From donross at bigpond.com Wed Oct 1 07:18:59 2008 From: donross at bigpond.com (Donald Ross) Date: Tue Sep 30 16:19:34 2008 Subject: [HSF] Chest Tubes Post Cardiac Surgery In-Reply-To: <89c4ed2d0809300519i57581c64l4ef47fe378ee286@mail.gmail.com> References: <537098.49674.qm@web81601.mail.mud.yahoo.com> <89c4ed2d0809272142o1116b4b5k18ad57a892da3764@mail.gmail.com> <4CFA0B74570F4138903416E1F08E17F7@ErezPC> <89c4ed2d0809280534y15b0f64cs1d61c357d5caeb9d@mail.gmail.com> <6.2.1.2.2.20080928204636.01de8608@pop.east.cox.net> <89c4ed2d0809281915y75fea145g2a035bb77df2ffda@mail.gmail.com> <89c4ed2d0809300401xcfb0afeyaecdab22929ec9f4@mail.gmail.com> <89c4ed2d0809300407t64693744hfc750a127aa793bc@mail.gmail.com> <91310CA7-E2B7-4937-A6F0-91A72ADD7A58@bigpond.com> <89c4ed2d0809300519i57581c64l4ef47fe378ee286@mail.gmail.com> Message-ID: <3B460DAC-B65E-44D5-8026-DDA9499C019E@bigpond.com> On 30/09/2008, at 10:19 PM, Prasanna Simha M wrote: > How do you connect the redivacs to the larger chest drain etc ? the nurses bodge up something with Y pieces and bit of tube. > Does > mediastinal drain refers to the retrosternal drain ? yes > > Prasanna > > On Tue, Sep 30, 2008 at 5:21 PM, Donald Ross > wrote: > >> I use large redivac tubes as chest and pericardial drains with a 20F >> "chest" tube for the mediastinum, >> These are all connected to the U/W seal on low suction. The >> redivacs are >> about 16F. >> Don >> >> On 30/09/2008, at 9:07 PM, Prasanna Simha M wrote: >> >> Incidentally has anyone use the redivac type of drains in cardiac >> cases >>> (The >>> ones with small tubes , multiple holes and which connect to a vacuum >>> bottle >>> or a concertina type bottle ?) >>> Incidnetally the value on the RCT done on chest tube drainage and >>> recurrent >>> effusions was 100 ml/12 hour shift not 10 ml !!) >>> Prasanna >>> >>> On Tue, Sep 30, 2008 at 4:31 PM, Prasanna Simha M >>> wrote: >>> >>> My take on the answers >>>> Tube position - retrocardiac is a bent tube under the heart away >>>> from any >>>> grafts and retrosternal is placed behind the sternum ornest to >>>> the RA if >>>> the >>>> RV is dilated. The plueral tubes can come out anteriorly (I use a >>>> bent >>>> tube >>>> then) orlaterally - straight tubes. >>>> >>>> I was trained in a centre where the stndard tube was a 20 fr >>>> tube. In >>>> the >>>> place I work I was surprised at the pipes that were placed >>>> (Typcially 32 >>>> -34)My residents want big tubes and I wnat small ones !! (We have >>>> to >>>> usually >>>> defer to their requests !! ;)) Big tubes are more painful >>>> especially when >>>> placed interocostally). I prefer soft tubes but cannot use blake >>>> drains >>>> for >>>> the simple reason of cost. They are madly priced in India. >>>> >>>> I only strip a tube if I think they are clotted/obstructed. >>>> >>>> There have been studies wrt chest tube drainage - 10ml in 12 >>>> hours is >>>> adequate for removing in effusions. >>>> Most patients (cardiac) have their tubes removed next day 11 AM. >>>> What do you want to check Hb for ? >>>> I do not keep chest tubes in just becausea patient is being >>>> ventilated. >>>> They come out on their own merits. >>>> I have vacuum on when removing tubes. A simple thing to do when >>>> removing >>>> drains near coronary grafts is to turn the tube around360 deg to >>>> prevent >>>> any >>>> entrapment of a graft etc. frankly I have never seen it happen >>>> and the >>>> best >>>> way is to keep drains away from grafts. >>>> >>>> I remove mediastinal drains first and the pleural. >>>> >>>> I tie anchoring stitches after removal of drains. Where I trained >>>> we used >>>> to put a petrolatum gauze and no stitches. patients would leak >>>> and thus >>>> refuse to go home even if theyw were told it is >>>> innocuous.Incidentally I >>>> use >>>> a Vicryl stitch so I dont have to worry about the removal of >>>> these when >>>> sending a patient home 500 kms away with limited access to >>>> medical care >>>> 72 >>>> hours after shifting from the ICU.Helps in fast track discharge to >>>> home.(Especially for repairs and straight forwardcase etc who are >>>> operated >>>> say on Monday and leave hospital on Wednesday night or Thursday >>>> morning >>>> train home). Patients on Coumadin stay longer to get their INR's >>>> stable. >>>> Prasanna >>>> >>>> >>>> >>>> On Mon, Sep 29, 2008 at 2:27 PM, Vitaly Demyanchuk >>>> wrote: >>>> >>>> >>>>> >>>>> Dear Colleagues, >>>>> >>>>> I think we have an interesting discussion as for the chest tubes >>>>> management in CT surgery. Details , details are crucial in our >>>>> job. >>>>> Everyone is sure that they play or may play the role of >>>>> cornerstone in >>>>> the >>>>> good outcome of operation. Looks like chest tubes can have many >>>>> of >>>>> details. >>>>> >>>>> = tubes position in pericardium and their relation to great >>>>> vessels and >>>>> especially to grafts after CABG; >>>>> = preferable tube diameter (for average adult patient); >>>>> = soft tube vs rigid; >>>>> = to milk or to just squeeze, stripping or no touch in ICU; >>>>> = indication for tubes removing ? 100cc or 240cc per last 24hrs; >>>>> or 50 >>>>> cc >>>>> per last 12hrs;?. >>>>> = Is it important to check Hb in exudation? >>>>> = Should we keep tubes in when patient is on prolonged >>>>> ventilation? >>>>> = how should tubes be removed? With vacuum or not? If yes, >>>>> what level >>>>> of >>>>> negative pressure is safety? >>>>> = if pleura was opened what is the right sequences of moves? >>>>> First >>>>> pericardial (mediastinal) and then chest or quite the contrary? >>>>> = anchoring stitches ? to tie or not to tie in the case when >>>>> pleura is >>>>> intact. >>>>> >>>>> In the last edition of Dr. Khonsari great textbook these >>>>> questions were >>>>> touched but it seems to me were not properly opened. As for me >>>>> such >>>>> discussion would be extremely interesting from theoretical >>>>> educational >>>>> point >>>>> of view. >>>>> >>>>> Sincerely, >>>>> >>>>> >>>>> Vitaly Demyanchuk >>>>> Kiyv Heart Center >>>>> Ukraine >>>>> _________________________________________________________________ >>>>> Stay up to date on your PC, the Web, and your mobile phone with >>>>> Windows >>>>> Live. >>>>> >>>>> >>>>> http://clk.atdmt.com/MRT/go/msnnkwxp1020093185mrt/direct/01/_______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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 >>>>> ----------------------------------------- >>>>> >>>>> >>>> >>>> >>>> -- >>>> Prasanna Simha M >>>> >>>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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 >> anddisclaimers posted at: >> >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From donross at bigpond.com Wed Oct 1 07:37:14 2008 From: donross at bigpond.com (Donald Ross) Date: Tue Sep 30 16:38:49 2008 Subject: [HSF] polybutester suture In-Reply-To: References: <7339CBB0-7DCA-416D-BCAF-7B48649195C6@bigpond.com> <89c4ed2d0809300413q6e9700d3qde0d243f3d470f30@mail.gmail.com> <6508E4BC-9DEE-4B91-8F96-FB0842B650D3@bigpond.com> <8CAF11B88E847DF-4C0-BC9@FWM-M05.sysops.aol.com> Message-ID: Don't be so sure, Victor, Al Starr didn't and he became testy when I pointed it out. Interestingly it was one of his partners, Aftab Ahmed, who taught me the correct technique. Don On 01/10/2008, at 4:27 AM, V. Aldrete, M.D. wrote: > I really cannot believe this thread. To be talking about technical > issues of knot tying amongst this selective group of highly skillful > and experienced surgeons. I am certain that all of you knew how to > properly tie a knot, regardless of the suture material many years ago. > > Victor. > Ps I remember some time around the middle 80's when a suture became > available to replace polypropelene for coronary artery anastomosis. > It was the kind without memory and easier to handle, alas it also > tended to stretch, thus either you had to tug a bit more than > necessary on the anastomotic suture possibly creating a purse string > effect or you would end up with a "leaky" anastomosis. Either way > it did not last long in our operating room. > > > On Sep 30, 2008, at 6:56 AM, rwmfglycar@aol.com wrote: > >> The real secret of perfect knot tying is to apply just the right >> amount of?graduated pressure as each throw?is cinched down to >> produce?enough compression of the thread to overcome its >> slipperiness.. The degree of compression needed to counteract the >> known slipperiness of the thread varies from make to make. In the >> assembly of our Quattro valve we had sutures which held?adjacent >> pericardial sheets in correct alignment. These were exposed to the >> circulation and if they unravelled and worked themselves