From donross at bigpond.com Fri Feb 1 11:13:02 2008 From: donross at bigpond.com (Donald Ross) Date: Thu Jan 31 19:14:34 2008 Subject: [HSF] Occluded SVC In-Reply-To: References: Message-ID: <9160AAC8-89E7-41A4-A79A-3054B8AD8E67@bigpond.com> Hal, Does your assistant have a strong arm? Or do you use a self retaining retractor? Don > Nasser, > I couldn't tell exactly where the lacerations were located on > the IVC and > SVC. In both vessels, the bleeding was directly posterior. I > controlled > both with horizontal mattress pledgetted 4-0 Prolenes. Though I > didn't realize > it at the time of surgery, I must have narrowed the SVC with the > repair. > Inserting the pacing leads a few days later probably occluded the > SVC lumen > sufficiently to precipitate thrombosis. > > Hal > > > > **************Start the year off right. Easy ways to stay in shape. > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Fri Feb 1 10:36:07 2008 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Thu Jan 31 19:36:50 2008 Subject: [HSF] Rhabdomyolysis following CABG In-Reply-To: References: <367336.62683.qm@web26710.mail.ukl.yahoo.com> Message-ID: Blauth presented a paper when he was a fellow at the Cleveland Clinic in the 90's. At autopsy they looked at the frequency and distribution of emboli after OHS. PMID- 1597974 OWN - NLM STAT- MEDLINE DA - 19920706 DCOM- 19920706 LR - 20061115 PUBM- Print IS - 0022-5223 (Print) VI - 103 IP - 6 DP - 1992 Jun TI - Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. PG - 1104-11; discussion 1111-2 AB - As the ages of patients undergoing cardiac operations have increased, noncardiac causes of death have increased. To identify these causes of death, we analyzed the autopsy findings in 221 patients undergoing myocardial revascularization or valve operations between 1982 and 1989. Mean age was 65.6 +/- 9.5 years and the range was from 32 to 94 years; 130 patients (58.8%) were male. Autopsies were complete in 129 patients (58.4%) and limited to the chest and abdomen in the remainder. Embolic disease was identified in 69 patients (31.2%). Atheroemboli or abnormalities consistent with atheroemboli were identified in 48 patients (21.7%). Fourteen patients had thromboembolism and 7 had disseminated intravascular coagulation. The prevalence of atheroembolic disease increased dramatically from 4.5% in 1982 to 48.3% in 1989 (p = 0.001). Atheroembolic disease was found in the brain in 16.3% of patients, spleen in 10.9%, kidney in 10.4%, and pancreas in 6.8%. Thirty (62.5%) of the 48 patients had multiple atheroembolic sites. Atheroemboli were more common in patients undergoing coronary artery procedures (43/165; 26.1%) than in those undergoing valve procedures (5/56; 8.9%) (p = 0.008). There was a high correlation of atheroemboli with severe atherosclerosis of the ascending aorta. Atheroembolic events occurred in 46 of 123 patients (37.4%) with severe disease of the ascending aorta but in only 2 of 98 patients (2%) without significant ascending aortic disease (p less than 0.0001). Forty-six of 48 patients (95.8%) who had evidence of atheroemboli had severe atherosclerosis of the ascending aorta. There was a direct correlation between age, severe atherosclerosis of the ascending aorta, and atheroemboli. Incremental risk factors for atheroembolic are peripheral vascular disease and severe atherosclerosis of the ascending aorta. AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195-5066. FAU - Blauth, C I AU - Blauth CI FAU - Cosgrove, D M AU - Cosgrove DM FAU - Webb, B W AU - Webb BW FAU - Ratliff, N B AU - Ratliff NB FAU - Boylan, M AU - Boylan M FAU - Piedmonte, M R AU - Piedmonte MR FAU - Lytle, B W AU - Lytle BW FAU - Loop, F D AU - Loop FD LA - eng PT - Comparative Study PT - Journal Article PL - UNITED STATES TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - AIM SB - IM MH - Age Factors MH - Aorta/pathology MH - Aortic Diseases/*complications/epidemiology/pathology MH - Arteriosclerosis/*complications/epidemiology/pathology MH - Chi-Square Distribution MH - Coronary Disease/complications/surgery MH - Disseminated Intravascular Coagulation/epidemiology/etiology MH - Embolism/epidemiology/*etiology/pathology MH - Heart Valve Diseases/complications/surgery MH - Humans MH - Incidence MH - Logistic Models MH - Ohio/epidemiology MH - Postoperative Complications/epidemiology/*etiology/pathology MH - Prevalence MH - Probability MH - Risk Factors MH - Sex Factors EDAT- 1992/06/01 MHDA- 1992/06/01 00:01 PST - ppublish SO - J Thorac Cardiovasc Surg. 1992 Jun;103(6):1104-11; discussion 1111-2. >Ahmed > >I have just come back from one of my not infrequent visits to the >autopsy suite to study one of my VAD catastophes and suspect your >patient may have what we found in mine. I would suggest you consider >cholesterol crystal embolization from the IABP as the cause of your >findings in this patient. It is well described in the setting of >IABP use and would explain your renal failure and skin findings. > >I had a patient I placed an LVAD in last week who developed severe >lactic acidosis within 24 hours of surgery. An IABP had been placed >the day before surgery. Colonoscopy showed what had appearance of >full thickness rectal necrosis (rectal necrosis is rare and >signifies some pronounced low flow state or watershed embolization). >At autopsy there were infarcts in the liver, spleen, kidneys and >gut. The descending aorta showed multiple soft plaques with a 2cm >disruption in one plaque. Looking at the aorta it is not difficult >to imagine how having it rammed by a balloon 90 times a minute for 2 >days could not have been a good thing. The pathologist tells me that >they will almost certainly see embolized cholesterol crystals when >they look at the tissues. > >Ani > > > >> Date: Thu, 31 Jan 2008 23:05:35 +0000> From: >>drdharris@yahoo.co.uk> Subject: RE: [HSF] Rhabdomyolysis following >>CABG> To: OpenHeart-L@lists.hsforum.com> CC: > > Next time try >>anaortic OPCAB with BIMA?> Dave> > --- alsadd >>wrote:> > > I will try Nasser > > > > -----Original Message-----> > >>From: openheart-l-bounces@lists.hsforum.com> > >>[mailto:openheart-l-bounces@lists.hsforum.com] On> > Behalf Of >>Nasser F.> > Abou'Seada> > Sent: Wednesday, January 30, 2008 7:41 >>AM> > To: OpenHeart-L@lists.hsforum.com> > Subject: Re: [HSF] >>Rhabdomyolysis following CABG> > > > Could you possibly post the CT >>/ MRI scans ?> > NFA> > On Jan 30, 2008 1:19 PM, alsadd >>> > wrote:> > > > > Dear Forum >>Members:> > >> > >> > >> > >> > >> > > While I was out of town one >>of our surgeons> > operated a 69 years old man> > > for> > > a 3 >>vessel disease. The patient had bilateral> > carotid stenosis the >>right> > > 70%> > > and the left 80% he had no symptoms because of >>the> > vascular surgeon> > > elected> > > to do nothing. At surgery >>the patient had LIMA to> > LAD, SVG to Diagonal and> > > OM1. After >>protamine ST segment changes and drop> > in BP. They >>re-haprinized> > > went back to for a short time elected not to> > >>reverse heparin the second> > > time> > > and put an >>IABP.> > >> > > The patient remained stable post op and was> > >>extubated the following> > > morning.> > > IABP removed. The >>evening of that day became> > confused and combative ABG> > > >>were> > > acceptable had to be re intubated over night. It> > was >>noticed that his CPK> > > level kept on rising initially to 7000 >>and later> > to more than 10000 units.> > > He was put on PRISMA >>for renal failure in spite of> > this his K went up and> > > was >>controlled but with difficulty. The following> > morning he >>developed> > > epidermolysis and blisters of the lower> > >>extremities skin no compartment> > > was> > > found on assessment >>both the femoral veins and> > arteries were patent by> > > duplex >>assessment. He was seen by neurology CT> > scan and MRI were >>normal.> > > Abdominal CT was normal. He was assessed by> > various >>services and the> > > differential diagnoses were narrowed to> > >>rhabdomyolysis. Any thoughts from> > > members would be greatly >>appreciated> > >> > >> > >> > >> > >> > > Ahmed> > >> > >> > >> > > >>_______________________________________________> > > OpenHeart-L >>mailing list> > >> > > Send postings to:> > > >>OpenHeart-L@lists.hsforum.com> > >> > > To UNSUBSCRIBE, to CHANGE >>email address, or to> > view archives:> > > >>http://mmp.cjp.com/mailman/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> > >>-----------------------------------------> > > > > Dr. David G. >>Harris, FCS, MMED,> Cardiothoracic Surgeon > Suite 207 > Kuils >>River Private Hospital, > PO Box 1200, Kuils River, 7579, Cape >>Town, South Africa. > Tel +27-21-9006411 > Fax +27-21-9006412 >>Mobile +27-83-3309587> >>_______________________________________________> OpenHeart-L >>mailing list> > Send postings to:> OpenHeart-L@lists.hsforum.com> > >>To UNSUBSCRIBE, to CHANGE email address, or to view archives:> >>http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages >>transmitted by the OpenHeart-L are subject to the policies and > >>disclaimers posted at:> http://www.hsforum.com/listdisclaim> >>----------------------------------------- >_________________________________________________________________ >Share what Santa brought you >https://www.mycooluncool.com_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From donross at bigpond.com Fri Feb 1 11:52:30 2008 From: donross at bigpond.com (Donald Ross) Date: Thu Jan 31 19:53:10 2008 Subject: [HSF] Rhabdomyolysis following CABG In-Reply-To: References: <367336.62683.qm@web26710.mail.ukl.yahoo.com> Message-ID: <10FDD442-47D4-425F-9439-34AF87A5D223@bigpond.com> Aortas! Don't touch em myself. On 01/02/2008, at 11:36 AM, Ben Bidstrup wrote: > Blauth presented a paper when he was a fellow at the Cleveland > Clinic in the 90's. At autopsy they looked at the frequency and > distribution of emboli after OHS. > > > PMID- 1597974 > OWN - NLM > STAT- MEDLINE > DA - 19920706 > DCOM- 19920706 > LR - 20061115 > PUBM- Print > IS - 0022-5223 (Print) > VI - 103 > IP - 6 > DP - 1992 Jun > TI - Atheroembolism from the ascending aorta. An emerging problem > in cardiac surgery. > PG - 1104-11; discussion 1111-2 > AB - As the ages of patients undergoing cardiac operations have > increased, noncardiac > causes of death have increased. To identify these causes of > death, we analyzed > the autopsy findings in 221 patients undergoing myocardial > revascularization or > valve operations between 1982 and 1989. Mean age was 65.6 +/- > 9.5 years and the > range was from 32 to 94 years; 130 patients (58.8%) were > male. Autopsies were > complete in 129 patients (58.4%) and limited to the chest and > abdomen in the > remainder. Embolic disease was identified in 69 patients > (31.2%). Atheroemboli or > abnormalities consistent with atheroemboli were identified in > 48 patients > (21.7%). Fourteen patients had thromboembolism and 7 had > disseminated > intravascular coagulation. The prevalence of atheroembolic > disease increased > dramatically from 4.5% in 1982 to 48.3% in 1989 (p = 0.001). > Atheroembolic > disease was found in the brain in 16.3% of patients, spleen > in 10.9%, kidney in > 10.4%, and pancreas in 6.8%. Thirty (62.5%) of the 48 > patients had multiple > atheroembolic sites. Atheroemboli were more common in > patients undergoing > coronary artery procedures (43/165; 26.1%) than in those > undergoing valve > procedures (5/56; 8.9%) (p = 0.008). There was a high > correlation of atheroemboli > with severe atherosclerosis of the ascending aorta. > Atheroembolic events occurred > in 46 of 123 patients (37.4%) with severe disease of the > ascending aorta but in > only 2 of 98 patients (2%) without significant ascending > aortic disease (p less > than 0.0001). Forty-six of 48 patients (95.8%) who had > evidence of atheroemboli > had severe atherosclerosis of the ascending aorta. There was > a direct correlation > between age, severe atherosclerosis of the ascending aorta, > and atheroemboli. > Incremental risk factors for atheroembolic are peripheral > vascular disease and > severe atherosclerosis of the ascending aorta. > AD - Department of Thoracic and Cardiovascular Surgery, Cleveland > Clinic Foundation, > OH 44195-5066. > FAU - Blauth, C I > AU - Blauth CI > FAU - Cosgrove, D M > AU - Cosgrove DM > FAU - Webb, B W > AU - Webb BW > FAU - Ratliff, N B > AU - Ratliff NB > FAU - Boylan, M > AU - Boylan M > FAU - Piedmonte, M R > AU - Piedmonte MR > FAU - Lytle, B W > AU - Lytle BW > FAU - Loop, F D > AU - Loop FD > LA - eng > PT - Comparative Study > PT - Journal Article > PL - UNITED STATES > TA - J Thorac Cardiovasc Surg > JT - The Journal of thoracic and cardiovascular surgery > JID - 0376343 > SB - AIM > SB - IM > MH - Age Factors > MH - Aorta/pathology > MH - Aortic Diseases/*complications/epidemiology/pathology > MH - Arteriosclerosis/*complications/epidemiology/pathology > MH - Chi-Square Distribution > MH - Coronary Disease/complications/surgery > MH - Disseminated Intravascular Coagulation/epidemiology/etiology > MH - Embolism/epidemiology/*etiology/pathology > MH - Heart Valve Diseases/complications/surgery > MH - Humans > MH - Incidence > MH - Logistic Models > MH - Ohio/epidemiology > MH - Postoperative Complications/epidemiology/*etiology/pathology > MH - Prevalence > MH - Probability > MH - Risk Factors > MH - Sex Factors > EDAT- 1992/06/01 > MHDA- 1992/06/01 00:01 > PST - ppublish > SO - J Thorac Cardiovasc Surg. 1992 Jun;103(6):1104-11; discussion > 1111-2. > > >> Ahmed >> >> I have just come back from one of my not infrequent visits to the >> autopsy suite to study one of my VAD catastophes and suspect your >> patient may have what we found in mine. I would suggest you >> consider cholesterol crystal embolization from the IABP as the >> cause of your findings in this patient. It is well described in >> the setting of IABP use and would explain your renal failure and >> skin findings. >> >> I had a patient I placed an LVAD in last week who developed severe >> lactic acidosis within 24 hours of surgery. An IABP had been >> placed the day before surgery. Colonoscopy showed what had >> appearance of full thickness rectal necrosis (rectal necrosis is >> rare and signifies some pronounced low flow state or watershed >> embolization). At autopsy there were infarcts in the liver, >> spleen, kidneys and gut. The descending aorta showed multiple soft >> plaques with a 2cm disruption in one plaque. Looking at the aorta >> it is not difficult to imagine how having it rammed by a balloon >> 90 times a minute for 2 days could not have been a good thing. The >> pathologist tells me that they will almost certainly see embolized >> cholesterol crystals when they look at the tissues. >> >> Ani >> >> >> >>> Date: Thu, 31 Jan 2008 23:05:35 +0000> From: >>> drdharris@yahoo.co.uk> Subject: RE: [HSF] Rhabdomyolysis >>> following CABG> To: OpenHeart-L@lists.hsforum.com> CC: > > Next >>> time try anaortic OPCAB with BIMA?> Dave> > --- alsadd >>> wrote:> > > I will try Nasser > > > > ----- >>> Original Message-----> > From: openheart-l- >>> bounces@lists.hsforum.com> > [mailto:openheart-l- >>> bounces@lists.hsforum.com] On> > Behalf Of Nasser F.> > >>> Abou'Seada> > Sent: Wednesday, January 30, 2008 7:41 AM> > To: >>> OpenHeart-L@lists.hsforum.com> > Subject: Re: [HSF] >>> Rhabdomyolysis following CABG> > > > Could you possibly post the >>> CT / MRI scans ?> > NFA> > On Jan 30, 2008 1:19 PM, alsadd >>> > > wrote:> > > > > Dear Forum Members:> > >> >>> > >> > >> > >> > >> > > While I was out of town one of our >>> surgeons> > operated a 69 years old man> > > for> > > a 3 vessel >>> disease. The patient had bilateral> > carotid stenosis the right> >>> > > 70%> > > and the left 80% he had no symptoms because of the> >>> > vascular surgeon> > > elected> > > to do nothing. At surgery >>> the patient had LIMA to> > LAD, SVG to Diagonal and> > > OM1. >>> After protamine ST segment changes and drop> > in BP. They re- >>> haprinized> > > went back to for a short time elected not to> > >>> reverse heparin the second> > > time> > > and put an IABP.> > >> >>> > > The patient remained stable post op and was> > extubated the >>> following> > > morning.> > > IABP removed. The evening of that >>> day became> > confused and combative ABG> > > were> > > >>> acceptable had to be re intubated over night. It> > was noticed >>> that his CPK> > > level kept on rising initially to 7000 and >>> later> > to more than 10000 units.> > > He was put on PRISMA for >>> renal failure in spite of> > this his K went up and> > > was >>> controlled but with difficulty. The following> > morning he >>> developed> > > epidermolysis and blisters of the lower> > >>> extremities skin no compartment> > > was> > > found on assessment >>> both the femoral veins and> > arteries were patent by> > > duplex >>> assessment. He was seen by neurology CT> > scan and MRI were >>> normal.> > > Abdominal CT was normal. He was assessed by> > >>> various services and the> > > differential diagnoses were >>> narrowed to> > rhabdomyolysis. Any thoughts from> > > members >>> would be greatly appreciated> > >> > >> > >> > >> > >> > > Ahmed> >>> > >> > >> > >> > > >>> _______________________________________________> > > OpenHeart-L >>> mailing list> > >> > > Send postings to:> > > OpenHeart- >>> L@lists.hsforum.com> > >> > > To UNSUBSCRIBE, to CHANGE email >>> address, or to> > view archives:> > > http://mmp.cjp.com/mailman/ >>> 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> > >>> -----------------------------------------> > > > > Dr. David G. >>> Harris, FCS, MMED,> Cardiothoracic Surgeon > Suite 207 > Kuils >>> River Private Hospital, > PO Box 1200, Kuils River, 7579, Cape >>> Town, South Africa. > Tel +27-21-9006411 > Fax +27-21-9006412 >>> Mobile +27-83-3309587> >>> _______________________________________________> OpenHeart-L >>> mailing list> > Send postings to:> OpenHeart-L@lists.hsforum.com> >>> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> >>> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages >>> transmitted by the OpenHeart-L are subject to the policies and > >>> disclaimers posted at:> http://www.hsforum.com/listdisclaim> >>> ----------------------------------------- >> _________________________________________________________________ >> Share what Santa brought you >> https:// >> www.mycooluncool.com_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > > -- > Ben Bidstrup FRACS FRCSEd FEBCTS > Consultant Cardiothoracic Surgeon > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 donross at bigpond.com Fri Feb 1 15:14:00 2008 From: donross at bigpond.com (Donald Ross) Date: Thu Jan 31 23:15:30 2008 Subject: [HSF] Failed perimount In-Reply-To: <8CA329E524B4527-734-28CD@webmail-da01.sysops.aol.com> References: <624285.84257.qm@web81602.mail.mud.yahoo.com> <8CA329E524B4527-734-28CD@webmail-da01.sysops.aol.com> Message-ID: <13141803-10F5-4DF1-9CB1-B30887198493@bigpond.com> What was his 6th valve and what is his age and valve history? Sounds interesting. Don On 01/02/2008, at 3:01 PM, tdmartin2000@aol.com wrote: > Just before the STS I removed a perimount that I had implanted in > 1993 - 15 YRS AGO! > ?As you know I have been preaching that these valves almost all > fail by calcification and stenosis. Well, this one failed from > stress holes in the leaflets and AI with absolutely NO evidence of > calcification anywhere on the valve. I will have to say however > that it was his 5th valve and the porcine valve I took out in 93 > had been in for almost 18 yrs. > > Tom Martin > U of Florida > Gainesville > > > -----Original Message----- > From: Tea Acuff > To: OpenHeart-L > Sent: Thu, 31 Jan 2008 10:03 pm > Subject: [HSF] STS funny story > > > > I don't remember who said this to me. Maybe the guilty party will > fess up. > > We had been at the STS for less than a day and visited with a few > of us from > HSF. (I'm sure others did the same else where). A few hours later a > ran into > someone again who reported that so and so had already got his notes > out on the > HSF. "He really had to get his ideas out. He's got it bad...." > > Thinking later it reminded me of my second grade observation which > I have shared > before. "Johnny had his eyes open during the prayer". > > tea > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > ______________________________________________________________________ > __ > More new features than ever. Check out the new AOL Mail ! - http:// > webmail.aol.com > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Feb 1 11:40:02 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Feb 1 01:10:31 2008 Subject: [HSF] aortic aneurism and florida sleeve (maybe) In-Reply-To: <8CA329B92095F39-734-2829@webmail-da01.sysops.aol.com> References: <8E960EDE-B5D4-4CFE-843C-8F53D35C85DD@bigpond.com> <00bc01c862bd$9378fd20$538733aa@LIBERTAD> <000f01c86296$664bf6d0$b3160a06@HZLPC0679> <8CA31DECE5A2F0B-1440-2803@MBLK-M25.sysops.aol.com> <004001c8640f$b002a6f0$b3160a06@HZLPC0679> <8CA329B92095F39-734-2829@webmail-da01.sysops.aol.com> Message-ID: <89c4ed2d0801312210m45b06c80r46056bb60a808d01@mail.gmail.com> Oh Yes he is very humble. I remember him setting up the emaze video - videographed in Mexico (Ovidio) edited in US (Mark Levinson) and reviewed in India (Me). That was incredible experience that we have to also thank the Internet Gods for !! (Is there a Patron saint of the Internet ??). Prasanna On Feb 1, 2008 9:12 AM, wrote: > I have to be honest and tell you that Mark took the instructions that I > gave him for his first operation via email and turned it into the article. > We included Phil Hess, Tom Beaver and Chuck Klodell as they are my partners > in crime here when it comes to aortic surgery. Last year we did well over > 300 major thoracic aortic cases and I did about 130 with these guys doing > the other 170. They are younger but every bit as capeable. > My hat off to Mark who is so humble. > > Tom Martin > > > -----Original Message----- > From: Dr. Roberto Battellini > To: OpenHeart-L@lists.hsforum.com > Sent: Thu, 31 Jan 2008 8:46 am > Subject: AW: [HSF] aortic aneurism and florida sleeve (maybe) > > > > I saw the video, Tom, congrats. > he article is written by Phillip Hess and yourself, where can Mark?s > rticle be found? > oberto > -----Urspr?ngliche Nachricht----- > on: openheart-l-bounces@lists.hsforum.com > mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von > dmartin2000@aol.com > esendet: Donnerstag, 31. Januar 2008 06:11 > n: OpenHeart-L@lists.hsforum.com > etreff: Re: [HSF] aortic aneurism and florida sleeve (maybe) > > ounds like a great candidate for a sleeve. There is a good description on > he forum that was actually written by Mark Levinson to go along with the > ideo. > > Tom Martin > U of Florida > Gainesville > > ----Original Message----- > rom: Dr. Roberto Battellini > o: OpenHeart-L@lists.hsforum.com > ent: Tue, 29 Jan 2008 11:45 am > ubject: AW: [HSF] aortic aneurism and florida sleeve (maybe) > > > o a classic Bentall-Kouchoukos. If not, let the case be made from someone > perienced in David?s Reimplantation. Read the review from Craig Miller in > e Annals 2007; 83 :S736-9. There you will find a great amount of > terature to read, inclusive the articles from Tirone David. > l the basics is in the book of Lawrence Cohn and Edmunds, the new edition > peared. > berto > ----Urspr?ngliche Nachricht----- > n: openheart-l-bounces@lists.hsforum.com > ailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von gustavo abuin > sendet: Dienstag, 29. Januar 2008 22:26 > : OpenHeart-L@lists.hsforum.com > treff: [HSF] aortic aneurism and florida sleeve (maybe) > ear members of the forum. > have a 35 year old not marfan patient with a 57mm aortic ascending > eurism, > ntral aortic insufficience and good LV function. The aortic arch is normal > n size. > think that the patient is a good candidate for "Tom Martin`s procedure > he Florida`s Sleeve), a Yacoub or David procedure. > have no experience with any of the procedures (I`ve only performed Bentall > r Cabrol procedures, resuspension in dissections, some