[HSF] Thoracic Pseudoaneurym {OT}

Thu May 29 20:27:02 EDT 2008

So does refusing blood products. Or conversesly does does accepting blood transfusion. ??? More to come.
tea

----- Original Message ----
From: Donald Ross <donross at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, May 29, 2008 7:02:38 PM
Subject: Re: [HSF] Thoracic Pseudoaneurym {OT}

But Everest climbing and AIDS blood bathing  carry risks which are  
based on fact.

> 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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