biplanes, no altimeters, no equipment to guide >> them. They would recognize when they were over enemy territory, and >> they shot what they could see. That's how it was. It was a >> seat-of-the-pants diagnosis." >> >> Braunwald related the story to heartwire following a report >> commemorating the event in the November 15, 2008 American Journal of >> Cardiology [1], which also pays tribute to the long life of the >> patient, Claude Brady, of Arlington, VA, who received a new heart in >> 1989 and is now 71 years old. >> He said to me, you must have made a mistake. I left the operating room >> very humbled. >> >> "Mr Brady is now healthy and vigorous and has been particularly active >> in promoting heart transplantation as the founder of two >> organizations: Transplant Recipients International Organization, Inc >> (National Capital Chapter), as well as Transplant Awareness, Inc," >> write the report's authors, who include Braunwald and first author Dr >> Barry J Maron (Minneapolis Heart Institute Foundation, MN). >> >> As Braunwald tells it, one day during his fellowship at the National >> Heart Institute (NIH), in Bethesda, MD (which later folded into the >> National Heart, Lung, and Blood Institute), some months before the >> clinical diagnosis, he observed a pressure gradient in the subaortic >> area of a different patient's left ventricle during cardiac >> catheterization. In the late 1950s, that meant only one thing, an >> obstruction. The patient, diagnosed with congenital (membranous) >> hypertrophic subaortic stenosis, went to surgery. >> >> Later on, he said, the late Dr Andrew G Morrow, chief of surgery there >> at the time, called Braunwald up to the operating room to show him >> something unexpected with what should have been a simple operation. >> "To my chagrin," he said, Morrow showed him how he could put a finger >> from one hand through the aortic valve and the forefinger from the >> other hand through the left atrium, so the two could meet in the left >> ventricle. No obstruction! There shouldn't be a pressure gradient. >> >> "And he said to me, you must have made a mistake. I left the operating >> room very humbled." >> >> Braunwald said he later returned to the OR and asked Morrow if, before >> he closed up the patient's chest, he would check the LV pressure >> anyway. Then he left again. >> >> Sometime later, Morrow pulled him out of the cath lab to tell him that >> there was, in fact, a gradient of about 100 mm Hg. >> >> The two men puzzled over their findings for days but dropped it after >> a while and moved on. "Then a second case came along about a month >> later, exactly the same thing. So we knew we had something new" [2]. >> >> "And of course we were thrilled," Braunwald said. "This was a paradigm >> shift in this field, that you could have a gradient without >> obstruction in a noncontracting heart." >> >> In the following months, "a picture of the disorder began to form, in >> a vague way," he said. "We had a high index of suspicion for young >> adults who came in with a loud murmur along the left sternal border, >> murmurs like in a ventricular septal defect, lower down than with the >> classic aortic-stenosis murmur." >> This was a paradigm shift in this field, that you could have a >> gradient without obstruction in a noncontracting heart. >> >> Then along came Brady, who presented with exertional dyspnea and >> fatigue and who reported having a heart murmur first detected when he >> was 11. "When I examined him, he told me he had a brother and a sister >> who also had loud heart murmurs since early childhood. And therefore >> the index of suspicion that he might have this was high." >> >> As the commemorative article relates, "Several aunts and uncles had >> died of heart failure, believed to be due to rheumatic fever. . . . >> His two siblings had heart murmurs, and many members of his father's >> family were said to have heart murmurs. Several of these had died >> suddenly in childhood or during early adult life. Notably, a grade >> IV/VI midsystolic murmur was heard at the fourth left intercostal >> space and apex associated with a prominent left ventricular lift. >> Electrocardiography showed right-axis deviation and incomplete right >> bundle branch block." >> >> "He had the classic physical findings, and so I made the clinical >> diagnosis, idiopathic hypertrophic subaortic stenosis," Braunwald >> said, using the name that would eventually be changed to HCM. "Then we >> did the catheterization." >> >> As related by Maron et al, "a peak systolic outflow gradient of 40 mm >> Hg was recorded between the left ventricular cavity and the subaortic >> area, confirming the precatheterization diagnosis." >> >> The next challenge was to recognize such patients before they go to >> catheterization and surgery even when their family history is >> negative. "We spent the next three to five years trying to figure that >> out." By the time he, Morrow, and others had published a series of >> about 12 patients in 1960 [3], "we were able to draw a pretty good >> clinical description." >> >> A review of 64 patients followed four years later [4], and in 1968, >> Braunwald's last year at the NIH, he and his colleagues published >> reports on the disorder's physiologic effects and treating it with >> beta blockers and surgery [5,6,7] along with another series of 126 >> patients [8]. "It was my parting gift. And a year after I left, >> echocardiography came along and changed everything." >> Sources >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From Rwmfglycar at aol.com Wed Dec 10 08:05:26 2008 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Wed Dec 10 08:06:03 2008 Subject: [HSF] HOCM Message-ID: In a message dated 12/10/2008 4:50:08 A.M. Eastern Standard Time, prasannasimha@gmail.com writes: Could you highlight a bit more on papillary muscle release . Prasanna Prasanna look up articles by Dan Swistel who has written excellent articles on surgery for HOCM. He is chief of cardiac surgery at St Luke's-Roosevelt in NY. and has established a Foundation for the study of HOCM. He also adds a reduction of the anterior leaflet to the myomecdtomy and papillary release. All my material is still in storage so I can't give you the actual reference, but you should be able to find it. Dan did his training in Cardiothoracic surgeryin my department and although I was told in my youth that pride was sinful I take quiet pride in his achievements. Bob **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From Rwmfglycar at aol.com Wed Dec 10 08:10:14 2008 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Wed Dec 10 08:11:19 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs Message-ID: In a message dated 12/10/2008 4:15:04 A.M. Eastern Standard Time, prasannasimha@gmail.com writes: Excisable local calcium is OK **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From Rwmfglycar at aol.com Wed Dec 10 08:34:29 2008 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Wed Dec 10 08:35:36 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs Message-ID: In a message dated 12/10/2008 4:15:04 A.M. Eastern Standard Time, prasannasimha@gmail.com writes: Excisable local calcium is OK Prasanna when you say excisable do you mean extrinsic calcium on the atrial side of the leaflet which when removed leaves a relatively pliable although somewhat thickened leaflet underneath? I had a case in which the whole anterior leaflet was covered with several mm of nonululcerated calcium. I found a plane and removed all of this leaving a smooth quite pliable anterior leaflet.(By coincidence Dan Swistel, the HOCM man, was the resident in this case and his silent disapproval of his mad chief's actions were obvious). On water testing there was a pinhole on the right side of the anterior leaflet. I fixed this with one X stitch and the hemodynamic result was excellent. However Dan's disapproval had been right; she came back a year later with a 7mm hole at the stitch site which obviously caused significant insufficiency. I proposed to patch it because it was still a very good anterior leaflet but she demanded a replacement. Bob **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From prasannasimha at gmail.com Wed Dec 10 19:15:04 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Dec 10 08:45:28 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: <89c4ed2d0812100545h7f5a104cu2211aafd95b22780@mail.gmail.com> Yes or if I can excise and patch the hole ie leave adequately good but pliable tissue one way or the other. Prasanna On Wed, Dec 10, 2008 at 7:04 PM, wrote: > > In a message dated 12/10/2008 4:15:04 A.M. Eastern Standard Time, > prasannasimha@gmail.com writes: > > Excisable local calcium is OK > > > Prasanna when you say excisable do you mean extrinsic calcium on the atrial > side of the leaflet which when removed leaves a relatively pliable although > somewhat thickened leaflet underneath? > I had a case in which the whole anterior leaflet was covered with several mm > of nonululcerated calcium. I found a plane and removed all of this leaving a > smooth quite pliable anterior leaflet.(By coincidence Dan Swistel, the HOCM > man, was the resident in this case and his silent disapproval of his mad > chief's actions were obvious). On water testing there was a pinhole on the right > side of the anterior leaflet. I fixed this with one X stitch and the > hemodynamic result was excellent. > However Dan's disapproval had been right; she came back a year later with a > 7mm hole at the stitch site which obviously caused significant insufficiency. > I proposed to patch it because it was still a very good anterior leaflet but > she demanded a replacement. > Bob > > **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From FONHMD at aol.com Wed Dec 10 09:00:34 2008 From: FONHMD at aol.com (FONHMD@aol.com) Date: Wed Dec 10 09:01:35 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs Message-ID: All chords to P2 were scarred together with the leaflet, more like a wall of tissue. I could just distinguish the strands/ridges of chords on the ventricular side. No way to tell which were what. The pericardial patch effectively increased the surface area or baffle, as you describe it, for the anterior leaflet to coapt against. Thanks. Fon **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From prasannasimha at gmail.com Wed Dec 10 19:37:20 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Dec 10 09:07:38 2008 Subject: [HSF] Durability - Rheumatic Mitral repairs In-Reply-To: References: Message-ID: <89c4ed2d0812100607p668dc9besc7be81b684ee581@mail.gmail.com> I would then assume there was P2 retraction rather than prolapse. prasanna On Wed, Dec 10, 2008 at 7:30 PM, wrote: > All chords to P2 were scarred together with the leaflet, more like a wall of > tissue. I could just distinguish the strands/ridges of chords on the > ventricular side. No way to tell which were what. The pericardial patch > effectively increased the surface area or baffle, as you describe it, for the anterior > leaflet to coapt against. Thanks. > > Fon > **************Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From ichfno at aol.com Wed Dec 10 10:08:48 2008 From: ichfno at aol.com (ichfno@aol.com) Date: Wed Dec 10 10:10:39 2008 Subject: [HSF] Post operative Senning In-Reply-To: References: Message-ID: <8CB28F052FD9C8C-F04-53F@mblk-d49.sysops.aol.com> We arrived at our latest