plication of a > lve). > e Question is: > at of the procedures is more reproducible, that`s to say, in this kind of > rgery, what procedure is safer in order to avoid aortic incompetence? > anks in advance. > ______________________________________________ > enHeart-L mailing list > end postings to: > penHeart-L@lists.hsforum.com > o UNSUBSCRIBE, to CHANGE email address, or to view archives: > tp://mmp.cjp.com/mailman/listinfo/openheart-l > ll messages transmitted by the OpenHeart-L are subject to the policies and > sclaimers posted at: > tp://www.hsforum.com/listdisclaim > --------------------------------------- > ______________________________________________ > enHeart-L mailing list > end postings to: > penHeart-L@lists.hsforum.com > o UNSUBSCRIBE, to CHANGE email address, or to view archives: > tp://mmp.cjp.com/mailman/listinfo/openheart-l > ll messages transmitted by the OpenHeart-L are subject to the policies and > sclaimers posted at: > tp://www.hsforum.com/listdisclaim > --------------------------------------- > > _______________________________________________________________________ > ore new features than ever. Check out the new AOL Mail ! - > ttp://webmail.aol.com > ______________________________________________ > 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 > ---------------------------------------- > _______________________________________________ > 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 > ---------------------------------------- > > > ________________________________________________________________________ > More new features than ever. Check out the new AOL Mail ! - > http://webmail.aol.com > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 nfaabouseada at gmail.com Fri Feb 1 00:59:52 2008 From: nfaabouseada at gmail.com (Nasser F. Abou'Seada) Date: Fri Feb 1 02:06:33 2008 Subject: [HSF] Intimal Tears Message-ID: "Frankly, I'm surprised I've never encountered this complication until now" Hal That adds to your critical observance as a surgeon, recognizing the fault first time seeing it. I faced that situation before in a 55 y old female having a straight forwards Mitral repair. everything went smoothly yet there was some bleeding welling up in the pericardium, that we could not come off bypass ........ all manouvres to find out the source of bleeding were evading ..... blood seemed to come from around the SVC upper part, where nothing was ever touched .... patient passed off after some 5 hours on bypass and blood thinning out. On table autopsy, I dissected around the SVC up to the IJV.... to find the whole area bathing in blood, ecchymosed .... and blood perculating through the wall of the vein .. down the sheath .... around the SVC ..... into the pericardium .. !! .... opening the vein longitudinally, multiple non peneterating longitudinal tears were found in the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly appointed anaesthesiologist tried many times before securing the IJV cannula in place .... as usual ... mortality was ascribed to the surgeon .... !!!! ... a new lesson with a hard price ..!! .. never forgotten .. NFA On Jan 31, 2008 7:09 PM, wrote: > Don, > My assistant is pretty strong, but I'm not blaming him. Frankly, I'm > surprised I've never encountered this complication until now. > > Hal > From donross at bigpond.com Fri Feb 1 18:22:27 2008 From: donross at bigpond.com (Donald Ross) Date: Fri Feb 1 02:23:10 2008 Subject: [HSF] Intimal Tears In-Reply-To: References: Message-ID: <9BF6CCF5-5EC0-464F-AA85-84334212DC05@bigpond.com> That is an important lesson, Nasser. I have had a patient despatched with a dissected carotid artery after an IJ stab oops! Don On 01/02/2008, at 5:59 PM, Nasser F. Abou'Seada wrote: > "Frankly, I'm surprised I've never encountered this complication > until now" > > Hal > That adds to your critical observance as a surgeon, recognizing the > fault > first time seeing it. I faced that situation before in a 55 y old > female > having a straight forwards Mitral repair. everything went smoothly > yet there > was some bleeding welling up in the pericardium, that we could not > come off > bypass ........ all manouvres to find out the source of bleeding were > evading ..... blood seemed to come from around the SVC upper part, > where > nothing was ever touched .... patient passed off after some 5 hours on > bypass and blood thinning out. On table autopsy, I dissected around > the SVC > up to the IJV.... to find the whole area bathing in blood, > ecchymosed .... > and blood perculating through the wall of the vein .. down the > sheath .... > around the SVC ..... into the pericardium .. !! .... opening the vein > longitudinally, multiple non peneterating longitudinal tears were > found in > the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly > appointed anaesthesiologist tried many times before securing the > IJV cannula > in place .... as usual ... mortality was ascribed to the > surgeon .... !!!! > ... a new lesson with a hard price ..!! .. never forgotten .. > > NFA > > > > > > > On Jan 31, 2008 7:09 PM, wrote: > >> Don, >> My assistant is pretty strong, but I'm not blaming him. >> Frankly, I'm >> surprised I've never encountered this complication until now. >> >> Hal >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 battr at medizin.uni-leipzig.de Fri Feb 1 09:24:38 2008 From: battr at medizin.uni-leipzig.de (Dr. Roberto Battellini) Date: Fri Feb 1 03:15:59 2008 Subject: AW: AW: [HSF] Occluded SVC In-Reply-To: References: Message-ID: <000c01c864ab$e2f34c80$b3160a06@HZLPC0679> I heard about some device which could aspirate the thrombus, may be? Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Hgrmd@aol.com Gesendet: Freitag, 1. Februar 2008 00:45 An: OpenHeart-L@lists.hsforum.com Betreff: Re: AW: [HSF] Occluded SVC Roberto, Yes, I think the SVC is stenotic and thrombosed. The only thing against stenting is that it is a fresh heart (worry that stent might rupture SVC in area that I sutured). Plus, I would also be concerned about all of the clot that would be expected in the SVC and the innominate veins. On ultrasound, the right IJ is thrombosed as well. Hal **************Start the year off right. Easy ways to stay in shape. http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 battr at medizin.uni-leipzig.de Fri Feb 1 09:39:37 2008 From: battr at medizin.uni-leipzig.de (Dr. Roberto Battellini) Date: Fri Feb 1 03:30:20 2008 Subject: AW: [HSF] Occluded SVC In-Reply-To: References: Message-ID: <001801c864ad$fc46d740$b3160a06@HZLPC0679> Patch angioplasty, but if the cava is very retracted would be better to have an homograft. I once replaced the cava -distroyed by a thoracic surgeon doing lobectomy-by a Goretex graft, remained open 1 year until we took the anticoagulation away, then thromboses, but with the time got collateral circulation. Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Nasser F. Abou'Seada Gesendet: Freitag, 1. Februar 2008 01:40 An: OpenHeart-L@lists.hsforum.com Betreff: Re: [HSF] Occluded SVC Dear Hal: Yes .... and it is marvelous that you realized the event and took care of it the right way .... many would not notice the cause ... the point is .... in such case with the pacing wire(S) in the stenosed SVC .... a deployed stent would be an invitation for a disaster ..!! .... ascribed to the surgeon at the end !!!! ........ also .... is there any hope of freeing the SVC from the formed thrombus ?? amalgamated with the wires ??? without fragmentation of the thrombus ???? to my mind ........ I'd try a very conservative approach ... a targeted catheter at the tip of the thrombus ... "now in IJV?" ...... and work it "down" from there ........... if failed ... I would not hesitate to do as you have thought ....... a patch angioplasty ......... a few minutes on bypass would not be a problem ..... leaving it for observation might be ok ....... but as well might be disasterous .... a few minutes of bypass ....... with under vision fixation ,..... would not cause any harm .. again ....I trust your surgical instincts NFA On Jan 31, 2008 5:50 PM, wrote: > Nasser, > I couldn't tell exactly where the lacerations were located on the IVC > and > SVC. In both vessels, the bleeding was directly posterior. I controlled > both with horizontal mattress pledgetted 4-0 Prolenes. Though I didn't > realize > it at the time of surgery, I must have narrowed the SVC with the repair. > Inserting the pacing leads a few days later probably occluded the SVC > lumen > sufficiently to precipitate thrombosis. > > Hal > > > > **************Start the year off right. Easy ways to stay in shape. > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 benjamin.bidstrup at bigpond.com Fri Feb 1 20:26:47 2008 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Fri Feb 1 05:27:40 2008 Subject: AW: AW: [HSF] Occluded SVC In-Reply-To: <000c01c864ab$e2f34c80$b3160a06@HZLPC0679> References: <000c01c864ab$e2f34c80$b3160a06@HZLPC0679> Message-ID: Rather like the devices for dealing with pulmonary emboli. >I heard about some device which could aspirate the thrombus, may be? >Roberto > >-----Urspr?ngliche Nachricht----- >Von: openheart-l-bounces@lists.hsforum.com >[mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Hgrmd@aol.com >Gesendet: Freitag, 1. Februar 2008 00:45 >An: OpenHeart-L@lists.hsforum.com >Betreff: Re: AW: [HSF] Occluded SVC > >Roberto, > Yes, I think the SVC is stenotic and thrombosed. The only thing against >stenting is that it is a fresh heart (worry that stent might rupture SVC in > >area that I sutured). Plus, I would also be concerned about all of the >clot >that would be expected in the SVC and the innominate veins. On ultrasound, >the >right IJ is thrombosed as well. > >Hal > > > >**************Start the year off right. Easy ways to stay in shape. >http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/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 >----------------------------------------- -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From prasannasimha at gmail.com Fri Feb 1 16:12:15 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Feb 1 05:42:38 2008 Subject: [HSF] Intimal Tears In-Reply-To: References: Message-ID: <89c4ed2d0802010242s1bcf467aicbd3b14f23d47091@mail.gmail.com> Last week I had an unexplained retro IVC bleed that I could stop by two purse strings , one in the RIPV IVC junction and the other around the IVC RA LA junction at the oblique sinus. Now I wonder if it could have been due to something like this . (Though I didn't see any flap on TEE) Prasanna On Feb 1, 2008 12:29 PM, Nasser F. Abou'Seada wrote: > "Frankly, I'm surprised I've never encountered this complication until > now" > > Hal > That adds to your critical observance as a surgeon, recognizing the fault > first time seeing it. I faced that situation before in a 55 y old female > having a straight forwards Mitral repair. everything went smoothly yet > there > was some bleeding welling up in the pericardium, that we could not come > off > bypass ........ all manouvres to find out the source of bleeding were > evading ..... blood seemed to come from around the SVC upper part, where > nothing was ever touched .... patient passed off after some 5 hours on > bypass and blood thinning out. On table autopsy, I dissected around the > SVC > up to the IJV.... to find the whole area bathing in blood, ecchymosed .... > and blood perculating through the wall of the vein .. down the sheath .... > around the SVC ..... into the pericardium .. !! .... opening the vein > longitudinally, multiple non peneterating longitudinal tears were found in > the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly > appointed anaesthesiologist tried many times before securing the IJV > cannula > in place .... as usual ... mortality was ascribed to the surgeon .... !!!! > ... a new lesson with a hard price ..!! .. never forgotten .. > > NFA > > > > > > > On Jan 31, 2008 7:09 PM, wrote: > > > Don, > > My assistant is pretty strong, but I'm not blaming him. Frankly, I'm > > surprised I've never encountered this complication until now. > > > > Hal > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 gabuin at intramed.net Fri Feb 1 04:05:15 2008 From: gabuin at intramed.net (gustavo abuin) Date: Fri Feb 1 07:06:48 2008 Subject: AW: [HSF] Occluded SVC References: <000c01c864ab$e2f34c80$b3160a06@HZLPC0679> Message-ID: <000a01c864ca$b5c7ca00$0a9933aa@LIBERTAD> another option is to put a Dispache catheter (similar to a pigtail, your interventional cardiologist sure has one of it) in the midle of the thrombus and infuse rTPA using the Mc Nammara protocol. rTPA: 20mg bolus in 10 minutes 70mg in 12 hours, maximum 90mg. It must be used rTPA because its low mollecular weight and penetration in the thrombus. Hope this helps ----- Original Message ----- From: "Dr. Roberto Battellini" To: Sent: Friday, February 01, 2008 12:24 AM Subject: AW: AW: [HSF] Occluded SVC I heard about some device which could aspirate the thrombus, may be? Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Hgrmd@aol.com Gesendet: Freitag, 1. Februar 2008 00:45 An: OpenHeart-L@lists.hsforum.com Betreff: Re: AW: [HSF] Occluded SVC Roberto, Yes, I think the SVC is stenotic and thrombosed. The only thing against stenting is that it is a fresh heart (worry that stent might rupture SVC in area that I sutured). Plus, I would also be concerned about all of the clot that would be expected in the SVC and the innominate veins. On ultrasound, the right IJ is thrombosed as well. Hal **************Start the year off right. Easy ways to stay in shape. http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 ----------------------------------------- -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.5.516 / Virus Database: 269.19.17/1252 - Release Date: 1/30/2008 8:51 PM From john_pj15 at yahoo.com Fri Feb 1 04:09:57 2008 From: john_pj15 at yahoo.com (john pj) Date: Fri Feb 1 07:10:25 2008 Subject: [HSF] LIMA harvest- extra pleural haematoma Message-ID: <846282.88144.qm@web35903.mail.mud.yahoo.com> In the last 2 years we have seen at least 3 times an extra pleural haematoma at the apex/ upper zone of the left lung after CABG with LIMA. In one of them it?s extra pleural location was confirmed with CT and took 3 months to clear radiologically We suspect that it could be from post op bleeding in to the chest wall from one of the braches of LIMA. Any comments about such a complication? --------------------------------- Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. From Hgrmd at aol.com Fri Feb 1 07:20:45 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Fri Feb 1 07:22:46 2008 Subject: AW: [HSF] Occluded SVC Message-ID: Mitch, The patient had a Swan-Ganz for probably the first couple of postop days. Thereafter, I don't believe he needed central access. The problem was that he required a permanent pacemaker. Hal **************Start the year off right. Easy ways to stay in shape. http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 From prasannasimha at gmail.com Fri Feb 1 17:51:20 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Feb 1 07:28:02 2008 Subject: AW: [HSF] Occluded SVC In-Reply-To: <000a01c864ca$b5c7ca00$0a9933aa@LIBERTAD> References: <000c01c864ab$e2f34c80$b3160a06@HZLPC0679> <000a01c864ca$b5c7ca00$0a9933aa@LIBERTAD> Message-ID: <89c4ed2d0802010421l852e673jab44bab4386d694c@mail.gmail.com> Problem is patient just had cardiac surgery done. Prasanna On Feb 1, 2008 5:35 PM, gustavo abuin wrote: > another option is to put a Dispache catheter (similar to a pigtail, your > interventional cardiologist sure has one of it) in the midle of the > thrombus > and infuse rTPA using the Mc Nammara protocol. > > rTPA: > 20mg bolus in 10 minutes > 70mg in 12 hours, maximum 90mg. > It must be used rTPA because its low mollecular weight and penetration in > the thrombus. > Hope this helps > > ----- Original Message ----- > From: "Dr. Roberto Battellini" > To: > Sent: Friday, February 01, 2008 12:24 AM > Subject: AW: AW: [HSF] Occluded SVC > > > I heard about some device which could aspirate the thrombus, may be? > Roberto > > -----Urspr?ngliche Nachricht----- > Von: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von > Hgrmd@aol.com > Gesendet: Freitag, 1. Februar 2008 00:45 > An: OpenHeart-L@lists.hsforum.com > Betreff: Re: AW: [HSF] Occluded SVC > > Roberto, > Yes, I think the SVC is stenotic and thrombosed. The only thing against > stenting is that it is a fresh heart (worry that stent might rupture SVC > in > > area that I sutured). Plus, I would also be concerned about all of the > clot > that would be expected in the SVC and the innominate veins. On > ultrasound, > the > right IJ is thrombosed as well. > > Hal > > > > **************Start the year off right. Easy ways to stay in shape. > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 > ----------------------------------------- > > > -- > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.5.516 / Virus Database: 269.19.17/1252 - Release Date: > 1/30/2008 > 8:51 PM > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Fri Feb 1 18:00:00 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Feb 1 07:30:25 2008 Subject: AW: [HSF] Occluded SVC In-Reply-To: References: Message-ID: <89c4ed2d0802010430p74c29efahd60fb37753a4f287@mail.gmail.com> Now ,how will patching the SVC decrease the risk of rethrombosis in the SVC with the lead in place ? Prasanna On Feb 1, 2008 5:50 PM, wrote: > Mitch, > The patient had a Swan-Ganz for probably the first couple of postop > days. > Thereafter, I don't believe he needed central access. The problem was > that > he required a permanent pacemaker. > > Hal > > > > **************Start the year off right. Easy ways to stay in shape. > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 jpym at erols.com Fri Feb 1 08:55:41 2008 From: jpym at erols.com (John Pym) Date: Fri Feb 1 08:56:15 2008 Subject: [HSF] Occluded SVC In-Reply-To: References: Message-ID: Hal I agree with those who advise anticoagulation and waiting for the clot to lyse (most likely) or for further venous collaterals to form. The important point is that the patient does not have a full-blown SVC syndrome and is therefore unlikely to deteriorate from this point of view - he already has collaterals. Another significant consideration is the fate of the pacing wires. What if the leads become infected or the pacemaker erodes or the RV lead needs to be extracted to provide venous access for an ICD lead (not uncommon in this day and age)? You would be looking at a very unpleasant open redo if the leads are locked in place by a stent. John Pym On Jan 31, 2008 7:11 AM, wrote: > Dear Members, > First, it was such a pleasure to meet several of you for the first time > at > the HSF dinner. > I need some urgent advice. About 2 weeks ago, I did a redo AVR, mitral > repair, tricuspid repair, Cox-maze on a 75 yo man. Intraop, while > retracting > the atrial septum for the work in the LA, noncircumferential intimal > tears > developed on both the SVC and IVC. I could tell because there was > substantial > venous blood coming from underneath the SVC and IVC. I was able to > repair > both with external suturing. The rest of the case went well. About a > week > later, we inserted a DDD pacemaker (the patient had been in continuous AF > for > years). A few days later, he developed severe facial and upper extremity > swelling. Workup reveals he has an occluded SVC. The cardiologist took > him to the > lab and measured a 30 mm gradient across the SVC. The patient is > ambulating > well and generally feels OK, but he has the persistent swelling. There > is > no evidence of symptomatic intracranial swelling or upper airway > compromise. > The cardiologist insists something must be done. I'm reluctant to have a > stent deployed in a fresh heart. The surgical option would be to extract > the > thrombus on CPB and patch the SVC. My question is: Is it justified? > > Hal > > > From smmalik at brain.net.pk Fri Feb 1 18:56:08 2008 From: smmalik at brain.net.pk (Shahid Mahmud Malik) Date: Fri Feb 1 08:57:44 2008 Subject: [HSF] Occluded SVC References: Message-ID: <013101c864da$35002830$1bc651cb@shahid> Hal, I had a similar situation whilst doing a MVR for severe mitral stenosis only last week in a frail lady.The tape snare when removed from IVC unwieled a tear in the back of IVC as blood continued to well up.I must have caused a tear passing the instrument behind the ivc prior to the tape snare.Briefly on low flows,I stitched the posterior pericardium to the ivc medially and right pleura laterally.Bleeding stopped and so far no problems.If the problem with your patient does not go away with time ,you may consider Bovine tube graft among other solutions. Shahid Malik ----- Original Message ----- From: To: Sent: Friday, February 01, 2008 6:41 AM Subject: Re: [HSF] Occluded SVC > Nasser, > Your thoughts are probably where I'm headed. Thanks. > > Hal > > > > **************Start the year off right. Easy ways to stay in shape. > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Feb 1 19:42:22 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Feb 1 09:21:49 2008 Subject: [HSF] Occluded SVC In-Reply-To: <013101c864da$35002830$1bc651cb@shahid> References: <013101c864da$35002830$1bc651cb@shahid> Message-ID: <89c4ed2d0802010612o7488766exd68705393d332c9b@mail.gmail.com> Ah !! I have to do that yearly when a newly "passed" MCh graduate dose his first few ASD's or any other open heart independently. Other times it is an innominate artery injury while trying to dissect the suprasternal notch. History repeats itself regularly. (Not that this cannot happen to consultatnts as statistics do catch up with numbers!!) Incidentally for the neophytes on the list remember that if direct suture cannot be done /difficult or impossible open the RA and suture the tear from within. Vacuum assist works well and you can also use an cuffed endotracheal tube as the IVC cannula if vacuum assist is not available . Prasanna On Feb 1, 2008 7:26 PM, Shahid Mahmud Malik wrote: > Hal, > I had a similar situation whilst doing a MVR for severe mitral stenosis > only > last week in a frail lady.The tape snare when removed from IVC unwieled a > tear in the back of IVC as blood continued to well up.I must have caused > a > tear passing the instrument behind the ivc prior to the tape snare.Briefly > on low flows,I stitched the posterior pericardium to the ivc medially and > right pleura laterally.Bleeding stopped and so far no problems.If the > problem with your patient does not go away with time ,you may consider > Bovine tube graft among other solutions. > Shahid Malik > ----- Original Message ----- > From: > To: > Sent: Friday, February 01, 2008 6:41 AM > Subject: Re: [HSF] Occluded SVC > > > > Nasser, > > Your thoughts are probably where I'm headed. Thanks. > > > > Hal > > > > > > > > **************Start the year off right. Easy ways to stay in shape. > > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 battr at medizin.uni-leipzig.de Fri Feb 1 15:41:05 2008 From: battr at medizin.uni-leipzig.de (Dr. Roberto Battellini) Date: Fri Feb 1 09:31:47 2008 Subject: AW: AW: [HSF] Occluded SVC In-Reply-To: <000a01c864ca$b5c7ca00$0a9933aa@LIBERTAD> References: <000c01c864ab$e2f34c80$b3160a06@HZLPC0679> <000a01c864ca$b5c7ca00$0a9933aa@LIBERTAD> Message-ID: <001f01c864e0$79bb0250$b3160a06@HZLPC0679> Gustavo, Tell us how ist he Mc Namara protocol, I never used it. Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von gustavo abuin Gesendet: Freitag, 1. Februar 2008 13:05 An: OpenHeart-L@lists.hsforum.com Betreff: Re: AW: [HSF] Occluded SVC another option is to put a Dispache catheter (similar to a pigtail, your interventional cardiologist sure has one of it) in the midle of the thrombus and infuse rTPA using the Mc Nammara protocol. rTPA: 20mg bolus in 10 minutes 70mg in 12 hours, maximum 90mg. It must be used rTPA because its low mollecular weight and penetration in the thrombus. Hope this helps ----- Original Message ----- From: "Dr. Roberto Battellini" To: Sent: Friday, February 01, 2008 12:24 AM Subject: AW: AW: [HSF] Occluded SVC I heard about some device which could aspirate the thrombus, may be? Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Hgrmd@aol.com Gesendet: Freitag, 1. Februar 2008 00:45 An: OpenHeart-L@lists.hsforum.com Betreff: Re: AW: [HSF] Occluded SVC Roberto, Yes, I think the SVC is stenotic and thrombosed. The only thing against stenting is that it is a fresh heart (worry that stent might rupture SVC in area that I sutured). Plus, I would also be concerned about all of the clot that would be expected in the SVC and the innominate veins. On ultrasound, the right IJ is thrombosed as well. Hal **************Start the year off right. Easy ways to stay in shape. http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 ----------------------------------------- -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.5.516 / Virus Database: 269.19.17/1252 - Release Date: 1/30/2008 8:51 PM _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 battr at medizin.uni-leipzig.de Fri Feb 1 15:43:43 2008 From: battr at medizin.uni-leipzig.de (Dr. Roberto Battellini) Date: Fri Feb 1 09:35:17 2008 Subject: AW: [HSF] LIMA harvest- extra pleural haematoma In-Reply-To: <846282.88144.qm@web35903.mail.mud.yahoo.com> References: <846282.88144.qm@web35903.mail.mud.yahoo.com> Message-ID: <002001c864e0$d7815b50$b3160a06@HZLPC0679> John, may be a tear in the first collateral of the LIMA. I had the same case last year in a patient with preoperative thrombopenia. We reoperated him, and put a lot of fibringlue there. Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von john pj Gesendet: Freitag, 1. Februar 2008 13:10 An: OpenHeart-L@lists.hsforum.com Betreff: [HSF] LIMA harvest- extra pleural haematoma In the last 2 years we have seen at least 3 times an extra pleural haematoma at the apex/ upper zone of the left lung after CABG with LIMA. In one of them it?s extra pleural location was confirmed with CT and took 3 months to clear radiologically We suspect that it could be from post op bleeding in to the chest wall from one of the braches of LIMA. Any comments about such a complication? --------------------------------- Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 battr at medizin.uni-leipzig.de Fri Feb 1 15:51:16 2008 From: battr at medizin.uni-leipzig.de (Dr. Roberto Battellini) Date: Fri Feb 1 09:42:30 2008 Subject: AW: [HSF] Occluded SVC In-Reply-To: References: Message-ID: <002601c864e1$e5eef0c0$b3160a06@HZLPC0679> Hal, What a discussion ! Dees the patient needs the pacer? If you give thrombolytics you need to take the electrodes away, otherwise the cava will still thrombose. Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von John Pym Gesendet: Freitag, 1. Februar 2008 14:56 An: OpenHeart-L@lists.hsforum.com Betreff: Re: [HSF] Occluded SVC Hal I agree with those who advise anticoagulation and waiting for the clot to lyse (most likely) or for further venous collaterals to form. The important point is that the patient does not have a full-blown SVC syndrome and is therefore unlikely to deteriorate from this point of view - he already has collaterals. Another significant consideration is the fate of the pacing wires. What if the leads become infected or the pacemaker erodes or the RV lead needs to be extracted to provide venous access for an ICD lead (not uncommon in this day and age)? You would be looking at a very unpleasant open redo if the leads are locked in place by a stent. John Pym On Jan 31, 2008 7:11 AM, wrote: > Dear Members, > First, it was such a pleasure to meet several of you for the first time > at > the HSF dinner. > I need some urgent advice. About 2 weeks ago, I did a redo AVR, mitral > repair, tricuspid repair, Cox-maze on a 75 yo man. Intraop, while > retracting > the atrial septum for the work in the LA, noncircumferential intimal > tears > developed on both the SVC and IVC. I could tell because there was > substantial > venous blood coming from underneath the SVC and IVC. I was able to > repair > both with external suturing. The rest of the case went well. About a > week > later, we inserted a DDD pacemaker (the patient had been in continuous AF > for > years). A few days later, he developed severe facial and upper extremity > swelling. Workup reveals he has an occluded SVC. The cardiologist took > him to the > lab and measured a 30 mm gradient across the SVC. The patient is > ambulating > well and generally feels OK, but he has the persistent swelling. There > is > no evidence of symptomatic intracranial swelling or upper airway > compromise. > The cardiologist insists something must be done. I'm reluctant to have a > stent deployed in a fresh heart. The surgical option would be to extract > the > thrombus on CPB and patch the SVC. My question is: Is it justified? > > Hal > > > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 battr at medizin.uni-leipzig.de Fri Feb 1 15:55:05 2008 From: battr at medizin.uni-leipzig.de (Dr. Roberto Battellini) Date: Fri Feb 1 09:46:02 2008 Subject: AW: [HSF] Occluded SVC-Wiki-Prasanna In-Reply-To: <89c4ed2d0802010612o7488766exd68705393d332c9b@mail.gmail.com> References: <013101c864da$35002830$1bc651cb@shahid> <89c4ed2d0802010612o7488766exd68705393d332c9b@mail.gmail.com> Message-ID: <002701c864e2$6e9f9dc0$b3160a06@HZLPC0679> Prasanna, good idea, post in the Wikipedia the internal suture of IVC under femoral vein cannulation and blockade. Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Prasanna Simha M Gesendet: Freitag, 1. Februar 2008 15:12 An: OpenHeart-L@lists.hsforum.com Betreff: Re: [HSF] Occluded SVC Ah !! I have to do that yearly when a newly "passed" MCh graduate dose his first few ASD's or any other open heart independently. Other times it is an innominate artery injury while trying to dissect the suprasternal notch. History repeats itself regularly. (Not that this cannot happen to consultatnts as statistics do catch up with numbers!!) Incidentally for the neophytes on the list remember that if direct suture cannot be done /difficult or impossible open the RA and suture the tear from within. Vacuum assist works well and you can also use an cuffed endotracheal tube as the IVC cannula if vacuum assist is not available . Prasanna On Feb 1, 2008 7:26 PM, Shahid Mahmud Malik wrote: > Hal, > I had a similar situation whilst doing a MVR for severe mitral stenosis > only > last week in a frail lady.The tape snare when removed from IVC unwieled a > tear in the back of IVC as blood continued to well up.I must have caused > a > tear passing the instrument behind the ivc prior to the tape snare.Briefly > on low flows,I stitched the posterior pericardium to the ivc medially and > right pleura laterally.Bleeding stopped and so far no problems.If the > problem with your patient does not go away with time ,you may consider > Bovine tube graft among other solutions. > Shahid Malik > ----- Original Message ----- > From: > To: > Sent: Friday, February 01, 2008 6:41 AM > Subject: Re: [HSF] Occluded SVC > > > > Nasser, > > Your thoughts are probably where I'm headed. Thanks. > > > > Hal > > > > > > > > **************Start the year off right. Easy ways to stay in shape. > > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489 > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 anianyanwu at hotmail.com Fri Feb 1 16:21:17 2008 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Fri Feb 1 11:22:05 2008 Subject: [HSF] Occluded SVC In-Reply-To: References: Message-ID: Hal What was the indication for the pacemaker? Could it be explanted now or is patient dependent on it? Ani > Date: Fri, 1 Feb 2008 08:55:41 -0500> From: jpym@erols.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Occluded SVC> CC: > > Hal> > I agree with those who advise anticoagulation and waiting for the clot to> lyse (most likely) or for further venous collaterals to form. The important> point is that the patient does not have a full-blown SVC syndrome and is> therefore unlikely to deteriorate from this point of view - he already has> collaterals.> > Another significant consideration is the fate of the pacing wires. What if> the leads become infected or the pacemaker erodes or the RV lead needs to be> extracted to provide venous access for an ICD lead (not uncommon in this day> and age)? You would be looking at a very unpleasant open redo if the> leads are locked in place by a stent.> > John Pym> > On Jan 31, 2008 7:11 AM, wrote:> > > Dear Members,> > First, it was such a pleasure to meet several of you for the first time> > at> > the HSF dinner.> > I need some urgent advice. About 2 weeks ago, I did a redo AVR, mitral> > repair, tricuspid repair, Cox-maze on a 75 yo man. Intraop, while> > retracting> > the atrial septum for the work in the LA, noncircumferential intimal> > tears> > developed on both the SVC and IVC. I could tell because there was> > substantial> > venous blood coming from underneath the SVC and IVC. I was able to> > repair> > both with external suturing. The rest of the case went well. About a> > week> > later, we inserted a DDD pacemaker (the patient had been in continuous AF> > for> > years). A few days later, he developed severe facial and upper extremity> > swelling. Workup reveals he has an occluded SVC. The cardiologist took> > him to the> > lab and measured a 30 mm gradient across the SVC. The patient is> > ambulating> > well and generally feels OK, but he has the persistent swelling. There> > is> > no evidence of symptomatic intracranial swelling or upper airway> > compromise.> > The cardiologist insists something must be done. I'm reluctant to have a> > stent deployed in a fresh heart. The surgical option would be to extract> > the> > thrombus on CPB and patch the SVC. My question is: Is it justified?> >> > Hal> >> >> >> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> ----------------------------------------- _________________________________________________________________ Telly addicts unite! http://www.searchgamesbox.com/tvtown.shtml From alsadd at ksu.edu.sa Fri Feb 1 20:31:12 2008 From: alsadd at ksu.edu.sa (alsadd) Date: Fri Feb 1 12:31:25 2008 Subject: [HSF] Re: ENHANCE Trial Message-ID: Dear Forum Members: Any thoughts on ENHANCE study that is coming to light It has engendered considerable controversy because, while the study was concluded almost two years ago, the release of its results has been greatly (and famously) delayed. There has been a strong and growing suspicion that the trial did not come out the way the sponsors wanted it to, and that the delay has been for the purpose of trying to salvage something positive before releasing the results. Indeed, this suspicion recently has led to an investigation by Congress. I understand it questions a lot of held belief on cholesterol lowering drugs and hyperlipidemia in general. Your thoughts please Ahmed From prasannasimha at gmail.com Fri Feb 1 23:14:15 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Feb 1 12:44:45 2008 Subject: [HSF] Re: ENHANCE Trial In-Reply-To: References: Message-ID: <89c4ed2d0802010944k7dd74c4fqbf7d4693b4effdc@mail.gmail.com> I was always worried about the widespread use of Ezetimibe and the reckless unsubstantiated promotion of it. Prasanna On Feb 2, 2008 10:01 AM, alsadd wrote: > Dear Forum Members: > > > > Any thoughts on ENHANCE study that is coming to light It has engendered > considerable controversy because, while the study was concluded almost two > years ago, the release of its results has been greatly (and famously) > delayed. There has been a strong and growing suspicion that the trial did > not come out the way the sponsors wanted it to, and that the delay has > been > for the purpose of trying to salvage something positive before releasing > the > results. Indeed, this suspicion recently has led to an investigation by > Congress. I understand it questions a lot of held belief on cholesterol > lowering drugs and hyperlipidemia in general. Your thoughts please > > > > > > Ahmed > > > > > > > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Fri Feb 1 17:06:35 