[HSF] Mitral ring redux

Sat May 3 19:06:41 EDT 2008

This "concern" came from a very young cardiologist. Very good. Very smart. 
Well trained, but still a little wet...

Having over 25yrs experience on him, I'm sure he'll listen to what I have 
to say. Especially after Thursday's case, the worst infected mitral I've 
ever seen. I'll get the pix and full story to you all soon. He almost 
dropped his dentures when he saw me do that case. More later...

MitchAt 04:04 PM 5/3/2008, you wrote:
>Excellent question.
>This is where your "relationship" and level of trust come into play.  This
>is a two way street.  Do you trust the cardiologist and does the
>cardiologist trust you?  I've found that over the years, there are referring
>docs that yield to my judgment in the care of the patient.  If there are
>disagreements, then there are discussions and a give-and-take.
>On the other hand, there are some physicians to whom I must prove myself on
>each and every case.  Thankfully, after more than 12 years at my hospital,
>these folks are few and far between.
>In some cases, I have changed my treatment options on the basis of what a
>trustworthy cardiologist has discussed with me (and vice versa).  It can be
>an enjoyable (and pseudo-academic exercise).
>
>Ed Bender, MD
>
>
>On 5/3/08 11:37 AM, "Michael Firstenberg" <msfirst at gmail.com> wrote:
>
> > But this does raise an important question of when we get sent patient by
> > cardiologists who want (insist?) on something (or dont want something) that
> > is inconsistent with current thinking.  For example, we previously 
> discussed
> > the whole TR issue.  Sure we want to do the right thing and have literature
> > and experience to back it up....BUT if that is not what our customers (i.e.
> > the cardiologists) want then they will shop elsewhere????
> >
> >
> > -michael
> >
> >
> >
> >
> > On 5/3/08, Edward Bender <ebender001 at charter.net> wrote:
> >>
> >> I'm not sure whether this is in the literature or not, but, my experience
> >> is
> >> that one can divide these types of patients into two groups: those with
> >> important pulmonary hypertension (> 1/2 systemic - my definition) and
> >> those
> >> with no or mild pulmonary hypertension.  Both groups can survive surgery,
> >> but the latter group is a lot easier to deal with post-operatively and, in
> >> my experience, has a better long term outlook.
> >>
> >> As to the pop-off valve theory, we all know it should be consigned to the
> >> trash heap of failed ideas (along with the thought that MR will resolve
> >> after revascularization alone).  These "attitudes" will probably not
> >> change
> >> much. Teach the younger referring doctors and humor the older ones.  Read
> >> Thomas Kuhn's Structure of Scientific Revolutions to understand that
> >> paradigm shifts occur not by educating belief-holders, but by letting the
> >> older tenet holders to die off or retire.
> >>
> >> Ed Bender, MD
> >>
> >>
> >> On 5/2/08 9:48 PM, "Mitch Lirtzman" <drmitch at cox.net> wrote:
> >>
> >>> Please help clarify a point I made concerning mitral repair.
> >>>
> >>> I have a 50yo male smoker with no history of drugs, EtOH, industrial
> >>> exposure, etc, and rather severe CAD. The LAD is previously stented and
> >>> occluded at it's origin. Fills rt-to lt. The Cx has a proximal 90%
> >> lesion.
> >>> RCA normal. EF is 20%. LVEDD~ 7cm. TEE shows moderate MR with a central
> >> jet
> >>> to mid-atrium. Septum and lateral walls still move. Previously refused
> >> by
> >>> another surgeon. They putzed around with him at the local Charity
> >> hospital
> >>> til he went into VT...and sent him to me. Still has occasional chest
> >> pains
> >>> in ICU.
> >>>
> >>>
> >>> Frankly, the guy has no chance without surgery and at high risk with it.
> >>> I've done bunches of low-EF patients with quite satisfactory results.
> >> The
> >>> question is that I plan to put a "quick" ring on his mitral as has been
> >> my
> >>> practise for several years. You all know the possible scenario in six
> >>> months with CHF and worsening MR, if the MR is not corrected. The
> >>> cardiologist feels that his LV won't be able to take the added strain
> >>> without that "pop-off valve".
> >>>
> >>> Thanks in advance for your comments and advice in advance.
> >>> Mitch
> >>>
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