[HSF] Sympathy anyone.......

Fri May 2 11:45:41 EDT 2008

Ani,
I am not being to critical on the Cardiologists for this - they also were
handed a problem.  The guy did not have a huge aneurysm so his CXR was not
all that unusual.  The drugs were given by the ED folks - I am critical of
them, but that is nothing new.  I am not sure that all of the drugs that he
got were consistent with current ACC/ACS guidelines.

Guilty of taking a 52 year/old with Marfanoid features, no other past
medical/surgical history with an obviously ascending dissection from just
above his root to his iliac with involvement of his renals/SMA emergently to
the operating room?  (while we were waiting for an OR we did run him thru
the CT scanner - of course.... A for airway, B for breathing, and C for CT
scan).    I would have done the same even he got tPA (which we have done) -
he was stable with a very unstable and unpredictable and lethal problem (if
he had arrested then he would have died).  Does the delayed management
protocols which people refer to applied to Marfans?  I had a diagnosis, a
good operative candidate, and relied on well established standard of care -
we deal with bleeding problems all of the time.  Yes it sucks - but so does
death.  I am a little surprise that there are people who are so afraid of
these "routine" drugs that they are willing to risk major morbidity and
mortality in waiting for them to wear off.

Who would have waited?    and for how long?

With regards to the AVR - I am referring to Marfans/connective tissue
patients - I think there is enough data to support that these patients (like
mine) have abnormal valves also.  While a Bentall would have been a good
option in him, everything was falling apart and I was afraid that doing
anything to the coronaries (which were not involved with the dissection)
would make a bad problem worse.  He got a lot of felt.

So far, no TRALI - which we see sometimes.  He did not get "that much" -
probably 10x5 platelets, <10 U PRBc, 8 u FFP, 2 cryo, and a single dose of
Factor VII - which he really liked.  Getting him warms and dark also really
help.  This is what I usually use on my elective CABGs (I dont use cryo on
the off-pumps though)........

I am very much aware of the long-term I.D. issues of blood - we had a
patient last year who got a transfusion from a donor who, after he donated
came back a few months later to donate again, who sero-converted to HIV.
That scared us.  But, to have long term survivors, you need to have short
term survivors.

-michael

On 5/2/08, Dr. Roberto Battellini <battr at medizin.uni-leipzig.de> wrote:
>
> Michael,
>
> You are late!
> Tommy Walther has done "valve in a valve" twice. It seems very easy!
> Roberto
>
> -----Ursprüngliche Nachricht-----
> Von: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Michael
> Firstenberg
> Gesendet: Donnerstag, 1. Mai 2008 03:20
> An: OpenHeart-L at lists.hsforum.com
> Betreff: Re: [HSF] Sympathy anyone.......
>
> 25mm Perimount
>
> I figured that coumadin would be a disaster (his tissues were crap... I am
> going to work him up for a connective tissue disorder), but I never want
> to
> be in his chest again (dont we always say that?) and I figure Edwards will
> be the most likely company to have a Perc AVR that will fit in one of
> their
> valves in a few years when he needs a redo......then again, maybe by then
> I
> will have forgotten how painful it was the first time - although a redo
> maybe not be all that bad (wait a minute... I need my head
> examined).......
>
> -michael
>
>
> On 4/30/08, zzhoumd at pol.net <zzhoumd at pol.net> wrote:
> >
> >
> > What valve did you give him?
> >
> >
> >
> > Sent via BlackBerry by AT&T
> >
> > -----Original Message-----
> > From: "Michael Firstenberg" <msfirst at gmail.com>
> >
> > Date: Wed, 30 Apr 2008 21:26:16
> > To:OpenHeart-L at lists.hsforum.com <To%3AOpenHeart-L at lists.hsforum.com> <
> To%3AOpenHeart-L at lists.hsforum.com <To%253AOpenHeart-L at lists.hsforum.com>>
> > Subject: [HSF] Sympathy anyone.......
> >
> >
> > 51 year/old.....presented with 4 day history of chest pain.
> > Tall, thin, long fingers....
> > ST changes on ECG.
> > Concern for AMI
> > Given:
> > ASA
> > High dose Plavix
> > Lovenox
> >
> > taken to cath lab
> >
> > found to have Type A dissection from valvue to iliacs........
> >
> >
> > oh, he also got reopro............
> >
> >
> > it has been a long day.
> >
> >
> > -michael
> > _______________________________________________
> > 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
> > -----------------------------------------
> >
> _______________________________________________
> 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
> -----------------------------------------
>