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Fri Feb 1 17:07:00 2008 Subject: [HSF] Re: ENHANCE Trial In-Reply-To: <89c4ed2d0802010944k7dd74c4fqbf7d4693b4effdc@mail.gmail.com> References: <89c4ed2d0802010944k7dd74c4fqbf7d4693b4effdc@mail.gmail.com> Message-ID: I think these studies and results are going to become more common..... the closer and closer ties with industry, the financial and other incentives, reputations, frequent flier miles, etc that are at stake will further bring to light to any and all biases. It is interesting that in a study (not any in particular - but more the lingo) that shows, after looking at thousands of patients the results show Drug A is associated with a 0.5% complication rate vs 1.0% is called 50% better and ergo. We will be reading more and more about these studies in the Times, WSJ, CNN than in the medical literature - in part that is where the news is There needs to be a little reality testing - the scientific method, process, and review process areclearly tranished by the hoopla and shell games that are played out. There is too much at stake these days - and we are all guilty to some degree. -michael On 2/1/08, Prasanna Simha M wrote: > > I was always worried about the widespread use of Ezetimibe and the > reckless > unsubstantiated promotion of it. > Prasanna > > On Feb 2, 2008 10:01 AM, alsadd wrote: > > > Dear Forum Members: > > > > > > > > Any thoughts on ENHANCE study that is coming to light It has engendered > > considerable controversy because, while the study was concluded almost > two > > years ago, the release of its results has been greatly (and famously) > > delayed. There has been a strong and growing suspicion that the trial > did > > not come out the way the sponsors wanted it to, and that the delay has > > been > > for the purpose of trying to salvage something positive before releasing > > the > > results. Indeed, this suspicion recently has led to an investigation by > > Congress. I understand it questions a lot of held belief on cholesterol > > lowering drugs and hyperlipidemia in general. Your thoughts please > > > > > > > > > > > > Ahmed > > > > > > > > > > > > > > > > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 tdmartin2000 at aol.com Fri Feb 1 20:16:32 2008 From: tdmartin2000 at aol.com (tdmartin2000@aol.com) Date: Fri Feb 1 20:20:53 2008 Subject: [HSF] Failed perimount In-Reply-To: <13141803-10F5-4DF1-9CB1-B30887198493@bigpond.com> References: <624285.84257.qm@web81602.mail.mud.yahoo.com> <8CA329E524B4527-734-28CD@webmail-da01.sysops.aol.com> <13141803-10F5-4DF1-9CB1-B30887198493@bigpond.com> Message-ID: <8CA335061C0F4E4-BD4-40A5@FWM-M45.sysops.aol.com> Started with congenital AS in the mid 60's. Don't know all the valves except for the last 3. Hancock sometime in the late 70's, perimount in '93 and now magna. Tom -----Original Message----- From: Donald Ross To: OpenHeart-L@lists.hsforum.com Sent: Thu, 31 Jan 2008 11:14 pm Subject: Re: [HSF] Failed perimount What was his 6th valve and what is his age and valve history?? Sounds interesting.? Don? On 01/02/2008, at 3:01 PM, tdmartin2000@aol.com wrote:? ? > Just before the STS I removed a perimount that I had implanted in > 1993 - 15 YRS AGO!? > ?As you know I have been preaching that these valves almost all > fail by calcification and stenosis. Well, this one failed from > stress holes in the leaflets and AI with absolutely NO evidence of > calcification anywhere on the valve. I will have to say however > that it was his 5th valve and the porcine valve I took out in 93 > had been in for almost 18 yrs.? >? > Tom Martin? > U of Florida? > Gainesville? >? >? > -----Original Message-----? > From: Tea Acuff ? > To: OpenHeart-L ? > Sent: Thu, 31 Jan 2008 10:03 pm? > Subject: [HSF] STS funny story? >? >? >? > I don't remember who said this to me. Maybe the guilty party will > fess up.? >? > We had been at the STS for less than a day and visited with a few > of us from? > HSF. (I'm sure others did the same else where). A few hours later a > ran into? > someone again who reported that so and so had already got his notes > out on the? > HSF. "He really had to get his ideas out. He's got it bad...."? >? > Thinking later it reminded me of my second grade observation which > I have shared? > before. "Johnny had his eyes open during the prayer".? >? > tea? > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@lists.hsforum.com? >? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? >? > All messages transmitted by the OpenHeart-L are subject to the > policies and? > disclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? >? >? > ______________________________________________________________________> __? > More new features than ever. Check out the new AOL Mail ! - http://> webmail.aol.com? > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@lists.hsforum.com? >? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/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? -----------------------------------------? ________________________________________________________________________ More new features than ever. Check out the new AOL Mail ! - http://webmail.aol.com From tacuff at swbell.net Fri Feb 1 17:41:32 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Feb 1 20:43:01 2008 Subject: [HSF] Failed perimount Message-ID: <644617.87270.qm@web81605.mail.mud.yahoo.com> Gives a whole new meaning to the concept of promiscuous... tea ----- Original Message ---- From: "tdmartin2000@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Friday, February 1, 2008 7:16:32 PM Subject: Re: [HSF] Failed perimount Started with congenital AS in the mid 60's. Don't know all the valves except for the last 3. Hancock sometime in the late 70's, perimount in '93 and now magna. Tom -----Original Message----- From: Donald Ross To: OpenHeart-L@lists.hsforum.com Sent: Thu, 31 Jan 2008 11:14 pm Subject: Re: [HSF] Failed perimount What was his 6th valve and what is his age and valve history?? Sounds interesting.? Don? On 01/02/2008, at 3:01 PM, tdmartin2000@aol.com wrote:? ? > Just before the STS I removed a perimount that I had implanted in > 1993 - 15 YRS AGO!? > ?As you know I have been preaching that these valves almost all > fail by calcification and stenosis. Well, this one failed from > stress holes in the leaflets and AI with absolutely NO evidence of > calcification anywhere on the valve. I will have to say however > that it was his 5th valve and the porcine valve I took out in 93 > had been in for almost 18 yrs.? >? > Tom Martin? > U of Florida? > Gainesville? >? >? > -----Original Message-----? > From: Tea Acuff ? > To: OpenHeart-L ? > Sent: Thu, 31 Jan 2008 10:03 pm? > Subject: [HSF] STS funny story? >? >? >? > I don't remember who said this to me. Maybe the guilty party will > fess up.? >? > We had been at the STS for less than a day and visited with a few > of us from? > HSF. (I'm sure others did the same else where). A few hours later a > ran into? > someone again who reported that so and so had already got his notes > out on the? > HSF. "He really had to get his ideas out. He's got it bad...."? >? > Thinking later it reminded me of my second grade observation which > I have shared? > before. "Johnny had his eyes open during the prayer".? >? > tea? > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@lists.hsforum.com? >? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? >? > All messages transmitted by the OpenHeart-L are subject to the > policies and? > disclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? >? >? > ______________________________________________________________________> __? > More new features than ever. Check out the new AOL Mail ! - http://> webmail.aol.com? > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@lists.hsforum.com? >? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/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? -----------------------------------------? ________________________________________________________________________ More new features than ever. Check out the new AOL Mail ! - http://webmail.aol.com _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Fri Feb 1 22:40:35 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Fri Feb 1 22:44:56 2008 Subject: AW: [HSF] Occluded SVC Message-ID: I would be reluctant to use TPA in a relatively fresh open heart. Hal **************Biggest Grammy Award surprises of all time on AOL Music. (http://music.aol.com/grammys/pictures/never-won-a-grammy?NCID=aolcmp003000000025 48) From Hgrmd at aol.com Fri Feb 1 22:48:54 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Fri Feb 1 22:53:14 2008 Subject: [HSF] Occluded SVC Message-ID: Dear Shahid, Thanks for your advice. The bovine tube graft would probably be easier to obtain than a cryopreserved SVC. Hal **************Biggest Grammy Award surprises of all time on AOL Music. (http://music.aol.com/grammys/pictures/never-won-a-grammy?NCID=aolcmp003000000025 48) From Hgrmd at aol.com Fri Feb 1 22:51:42 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Fri Feb 1 22:55:57 2008 Subject: AW: [HSF] Occluded SVC Message-ID: Dear Roberto, Unfortunately, the patient needs the pacemaker for complete heart block (he had a Cox-maze for continuous AF). Hal **************Biggest Grammy Award surprises of all time on AOL Music. (http://music.aol.com/grammys/pictures/never-won-a-grammy?NCID=aolcmp003000000025 48) From Hgrmd at aol.com Fri Feb 1 22:58:49 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Fri Feb 1 23:00:43 2008 Subject: [HSF] Occluded SVC Message-ID: Ani, Unfortunately, the patient is pacer dependent. Hal **************Biggest Grammy Award surprises of all time on AOL Music. (http://music.aol.com/grammys/pictures/never-won-a-grammy?NCID=aolcmp003000000025 48) From gabuin at intramed.net Sat Feb 2 08:56:46 2008 From: gabuin at intramed.net (gustavo abuin) Date: Sat Feb 2 05:58:32 2008 Subject: AW: [HSF] Occluded SVC References: Message-ID: <002601c865bc$99da3290$189d33aa@LIBERTAD> Yes, but there is another option if you don`t want the entire doses. The absolute contraindication for the use of rTPA is 10 days after a surgery. I will be concerned too and I will use it if the patient worsens its clinical status. But, there is another option using tpa with less doses: Bolus of 5mg by direct vision of the interventional group. ----- Original Message ----- From: To: Sent: Friday, February 01, 2008 7:40 PM Subject: Re: AW: [HSF] Occluded SVC >I would be reluctant to use TPA in a relatively fresh open heart. > > Hal > > > > **************Biggest Grammy Award surprises of all time on AOL Music. > (http://music.aol.com/grammys/pictures/never-won-a-grammy?NCID=aolcmp003000000025 > 48) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > -- > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.5.516 / Virus Database: 269.19.17/1252 - Release Date: > 1/30/2008 8:51 PM > > From Hgrmd at aol.com Sat Feb 2 06:34:12 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sat Feb 2 06:38:30 2008 Subject: AW: [HSF] Occluded SVC Message-ID: Dear Gabuin (?, please sign your name after you post so we can know who you are), The low dose TPA option is good to know. I was unaware that it could be safely administered after 10 postop days. However, the other readers have pointed out that the presence of permanent pacing leads would probably cause the SVC to just clot again. Unfortunately, I don't think there are very many good options other than surgery. The patient continues to have severe facial and upper extremity edema. He's also had some new visual disturbances. I'm having an ophthalmologist and a neurologist see him. I suspect I'll be taking him to the OR soon. Hal **************Biggest Grammy Award surprises of all time on AOL Music. (http://music.aol.com/grammys/pictures/never-won-a-grammy?NCID=aolcmp003000000025 48) From msfirst at gmail.com Sat Feb 2 13:21:57 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Sat Feb 2 13:21:55 2008 Subject: [HSF] LIMA harvest- extra pleural haematoma In-Reply-To: <846282.88144.qm@web35903.mail.mud.yahoo.com> References: <846282.88144.qm@web35903.mail.mud.yahoo.com> Message-ID: <3620DC7A-DDED-4C47-966F-E14D28BF5F74@gmail.com> how do you divide the branches - bovie? clips? harmonic? who takes your IMA? are you extubating in the OR or right away? if I find a lot of mediastinal fat/tissue in that area, I will pack with a little fibrillar, which combined with the positive pressure from the vent, will help tamponade any smaller bleeders -michael On Feb 1, 2008, at 7:09 AM, john pj wrote: > > > In the last 2 years we have seen at least 3 times an extra > pleural haematoma at the apex/ upper zone of the left lung after > CABG with LIMA. In one of them it?s extra pleural location was > confirmed with CT and took 3 months to clear radiologically > > We suspect that it could be from post op bleeding in to the chest > wall from one of the braches of LIMA. > Any comments about such a complication? > > > > > > > --------------------------------- > Be a better friend, newshound, and know-it-all with Yahoo! Mobile. > Try it now. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Sat Feb 2 15:00:15 2008 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Sat Feb 2 15:04:43 2008 Subject: [HSF] Failed perimount In-Reply-To: <8CA329E524B4527-734-28CD@webmail-da01.sysops.aol.com> References: <624285.84257.qm@web81602.mail.mud.yahoo.com> <8CA329E524B4527-734-28CD@webmail-da01.sysops.aol.com> Message-ID: <8CA33ED5CD67D7C-B1C-2848@mblk-d32.sysops.aol.com> None ?of the ?various tissue valves I used ?in my life had a ?single mode ?of failure or even a standard time table. For instance the Hancock 1 developed calcification in 25 % of the cases during ?the first ?ten years sometimes with tears along ?the ?margin of ?a ?calcific nodule ?(mean age around 50+) and thereafter went on to develop thinning of the leaflets and tears in the leaflet belly or sometimes ?the ?commissures during ?the second decade and ?even reaching ?the ?third decade in rare cases. ?The Ionescu had early abrasion wear tears in a high proportion of ?cases but ?if it ?escaped ?these went ?on ?to calcify in the ?second ?decade. I had ?one which lasted 23 years. The Perimount ?had rare tears in the ?first ten years with ?calcification developing ?in the second decade. However tears were still possible.? One ?young ?lady had a mechanical at ?19 removed for thromboembolic problems, had a ?first Hancock at ?29 that lasted 14 years and then another ?Hancock that lasted ?8 years (Failures in each case ?dominated by calcification). Bob ? -----Original Message----- From: tdmartin2000@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Thu, 31 Jan 2008 11:01 pm Subject: Re: [HSF] Failed perimount Just before the STS I removed a perimount that I had implanted in 1993 - 15 YRS AGO! ?As you know I have been preaching that these valves almost all fail by calcification and stenosis. Well, this one failed from stress holes in the leaflets and AI with absolutely NO evidence of calcification anywhere on the valve. I will have to say however that it was his 5th valve and the porcine valve I took out in 93 had been in for almost 18 yrs. Tom Martin U of Florida Gainesville -----Original Message----- From: Tea Acuff To: OpenHeart-L Sent: Thu, 31 Jan 2008 10:03 pm Subject: [HSF] STS funny story I don't remember who said this to me. Maybe the guilty party will fess up. We had been at the STS for less than a day and visited with a few of us from HSF. (I'm sure others did the same else where). A few hours later a ran into someone again who reported that so and so had already got his notes out on the HSF. "He really had to get his ideas out. He's got it bad...." Thinking later it reminded me of my second grade observation which I have shared before. "Johnny had his eyes open during the prayer". tea _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- ________________________________________________________________________ More new features than ever. Check out the new AOL Mail ! - http://webmail.aol.com _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- ________________________________________________________________________ More new features than ever. Check out the new AOL Mail ! - http://webmail.aol.com From grescigno at mac.com Sun Feb 3 16:32:02 2008 From: grescigno at mac.com (Macbook) Date: Sun Feb 3 10:35:13 2008 Subject: [HSF] Intimal Tears In-Reply-To: References: Message-ID: <1CE0E1FE-0059-4F3D-A5D2-C4EFD21ED153@mac.com> Nasser, two weeks ago a did an AVR + PFO closure in a quite young woman (about 50). My resident opened the patient and did a large opening of the right pleura. At the end of the procedure I sucked almost 1 liter of blood from the right pleural cavity (I said to myself that this was blood collected during the operation). The day after the patient was extubated and well but there was still some bleeding from the right chest tube. The patient was reexplored by a collegue who found nothing. The patient continued to bleed and on postop day 2 I reexplored the woman. I found a bleeding spot from the apex of the parietal pleura. It was clearly related to the IJV catheter but the anesthesist said that it was related to surgery!!! BTW I put two stitches and stopped the bleeding. However, as the blood was quite red and I was worried about an arterial lesion I asked the vascular surgeon to do an intraoperative arteriography that was negative. The patient luckily did very well. We all make mistakes but it is nice to admit them. Giuseppe Il giorno 01/feb/08, alle ore 07:59, Nasser F. Abou'Seada ha scritto: > "Frankly, I'm surprised I've never encountered this complication > until now" > > Hal > That adds to your critical observance as a surgeon, recognizing the > fault > first time seeing it. I faced that situation before in a 55 y old > female > having a straight forwards Mitral repair. everything went smoothly > yet there > was some bleeding welling up in the pericardium, that we could not > come off > bypass ........ all manouvres to find out the source of bleeding were > evading ..... blood seemed to come from around the SVC upper part, > where > nothing was ever touched .... patient passed off after some 5 hours on > bypass and blood thinning out. On table autopsy, I dissected around > the SVC > up to the IJV.... to find the whole area bathing in blood, > ecchymosed .... > and blood perculating through the wall of the vein .. down the > sheath .... > around the SVC ..... into the pericardium .. !! .... opening the vein > longitudinally, multiple non peneterating longitudinal tears were > found in > the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly > appointed anaesthesiologist tried many times before securing the > IJV cannula > in place .... as usual ... mortality was ascribed to the > surgeon .... !!!! > ... a new lesson with a hard price ..!! .. never forgotten .. > > NFA > > > > > > > On Jan 31, 2008 7:09 PM, wrote: > >> Don, >> My assistant is pretty strong, but I'm not blaming him. >> Frankly, I'm >> surprised I've never encountered this complication until now. >> >> Hal >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Sun Feb 3 10:55:55 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Feb 3 10:56:27 2008 Subject: [HSF] Intimal Tears Message-ID: <47a5e40f.1aab7e0a.3295.168a@mx.google.com> We are the only ones who do procedures which result in complications. You should know that by now. By the way - what did you tell the family? Michael Firstenberg -----Original Message----- From: "Macbook" To: OpenHeart-L@lists.hsforum.com Sent: 2/3/2008 10:32 AM Subject: Re: [HSF] Intimal Tears Nasser, two weeks ago a did an AVR + PFO closure in a quite young woman (about 50). My resident opened the patient and did a large opening of the right pleura. At the end of the procedure I sucked almost 1 liter of blood from the right pleural cavity (I said to myself that this was blood collected during the operation). The day after the patient was extubated and well but there was still some bleeding from the right chest tube. The patient was reexplored by a collegue who found nothing. The patient continued to bleed and on postop day 2 I reexplored the woman. I found a bleeding spot from the apex of the parietal pleura. It was clearly related to the IJV catheter but the anesthesist said that it was related to surgery!!! BTW I put two stitches and stopped the bleeding. However, as the blood was quite red and I was worried about an arterial lesion I asked the vascular surgeon to do an intraoperative arteriography that was negative. The patient luckily did very well. We all make mistakes but it is nice to admit them. Giuseppe Il giorno 01/feb/08, alle ore 07:59, Nasser F. Abou'Seada ha scritto: > "Frankly, I'm surprised I've never encountered this complication > until now" > > Hal > That adds to your critical observance as a surgeon, recognizing the > fault > first time seeing it. I faced that situation before in a 55 y old > female > having a straight forwards Mitral repair. everything went smoothly > yet there > was some bleeding welling up in the pericardium, that we could not > come off > bypass ........ all manouvres to find out the source of bleeding were > evading ..... blood seemed to come from around the SVC upper part, > where > nothing was ever touched .... patient passed off after some 5 hours on > bypass and blood thinning out. On table autopsy, I dissected around > the SVC > up to the IJV.... to find the whole area bathing in blood, > ecchymosed .... > and blood perculating through the wall of the vein .. down the > sheath .... > around the SVC ..... into the pericardium .. !! .... opening the vein > longitudinally, multiple non peneterating longitudinal tears were > found in > the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly > appointed anaesthesiologist tried many times before securing the > IJV cannula > in place .... as usual ... mortality was ascribed to the > surgeon .... !!!! > ... a new lesson with a hard price ..!! .. never forgotten .. > > NFA > > > > > > > On Jan 31, 2008 7:09 PM, wrote: > >> Don, >> My assistant is pretty strong, but I'm not blaming him. >> Frankly, I'm >> surprised I've never encountered this complication until now. >> >> Hal >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 grescigno at mac.com Sun Feb 3 17:02:54 2008 From: grescigno at mac.com (Macbook) Date: Sun Feb 3 11:05:59 2008 Subject: [HSF] Intimal Tears In-Reply-To: <47a5e40f.1aab7e0a.3295.168a@mx.google.com> References: <47a5e40f.1aab7e0a.3295.168a@mx.google.com> Message-ID: <7C247E41-CDE9-4210-B9C7-64A788623D05@mac.com> Michael, I said that there was a bleeding I was unable to explain... they were very kind and trusty Il giorno 03/feb/08, alle ore 16:55, Michael Firstenberg ha scritto: > We are the only ones who do procedures which result in > complications. You should know that by now. > > By the way - what did you tell the family? > > > Michael Firstenberg > > -----Original Message----- > From: "Macbook" > To: OpenHeart-L@lists.hsforum.com > Sent: 2/3/2008 10:32 AM > Subject: Re: [HSF] Intimal Tears > > Nasser, > > two weeks ago a did an AVR + PFO closure in a quite young woman > (about 50). My resident opened the patient and did a large opening of > the right pleura. At the end of the procedure I sucked almost 1 liter > of blood from the right pleural cavity (I said to myself that this > was blood collected during the operation). The day after the patient > was extubated and well but there was still some bleeding from the > right chest tube. The patient was reexplored by a collegue who found > nothing. The patient continued to bleed and on postop day 2 I > reexplored the woman. I found a bleeding spot from the apex of the > parietal pleura. It was clearly related to the IJV catheter but the > anesthesist said that it was related to surgery!!! BTW I put two > stitches and stopped the bleeding. However, as the blood was quite > red and I was worried about an arterial lesion I asked the vascular > surgeon to do an intraoperative arteriography that was negative. The > patient luckily did very well. We all make mistakes but it is nice to > admit them. > > Giuseppe > > > Il giorno 01/feb/08, alle ore 07:59, Nasser F. Abou'Seada ha scritto: > >> "Frankly, I'm surprised I've never encountered this complication >> until now" >> >> Hal >> That adds to your critical observance as a surgeon, recognizing the >> fault >> first time seeing it. I faced that situation before in a 55 y old >> female >> having a straight forwards Mitral repair. everything went smoothly >> yet there >> was some bleeding welling up in the pericardium, that we could not >> come off >> bypass ........ all manouvres to find out the source of bleeding were >> evading ..... blood seemed to come from around the SVC upper part, >> where >> nothing was ever touched .... patient passed off after some 5 >> hours on >> bypass and blood thinning out. On table autopsy, I dissected around >> the SVC >> up to the IJV.... to find the whole area bathing in blood, >> ecchymosed .... >> and blood perculating through the wall of the vein .. down the >> sheath .... >> around the SVC ..... into the pericardium .. !! .... opening the vein >> longitudinally, multiple non peneterating longitudinal tears were >> found in >> the intima of the RIJV ... !!!! ... inquiring in retrospect, the >> newly >> appointed anaesthesiologist tried many times before securing the >> IJV cannula >> in place .... as usual ... mortality was ascribed to the >> surgeon .... !!!! >> ... a new lesson with a hard price ..!! .. never forgotten .. >> >> NFA >> >> >> >> >> >> >> On Jan 31, 2008 7:09 PM, wrote: >> >>> Don, >>> My assistant is pretty strong, but I'm not blaming him. >>> Frankly, I'm >>> surprised I've never encountered this complication until now. >>> >>> Hal >>> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 battr at medizin.uni-leipzig.de Sun Feb 3 17:23:25 2008 From: battr at medizin.uni-leipzig.de (Dr. Roberto Battellini) Date: Sun Feb 3 11:14:43 2008 Subject: AW: [HSF] Intimal Tears In-Reply-To: <1CE0E1FE-0059-4F3D-A5D2-C4EFD21ED153@mac.com> References: <1CE0E1FE-0059-4F3D-A5D2-C4EFD21ED153@mac.com> Message-ID: <004e01c86681$1a540f30$b3160a06@HZLPC0679> Giuseppe, I had the same experience twice. But if you open the pleura and look at the haematoma, you will recognize the problem. Of course, the one who put the catheter will not...It is a not uncommon complication of jugular indwelling catheters. I agree, it is better for the patient to admit errors. Roberto -----Urspr?ngliche Nachricht----- Von: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Macbook Gesendet: Sonntag, 3. Februar 2008 16:32 An: OpenHeart-L@lists.hsforum.com Betreff: Re: [HSF] Intimal Tears Nasser, two weeks ago a did an AVR + PFO closure in a quite young woman (about 50). My resident opened the patient and did a large opening of the right pleura. At the end of the procedure I sucked almost 1 liter of blood from the right pleural cavity (I said to myself that this was blood collected during the operation). The day after the patient was extubated and well but there was still some bleeding from the right chest tube. The patient was reexplored by a collegue who found nothing. The patient continued to bleed and on postop day 2 I reexplored the woman. I found a bleeding spot from the apex of the parietal pleura. It was clearly related to the IJV catheter but the anesthesist said that it was related to surgery!!! BTW I put two stitches and stopped the bleeding. However, as the blood was quite red and I was worried about an arterial lesion I asked the vascular surgeon to do an intraoperative arteriography that was negative. The patient luckily did very well. We all make mistakes but it is nice to admit them. Giuseppe Il giorno 01/feb/08, alle ore 07:59, Nasser F. Abou'Seada ha scritto: > "Frankly, I'm surprised I've never encountered this complication > until now" > > Hal > That adds to your critical observance as a surgeon, recognizing the > fault > first time seeing it. I faced that situation before in a 55 y old > female > having a straight forwards Mitral repair. everything went smoothly > yet there > was some bleeding welling up in the pericardium, that we could not > come off > bypass ........ all manouvres to find out the source of bleeding were > evading ..... blood seemed to come from around the SVC upper part, > where > nothing was ever touched .... patient passed off after some 5 hours on > bypass and blood thinning out. On table autopsy, I dissected around > the SVC > up to the IJV.... to find the whole area bathing in blood, > ecchymosed .... > and blood perculating through the wall of the vein .. down the > sheath .... > around the SVC ..... into the pericardium .. !! .... opening the vein > longitudinally, multiple non peneterating longitudinal tears were > found in > the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly > appointed anaesthesiologist tried many times before securing the > IJV cannula > in place .... as usual ... mortality was ascribed to the > surgeon .... !!!! > ... a new lesson with a hard price ..!! .. never forgotten .. > > NFA > > > > > > > On Jan 31, 2008 7:09 PM, wrote: > >> Don, >> My assistant is pretty strong, but I'm not blaming him. >> Frankly, I'm >> surprised I've never encountered this complication until now. >> >> Hal >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Michael.Crittenden at va.gov Sun Feb 3 11:40:34 2008 From: Michael.Crittenden at va.gov (Crittenden, Michael) Date: Sun Feb 3 11:42:05 2008 Subject: [HSF] STS funny story In-Reply-To: <624285.84257.qm@web81602.mail.mud.yahoo.com> References: <624285.84257.qm@web81602.mail.mud.yahoo.com> Message-ID: <4130F1CC8938984AA557B3A0CB875D66043916D9@VHAV01MSGA1.v01.med.va.gov> Tea, I remember saying that to you in the exhibition hall the next day. Perhaps there were others. My natural paranoia drives me to keep track of work email while away. I was amazed at Bill Novick's and Mike Firstenberg's on-going prolific postings despite having had as much red meat and wine as I did the night before at the HSF Dinner. Mike Crittenden -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Tea Acuff Sent: Thursday, January 31, 2008 10:03 PM To: OpenHeart-L Subject: [HSF] STS funny story I don't remember who said this to me. Maybe the guilty party will fess up. We had been at the STS for less than a day and visited with a few of us from HSF. (I'm sure others did the same else where). A few hours later a ran into someone again who reported that so and so had already got his notes out on the HSF. "He really had to get his ideas out. He's got it bad...." Thinking later it reminded me of my second grade observation which I have shared before. "Johnny had his eyes open during the prayer". tea _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Sun Feb 3 12:15:10 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Feb 3 12:15:41 2008 Subject: [HSF] Intimal Tears In-Reply-To: <004e01c86681$1a540f30$b3160a06@HZLPC0679> References: <1CE0E1FE-0059-4F3D-A5D2-C4EFD21ED153@mac.com> <004e01c86681$1a540f30$b3160a06@HZLPC0679> Message-ID: Right before the STS, I took a partners patient back for a huge right hemothorax. He was 2 weeks post-op (double valve endocarditis), doing fine, and the only thing recent was a new right neck line by the Cardiology team (he was waiting for a pacemaker on their service.....long story and not for now) Which begs the question - if Anesthesia hits the carotid (finder needle, introducer, whatever) - will people postpone the case? (I know an open and vague question - but am interested in the responses) -michael On 2/3/08, Dr. Roberto Battellini wrote: > > Giuseppe, > I had the same experience twice. But if you open the pleura and look at > the > haematoma, you will recognize the problem. Of course, the one who put the > catheter will not...It is a not uncommon complication of jugular > indwelling > catheters. > I agree, it is better for the patient to admit errors. > Roberto > > -----Urspr?ngliche Nachricht----- > Von: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Macbook > Gesendet: Sonntag, 3. Februar 2008 16:32 > An: OpenHeart-L@lists.hsforum.com > Betreff: Re: [HSF] Intimal Tears > > Nasser, > > two weeks ago a did an AVR + PFO closure in a quite young woman > (about 50). My resident opened the patient and did a large opening of > the right pleura. At the end of the procedure I sucked almost 1 liter > of blood from the right pleural cavity (I said to myself that this > was blood collected during the operation). The day after the patient > was extubated and well but there was still some bleeding from the > right chest tube. The patient was reexplored by a collegue who found > nothing. The patient continued to bleed and on postop day 2 I > reexplored the woman. I found a bleeding spot from the apex of the > parietal pleura. It was clearly related to the IJV catheter but the > anesthesist said that it was related to surgery!!! BTW I put two > stitches and stopped the bleeding. However, as the blood was quite > red and I was worried about an arterial lesion I asked the vascular > surgeon to do an intraoperative arteriography that was negative. The > patient luckily did very well. We all make mistakes but it is nice to > admit them. > > Giuseppe > > > Il giorno 01/feb/08, alle ore 07:59, Nasser F. Abou'Seada ha scritto: > > > "Frankly, I'm surprised I've never encountered this complication > > until now" > > > > Hal > > That adds to your critical observance as a surgeon, recognizing the > > fault > > first time seeing it. I faced that situation before in a 55 y old > > female > > having a straight forwards Mitral repair. everything went smoothly > > yet there > > was some bleeding welling up in the pericardium, that we could not > > come off > > bypass ........ all manouvres to find out the source of bleeding were > > evading ..... blood seemed to come from around the SVC upper part, > > where > > nothing was ever touched .... patient passed off after some 5 hours on > > bypass and blood thinning out. On table autopsy, I dissected around > > the SVC > > up to the IJV.... to find the whole area bathing in blood, > > ecchymosed .... > > and blood perculating through the wall of the vein .. down the > > sheath .... > > around the SVC ..... into the pericardium .. !! .... opening the vein > > longitudinally, multiple non peneterating longitudinal tears were > > found in > > the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly > > appointed anaesthesiologist tried many times before securing the > > IJV cannula > > in place .... as usual ... mortality was ascribed to the > > surgeon .... !!!! > > ... a new lesson with a hard price ..!! .. never forgotten .. > > > > NFA > > > > > > > > > > > > > > On Jan 31, 2008 7:09 PM, wrote: > > > >> Don, > >> My assistant is pretty strong, but I'm not blaming him. > >> Frankly, I'm > >> surprised I've never encountered this complication until now. > >> > >> Hal > >> > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 grescigno at mac.com Sun Feb 3 18:16:35 2008 From: grescigno at mac.com (Macbook) Date: Sun Feb 3 12:19:37 2008 Subject: [HSF] Intimal Tears In-Reply-To: References: <1CE0E1FE-0059-4F3D-A5D2-C4EFD21ED153@mac.com> <004e01c86681$1a540f30$b3160a06@HZLPC0679> Message-ID: <5A9D8EB4-8EBE-4DE9-A644-71494612B020@mac.com> We don't. They change side while someone makes some compression on the neck. Il giorno 03/feb/08, alle ore 18:15, Michael Firstenberg ha scritto: > Right before the STS, I took a partners patient back for a huge right > hemothorax. He was 2 weeks post-op (double valve endocarditis), > doing fine, > and the only thing recent was a new right neck line by the > Cardiology team > (he was waiting for a pacemaker on their service.....long story and > not for > now) > > Which begs the question - if Anesthesia hits the carotid (finder > needle, > introducer, whatever) - will people postpone the case? > (I know an open and vague question - but am interested in the > responses) > > > > > -michael > > > On 2/3/08, Dr. Roberto Battellini