destination to find the Peds CICU empty and ready for us to operate on 23 children over the next 9 days. However, in the transitional unit there was a 14 year old who had undergone a Senning exactly 8 days before. The child had an uneventful intra-operatve period came off bypass with LAp of 5-6 and CVP of 8-9 with normal PAp's, on Milrinone 0.5 and low dose 0.05 epi. Extubation was delayed secondary to excessive bleeding, which eventually required a return to the OR for hemostasis. Extubated the next morning, epi weaned off, but this precipitated a fall in the BP, so restarted, lab revealed a drop in Hemoglobin/Hct from 6 hours before, but no chest tube output, x-ray obtained, large R pleural effusion. Chest tube placed, by junior, evacuated large amount of old blood initially, but alas continued to drain, now red blood. So, after a total of 1200 mls, back to the OR, and yes was reintubated prior to going. Intercostal found and sutured, hemostasis obtained. Was extubated the next morning. However, epi could not be weaned, and actually had to be increased to 0.2 mcgs/kg/min and dopa added progressively until BP stable (15 mcgs/kg/min). Echos showed non-obstructed pathways and x-ray started showing R sided infiltrate. CPAP initiated, triple antibiotics started. Up and down on epi over the next couple of days, without success in weaning below 0.125, dopamine down to 7. We are asked to see late Monday afternoon/early evening, about 4 hours after we have arrived. Patients PAp now 66% of systemic, BP is 107/45, LA is removed, CVP is 18 from IJ line and is in sinus rhythm. CXR shows R infiltrate predominately lower lobe, and LLL atelectasis with volume loss, no obvious pulmonary edema. WBC is trending up, now 14K and low grade temp at most 38.2 in the last 46 hours. So we have the child intubated, restart the milrinone, add an antifungal, increase Hgb to 14 from 10, and plan for bronchoscopy the next morning, as we are told that the echo performed that morning shows good systemic ventricular f unction, no pathway obstruction and competent AV valves. Morning arrives (Yesterday) and on rounds we discover that his platlet count is 15K, WBC has increased to 24K, had fever last night and the consolidation on the CXR looks worse. PAp's are still 60% of systemic. So, we decide to change the lines, repeat the cultures, get the bronchoscopy and see if we can wean the epi and dopa and give a platlet transfusion. Yes D-dimers were sent. Platlets are given bronch shows inflammation and mucosal edema with copious secretions and some plugs in? LLL. Sats improve from high 80's to low 90's with decreasing ventilatory support.Inotropes are able to be weaned over the course of the day. Next morning (today) WBC is down to less than 10K, platlets are still low, but 44K and over the course of the day we are able to wean all inotropes to off. They delay the line change until today. We had 3 cases on for the day, AV Canal is a 4 kg Down's child, VSD with PS in 5 year old and VSD closure with RV/PA conduit placement for TOF/PA with previous shunt. So, they change the lines they notice that the R IJ site develops a hematoma, rather significant. So, they get another echo, and low and behold there is thrombus in the innominate vein, down from IJ and into the SVC, but not intra-cardiac into the baffle. CVP is 16 and IVC pressure from femoral vein line is 11. Peak gradient is about 8 by echo. This is all finally discovered about 7:30 p.m. when I walk out of the last case. So, the infection is significant, but probably a red herring for the elevated PAp's, sorry this is a question. We elected to heparinze the child overnight. The BP is 101/59 off all beta agonists, he is still on 0.5 of milrinone. We are planning cath tomorrow. Suggestions? WNovick From prasannasimha at gmail.com Wed Dec 10 20:46:44 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Dec 10 10:24:14 2008 Subject: [HSF] Post operative Senning In-Reply-To: <8CB28F052FD9C8C-F04-53F@mblk-d49.sysops.aol.com> References: <8CB28F052FD9C8C-F04-53F@mblk-d49.sysops.aol.com> Message-ID: <89c4ed2d0812100716n5476f838mf53a4e3085888f76@mail.gmail.com> The question is why the thrombosis. Are you thinking of the line or is there any stenosis at the cannulation purse string ? Prasanna On Wed, Dec 10, 2008 at 8:38 PM, wrote: > > We arrived at our latest destination to find the Peds CICU empty and ready for us to operate on 23 children over the next 9 days. However, in the transitional unit there was a 14 year old who had undergone a Senning exactly 8 days before. The child had an uneventful intra-operatve period came off bypass with LAp of 5-6 and CVP of 8-9 with normal PAp's, on Milrinone 0.5 and low dose 0.05 epi. Extubation was delayed secondary to excessive bleeding, which eventually required a return to the OR for hemostasis. Extubated the next morning, epi weaned off, but this precipitated a fall in the BP, so restarted, lab revealed a drop in Hemoglobin/Hct from 6 hours before, but no chest tube output, x-ray obtained, large R pleural effusion. Chest tube placed, by junior, evacuated large amount of old blood initially, but alas continued to drain, now red blood. So, after a total of 1200 mls, back to the OR, and yes was reintubated prior to going. Intercostal found and sutured, hemostasis ob > tained. Was extubated the next morning. However, epi could not be weaned, and actually had to be increased to 0.2 mcgs/kg/min and dopa added progressively until BP stable (15 mcgs/kg/min). Echos showed non-obstructed pathways and x-ray started showing R sided infiltrate. CPAP initiated, triple antibiotics started. Up and down on epi over the next couple of days, without success in weaning below 0.125, dopamine down to 7. We