[HSF] Aortic Valve Stenosis and Carotid Stenosis

[Tea Acuff]

We recently did a similar case status post CABG several years ago. I did each carotid a couple of days apart and the the patient (who was elderly siad uncel and we gave him a week or so prior to redo sterntomy for AVR. This is what i do for CAB and carotids also. I see no clear difference in the face of no documented difference.

tea 


----- Original Message ----
From: "Douville, Chuck" <ecdouville at orclinic.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, January 21, 2008 10:17:31 PM
Subject: RE: [HSF] Aortic Valve Stenosis and Carotid Stenosis

Ed interesting question. I personally would stage the carotids, about 3 days apart and do the valve shortly thereafter. We have had good results with combining urgent carotids with CABG but have no experience with your situation. I would stage them because of the literature we are all familiar with, no other (better) reason. chuck

________________________________

From: openheart-l-bounces at lists.hsforum.com on behalf of zzhoumd at pol.net
Sent: Mon 1/21/2008 8:07 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Aortic Valve Stenosis and Carotid Stenosis




In a asymptomatic patient, the stroke rate is low whatever you do probably not much of difference either way.

Sent via BlackBerry by AT&T

-----Original Message-----
From: Edward Bender <ebender001 at charter.net>

Date: Mon, 21 Jan 2008 21:07:47
To:OpenHeart-L <OpenHeart-L at hsforum.com>
Subject: [HSF] Aortic Valve Stenosis and Carotid Stenosis


I'd be interested in the members' opinions about the following 
patient.  She is a 74 year old diabetic patient admitted to an outside 
hospital with chest pain and class 2 heart failure symptoms.  She 
underwent echo and cardiac cath showing trivial coronary artery 
disease (50% LAD at most), 50 mmHg gradient across the aortic valve, 
normal LV function.  The indexed valve area is 0.4.  She underwent 
carotid dopplers due to a bruit.  This showed over 80% stenosis in 
both internal carotid arteries.  She is left dominant.  I repeated the 
cardiac and carotid echos in our hospital and the outside studies are 
supported by our studies.  The outside cath did not include an LV 
gram, and I see no attempt to have crossed the aortic valve.

The patient is a relative of one of our local physicians, and she is 
now an outpatient on appropriate medical therapy.  Although I think 
that she will need AVR, I do not think it is an urgent requirement.  
The outside hospital cardiologist said she needed 3 bypasses and an 
aortic valve next week, and that he would have a surgeon come down 
from a major midwestern university to do the operation at their 
hospital (itinerant surgery).  Needless to say, after the patient was 
discharged on medical therapy, the local physician took his relative 
out of that hospital system.

I was planning to do a left carotid endarterectomy, followed by a 
right carotid when the patient is feeling well and recovered.  Any 
thoughts about doing the aortic valve at the time of the second 
carotid surgery?  I do this alot with coronaries (I think we had 
several discussions about this topic), but have not had the same 
scenario with valvular heart disease in the absence of important 
carotid disease.

Ed Bender, MD
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