loose >> would be emboli. Only three throws were allowed. A? standard >> surgical polyester suture was used. Each throw was square. The >> sewer had to pass a test: a normally serrated surgical forceps was >> scraped firmly back and forth across the knot 5 times without >> causing the knot to unravel. >> The valve?wear tester was an ideal method of checking the quality >> of knots. Knots remained tied past 200 to 800 million cycles. >> The forceps test is very useful for teaching trainees to tie proper >> knots. They are startled to see seven or more throws of a polyester >> or polypropylene suture start unravelling with the second or third >> scrape. >> This principle obviously?needs modification according to the suture >> used. I never used nor allowed more than 5 throws during valve >> insertions. I would include one double throw ("surgeon's knot") for >> polytetrafluorethylene sutures. >> Bob >> >> -----Original Message----- >> From: Donald Ross >> To: OpenHeart-L@lists.hsforum.com >> Sent: Tue, 30 Sep 2008 8:12 am >> Subject: Re: [HSF] polybutester suture >> >> >> Perhaps you don't know how to tie a square knot; many surgeons >> think it is enough to put down alternate throws but the hands need >> to cross or exchange ends to properly square the knot.? >> Don? >> ? >> On 30/09/2008, at 9:13 PM, Prasanna Simha M wrote:? >> ? >>> On the same note I had a peculiar problem. I used a regular brand >>> of? >>> Polybutylate ester suture and after tying 7 knots in a valve, >>> after > going? >>> round the whole valve I found the entire knot unravelled despite > >>> squared? >>> knots etc !! I was stunned .Has anyone seen this happening ? I was >>> > pretty? >>> sure that I had tied down the sutures tight. I removed it and >>> placed > a know? >>> suture.? >>> prasanna? >>> ? >>> On Tue, Sep 30, 2008 at 9:46 AM, Donald Ross >>> > wrote:? >>> ? >>>> I just tried an alternative to prolene: "Vascufil" which is and >>>> >> entirely? >>>> different polymer.? >>>> It has no memory which seems to make it less prone to tangling >> >>>> which is? >>>> especially nice for coronary surgery and it is supposed to be >>>> free >> from the? >>>> shredding you get after flogging prolene.? >>>> Have any members had any experience or problems with this suture?? >>>> Don? >>>> _______________________________________________? >>>> OpenHeart-L mailing list? >>>> ? >>>> Send postings to:? >>>> OpenHeart-L@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? >>>> anddisclaimers posted at:? >>>> http://www.hsforum.com/listdisclaim? >>>> -----------------------------------------? >>>> ? >>> ? >>> ? >>> ? >>> --> Prasanna Simha M? >>> _______________________________________________? >>> OpenHeart-L mailing list? >>> ? >>> Send postings to:? >>> OpenHeart-L@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@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 anddisclaimers posted at:? >> http://www.hsforum.com/listdisclaim? >> -----------------------------------------? >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From prasannasimha at gmail.com Wed Oct 1 09:01:48 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Sep 30 22:37:38 2008 Subject: [HSF] SVC Syndrome? In-Reply-To: References: Message-ID: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> Anticoagulate. get blood cultures. Prasanna On Wed, Oct 1, 2008 at 6:29 AM, Michael Firstenberg wrote: > 38 year/old resident of a city hit hard by hurricanes (and wanting very > much > to go home asap) gets transferred in to our hospital.Severe Wegner's with > pulmonary vasculopathy - chronic oxygen, previous lung biospies, 120mg > Prednisone a day (yes 120mg) for at least a year. Recent Hickman type > catheter removed due to "infection" and no longer needed - just finished a > course of some type of immune modulating chemotherapy. Chronic anemia, > volumetrically challenged (i.e. obese), and did I mention long standing > high > dose steroids, she complains that she heels very poorly - even IV get > infiltrated often and are a problem - hence >25 different central lines. > > The problem now - complete occlusion of SVC from immoninate (open) to right > atrium with clot (presumed to be clot - patient is reasonable and reports a > "negative" venogram/ultrasound in March of this year) extending into RA. > Echo today (which I have not seen - happy year to all) suggests extension > into RV and a PFO (not sure how they saw that - but we have pretty good > echo > people). On CT the clot has several areas that are being read out as "air" > which people are now calling infection. PE study shows small PEs > bilaterally - but nothing major. She has been on antibiotics for a long > time and recent cultures are pending (I think the "air" is just small > tracts > from recent lines??). Both arms are swollen (has separate clot in left > subclavian) and face feels a little puffy. Interventional Radiology does > not want to try lytics or anything in fear that this may break-up and > result > in massive PE (probably a reasonable answer - from a IR guy I trust) > > My initial recommendation was heparin (which just got started when I got > the > consult monday afternoon) and coumadin forever. Hematology work-up for > hypercoag state. Once stable on coumadin allow her to go back home........ > > > any different thoughts? > would anyone try to clean-out her SVC in the OR? > no one is excited about suction aspiration (like what they use for fresh > thrombus in coronaries) > > -michael > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From robertobattellini at hotmail.com Wed Oct 1 08:55:57 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Oct 1 01:56:25 2008 Subject: [HSF] images of the circumflex in the groove In-Reply-To: <00a001c92364$d7acd620$76c37ec8@LIBERTAD> References: <537098.49674.qm@web81601.mail.mud.yahoo.com><89c4ed2d0809272142o1116b4b5k18ad57a892da3764@mail.gmail.com><4CFA0B74570F4138903416E1F08E17F7@ErezPC><89c4ed2d0809280534y15b0f64cs1d61c357d5caeb9d@mail.gmail.com><6.2.1.2.2.20080928204636.01de8608@pop.east.cox.net><89c4ed2d0809281915y75fea145g2a035bb77df2ffda@mail.gmail.com><89c4ed2d0809300401xcfb0afeyaecdab22929ec9f4@mail.gmail.com><89c4ed2d0809300407t64693744hfc750a127aa793bc@mail.gmail.com><8CAF122CD7B8FB4-C78-E3F@FWM-M44.sysops.aol.com> <8CAF1322EC773FF-1108-16D1@webmail-da16.sysops.aol.com> <00a001c92364$d7acd620$76c37ec8@LIBERTAD> Message-ID: Bob, the second cast is impressive, but an experienced surgeon can free it from the CX. Roberto> From: gabuin@intramed.net> To: OpenHeart-L@lists.hsforum.com> Date: Tue, 30 Sep 2008 22:27:13 -0300> CC: > Subject: [HSF] images of the circumflex in the groove> > Just to remember.> The risk of injury of the coronary sinus is very "interesting".> Personally, I have not yet to use this -I think- the last option to > revascularize the lateral wall.> Pherhaps one day I have to deal with it.> > ----- Original Message ----- > From: > To: > Sent: Tuesday, September 30, 2008 1:39 PM> Subject: Re: [HSF] circumflex in the groove> > > > The very first circumflex I ever grafted (late 68) was on a dentist. The > > lesion was? very tight at the?takeoff ?from the Ieft main. I?didn't know > > any better but it seemed right to? put the graft onto the main circumflex > > so the blood would? go forward down each of the quite substantial > > marginals. With a dedicated second assistant on my right holding the > > heart?and Siavosh Khonsari (you may have read his very good book on > > Pitfalls)?opposite me, squirting? lots of saline, we got through the > > anastamosis of a vein to a big fat circumflex (size match was good) > > without need for extra stitches and the patient did very well for a good > > many years. ?I remember getting tongue tied? and saying "squirt"? when I > > meant "suck" and "suck" when I meant "squirt" which seemed to cause > > muffled amusement among the nurses. ?The fat that we had to go through to > > get to the artery had venous bleeders presumably related to the atrial > > blood supply which was not affecdted by the aortic clamp. The myocardia> > l "protection" was ischemic arrest under moderate hypothermia?giving the > > heart a drink every ten minutes.?I never tried it again.> > Bob> >> >> > -----Original Message-----> > From: wftjrtyler@aol.com> > To: OpenHeart-L@lists.hsforum.com> > Sent: Tue, 30 Sep 2008 10:48 am> > Subject: [HSF] circumflex in the groove> >> >> >> >> > A question for group> >> > 50 yo lady post ACB 2000....patent LIMA-LAD.SVG-RCA?? 99% ostial CX?? CX > > is> > large and appears only in AV groove.? All OMs barely visible and small( of > > the> > gnat dick variety)?? Pt. with intractable angina?? Unable to cross lesion> > percutaneously.?? Would anyone graft this and if so, by what approach????? > > Pt is> > also s/p renal and pancreas transplant.??????? thanks,bill turner> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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> > -----------------------------------------> >> >> > -- > > No virus found in this incoming message.