are asked to see late Monday afternoon/early evening, about 4 hours after we have arrived. Patients PAp now 66% of systemic, BP is 107/45, LA is removed, CVP is 18 from IJ line and is in sinus rhythm. CXR shows R infiltrate predominately lower lobe, and LLL atelectasis with volume loss, no obvious pulmonary edema. WBC is trending up, now 14K and low grade temp at most 38.2 in the last 46 hours. So we have the child intubated, restart the milrinone, add an antifungal, increase Hgb to 14 from 10, and plan for bronchoscopy the next morning, as we are told th > at the echo performed that morning shows good systemic ventricular f > unction, no pathway obstruction and competent AV valves. Morning arrives (Yesterday) and on rounds we discover that his platlet count is 15K, WBC has increased to 24K, had fever last night and the consolidation on the CXR looks worse. PAp's are still 60% of systemic. So, we decide to change the lines, repeat the cultures, get the bronchoscopy and see if we can wean the epi and dopa and give a platlet transfusion. Yes D-dimers were sent. Platlets are given bronch > shows inflammation and mucosal edema with copious secretions and some > plugs in? LLL. Sats improve from high 80's to low 90's with decreasing > ventilatory support.Inotropes are able to be weaned over the course of the day. Next morning (today) WBC is down to less than 10K, platlets are still low, but 44K and over the course of the day we are able to wean all inotropes to off. They delay the line change until today. We had 3 cases on for the day, AV Canal is a 4 kg Down's child, VSD with PS in 5 year old and VSD closure with RV/PA conduit placement for TOF/PA with previous shunt. > > So, they change the lines they notice that the R IJ site develops a hematoma, rather significant. So, they get another echo, and low and behold there is thrombus in the innominate vein, down from IJ and into the SVC, but not intra-cardiac into the baffle. CVP is 16 and IVC pressure from femoral vein line is 11. Peak gradient is about 8 by echo. > > This is all finally discovered about 7:30 p.m. when I walk out of the last case. > > So, the infection is significant, but probably a red herring for the elevated PAp's, sorry this is a question. We elected to heparinze the child overnight. The BP is 101/59 off all beta agonists, he is still on 0.5 of milrinone. We are planning cath tomorrow. > > Suggestions? > > WNovick > > > > > > > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From DukeB60 at aol.com Wed Dec 10 10:26:05 2008 From: DukeB60 at aol.com (DukeB60@aol.com) Date: Wed Dec 10 10:26:38 2008 Subject: [HSF] HOCM Message-ID: Thanks Chand. In a message dated 12/9/2008 8:10:53 P.M. Central Standard Time, chand.ramaiah@uky.edu writes: Ed, Barry Maron (Univ of Minnesota) talked about Prevention of SCD in HCM (AICD & Surgery) Rick Nishimura (Mayo) talked about Alcohol Septal Ablation, he talked more about the benefits of surgery and very cautious recommending ablation. Daniel Swistel (Surgeon from St. Lukes/Columbia Univ)- Evolution of surgery for HOCM as well as details of extended myectomy, release of Paps and plication. Nick Smedira (Cleveland clinic) Surgical septal myectomy. Chand On 12/9/08 6:37 PM, "DukeB60@aol.com" wrote: Chand, May I ask who gave the lecture on surgical treatment of HOCM? Ed In a message dated 12/9/2008 4:08:54 P.M. Central Standard Time, chand.ramaiah@uky.edu writes: Prasanna, Take home message... Most patients with HCM at least I risk factor will need discussion of AICD placement for primary prevention (In other countries 2- 3 risk factors). All patients with obstruction (HOCM) with gradients >50 should have referral for surgical myectomy. Extended myectomy is the preferred method with release of papillary muscles, if needed and any mitral placation if necessary. No place for just shaving the top part of the septum off- very high recurrence rates. Dobutamine stress test can be done safely and should be considered to assess severity of obstruction as a provocative test in patients with lower gradients. There is really no role for Alcohol septal ablation, especially in young patients (This was hammered in again and again by all the cardiologists that talked). Alcohol septal ablation may be considered for older patients. Surgical results from major centers were excellent, mortality less than 0.4% and post op gradient of <3mm of Hg. Chand -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Tuesday, December 09, 2008 9:01 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] HOCM And what did you learn from that meeting ? What is new ? Prasanna On Tue, Dec 9, 2008 at 6:37 PM, Ramaiah, Chandrashekar wrote: > Prasanna, > I was at the HCM meeting this past weekend. Barry Maron showed us the picture of Mr. Brady. It was a very good meeting. > > > Chand > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M > Sent: Monday, December 08, 2008 9:33 PM > To: OpenHeart-L@lists.hsforum.com; Discussion of Critical Care Medicine > Subject: [HSF] HOCM > > Portrait of the artist as a young man: First HCM clinical diagnosis > marks golden anniversary > December 8, 2008 | Steve Stiles > > Boston, MA - "It was the first week after being appointed head of the > cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald > (Brigham and Women's Hospital, Boston, MA) said about a memorable > early episode in his long and distinguished career. The key event, a > decade before the advent of echocardiography: the first known > diagnosis based solely on clinical signs of what is now called > hypertrophic cardiomyopathy (HCM). > > The diagnostic challenges in that simpler, preelectronic age of > cardiology were immense. "In movies about World War I, you see pilots > in those very early biplanes, no altimeters, no equipment to guide > them. They would recognize when they were over enemy territory, and > they shot what they could see. That's how it was. It was a > seat-of-the-pants diagnosis." > > Braunwald related the story to heartwire following a report > commemorating the event in the November 15, 2008 American Journal of > Cardiology [1], which also pays tribute to the long life of the > patient, Claude Brady, of Arlington, VA, who received a new heart in > 1989 and is now 71 years old. > He said to me, you must have made a mistake. I left the operating room > very humbled. > > "Mr Brady is now healthy and vigorous and has been particularly active > in promoting heart transplantation as the founder of two > organizations: Transplant Recipients International Organization, Inc > (National Capital Chapter), as well as Transplant Awareness, Inc," > write the report's authors, who include Braunwald and first author Dr > Barry J Maron (Minneapolis Heart Institute Foundation, MN). > > As Braunwald tells it, one day during his fellowship at the National > Heart Institute (NIH), in Bethesda, MD (which later folded into the > National Heart, Lung, and Blood Institute), some months before the > clinical diagnosis, he observed a pressure gradient in the subaortic > area of a different patient's left ventricle during cardiac > catheterization. In the late 1950s, that meant only one thing, an > obstruction. The patient, diagnosed with congenital (membranous) > hypertrophic subaortic stenosis, went to surgery. > > Later on, he said, the late Dr Andrew G Morrow, chief of surgery there > at the time, called Braunwald up to the operating room to show him > something unexpected with what should have been a simple operation. > "To my chagrin," he said, Morrow showed him how he could put a finger > from one hand through the aortic valve and the forefinger from the > other hand through the left atrium, so the two could meet in the left > ventricle. No obstruction! There shouldn't be a pressure gradient. > > "And he said to me, you must have made a mistake. I left the operating > room very humbled." > > Braunwald said he later returned to the OR and asked Morrow if, before > he closed up the patient's chest, he would check the LV pressure > anyway. Then he left again. > > Sometime later, Morrow pulled him out of the cath lab to tell him that > there was, in fact, a gradient of about 100 mm Hg. > > The two men puzzled over their findings for days but dropped it after > a while and moved on. "Then a second case came along about a month > later, exactly the same thing. So we knew we had something new" [2]. > > "And of course we were thrilled," Braunwald said. "This was a paradigm > shift in this field, that you could have a gradient without > obstruction in a noncontracting heart." > > In the following months, "a picture of the disorder began to form, in > a vague way," he said. "We had a high index of suspicion for young > adults who came in with a loud murmur along the left sternal border, > murmurs like in a ventricular septal defect, lower down than with the > classic aortic-stenosis murmur." > This was a paradigm shift in this field, that you could have a > gradient without obstruction in a noncontracting heart. > > Then along came Brady, who presented with exertional dyspnea and > fatigue and who reported having a heart murmur first detected when he > was 11. "When I examined him, he told me he had a brother and a sister > who also had loud heart murmurs since early childhood. And therefore > the index of suspicion that he might have this was high." > > As the commemorative article relates, "Several aunts and uncles had > died of heart failure, believed to be due to rheumatic fever. . . . > His two siblings had heart murmurs, and many members of his father's > family were said to have heart murmurs. Several of these had died > suddenly in childhood or during early adult life. Notably, a grade > IV/VI midsystolic murmur was heard at the fourth left intercostal > space and apex associated with a prominent left ventricular lift. > Electrocardiography showed right-axis deviation and incomplete right > bundle branch block." > > "He had the classic physical findings, and so I made the clinical > diagnosis, idiopathic hypertrophic subaortic stenosis," Braunwald > said, using the name that would eventually be changed to HCM. "Then we > did the catheterization." > > As related by Maron et al, "a peak systolic outflow gradient of 40 mm > Hg was recorded between the left ventricular cavity and the subaortic > area, confirming the precatheterization diagnosis." > > The next challenge was to recognize such patients before they go to > catheterization and surgery even when their family history is > negative. "We spent the next three to five years trying to figure that > out." By the time he, Morrow, and others had published a series of > about 12 patients in 1960 [3], "we were able to draw a pretty good > clinical description." > > A review of 64 patients followed four years later [4], and in 1968, > Braunwald's last year at the NIH, he and his colleagues published > reports on the disorder's physiologic effects and treating it with > beta blockers and surgery [5,6,7] along with another series of 126 > patients [8]. "It was my parting gift. And a year after I left, > echocardiography came along and changed everything." > Sources > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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 ----------------------------------------- **************Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom00000010) From prasannasimha at gmail.com Wed Dec 10 20:48:05 