AW: [HSF] Aortic Valve Stenosis and Carotid Stenosis

[Tea Acuff]

One question Roberto. Have you ever had an AVR with an asymptomatic carotid (whether it was noticed preop or not) have a beautiful operation (AVR) only to go home with hemiplegia or aphasia from a perioperative stroke?

tea


----- Original Message ----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, January 23, 2008 6:52:08 PM
Subject: AW: [HSF] Aortic Valve Stenosis and Carotid Stenosis

I remember one case of symptomatic carotid stenosis and severe aortic
stenosis. In 1999, the cardiologists asked to do first the carotid and later
the valve. Well, after a perfect carotid endarterectomy, and extubation of
the patient I went home, he was awake, all OK. Just to come the next day and
be informed he died at night suddenly in acute heart failure because of the
valve. After that case I never more did a carotid first. And before that
case, in the late 80´s  I had 3-4 cases in which I had to perform urgently
coronary surgery after a well done carotid endarterectomy. Now we do all
together if the carotid is 90% or more stenosed or if symptomatic.

So, CAVE of an aortic valve decompensation after carotid endarterectomy.
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von
tdmartin2000 at aol.com
Gesendet: Mittwoch, 23. Januar 2008 03:19
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: [HSF] Aortic Valve Stenosis and Carotid Stenosis


I really think it is dealer's choice in these situations. 



Tom Martin

U of Florida

Gainesville


-----Original Message-----
From: Edward Bender <ebender001 at charter.net>
To: OpenHeart-L <OpenHeart-L at hsforum.com>
Sent: Mon, 21 Jan 2008 10:07 pm
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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