> > Checked by AVG.> > Version: 7.5.524 / Virus Database: 270.7.5/1698 - Release Date: 9/29/2008 > > 7:25 PM> >> > From enaseri at hotmail.com.tr Wed Oct 1 07:13:54 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Wed Oct 1 02:14:23 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> Message-ID: Opinion requested regarding the following case: 51 Y/O male,CAH ( CABG 1 year ago)DM,COPD,ARF on top of chronic renal disease (undergoing HD for the last 1 month),frank ascites but hepatic function tests all right with slight increase in INR and normal USG.TTE:moderate LV function,moderate MR,PAP 60,severe TR,R chambers dilated . Planning to do heart cath and coronary angio, repeat TTE (personally review with cardiologist )and proceed with tricuspid and mitral surgery. erdinc From enaseri at hotmail.com.tr Wed Oct 1 07:38:42 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Wed Oct 1 02:39:32 2008 Subject: [HSF] circumflex in the groove In-Reply-To: <8CAF122CD7B8FB4-C78-E3F@FWM-M44.sysops.aol.com> References: <537098.49674.qm@web81601.mail.mud.yahoo.com><89c4ed2d0809272142o1116b4b5k18ad57a892da3764@mail.gmail.com><4CFA0B74570F4138903416E1F08E17F7@ErezPC><89c4ed2d0809280534y15b0f64cs1d61c357d5caeb9d@mail.gmail.com><6.2.1.2.2.20080928204636.01de8608@pop.east.cox.net><89c4ed2d0809281915y75fea145g2a035bb77df2ffda@mail.gmail.com><89c4ed2d0809300401xcfb0afeyaecdab22929ec9f4@mail.gmail.com><89c4ed2d0809300407t64693744hfc750a127aa793bc@mail.gmail.com> <8CAF122CD7B8FB4-C78-E3F@FWM-M44.sysops.aol.com> Message-ID: Trying to do RedoCABG on CRX with an open Lima has always been a very demanding and serious task for me. I would go through L chest but with a preop thoracic CT to evaluate the condition of the descending aorta.I have to add that going through L side has not been easy all the time due to diffuse lung adhesions. erdinc> From msfirst at gmail.com Wed Oct 1 08:21:31 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Wed Oct 1 07:27:48 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> Message-ID: good luckthis probably emphasizes why some of the problems - as this group continues to preach - should be addressed the first time. These problems did not pop up overnight, unless something dramatic happened. -michael On Wed, Oct 1, 2008 at 2:13 AM, erdin? naseri wrote: > > Opinion requested regarding the following case: > 51 Y/O male,CAH ( CABG 1 year ago)DM,COPD,ARF on top of chronic renal > disease (undergoing HD for the last 1 month),frank ascites but hepatic > function tests all right with slight increase in INR and normal > USG.TTE:moderate LV function,moderate MR,PAP 60,severe TR,R chambers dilated > . > Planning to do heart cath and coronary angio, repeat TTE (personally review > with cardiologist )and proceed with tricuspid and mitral surgery. > erdinc > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > From hgrmd at aol.com Wed Oct 1 12:32:41 2008 From: hgrmd at aol.com (hgrmd@aol.com) Date: Wed Oct 1 07:33:09 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> Message-ID: <417284927-1222860758-cardhu_decombobulator_blackberry.rim.net-547611522-@bxe149.bisx.prod.on.blackberry> Great point, Michael. Illustrates the reason TEE vital for every open heart. Don't leave unexpected valve disease at time of standalone CABG. Man up, and do what's needed. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: "Michael Firstenberg" Date: Wed, 1 Oct 2008 07:21:31 To: Subject: Re: [HSF] TVR 1 year after CABG good luckthis probably emphasizes why some of the problems - as this group continues to preach - should be addressed the first time. These problems did not pop up overnight, unless something dramatic happened. -michael On Wed, Oct 1, 2008 at 2:13 AM, erdin? naseri wrote: > > Opinion requested regarding the following case: > 51 Y/O male,CAH ( CABG 1 year ago)DM,COPD,ARF on top of chronic renal > disease (undergoing HD for the last 1 month),frank ascites but hepatic > function tests all right with slight increase in INR and normal > USG.TTE:moderate LV function,moderate MR,PAP 60,severe TR,R chambers dilated > . > Planning to do heart cath and coronary angio, repeat TTE (personally review > with cardiologist )and proceed with tricuspid and mitral surgery. > erdinc >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 ----------------------------------------- From prasannasimha at gmail.com Wed Oct 1 17:13:06 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Oct 1 08:40:16 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> Message-ID: <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> LV function ? Moderate MR and high PA pressures do not go hand in hand . You need to see the MR jet fully. Is it bouncing offa and reversing flow ? I presume you will be repairing the Tricuspid valve and mitral valves or are you planning to replace them ?I would have a look especially wrt to the RCA graft.. Prasanna On Wed, Oct 1, 2008 at 11:43 AM, erdin? naseri wrote: > > Opinion requested regarding the following case: > 51 Y/O male,CAH ( CABG 1 year ago)DM,COPD,ARF on top of chronic renal > disease (undergoing HD for the last 1 month),frank ascites but hepatic > function tests all right with slight increase in INR and normal > USG.TTE:moderate LV function,moderate MR,PAP 60,severe TR,R chambers dilated > . > Planning to do heart cath and coronary angio, repeat TTE (personally review > with cardiologist )and proceed with tricuspid and mitral surgery. > erdinc > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From rwmfglycar at aol.com Wed Oct 1 10:15:12 2008 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Wed Oct 1 09:17:16 2008 Subject: [HSF] polybutester suture In-Reply-To: References: <7339CBB0-7DCA-416D-BCAF-7B48649195C6@bigpond.com><89c4ed2d0809300413q6e9700d3qde0d243f3d470f30@mail.gmail.com><6508E4BC-9DEE-4B91-8F96-FB0842B650D3@bigpond.com><8CAF11B88E847DF-4C0-BC9@FWM-M05.sysops.aol.com> Message-ID: <8CAF1DEDE8442A2-16FC-12D7@webmail-me12.sysops.aol.com> Victor I have seen surgeons whose names you will know tie a nine throw knot tower with air visible between throws. I haveseen a valve repair at a video demonstation in which the goretex knots looked like a wheatfield. Just try the experiment of asking a trainee to tie a three throw knot andthen scrape his knotwith a forceps. Bob I really cannot believe this thread. To be talking about technical issues of knot tying amongst this selective group of highly skillful and experienced surgeons. I am certain that all of you knew how to properly tie a knot, regardless of the suture material many years ago.? ? Victor.? Ps I remember some time around the middle 80's when a suture became available to replace polypropelene for coronary artery anastomosis. It was the kind without memory and easier to handle, alas it also tended to stretch, thus either you had to tug a bit more than necessary on the anastomotic suture possibly creating a purse string effect or you would end up with a "leaky" anastomosis. Either way it did not last long in our operating room.? ? On Sep 30, 2008, at 6:56 AM, rwmfglycar@aol.com wrote:? ? > The real secret of perfect knot tying is to apply just the right > amount of?graduated pressure as each throw?is cinched down to > produce?enough compression of the thread to overcome its > slipperiness.. The degree of compression needed to counteract the > known slipperiness of the thread varies from make to make. In the > assembly of our Quattro valve we had sutures which held?adjacent > pericardial sheets in correct alignment. These were exposed to the > circulation and if they unravelled and worked themselves loose would > be emboli. Only three throws were allowed. A? standard surgical > polyester suture was used. Each throw was square. The sewer had to > pass a test: a normally serrated surgical forceps was scraped firmly > back and forth across the knot 5 times without causing the knot to > unravel.? > The valve?wear tester was an ideal method of checking the quality of > knots. Knots remained tied past 200 to 800 million cycles.? > The forceps test is very useful for teaching trainees to tie proper > knots. They are startled to see seven or more throws of a polyester > or polypropylene suture start unravelling with the second or third > scrape.? > This principle obviously?needs modification according to the suture > used. I never used nor