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Dec 10 10:39:58 2008 Subject: [HSF] Post operative Senning In-Reply-To: <89c4ed2d0812100716n5476f838mf53a4e3085888f76@mail.gmail.com> References: <8CB28F052FD9C8C-F04-53F@mblk-d49.sysops.aol.com> <89c4ed2d0812100716n5476f838mf53a4e3085888f76@mail.gmail.com> Message-ID: <89c4ed2d0812100718v759123f3s6a79c752866d3f39@mail.gmail.com> And where are you ? Prasanna On Wed, Dec 10, 2008 at 8:46 PM, Prasanna Simha M wrote: > The question is why the thrombosis. Are you thinking of the line or is > there any stenosis at the cannulation purse string ? > Prasanna > > On Wed, Dec 10, 2008 at 8:38 PM, wrote: >> >> We arrived at our latest destination to find the Peds CICU empty and ready for us to operate on 23 children over the next 9 days. However, in the transitional unit there was a 14 year old who had undergone a Senning exactly 8 days before. The child had an uneventful intra-operatve period came off bypass with LAp of 5-6 and CVP of 8-9 with normal PAp's, on Milrinone 0.5 and low dose 0.05 epi. Extubation was delayed secondary to excessive bleeding, which eventually required a return to the OR for hemostasis. Extubated the next morning, epi weaned off, but this precipitated a fall in the BP, so restarted, lab revealed a drop in Hemoglobin/Hct from 6 hours before, but no chest tube output, x-ray obtained, large R pleural effusion. Chest tube placed, by junior, evacuated large amount of old blood initially, but alas continued to drain, now red blood. So, after a total of 1200 mls, back to the OR, and yes was reintubated prior to going. Intercostal found and sutured, hemostasis ob >> tained. Was extubated the next morning. However, epi could not be weaned, and actually had to be increased to 0.2 mcgs/kg/min and dopa added progressively until BP stable (15 mcgs/kg/min). Echos showed non-obstructed pathways and x-ray started showing R sided infiltrate. CPAP initiated, triple antibiotics started. Up and down on epi over the next couple of days, without success in weaning below 0.125, dopamine down to 7. We are asked to see late Monday afternoon/early evening, about 4 hours after we have arrived. Patients PAp now 66% of systemic, BP is 107/45, LA is removed, CVP is 18 from IJ line and is in sinus rhythm. CXR shows R infiltrate predominately lower lobe, and LLL atelectasis with volume loss, no obvious pulmonary edema. WBC is trending up, now 14K and low grade temp at most 38.2 in the last 46 hours. So we have the child intubated, restart the milrinone, add an antifungal, increase Hgb to 14 from 10, and plan for bronchoscopy the next morning, as we are told th >> at the echo performed that morning shows good systemic ventricular f >> unction, no pathway obstruction and competent AV valves. Morning arrives (Yesterday) and on rounds we discover that his platlet count is 15K, WBC has increased to 24K, had fever last night and the consolidation on the CXR looks worse. PAp's are still 60% of systemic. So, we decide to change the lines, repeat the cultures, get the bronchoscopy and see if we can wean the epi and dopa and give a platlet transfusion. Yes D-dimers were sent. Platlets are given bronch >> shows inflammation and mucosal edema with copious secretions and some >> plugs in? LLL. Sats improve from high 80's to low 90's with decreasing >> ventilatory support.Inotropes are able to be weaned over the course of the day. Next morning (today) WBC is down to less than 10K, platlets are still low, but 44K and over the course of the day we are able to wean all inotropes to off. They delay the line change until today. We had 3 cases on for the day, AV Canal is a 4 kg Down's child, VSD with PS in 5 year old and VSD closure with RV/PA conduit placement for TOF/PA with previous shunt. >> >> So, they change the lines they notice that the R IJ site develops a hematoma, rather significant. So, they get another echo, and low and behold there is thrombus in the innominate vein, down from IJ and into the SVC, but not intra-cardiac into the baffle. CVP is 16 and IVC pressure from femoral vein line is 11. Peak gradient is about 8 by echo. >> >> This is all finally discovered about 7:30 p.m. when I walk out of the last case. >> >> So, the infection is significant, but probably a red herring for the elevated PAp's, sorry this is a question. We elected to heparinze the child overnight. The BP is 101/59 off all beta agonists, he is still on 0.5 of milrinone. We are planning cath tomorrow. >> >> Suggestions? >> >> WNovick >> >> >> >> >> >> >> >> >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From ichfno at aol.com Wed Dec 10 10:41:13 2008 From: ichfno at aol.com (ichfno@aol.com) Date: Wed Dec 10 10:42:26 2008 Subject: [HSF] Post operative Senning In-Reply-To: <89c4ed2d0812100716n5476f838mf53a4e3085888f76@mail.gmail.com> References: <8CB28F052FD9C8C-F04-53F@mblk-d49.sysops.aol.com> <89c4ed2d0812100716n5476f838mf53a4e3085888f76@mail.gmail.com> Message-ID: <8CB28F4DDFDAA5A-F04-7D2@mblk-d49.sysops.aol.com> Well we have 5 echo's on the kid by the same two cardiologists and this is the first time they detected any turbulence, so I am leaning towards the line, there were actually 3 lines in that IJ at one point, the 2.5 Fr line that went to the PA, and longish angio-cath that was 14G for volume and the 7 Fr double lumen. So, yes, I am thinking lines. Sorry failed to communicate that in the original description. Bill -----Original Message----- From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Wed, 10 Dec 2008 9:16 am Subject: Re: [HSF] Post operative Senning The question is why the thrombosis. Are you thinking of the line or is there any stenosis at the cannulation purse string ? Prasanna On Wed, Dec 10, 2008 at 8:38 