[HSF] Aortic Valve Stenosis and Carotid Stenosis

[erdinç naseri]

Dear Dr. Wetheimer,
This week I am going to operate on a  symptomatic patient( repeated CVA in 3 months ) with complete occlusion of R ICA and 90% stenosis of very short segment of L CCA bifurcation. The L sided system is very dilated . I was wondering whethet I can by-pass to L ICA if it is suitable intraoperatively. If not , I am concerned about the clamping of the L system even for shunt insertion.He has diffuse atherosclerosis and has been operated for CAD and peripheral arterial diseases by us.
erdinc> Subject: RE: [HSF] Aortic Valve Stenosis and Carotid Stenosis> Date: Tue, 22 Jan 2008 08:14:51 -0600> From: mwertheimer at mahealthcare.com> To: OpenHeart-L at lists.hsforum.com> CC: > > I agree with this opinion. I do a large number of carotid surgeries and> even with a total occlusion on the contralateral side we can clamp the> carotid artery without shunting and very rarely did we ever see any> suppression on the contralateral side. The circle of Willis is a> marvelous structure. Most cerebral events related to carotid disease> our embolic and have virtually nothing to do with full reduction through> the stenoses. I would think that a patient with significant aortic> stenosis and symptoms of chest pain and congestive failure really needs> to have her aortic valve done first. I would address her asymptomatic> carotid disease when she has recovered from the aortic valve surgery.> > -----Original Message-----> From: openheart-l-bounces at lists.hsforum.com> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of> zzhoumd at pol.net> Sent: Monday, January 21, 2008 10:08 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> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/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 at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------