[HSF] Thoracic Pseudoaneurym

Tea Acuff tacuff at swbell.net
Thu May 29 08:56:10 EDT 2008 

Of course this strange phenomenon is not limited to religious verse. Climbing Mt Everest and working in the blood of AIDS patients is studiously avoided by the vast majority of us sapiens. 
tea



----- Original Message ----
From: Donald Ross <donross at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, May 29, 2008 3:22:22 AM
Subject: Re: [HSF] Thoracic Pseudoaneurym

isn't it extraordinary how two passages in the bible have been used  
to bend the minds if folk so far that they will choose death over  
something that the rest of us accept? Strange species, homo sometimes  
sapiens.
Don

On 29/05/2008, at 4:24 AM, tdmartin2000 at aol.com wrote:

> Ani
> Our results with complex cases in JHW's really are good, but it is  
> only because we treat them differently. Maybe we should treat all  
> pts the same for blood conservation. It all starts preop and if at  
> all possible optimizing the pt. I am in disagreement with you when  
> it comes to absolutes and to the risk involved. If this pt does not  
> have an operation , the statistics would say that he will have  
> rupture of his aneurysm or a dissection somewhere in the next  
> several yrs. With surgery I would quote him a 70 to 80% chance of  
> long term cardiac/aortic survival beyond 3 to 5 yrs. I would also  
> quote him a 10 to15% risk of some type of at least short term  
> disability with the chance of longterm disability (stroke, resp  
> failure, renal failure). I would then let the pt and his family  
> decide.
> I do agree with refusing surgery to someone that has a near 100%  
> mortality - ie the pt that was just presented to me that is a JHW,  
> has sickle cell disease and a starting hct of 19.
> The pt presented by Michael however I think has a reasonable chance  
> of a good outcome with surgery if done properly.
>
> Tom Martin
> U of Florida
> Gainesville
>
>
> -----Original Message-----
> From: Ani Anyanwu <anianyanwu at hotmail.com>
> To: openheart-l at lists.hsforum.com
> Sent: Tue, 27 May 2008 9:50 pm
> Subject: RE: [HSF] Thoracic Pseudoaneurym
>
>
>
> Michael
>
> At 74 and with two prior, and gracious, gifts of bloodless cardiac  
> surgery, I
> think this patient needs a compelling reason, and a compelling  
> surgeon, to earn
> himself a third.
>
> I wonder given that he is asymptomatic how this was diagnosed: 7.8  
> cm might
> sound dreadful but if we had another CT from 18 months ago, or one  
> 12 months
> from now, that also showed 7.8 we might be a bit more relaxed. As  
> surgeons we
> always feel a need to fix things but it is not clear in my humble  
> opinion that
> his life expectancy with surgery is necessarily better than his  
> life expectancy
> without surgery. Certainly his surest way of being alive in three  
> or six, or
> even likely twelve, months is not to have surgery, and his surest  
> way to be dead
> in a month is to have surgery today. Although Dr Martin's group  
> does have
> phenomenal success in these patients, I suspect that in most hands,  
> embarking on
> such a surgery will transform to physician assisted death. Many  
> groups have not
> even been able to perform routine hypothermic arrest cases without  
> blood
> products.
>
> I think some things are mutually exclusive - in the same way a  
> cardiologist
> would not place a drug eluting stent in someone who will not take  
> antiplatelet
> agents, we should not embark on such major reoperative surgery in a  
> (relatively)
> anemic elderly patient who will not have a blood transfusion. Blood  
> transfusion
> is as integral a part of therapy for his disease as is antiplatelet  
> therapy for
> coronary stenting.
>
> Ani
>
>
>
>
>> From: cardsurg at bellsouth.net> To: OpenHeart-L at lists.hsforum.com>  
>> Date: Tue, 27
> May 2008 16:10:03 -0400> CC: > Subject: [HSF] Thoracic  
> Pseudoaneurym> > I have a
> 74 yo Jehovah witness two years out from a redo AVR with a 7.8 cm>
> pseudoaneurysm adjacent to the ascending aorta. The CTA suggest a  
> small>
> communication, at the level of the aortic suture line. The  
> Pseudoaneurysm> abuts
> the sternum. His hemoglobin is 12.6. He is presently asymptomatic>  
> with no fever
> or chills but occasionally gets "pressure in his chest". He> is the  
> sole care
> giver for his bedridden wife.> > I have proposed extracorporeal  
> circulation,
> hypothermic circulatory arrest> and repair with a conduit if his  
> hemoglobin were
> higher. With the current> limitations regarding erythropoietin use  
> I would
> welcome input on management> suggestions.> > Michael Vincent Smith,  
> MD> > > >
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