[HSF] surgical ventricular restoration

Tea Acuff tacuff at swbell.net
Fri Jan 11 20:20:04 EST 2008 

A software read is always more self consistent, but an edit is always necessary to confirm that the analysis in some sense is "consistent" with a general gestalt. Whether the review of a film or review of the "relevant" literature the meaning is always an interpretation through past understanding. We "learn" to trust tools not just others interpretations as we master a subject.
 
tea


----- Original Message ----
From: Prasanna Simha M <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, January 11, 2008 10:01:57 PM
Subject: Re: [HSF] surgical ventricular restoration

By the radiologists ability to read I meant is consistent reporting possible
? (Not the "radiologist" per se but more correctly the "reader") ie the
estimates given etc are consistently reliable to all "standardized" or
"mean" "average" reader ?

Prasanna
On Jan 12, 2008 9:22 AM, Tea Acuff <tacuff at swbell.net> wrote:

> One can let the radiologist read the study and charge for it, but that
> really misses the point. It would be like letting the radiologist (or
> cardiologist) read your angiograms, CXR, echo's etc. So what? Do they tell
> you what operation is necessary, or if it is nescessry?
>
> There is also software that a tech can analyze the data and you (or a
> radiologist) can edit for the formal analysis, biometrics (eg volumes, scar
> area or mass or whatever you like). This will allow objective decision
> making for pre and post op review.
>
> tea
>
>
>
>
>
> ----- Original Message ----
> From: Prasanna Simha M <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Friday, January 11, 2008 9:49:22 AM
> Subject: Re: [HSF] surgical ventricular restoration
>
> How much of this data is "radiologist opinion" dependent and actually
> independently measurable. (I have no real experience of cardiac MR and it
> is
> educational). As an aside my nuclear cardiologist is giving the same
> information with the current SPET scans including volume rendering ,
> functional analysis etc etc and RV function.There is software on which he
> reconstructs the ventriculogram  with wall motion scores etc based on the
> scintigraphic data.
> Prasanna
>
> On Jan 11, 2008 9:11 PM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
> > Tea can answer in detail but in summary it gives information about both
> > structure (anatomy), function and viability. You can work out the
> dyskinetic
> > area, work out the ventricular dimensions and volumes (to justify need
> for
> > SVR, work out the volume contributed to by the aneurysm or dyskinetic
> area,
> > work out a true ejection fraction, work out the residual ventricular
> volume
> > to expect after resection of the dyskinetic area and indeed work out how
> > much you can safely resect (so as not to end up with too small a
> ventricle -
> > for example if by MRI you computed that a patient will be left with a
> > ventricular volume of 80mls (extreme just for illustration) then you
> would
> > not do the procedure). Obviously you can also easily confirm what is
> scar
> > and what is not and what is viable and what is not. Also you can measure
> the
> > RV ejection fraction which is a prognostic marker for survivability in
> these
> > cases. Post op MRI will demonstrate one has achieved the set objective
> by
> > beautifully showing restoration of the elliptical shape to the heart,
> > elimination/reduction of the dyskinetic or akinetic segment, reduced
> > ventricular volume and improved function etc etc
> >
> > It is difficult to explain but once you start using MRIs you will wonder
> > how you actually survived without them and will place far more value on
> them
> > than you will the echocardiogram or cineventriculogram.
> >
> > Ani
> >
> >
> >
> > > Date: Fri, 11 Jan 2008 20:57:07 +0530> From: prasannasimha at gmail.com>
> > To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] surgical
> ventricular
> > restoration> CC: > > I have one question what is so magical about a
> cardiac
> > MRI versus say a> radionucliide scan ?> Prasanna> > On Jan 11, 2008 8:35
> PM,
> > Ani Anyanwu <anianyanwu at hotmail.com> wrote:> > > Hal> >> > Some would
> > argue though that without cardiac MRI you cannot be doing the> > careful
> > pre-op evaluation that you recommend.> >> > I agree though that the
> > procedure can be effective but I would not go so> > far as using the
> > miraculous improvements in EF as evidence of such. Such> > improvements
> were
> > also seen with cardiomyoplasty and Batista or indeed CABG> > alone so I
> > would not go so far as saying the improvements are dramatic and> > it
> > implies procedure is 'highly effective'. If it was that effective it> >
> > would have been unethical to randomize patients in the STITCH trial and
> I> >
> > personally have not heard of any IRB or ethics committee that refused> >
> > participation in the STITCH trial because the procedure is 'highly> >
> > effective' so would be unethical to deny patients.> >> > Remember also
> as
> > per our previous discussions the best way to get good> > results with
> the
> > SVR (and which is why many are sceptical of the data from> > Europe) is
> to
> > operate on patients who do not need it - any high risk low EF> > CABG
> just
> > do an SVR and of course results will be good (they would also be> > good
> > without an SVR) - and that is my problem with the marketing of the> >
> > procedure as centers offer this without the essential preop evaluation
> you>
> > > mentioned. These are different from the typical patients you would do
> an
> > SVR> > on but I suspect if you look countrywide it is these patients
> > (questionable> > indication) that prevail in SVR series.> >> > What if
> (as I
> > suspect) the STITCH trial reports and shows no survival> > difference
> > between SVR and CABG alone (or even worse lower survival with> > SVR)
> will
> > you then revise your opinion or will you (as we surgeons do)> > ignore
> the
> > data and still believe what you currently believe?> >> > Ani> >> >> >>
> >> >
> > > From: Hgrmd at aol.com> Date: Fri, 11 Jan 2008 07:15:16 -0500> Subject:
> > Re:> > [HSF] surgical ventricular restoration> To:
> > OpenHeart-L at lists.hsforum.com>> > CC: > > Tea,> I agree with you (for
> > once) about SVR. Ani sees failed ones,> > and thus > probably has a
> skewed
> > view of its efficacy. I've successfully> > done SVR's on > lots of
> patients
> > with global EF's of 10-15%. They often have> > remote postop EF's > in
> the
> > 30-40% range and become essentially> > asymptomatic. SVR is no gimmick.
> >
> > However, it is a dangerous operation> > (I've killed a couple) that
> requires
> > > careful preop and intraop evaluation> > in order to get a good
> result.> >
> > Hal> > > > **************Start the year> > off right. Easy ways to stay
> in
> > shape. >> >
> > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489>>
> >
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Prasanna Simha M
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