allowed more than 5 throws during valve > insertions. I would include one double throw ("surgeon's knot") for > polytetrafluorethylene sutures.? > Bob? >? > -----Original Message-----? > From: Donald Ross ? > To: OpenHeart-L@lists.hsforum.com? > Sent: Tue, 30 Sep 2008 8:12 am? > Subject: Re: [HSF] polybutester suture? >? >? > Perhaps you don't know how to tie a square knot; many surgeons think > it is enough to put down alternate throws but the hands need to > cross or exchange ends to properly square the knot.?? > Don?? > ?? > On 30/09/2008, at 9:13 PM, Prasanna Simha M wrote:?? > ?? >> On the same note I had a peculiar problem. I used a regular brand of?? >> Polybutylate ester suture and after tying 7 knots in a valve, after >> > going?? >> round the whole valve I found the entire knot unravelled despite > >> squared?? >> knots etc !! I was stunned .Has anyone seen this happening ? I was >> > pretty?? >> sure that I had tied down the sutures tight. I removed it and >> placed > a know?? >> suture.?? >> prasanna?? >> ?? >> On Tue, Sep 30, 2008 at 9:46 AM, Donald Ross >> > wrote:?? >> ?? >>> I just tried an alternative to prolene: "Vascufil" which is and >> >>> entirely?? >>> different polymer.?? >>> It has no memory which seems to make it less prone to tangling >> >>> which is?? >>> especially nice for coronary surgery and it is supposed to be free >>> >> from the?? >>> shredding you get after flogging prolene.?? >>> Have any members had any experience or problems with this suture??? >>> Don?? >>> _______________________________________________?? >>> OpenHeart-L mailing list?? >>> ?? >>> Send postings to:?? >>> OpenHeart-L@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?? >>> anddisclaimers posted at:?? >>> http://www.hsforum.com/listdisclaim?? >>> -----------------------------------------?? >>> ?? >> ?? >> ?? >> ?? >> --> Prasanna Simha M?? >> _______________________________________________?? >> OpenHeart-L mailing list?? >> ?? >> Send postings to:?? >> OpenHeart-L@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@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 anddisclaimers posted at:?? > http://www.hsforum.com/listdisclaim?? > -----------------------------------------?? >? > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@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@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 anddisclaimers posted at:? http://www.hsforum.com/listdisclaim? -----------------------------------------? From jbflegejr at aol.com Wed Oct 1 10:21:16 2008 From: jbflegejr at aol.com (jbflegejr@aol.com) Date: Wed Oct 1 09:22:05 2008 Subject: [HSF] circumflex in the groove In-Reply-To: References: Message-ID: <8CAF1DFB812EC86-86C-139B@WEBMAIL-MY38.sysops.aol.com> Grafting the circumflex in the a-v groove in a patient with no previous operations need not be difficult. Open the ?pericardium on the right well back toward the phrenic nerve, open the right pleural cavity, cannulate for venous drainage as you might for a transplant (one cannula directly into the SVC and the other through the atrium close to the SVC) so that cannulas do not get in the way of rotating the heart into the right chest. Then rotate the heart to the right beneath the sternum into the right chest and that flattens out the lateral aspect of the LV and enables work on the circumflex without any more retraction and with very nice exposure. Use of the bipolar cautery for hemostasis in the fat is helpful. John Flege -----Original Message----- From: Roberto Battellini To: openheart-l@lists.hsforum.com Sent: Tue, 30 Sep 2008 12:36 pm Subject: RE: [HSF] circumflex in the groove and read before the article written by John Flege, all the necessary details are there.John is a cavalier and doesn?t mention his paper.I did this approach 4 times on the beating heart with pleasure, but take care the aorta could be very calcified and in that case go to the axillary. Roberto> From: Jbflegejr@aol.com> Date: Tue, 30 Sep 2008 11:34:28 -0400> Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> CC: > > In a reoperation the circumflex in the AV groove is best approached by left > thoracotomy. Since the IMA is in use, a S VG or radial artery would be Ok with > the proximal anastomosis to the descending aorta if it is not too diseased, the > subclavian artery if you can reach it which should be possible through the > 4th IS and awkward thfough the 5th IS, or the axillary artery exposed by > subclavicular incision. I certainly would graft it if it is the cause of her > symptoms. John Flege> > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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 ----------------------------------------- From prasannasimha at gmail.com Wed Oct 1 19:53:14 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Oct 1 09:30:47 2008 Subject: [HSF] polybutester suture In-Reply-To: <8CAF1DEDE8442A2-16FC-12D7@webmail-me12.sysops.aol.com> References: <7339CBB0-7DCA-416D-BCAF-7B48649195C6@bigpond.com> <89c4ed2d0809300413q6e9700d3qde0d243f3d470f30@mail.gmail.com> <6508E4BC-9DEE-4B91-8F96-FB0842B650D3@bigpond.com> <8CAF11B88E847DF-4C0-BC9@FWM-M05.sysops.aol.com> <8CAF1DEDE8442A2-16FC-12D7@webmail-me12.sysops.aol.com> Message-ID: <89c4ed2d0810010623q126badfp2e7438e1d5676d21@mail.gmail.com> When a resident does that I say a song told by my Teacher when we mistied knots - it is in Hindi and was a very popular song of the 70's - Hava me udathe jaaye means - In the wind blows (My red muslin cape). prasanna On Wed, Oct 1, 2008 at 6:45 PM, wrote: > Victor I have seen surgeons whose names you will know tie a nine throw knot > tower with air visible between throws. I haveseen a valve repair at a video > demonstation in which the goretex knots looked like a wheatfield. Just try > the experiment of asking a trainee to tie a three throw knot andthen scrape > his knotwith a forceps. > Bob > > > > > > > > > > I really cannot believe this thread. To be talking about technical issues > of knot tying amongst this selective group of highly skillful and > experienced surgeons. I am certain that all of you knew how to properly tie > a knot, regardless of the suture material many years ago.? > ? > Victor.? > Ps I remember some time around the middle 80's when a suture became > available to replace polypropelene for coronary artery anastomosis. It was > the kind without memory and easier to handle, alas it also tended to > stretch, thus either you had to tug a bit more than necessary on the > anastomotic suture possibly creating a purse string effect or you would end > up with a "leaky" anastomosis. Either way it did not last long in our > operating room.? > ? > On Sep 30, 2008, at 6:56 AM, rwmfglycar@aol.com wrote:? > ? > > The real secret of perfect knot tying is to apply just the right > amount > of?graduated pressure as each throw?is cinched down to > produce?enough > compression of the thread to overcome its > slipperiness.. The degree of > compression needed to counteract the > known slipperiness of the thread > varies from make to make. In the > assembly of our Quattro valve we had > sutures which held?adjacent > pericardial sheets in correct alignment. These > were exposed to the > circulation and if they unravelled and worked > themselves loose would > be emboli. Only three throws were allowed. A? > standard surgical > polyester suture was used. Each throw was square. The > sewer had to > pass a test: a normally serrated surgical forceps was scraped > firmly > back and forth across the knot 5 times without causing the knot to > > unravel.? > > The valve?wear tester was an ideal method of checking the quality of > > knots. Knots remained tied past 200 to 800 million cycles.? > > The forceps test is very useful for teaching trainees to tie proper > > knots. They are startled to see seven or more throws of a polyester > or > polypropylene suture start unravelling with the second or third > scrape.? > > This principle obviously?needs modification according to the suture > > used. I never used nor allowed more than 5 throws during valve > insertions. > I would include one double throw ("surgeon's knot") for > > polytetrafluorethylene sutures.? > > Bob? > >? > > -----Original Message-----? > > From: Donald Ross ? > > To: OpenHeart-L@lists.hsforum.com? > > Sent: Tue, 30 Sep 2008 8:12 am? > > Subject: Re: [HSF] polybutester suture? > >? > >? > > Perhaps you don't know how to tie a square knot; many surgeons think > it > is enough to put down alternate throws but the hands need to > cross or > exchange ends to properly square the knot.?? > > Don?? > > ?? > > On 30/09/2008, at 9:13 PM, Prasanna Simha M wrote:?? > > ?? > >> On the same note I had a peculiar