[HSF] Occluded SVC

Thu Jan 31 18:27:57 EST 2008

"1st:
How can the contemplative cardiologist can put a stent with two wires in the
SVC, only splating them between the stent and the SVC wall. (Beatiful for an
eventual catheter extraction!)
2nd:
If the patient from a clinical standpoint is doing well, why the
contemplative cardiologist wants to be more aggressive than the former
surgeon?"

Gustavo:
Good Questions ....
probably as the case will be scored against the surgeon at the end ......
while just serve the cardiologist another BILL-Opportunity ...!!!!

NFA

On Jan 31, 2008 11:34 PM, gustavo abuin <gabuin at intramed.net> wrote:

> 1st:
> How can the contemplative cardiologist can put a stent with two wires in
> the
> SVC, only splating them between the stent and the SVC wall. (Beatiful for
> an
> eventual catheter extraction!)
> 2nd:
> If the patient from a clinical standpoint is doing well, why the
> contemplative cardiologist wants to be more aggressive than the former
> surgeon?
>
>
> ----- Original Message -----
> From: "Nasser F. Abou'Seada" <nfaabouseada at gmail.com>
> To: <OpenHeart-L at lists.hsforum.com>
> Sent: Thursday, January 31, 2008 7:22 AM
> Subject: Re: [HSF] Occluded SVC
>
>
> > Dear Hal
> > what is meant by "non-circumferential intimal tears" ... ? .... you
> > mentioned a "substantial venous blood coming from beneath the SVC and
> IVC"
> > ...... through perculation you mean ! ....I did have that situation
> before
> > in the IJV caused by a faulty trial of insertion of an IJV Cannula by
> the
> > anaesthesiologist ..... diagnosed PM !!!! .........   how could you
> > determine the sites of the tears ??? ..... . what sort of external
> > suturing
> > and sutures did you apply there ?? .... To which "side" of the SVC / IVC
> > the sutures were applied ??? ?? .... I mean median? lateral? posterior
> ???
> > ... were these under vision or blind stitches ??? . .... how
> > "circumferential" were the stitches ??? ..... did any of these stitches
> > has
> > purse string effects on the lateral wall ??? ....  Do you feel that the
> > SVC
> > have become stenotic - dysfigured thereafter? ??? .....
> >
> > When did the patient present postop with signs of SVC obstruction  ?
> ....
> > thrombosis is unlikely to form postoperatively should coumadin have been
> > instituted for the AVR ..... even with a dysfigured wall ...  .
> > obstruction
> > then would be from another reason .... again .... do you feel it was
> > stenotic - disfigured after your stitches ?? ...
> >
> > else-wise .... Was the pacemaker transvenous ??? .... any possibility
> that
> > its insertion might have been the exciting factor in the obstruction
> ????
> > deploying a stent here might just complicate the situation ..!!!
> > Sure the patient has got a gradient across the SVC .......... that can
> be
> > multifactorial ........ still ,.. his drainage is compensating and time
> is
> > in his favour .....
> > I would consider, in case of any doubt of thrombus, a targeted catheter
> > induced thrombolysis, otherwise I would - should I feel it is a stenotic
> > rather than thrombotic problem - go on and insert an onlay patch-plasty
> > ....
> >
> > Complicated operations have been undertaken for much trivial reasons !!!
> >
> > Good luck with your case .....
> >
> > Ani ??? .... comments ????
> >
> > NFA
> >
> >
> >
> > On Jan 31, 2008 6:11 AM, <Hgrmd at aol.com> wrote:
> >
> >> Dear Members,
> >>  First, it was such a pleasure to meet several of you for the first
>  time
> >> at
> >> the HSF dinner.
> >>  I need some urgent advice.  About 2 weeks ago, I did a redo  AVR,
> mitral
> >> repair, tricuspid repair, Cox-maze on a 75 yo man.  Intraop,  while
> >> retracting
> >> the atrial septum for the work in the LA, noncircumferential  intimal
> >> tears
> >> developed on both the SVC and IVC.  I could tell because  there was
> >> substantial
> >> venous blood coming from underneath the SVC and IVC.   I was able to
> >> repair
> >> both with external suturing.  The rest of the case  went well.  About a
> >> week
> >> later, we inserted a DDD pacemaker (the patient  had been in continuous
> >> AF
> >> for
> >> years).  A few days later, he developed  severe facial and upper
> >> extremity
> >> swelling.  Workup reveals he has an  occluded SVC.  The cardiologist
> took
> >> him to the
> >> lab and measured a 30 mm  gradient across the SVC.  The patient is
> >> ambulating
> >> well and generally  feels OK, but he has the persistent swelling.
>  There
> >> is
> >> no evidence of  symptomatic intracranial swelling or upper airway
> >> compromise.
> >> The  cardiologist insists something must be done.  I'm reluctant to
> have
> >> a
> >> stent  deployed in a fresh heart.  The surgical option would be to
> >> extract
> >> the
> >> thrombus on CPB and patch the SVC.  My question is:  Is it  justified?
> >>
> >> 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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