PM, wrote: > > We arrived at our latest destination to find the Peds CICU empty and ready for us to operate on 23 children over the next 9 days. However, in the transitional unit there was a 14 year old who had undergone a Senning exactly 8 days before. The child had an uneventful intra-operatve period came off bypass with LAp of 5-6 and CVP of 8-9 with normal PAp's, on Milrinone 0.5 and low dose 0.05 epi. Extubation was delayed secondary to excessive bleeding, which eventually required a return to the OR for hemostasis. Extubated the next morning, epi weaned off, but this precipitated a fall in the BP, so restarted, lab revealed a drop in Hemoglobin/Hct from 6 hours before, but no chest tube output, x-ray obtained, large R pleural effusion. Chest tube placed, by junior, evacuated large amount of old blood initially, but alas continued to drain, now red blood. So, after a total of 1200 mls, back to the OR, and yes was reintubated prior to going. Intercostal found and sutured, hemostasis ob > tained. Was extubated the next morning. However, epi could not be weaned, and actually had to be increased to 0.2 mcgs/kg/min and dopa added progressively until BP stable (15 mcgs/kg/min). Echos showed non-obstructed pathways and x-ray started showing R sided infiltrate. CPAP initiated, triple antibiotics started. Up and down on epi over the next couple of days, without success in weaning below 0.125, dopamine down to 7. We are asked to see late Monday afternoon/early evening, about 4 hours after we have arrived. Patients PAp now 66% of systemic, BP is 107/45, LA is removed, CVP is 18 from IJ line and is in sinus rhythm. CXR shows R infiltrate predominately lower lobe, and LLL atelectasis with volume loss, no obvious pulmonary edema. WBC is trending up, now 14K and low grade temp at most 38.2 in the last 46 hours. So we have the child intubated, restart the milrinone, add an antifungal, increase Hgb to 14 from 10, and plan for bronchoscopy the next morning, as we are told th > at the echo performed that morning shows good systemic ventricular f > unction, no pathway obstruction and competent AV valves. Morning arrives (Yesterday) and on rounds we discover that his platlet count is 15K, WBC has increased to 24K, had fever last night and the consolidation on the CXR looks worse. PAp's are still 60% of systemic. So, we decide to change the lines, repeat the cultures, get the bronchoscopy and see if we can wean the epi and dopa and give a platlet transfusion. Yes D-dimers were sent. Platlets are given bronch > shows inflammation and mucosal edema with copious secretions and some > plugs in? LLL. Sats improve from high 80's to low 90's with decreasing > ventilatory support.Inotropes are able to be weaned over the course of the day. Next morning (today) WBC is down to less than 10K, platlets are still low, but 44K and over the course of the day we are able to wean all inotropes to off. They delay the line change until today. We had 3 cases on for the day, AV Canal is a 4 kg Down's child, VSD with PS in 5 year old and VSD closure with RV/PA conduit placement for TOF/PA with previous shunt. > > So, they change the lines they notice that the R IJ site develops a hematoma, rather significant. So, they get another echo, and low and behold there is thrombus in the innominate vein, down from IJ and into the SVC, but not intra-cardiac into the baffle. CVP is 16 and IVC pressure from femoral vein line is 11. Peak gradient is about 8 by echo. > > This is all finally discovered about 7:30 p.m. when I walk out of the last case. > > So, the infection is significant, but probably a red herring for the elevated PAp's, sorry this is a question. We elected to heparinze the child overnight. The BP is 101/59 off all beta agonists, he is still on 0.5 of milrinone. We are planning cath tomorrow. > > Suggestions? > > WNovick > > > > > > > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From ichfno at aol.com Wed Dec 10 11:23:39 2008 From: ichfno at aol.com (ichfno@aol.com) Date: Wed Dec 10 11:24:46 2008 Subject: [HSF] Post operative Senning In-Reply-To: <89c4ed2d0812100718v759123f3s6a79c752866d3f39@mail.gmail.com> References: <8CB28F052FD9C8C-F04-53F@mblk-d49.sysops.aol.com><89c4ed2d0812100716n5476f838mf53a4e3085888f76@mail.gmail.com> <89c4ed2d0812100718v759123f3s6a79c752866d3f39@mail.gmail.com> Message-ID: <8CB28FACB1203E4-F04-B09@mblk-d49.sysops.aol.com> Not important. -----Original Message----- From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Wed, 10 Dec 2008 9:18 am Subject: Re: [HSF] Post operative Senning And where are you ? Prasanna On Wed, Dec 10, 2008 at 8:46 PM, Prasanna Simha M wrote: > The question is why the thrombosis. Are you thinking of the line or is > there any stenosis at the cannulation purse string ? > Prasanna > > On Wed, Dec 10, 2008 at 8:38 PM, wrote: >> >> We arrived at our latest destination to find the Peds CICU empty and ready for us to operate on 23 children over the next 9 days. However, in the transitional unit there was a 14 year old who had undergone a Senning exactly 8 days before. The child had an uneventful intra-operatve period came off bypass with LAp of 5-6 and CVP of 8-9 with normal PAp's, on Milrinone 0.5 and low dose 0.05 epi. Extubation was delayed secondary to excessive bleeding, which eventually required a return to the OR for hemostasis. Extubated the next morning, epi weaned off, but this precipitated a fall in the BP, so restarted, lab revealed a drop in Hemoglobin/Hct from 6 hours before, but no chest tube output, x-ray obtained, large R pleural effusion. Chest tube placed, by junior, evacuated large amount of old blood initially, but alas continued to drain, now red blood. So, after a total of 1200 mls, back to