problem. I used a regular brand of?? > >> Polybutylate ester suture and after tying 7 knots in a valve, after >> > > going?? > >> round the whole valve I found the entire knot unravelled despite > >> > squared?? > >> knots etc !! I was stunned .Has anyone seen this happening ? I was >> > > pretty?? > >> sure that I had tied down the sutures tight. I removed it and >> placed > > a know?? > >> suture.?? > >> prasanna?? > >> ?? > >> On Tue, Sep 30, 2008 at 9:46 AM, Donald Ross >> > > wrote:?? > >> ?? > >>> I just tried an alternative to prolene: "Vascufil" which is and >> >>> > entirely?? > >>> different polymer.?? > >>> It has no memory which seems to make it less prone to tangling >> >>> > which is?? > >>> especially nice for coronary surgery and it is supposed to be free >>> > >> from the?? > >>> shredding you get after flogging prolene.?? > >>> Have any members had any experience or problems with this suture??? > >>> Don?? > >>> _______________________________________________?? > >>> OpenHeart-L mailing list?? > >>> ?? > >>> Send postings to:?? > >>> OpenHeart-L@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?? > >>> anddisclaimers posted at:?? > >>> http://www.hsforum.com/listdisclaim?? > >>> -----------------------------------------?? > >>> ?? > >> ?? > >> ?? > >> ?? > >> --> Prasanna Simha M?? > >> _______________________________________________?? > >> OpenHeart-L mailing list?? > >> ?? > >> Send postings to:?? > >> OpenHeart-L@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@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 > anddisclaimers posted at:?? > > http://www.hsforum.com/listdisclaim?? > > -----------------------------------------?? > >? > > _______________________________________________? > > OpenHeart-L mailing list? > >? > > Send postings to:? > > OpenHeart-L@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@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 > anddisclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From enaseri at hotmail.com.tr Wed Oct 1 16:45:15 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Wed Oct 1 11:45:45 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> Message-ID: LV fx modeartely depressed .TTE insists on modearte MR.Will take thoracic CT to exclude PTE( as he has a history of several bouts of DVT).TRicuspid valve seems not amenable to repair( as per description of the echocardiographer)erdinc From tacuff at swbell.net Wed Oct 1 09:44:50 2008 From: tacuff at swbell.net (Tea Acuff) Date: Wed Oct 1 11:46:20 2008 Subject: [HSF] circumflex in the groove Message-ID: <720235.3643.qm@web81608.mail.mud.yahoo.com> That's funny. I am still trying to figure out if I hope to be heart surgeon. Tea Sent from my iPhone On Sep 30, 2008, at 12:50 PM, hgrmd@aol.com wrote: Bob, ?That was an inspiring recollection of probably one of the very first circumflex bypasses.? Guys like you were the ones that made me want to be a cardiac surgeon when I was barely a teenager. Hal -----Original Message----- From: rwmfglycar@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Tue, 30 Sep 2008 12:39 pm Subject: Re: [HSF] circumflex in the groove The very first circumflex I ever grafted (late 68) was on a dentist. The lesion was? very tight at the?takeoff ?from the Ieft main. I?didn't know any better but it seemed right to? put the graft onto the main circumflex so the blood would? go forward down each of the quite substantial marginals. With a dedicated second assistant on my right holding the heart?and Siavosh Khonsari (you may have read his very good book on Pitfalls)?opposite me, squirting? lots of saline, we got through the anastamosis of a vein to a big fat circumflex (size match was good) without need for extra stitches and the patient did very well for a good many years. ?I remember getting tongue tied? and saying "squirt"? when I meant "suck" and "suck" when I meant "squirt" which seemed to cause muffled amusement among the nurses. ?The fat that we had to go through to get to the artery had venous bleeders presumably related to the atrial blood supply which was not affecdted by the aortic clamp. The myocardia l "protection" was ischemic arrest under moderate hypothermia?giving the heart a drink every ten minutes.?I never tried it again. Bob -----Original Message----- From: wftjrtyler@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Tue, 30 Sep 2008 10:48 am Subject: [HSF] circumflex in the groove A question for group 50 yo lady post ACB 2000....patent LIMA-LAD.SVG-RCA?? 99% ostial CX?? CX is large and appears only in AV groove.? All OMs barely visible and small( of the gnat dick variety)?? Pt. with intractable angina?? Unable to cross lesion percutaneously.?? Would anyone graft this and if so, by what approach????? Pt is also s/p renal and pancreas transplant.??????? thanks,bill turner _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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@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@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 ----------------------------------------- From tacuff at swbell.net Wed Oct 1 09:49:12 2008 From: tacuff at swbell.net (Tea Acuff) Date: Wed Oct 1 11:49:41 2008 Subject: [HSF] polybutester suture Message-ID: <739619.56530.qm@web81601.mail.mud.yahoo.com> Being a highly trained heart surgeon is not an innoculation against being a bone head. Tea Sent from my iPhone On Sep 30, 2008, at 1:27 PM, "V. Aldrete, M.D." wrote: I really cannot believe this thread. To be talking about technical issues of knot tying amongst this selective group of highly skillful and experienced surgeons. I am certain that all of you knew how to properly tie a knot, regardless of the suture material many years ago. Victor. Ps I remember some time around the middle 80's when a suture became available to replace polypropelene for coronary artery anastomosis. It was the kind without memory and easier to handle, alas it also tended to stretch, thus either you had to tug a bit more than necessary on the anastomotic suture possibly creating a purse string effect or you would end up with a "leaky" anastomosis. Either way it did not last long in our operating room. On Sep 30, 2008, at 6:56 AM, rwmfglycar@aol.com wrote: The real secret of perfect knot tying is to apply just the right amount of?graduated pressure as each throw?is cinched down to produce?enough compression of the thread to overcome its slipperiness.. The degree of compression needed to counteract the known slipperiness of the thread varies from make to make. In the assembly of our Quattro valve we had sutures which held?adjacent pericardial sheets in correct alignment. These were exposed to the circulation and if they unravelled and worked themselves loose would be emboli. Only three throws were allowed. A? standard surgical polyester suture was used. Each throw was square. The sewer had to pass a test: a normally serrated surgical forceps was scraped firmly back and forth across the knot 5 times without causing the knot to unravel. The valve?wear tester was an ideal method of checking the quality of knots. Knots remained tied past 200 to 800 million cycles. The forceps test is very useful for teaching trainees to tie proper knots. They are startled to see seven or more throws of a polyester or polypropylene suture start unravelling with the second or third scrape. This principle obviously?needs modification according to the suture used. I never used nor allowed more than 5 throws during valve insertions. I would include one double throw ("surgeon's knot") for polytetrafluorethylene sutures. Bob -----Original Message----- From: Donald Ross To: OpenHeart-L@lists.hsforum.com Sent: Tue, 30 Sep 2008 8:12 am Subject: Re: [HSF] polybutester suture Perhaps you don't know how to tie a square knot; many surgeons think it is enough to put down alternate throws but the hands need to cross or exchange ends to properly square the knot.? Don? ? On 30/09/2008, at 9:13 PM, Prasanna Simha M wrote:? ? On the same note I had a peculiar problem. I used a regular brand of? Polybutylate ester suture and after tying 7 knots in a valve, after > going? round the whole valve I found the entire knot unravelled despite > squared? knots etc !! I was stunned .Has anyone seen this happening ? I was > pretty? sure that I had tied down the sutures tight. I removed it and placed > a know? suture.? prasanna? ? On Tue, Sep 30, 2008 at 9:46 AM, Donald Ross > wrote:? ? I just tried an alternative to prolene: "Vascufil" which is and >> entirely? different polymer.? It has no memory which seems to make it less prone to tangling >> which is? especially nice for coronary surgery and it is supposed to be free >> from the? shredding you get after flogging prolene.? Have any members had any experience or problems with this suture?? Don? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@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? anddisclaimers posted at:? http://www.hsforum.com/listdisclaim? -----------------------------------------? ? ? ? ? --> Prasanna Simha M? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@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@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 anddisclaimers posted at:? http://www.hsforum.com/listdisclaim? -----------------------------------------? _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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@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 anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From tacuff at swbell.net Wed Oct 1 09:57:18 2008 From: tacuff at swbell.net (Tea Acuff) Date: Wed Oct 1 11:58:37 2008 Subject: [HSF] circumflex in the groove Message-ID: <86348.20504.qm@web81608.mail.mud.yahoo.com> Exactly the same considerations and qualifications for off pump except no need to worry about canulae. Tea Sent from my iPhone On Oct 1, 2008, at 8:21 AM, jbflegejr@aol.com wrote: Grafting the circumflex in the a-v groove in a patient with no previous operations need not be difficult. Open the pericardium on the right well back toward the phrenic nerve, open the right pleural cavity, cannulate for venous drainage as you might for a transplant (one cannula directly into the SVC and the other through the atrium close to the SVC) so that cannulas do not get in the way of rotating the heart into the right chest. Then rotate the heart to the right beneath the sternum into the right chest and that flattens out the lateral aspect of the LV and enables work on the circumflex without any more retraction and with very nice exposure. Use of the bipolar cautery for hemostasis in the fat is helpful. John Flege -----Original Message----- From: Roberto Battellini To: openheart-l@lists.hsforum.com Sent: Tue, 30 Sep 2008 12:36 pm Subject: RE: [HSF] circumflex in the groove and read before the article written by John Flege, all the necessary details are there.John is a cavalier and doesn?t mention his paper.I did this approach 4 times on the beating heart with pleasure, but take care the aorta could be very calcified and in that case go to the axillary. Roberto> From: Jbflegejr@aol.com> Date: Tue, 30 Sep 2008 11:34:28 -0400> Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> CC: > > In a reoperation the circumflex in the AV groove is best approached by left > thoracotomy. Since the IMA is in use, a S VG or radial artery would be Ok with > the proximal anastomosis to the descending aorta if it is not too diseased, the > subclavian artery if you can reach it which should be possible through the > 4th IS and awkward thfough the 5th IS, or the axillary artery exposed by > subclavicular incision. I certainly would graft it if it is the cause of her > symptoms. John Flege> > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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@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 ----------------------------------------- From enaseri at hotmail.com.tr Wed Oct 1 17:11:46 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Wed Oct 1 12:12:36 2008 Subject: [HSF] circumflex in the groove In-Reply-To: <86348.20504.qm@web81608.mail.mud.yahoo.com> References: <86348.20504.qm@web81608.mail.mud.yahoo.com> Message-ID: Tea, If I understood correct you are in favor of doing an off-pump CABG to CRX trunk.Though I have never attempted it I will pose 3questions: 1. How to control the prx and distal artery without occluding the CS. 2.If not possible, what would be the implications of occluding CS in a severely tilted beating heart ? 3.Is it possible to maintain a stable hemodynamic condition in that position? erdinc> Date: Wed, 1 Oct 2008 08:57:18 -0700> From: tacuff@swbell.net> Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> CC: > > Exactly the same considerations and qualifications for off pump except no need to worry about canulae.> Tea> > Sent from my iPhone> > On Oct 1, 2008, at 8:21 AM, jbflegejr@aol.com wrote:> > Grafting the circumflex in the a-v groove in a patient with no previous operations need not be difficult. Open the pericardium on the right well back toward the phrenic nerve, open the right pleural cavity, cannulate for venous drainage as you might for a transplant (one cannula directly into the SVC and the other through the atrium close to the SVC) so that cannulas do not get in the way of rotating the heart into the right chest. Then rotate the heart to the right beneath the sternum into the right chest and that flattens out the lateral aspect of the LV and enables work on the circumflex without any more retraction and with very nice exposure. Use of the bipolar cautery for hemostasis in the fat is helpful. John Flege> > > -----Original Message-----> From: Roberto Battellini > To: openheart-l@lists.hsforum.com> Sent: Tue, 30 Sep 2008 12:36 pm> Subject: RE: [HSF] circumflex in the groove> > > > > > > > > and read before the article written by John Flege, all the necessary details are > there.John is a cavalier and doesn?t mention his paper.I did this approach 4 > times on the beating heart with pleasure, but take care the aorta could be very > calcified and in that case go to the axillary.> Roberto> From: Jbflegejr@aol.com> Date: Tue, 30 Sep 2008 11:34:28 -0400> > Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> > CC: > > In a reoperation the circumflex in the AV groove is best approached by > left > thoracotomy. Since the IMA is in use, a S> VG or radial artery would be Ok > with > the proximal anastomosis to the descending aorta if it is not too > diseased, the > subclavian artery if you can reach it which should be possible > through the > 4th IS and awkward thfough the 5th IS, or the axillary artery > exposed by > subclavicular incision. I certainly would graft it if it is the > cause of her > symptoms. John Flege> > > > **************Looking for simple > solutions to your real-life financial > challenges? Check out WalletPop for the > latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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@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@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@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> ----------------------------------------- From tacuff at swbell.net Wed Oct 1 11:11:42 2008 From: tacuff at swbell.net (Tea Acuff) Date: Wed Oct 1 13:12:12 2008 Subject: [HSF] Pacing wires Message-ID: <877082.37708.qm@web81601.mail.mud.yahoo.com> Note to michael: they don't call us professor Tea Sent from my iPhone On Sep 30, 2008, at 9:11 PM, Michael Firstenberg wrote: > "we are not usually there to manage it?????" > > sounds like you have a very very different post-operative care > system then we do. > > > -michael > > > > > > On Sep 30, 2008, at 12:04 AM, Ben Bidstrup wrote: > >> The lack of impact related to clopidogrel use may relate to >> insensitivity to this drug. ASA is the same. Also may only need a >> few hours for sufficient non poisoned platelets to be released into >> the circulation. Also may reflect som egood surgical hameostasis at >> the beginning of the operation. >> We do all remember the cases that take 12 hours to close albeit for >> a short period of time, and those that bleed in ICU and get lots of >> products albeit for an even shorter time! We are not usually there >> to manage it. >> >> >> Ben Bidstrup FRACS FRCSEd FEBCTS >> Cardiothoracic Surgeon >> >> >> >> On 30/09/2008, at 12:45 PM, Tea Acuff wrote: >> >>> Actually you do have experimental data, at least the kind that i >>> think is of the era of Hunter and his devotees today. All his >>> peers merely consulted the authoritative texts as proof or >>> "reference". That you have not spent hours mopping up bleeding and >>> associated disasters in this group of patients is very suggestive. >>> I remember how we used to postpone surgery because of ASA, but no >>> longer do. I just did an emergent CABG on chronic Plavix without >>> signficant bleeding or plt use. I suspect we will have to do >>> without a RCT of VAD explants with and without plavix, with and >>> without ASA, with and without betablocker, etc and etc. >>> >>> tea >>> >>> >>> >>> ----- Original Message ---- >>> From: Ani Anyanwu >>> To: openheart-l@lists.hsforum.com >>> Sent: Saturday, September 27, 2008 8:56:48 PM >>> Subject: RE: [HSF] Pacing wires >>> >>> Tea >>> >>> Yes we have done redo roots