AW: [HSF] Aortic Valve Stenosis and Carotid Stenosis

Sun Jan 27 12:21:05 EST 2008

Agreed.

This has been one of the enigmas of neurological defects with, say, CABG, on or off.
 One of the tenets of surgery must be that a patient can not be "caused" harm by not doing. This does not mean that not doing prevents harm. IE a patient may have a stroke but it can not be from the aortic cannula that was not placed.

I agree with not doing often. But are we really ready to say that the whole body of evidence for carotid endartecomy, including the asymptomatic, is bunk? As for symptoms I was trained as a traumas surgeon and am most comfortable with with saving people who are dying or treatening to die. But are we prepared to wait for symptoms? I have been thinking about the implications or your frequent and general argument and I think it is heading medicine in the wrong direction. I will explain why later unless you care to do so yourself.

tea

----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Sunday, January 27, 2008 12:29:50 PM
Subject: RE: AW: [HSF] Aortic Valve Stenosis and Carotid Stenosis

I am sure someone has had such a patient but that is not to say that 1) the asymptomatic carotid caused the stroke or 2) surgery on the asymptomatic carotid would have prevented the stroke.

I am sure there are far many more patients *without* severe carotid disease who had beautiful AVRs and went home hemiplegic and aphasic.

Ani

> Date: Wed, 23 Jan 2008 19:54:48 -0800> From: tacuff at swbell.net> Subject: Re: AW: [HSF] Aortic Valve Stenosis and Carotid Stenosis> To: OpenHeart-L at lists.hsforum.com> CC: > > 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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