the OR, and yes was reintubated prior to going. Intercostal found and sutured, hemostasis ob >> tained. Was extubated the next morning. However, epi could not be weaned, and actually had to be increased to 0.2 mcgs/kg/min and dopa added progressively until BP stable (15 mcgs/kg/min). Echos showed non-obstructed pathways and x-ray started showing R sided infiltrate. CPAP initiated, triple antibiotics started. Up and down on epi over the next couple of days, without success in weaning below 0.125, dopamine down to 7. We are asked to see late Monday afternoon/early evening, about 4 hours after we have arrived. Patients PAp now 66% of systemic, BP is 107/45, LA is removed, CVP is 18 from IJ line and is in sinus rhythm. CXR shows R infiltrate predominately lower lobe, and LLL atelectasis with volume loss, no obvious pulmonary edema. WBC is trending up, now 14K and low grade temp at most 38.2 in the last 46 hours. So we have the child intubated, restart the milrinone, add an antifungal, increase Hgb to 14 from 10, and plan for bronchoscopy the next morning, as we are told th >> at the echo performed that morning shows good systemic ventricular f >> unction, no pathway obstruction and competent AV valves. Morning arrives (Yesterday) and on rounds we discover that his platlet count is 15K, WBC has increased to 24K, had fever last night and the consolidation on the CXR looks worse. PAp's are still 60% of systemic. So, we decide to change the lines, repeat the cultures, get the bronchoscopy and see if we can wean the epi and dopa and give a platlet transfusion. Yes D-dimers were sent. Platlets are given bronch >> shows inflammation and mucosal edema with copious secretions and some >> plugs in? LLL. Sats improve from high 80's to low 90's with decreasing >> ventilatory support.Inotropes are able to be weaned over the course of the day. Next morning (today) WBC is down to less than 10K, platlets are still low, but 44K and over the course of the day we are able to wean all inotropes to off. They delay the line change until today. We had 3 cases on for the day, AV Canal is a 4 kg Down's child, VSD with PS in 5 year old and VSD closure with RV/PA conduit placement for TOF/PA with previous shunt. >> >> So, they change the lines they notice that the R IJ site develops a hematoma, rather significant. So, they get another echo, and low and behold there is thrombus in the innominate vein, down from IJ and into the SVC, but not intra-cardiac into the baffle. CVP is 16 and IVC pressure from femoral vein line is 11. Peak gradient is about 8 by echo. >> >> This is all finally discovered about 7:30 p.m. when I walk out of the last case. >> >> So, the infection is significant, but probably a red herring for the elevated PAp's, sorry this is a question. We elected to heparinze the child overnight. The BP is 101/59 off all beta agonists, he is still on 0.5 of milrinone. We are planning cath tomorrow. >> >> Suggestions? >> >> WNovick >> >> >> >> >> >> >> >> >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From hgrmd at aol.com Wed Dec 10 11:28:04 2008 From: hgrmd at aol.com (hgrmd@aol.com) Date: Wed Dec 10 11:34:39 2008 Subject: [HSF] Interesting article (Myxo Ring) In-Reply-To: Message-ID: <8CB28FB6922DE75-1020-1E7@WEBMAIL-MY14.sysops.aol.com> Ed, ? This just shows how much havoc can be produced by one motivated litigator.? I've put in hundreds of IMR ETlogix rings with excellent results.? This type of action only hurts the public. Hal -----Original Message----- From: Edward Bender To: HSF List Sent: Wed, 10 Dec 2008 4:28 am Subject: Re: [HSF] Interesting article (Myxo Ring) I wanted to use an IMR ring today, but it has disappeared from our shelves also. This is Chicago politics at its best. I believe that this is payback for some untoward deeds or influences by the new Chicago golden boy for cardiac surgery. For any of you who have lived in Chicago, I am sure you can relate to the level of retaliation that can occur by snubbed powers that be. Ed Bender, MD On 12/9/08 11:35 AM, "Ani Anyanwu" wrote: > > The plot thickens: > > http://www.reuters.com/article/domesticNews/idUSTRE4B30GL20081204?feedType=RSS > &feedName=domesticNews > > > Apparently the Senate (or specifically Senator Grassley) is now investigating > Edwards and the Myxo Ring has disappeared from Edwards USA website and news > reports are now saying that device may not have been appropriately FDA > approved. Strangely too the IMR ring has disappeared from the website also. > Strangely though, the Geoform is still on the website. The question seems to > center (as we discussed before though in relation to the Geoform) of the way > some devices can be cleared by FDA (without clinical trials or data) because > the device is deemed a minor modification of a predicate FDA approved device. > > If indeed the FDA does claim to have been misled and says that these devices > (Myxo ring and IMR ring) have been used without appropriate FDA approval then > we can expect a Pandora's box to open... > > Ani > > > >> Date: Wed, 8 Oct 2008 19:43:50 -0500> From: ebender001@me.com> To: >> OpenHeart-L@hsforum.com> CC: > Subject: [HSF] Interesting article> > >> http://www.theheart.org/article/909595.do> > Questions raised about >> Northwestern use of valve device; prominent surgeon> denies wrongdoing> >> October 7, 2008 | Shelley Wood> > Chicago, IL - Northwestern University is >> fending off criticism that one of> its star surgeons, Dr Patrick M McCarthy, >> used a device he invented before> it was formally approved by the FDA, >> without first telling patients he might> use it. The university , the >> manufacturer, and McCarthy himself all insist> that the device, known as the >> Myxo ETlogix annuloplasty ring