[HSF] A question of conduits

[cysmd613 at aol.com]

Mitch,


?


I would either just graft the LAD using the LIMA without getting any further studies, or have them do an IVUS to see exactly how tight (or not) the LAD stenosis is.


?


Carmi Stadlan










-----Original Message-----

From: Mitch Lirtzman 

To: OpenHeart-L at hsforum.com

Sent: Tue, 25 Mar 2008 10:58 pm

Subject: [HSF] A question of conduits





Let's start a new thread, shall we??

?

A 56yo male, non-diabetic smoker, admitted with NSTEMI. Cath shows total OM with faint distal flow as the culprit. RCA 100% w/ collateral to the PDA. D1 is 90% and LAD 40%-50% at most. LVEF~ 45%. Body habitus is mesomorph bordering on Cajun-porky.?

?

My plan would be skeletonized RIMA to the PDA, try to get the LIMA from D1 to OM and probably leave the LAD alone.?

?

Any thoughts/ contrary opinions??

?

Now, I hope you don't mind my changing directions, but for you "OPCAB-ers" out there, for the last several cases, I've been able to graft every vessel I need to, but for the last two, in positioning for the circ, the BP would just not tolerate the change. Trendelenburg, Rt lateral, volume loading, none of it worked. And "putting the heart into the rt chest", the worst. Any pearls would be happily accepted.?

?

Thanks, Mitch?

?

_______________________________________________?

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?

-----------------------------------------?