on Plavix. >>> >>> My personal feeling (and I dont have data) is that plavix has >>> little bearing on postoperative bleeding and I practically never >>> stop it even for redos. Several of my patients with ventricular >>> assist devices are on plavix and warfarin and they get called from >>> home for transplant and we do the redo to take VAD out and heart >>> transplant on plavix and warfarin - often this is the third or >>> even fourth redo. Many of these patients we do not give platelets >>> because we are worried about deleterious effects on the donor >>> right heart so we give FFP to reverse the warfarin, wait do a TEG, >>> pack, gelfoam thrombin etc and the majority we find we can control >>> the bleeding without platelet transfusion. There are a couple very >>> difficult VAD reop transplants that were troublesome though that >>> ended up with lots of platelets and factor VII but we have only >>> had one take back for bleeding in this group of patients over the >>> last 2 years. >>> >>> Certainly for patients with coronary disease as the indication for >>> surgery, I do not stop plavix - most these patients though I would >>> do off-pump with bilateral ITAs and almost as a rule bleeding has >>> not been a problem. >>> >>> Ani >>> >>> >>> >>> >>> >>> >>>> Date: Sat, 27 Sep 2008 18:45:42 -0700> From: tacuff@swbell.net> >>>> Subject: Re: [HSF] Pacing wires> To: OpenHeart- >>>> L@lists.hsforum.com> CC: > > so you do a redo AVR root on Plavix? >>>> > > tea> > > > ----- Original Message ----> From: Ani Anyanwu >>> >> To: openheart-l@lists.hsforum.com> Sent: Saturday, September >>>> 27, 2008 8:27:46 PM> Subject: RE: [HSF] Pacing wires> > All our >>>> OPCABs are on plavix post op. Also we no longer stop plavix pre- >>>> op on patients with intracoronary stents. If they have a pacing >>>> wire, plavix has no bearing on their removal.> > Ani> > > > > >>>> From: njucastro@gmail.com> To: OpenHeart-L@lists.hsforum.com> >>>> Date: Sat, 27 Sep 2008 20:10:13 -0500> CC: > Subject: [HSF] >>>> Pacing wires> > Hi all,> Follow up question and poll on pacing >>>> wires. If a patient has pacing > wires in the RV myocardium and >>>> he has somehow been started on plavix, > would you pull them or >>>> just cut them?> > J Castro> Minneapolis MN> > Sent from my >>>> iPhone> > On >>> Sep 27, 2008, at 17:27, David Harris >>> wrote:> > > The last case I had with a Calcified aorta needed 3 >>> grafts, valve, > > and we replaced the ascending. There was one >>> place to clamp, just > > below innominate. We got the cardiologist >>> to first take him to the > > cath lab, and deploy 2 carotid >>> filters, then proceeded directly. We > > cannulated femoral >>> artery, and managed to clamp (it leaked a bit!). > > So we managed >>> to shorten the procedure and avoid hypothermic arrest.> >> > The >>> filters were then removed under imaging. The left one had no > > >>> debris.> The right one`s wire fractured as we removed it, as the > >>> > clamp had gone over it!! The cardiologist snared it and removed >>> it > > the next day. It had a small bit of debris in it.> >> >> > >>> --- On Tue, 23/9/08, hgrmd@aol.com wrote:> >> > >>> From: hgrmd@aol.com > > Subject: Re: [HSF] Embol-x: >>> Snaring bits of embolic material does > > not mean we are >>> redu...> > To: OpenHeart-L@lists.hsforum.com> > Date: Tuesday, 23 >>> September, 2008, 8:29 PM> >> > Michael,> > ? The handful of cases >>> I've done, I've cannulated either femorally or> > axillary.? The >>> aorta is replaced.?> >> > Hal> >> >> >> >> >> >> >> > ----- >>> Original Message-----> > From: Michael Firstenberg >> >> > To: OpenHeart-L@lists.hsforum.com> > Sent: Tue, 23 Sep 2008 >>> 8:05 am> > Subject: Re: [HSF] Embol-x: Snaring bits of embolic >>> material does > > not mean we> > are redu...> >> >> >> > hal> > so >>> if you are doing a avr with an ugly aorta will you ax cannulate >>> and>> > use dhca AND clean out or just replace the ascending?> >> >>> > michael.> >> > On 9/23/08, Hgrmd@aol.com wrote:> >>> >> Roberto,> >> If I encounter a totally calcified ascending >>> aorta, I also use > >> DHCA to> > a> >> graft to the arch. Like >>> you, I carefully scavenge out any debris > >> from> > the> >> arch >>> prior to resuming CPB. I haven't used Embol-X on cases >>> like> > that. I> >> would> >> be hesitant in directly inserting >>> one into a graft, because I would> >> anticipate that getting >>> hemostasis at the cannulation site might > >> prove> >> >>> difficult.> >>> >> Hal> >>> >>> >>> >> **************Looking for >>> simple solutions to your real-life > >> financial> >> challenges? >>> Check out WalletPop for the latest news and > >> information, >>> tips> >> and> >> calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001 >>> > >> )> >> _______________________________________________> >> >>> OpenHeart-L mailing list> >>> >> Send postings to:> >>> OpenHeart-L@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@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@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@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@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 >>> > -----------------------------------------> >>> _________________________________________________________________> >>> Get all your favourite content with the slick new MSN Toolbar - >>> FREE> >>> http://clk.atdmt.com/UKM/go/111354027/direct/01/_______________________________________________ >>> > OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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 >>> > ----------------------------------------- >>> _________________________________________________________________ >>> Win New York holidays with Kellogg?s & Live Search >>> http://clk.atdmt.com/UKM/go/111354033/direct/01/_______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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@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 > ----------------------------------------- From prasannasimha at gmail.com Wed Oct 1 23:44:49 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Oct 1 13:15:13 2008 Subject: [HSF] Pacing wires In-Reply-To: <877082.37708.qm@web81601.mail.mud.yahoo.com> References: <877082.37708.qm@web81601.mail.mud.yahoo.com> Message-ID: <89c4ed2d0810011014n69116f71g8e66c872b834f405@mail.gmail.com> What do they call you there ? Prasanna On Wed, Oct 1, 2008 at 10:41 PM, Tea Acuff wrote: > Note to michael: they don't call us professor > Tea > > Sent from my iPhone > > On Sep 30, 2008, at 9:11 PM, Michael Firstenberg > wrote: > > > "we are not usually there to manage it?????" > > > > sounds like you have a very very different post-operative care > > system then we do. > > > > > > -michael > > > > > > > > > > > > On Sep 30, 2008, at 12:04 AM, Ben Bidstrup wrote: > > > >> The lack of impact related to clopidogrel use may relate to > >> insensitivity to this drug. ASA is the same. Also may only need a > >> few hours for sufficient non poisoned platelets to be released into > >> the circulation. Also may reflect som egood surgical hameostasis at > >> the beginning of the operation. > >> We do all remember the cases that take 12 hours to close albeit for > >> a short period of time, and those that bleed in ICU and get lots of > >> products albeit for an even shorter time! We are not usually there > >> to manage it. > >> > >> > >> Ben Bidstrup FRACS FRCSEd FEBCTS > >> Cardiothoracic Surgeon > >> > >> > >> > >> On 30/09/2008, at 12:45 PM, Tea Acuff wrote: > >> > >>> Actually you do have experimental data, at least the kind that i > >>> think is of the era of Hunter and his devotees today. All his > >>> peers merely consulted the authoritative texts as proof or > >>> "reference". That you have not spent hours mopping up bleeding and > >>> associated disasters in this group of patients is very suggestive. > >>> I remember how we used to postpone surgery because of ASA, but no > >>> longer do. I just did an emergent CABG on chronic Plavix without > >>> signficant bleeding or plt use. I suspect we will have to do > >>> without a RCT of VAD explants with and without plavix, with and > >>> without ASA, with and without betablocker, etc and etc. > >>> > >>> tea > >>> > >>> > >>> > >>> ----- Original Message ---- > >>> From: Ani Anyanwu > >>> To: openheart-l@lists.hsforum.com > >>> Sent: Saturday, September 27, 2008 8:56:48 PM > >>> Subject: RE: [HSF] Pacing wires > >>> > >>> Tea > >>> > >>> Yes we have done redo roots on Plavix. > >>> > >>> My personal feeling (and I dont have data) is that plavix has > >>> little bearing on postoperative bleeding and I practically never > >>> stop it even for redos. Several of my patients with ventricular > >>> assist devices are on plavix and warfarin and they get called from > >>> home for transplant and we do the redo to take VAD out and heart > >>> transplant on plavix and warfarin - often this is the third or > >>> even fourth redo. Many of these patients we do not give platelets > >>> because we are worried about deleterious effects on the donor > >>> right heart so we give FFP to reverse the warfarin, wait do a TEG, > >>> pack, gelfoam thrombin etc and the majority we find we can control > >>> the bleeding without platelet transfusion. There are a couple very > >>> difficult VAD reop transplants that were troublesome though that > >>> ended up with lots of platelets and factor VII but we have only > >>> had one take back for bleeding in this group of patients over the > >>> last 2 years. > >>> > >>> Certainly for patients with coronary disease as the indication for > >>> surgery, I do not stop plavix - most these patients though I would > >>> do off-pump with bilateral ITAs and almost as a rule bleeding has > >>> not been a problem. > >>> > >>> Ani > >>> > >>> > >>> > >>> > >>> > >>> > >>>> Date: Sat, 27 Sep 2008 18:45:42 -0700> From: tacuff@swbell.net> > >>>> Subject: Re: [HSF] Pacing wires> To: OpenHeart- > >>>> L@lists.hsforum.com> CC: > > so you do a redo AVR root on Plavix? > >>>> > > tea> > > > ----- Original Message ----> From: Ani Anyanwu < > anianyanwu@hotmail.com > >>>> >> To: openheart-l@lists.hsforum.com> Sent: Saturday, September > >>>> 27, 2008 8:27:46 PM> Subject: RE: [HSF] Pacing wires> > All our > >>>> OPCABs are on plavix post op. Also we no longer stop plavix pre- > >>>> op on patients with intracoronary stents. If they have a pacing > >>>> wire, plavix has no bearing on their removal.> > Ani> > > > > > >>>> From: njucastro@gmail.com> To: OpenHeart-L@lists.hsforum.com> > >>>> Date: Sat, 27 Sep 2008 20:10:13 -0500> CC: > Subject: [HSF] > >>>> Pacing wires> > Hi all,> Follow up question and poll on pacing > >>>> wires. If a patient has pacing > wires in the RV myocardium and > >>>> he has somehow been started on plavix, > would you pull them or > >>>> just cut them?> > J Castro> Minneapolis MN> > Sent from my > >>>> iPhone> > On > >>> Sep 27, 2008, at 17:27, David Harris > >>> wrote:> > > The last case I had with a Calcified aorta needed 3 > >>> grafts, valve, > > and we replaced the ascending. There was one > >>> place to clamp, just > > below innominate. We got the cardiologist > >>> to first take him to the > > cath lab, and deploy 2 carotid > >>> filters, then proceeded directly. We > > cannulated femoral > >>> artery, and managed to clamp (it leaked a bit!). > > So we managed > >>> to shorten the procedure and avoid hypothermic arrest.> >> > The > >>> filters were then removed under imaging. The left one had no > > > >>> debris.> The right one`s wire fractured as we removed it, as the > > >>> > clamp had gone over it!! The cardiologist snared it and removed > >>> it > > the next day. It had a small bit of debris in it.> >> >> > > >>> --- On Tue, 23/9/08, hgrmd@aol.com wrote:> >> > > >>> From: hgrmd@aol.com > > Subject: Re: [HSF] Embol-x: > >>> Snaring bits of embolic material does > > not mean we are > >>> redu...> > To: OpenHeart-L@lists.hsforum.com> > Date: Tuesday, 23 > >>> September, 2008, 8:29 PM> >> > Michael,> > ? The handful of cases > >>> I've done, I've cannulated either femorally or> > axillary.? The > >>> aorta is replaced.?> >> > Hal> >> >> >> >> >> >> >> > ----- > >>> Original Message-----> > From: Michael Firstenberg >>> >> > To: OpenHeart-L@lists.hsforum.com> > Sent: Tue, 23 Sep 2008 > >>> 8:05 am> > Subject: Re: [HSF] Embol-x: Snaring bits of embolic > >>> material does > > not mean we> > are redu...> >> >> >> > hal> > so > >>> if you are doing a avr with an ugly aorta will you ax cannulate > >>> and>> > use dhca AND clean out or just replace the ascending?> >> > >>> > michael.> >> > On 9/23/08, Hgrmd@aol.com wrote:> > >>> >> Roberto,> >> If I encounter a totally calcified ascending > >>> aorta, I also use > >> DHCA to> > a> >> graft to the arch. Like > >>> you, I carefully scavenge out any debris > >> from> > the> >> arch > >>> prior to resuming CPB. I haven't used Embol-X on cases > >>> like> > that. I> >> would> >> be hesitant in directly inserting > >>> one into a graft, because I would> >> anticipate that getting > >>> hemostasis at the cannulation site might > >> prove> >> > >>> difficult.> >>> >> Hal> >>> >>> >>> >> **************Looking for > >>> simple solutions to your real-life > >> financial> >> challenges? > >>> Check out WalletPop for the latest news and > >> information, > >>> tips> >> and> >> calculators. ( > http://www.walletpop.com/?NCID=emlcntuswall00000001 > >>> > >> )> >> _______________________________________________> >> > >>> OpenHeart-L mailing list> >>> >> Send postings to:> >>> > OpenHeart-L@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@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@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@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@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 > >>> > -----------------------------------------> > >>> _________________________________________________________________> > >>> Get all your favourite content with the slick new MSN Toolbar - > >>> FREE> > >>> > http://clk.atdmt.com/UKM/go/111354027/direct/01/_______________________________________________ > >>> > OpenHeart-L mailing list> > Send postings to:> > OpenHeart-L@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@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 > >>> > ----------------------------------------- > >>> _________________________________________________________________ > >>> Win New York holidays with Kellogg's & Live Search > >>> > http://clk.atdmt.com/UKM/go/111354033/direct/01/_______________________________________________ > >>> OpenHeart-L mailing list > >>> > >>> Send postings to: > >>> OpenHeart-L@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@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@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@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@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 > ----------------------------------------- > -- Prasanna Simha M From robertobattellini at hotmail.com Wed Oct 1 20:24:49 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Oct 1 13:25:18 2008 Subject: [HSF] circumflex in the groove In-Reply-To: <86348.20504.qm@web81608.mail.mud.yahoo.com> References: <86348.20504.qm@web81608.mail.mud.yahoo.com> Message-ID: Tea, do you mean through thoracotomy? as for sternotomy and big rotation of the heart without cannulas the heart could stay empty... Roberto> Date: Wed, 1 Oct 2008 08:57:18 -0700> From: tacuff@swbell.net> Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> CC: > > Exactly the same considerations and qualifications for off pump except no need to worry about canulae.> Tea> > Sent from my iPhone> > On Oct 1, 2008, at 8:21 AM, jbflegejr@aol.com wrote:> > Grafting the circumflex in the a-v groove in a patient with no previous operations need not be difficult. Open the pericardium on the right well back toward the phrenic nerve, open the right pleural cavity, cannulate for venous drainage as you might for a transplant (one cannula directly into the SVC and the other through the atrium close to the SVC) so that cannulas do not get in the way of rotating the heart into the right chest. Then rotate the heart to the right beneath the sternum into the right chest and that flattens out the lateral aspect of the LV and enables work on the circumflex without any more retraction and with very nice exposure. Use of the bipolar cautery for hemostasis in the fat is helpful. John Flege> > > -----Original Message-----> From: Roberto Battellini > To: openheart-l@lists.hsforum.com> Sent: Tue, 30 Sep 2008 12:36 pm> Subject: RE: [HSF] circumflex in the groove> > > > > > > > > and read before the article written by John Flege, all the necessary details are > there.John is a cavalier and doesn?t mention his paper.I did this approach 4 > times on the beating heart with pleasure, but take care the aorta could be very > calcified and in that case go to the axillary.> Roberto> From: Jbflegejr@aol.com> Date: Tue, 30 Sep 2008 11:34:28 -0400> > Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> > CC: > > In a reoperation the circumflex in the AV groove is best approached by > left > thoracotomy. Since the IMA is in use, a S> VG or radial artery would be Ok > with > the proximal anastomosis to the descending aorta if it is not too > diseased, the > subclavian artery if you can reach it which should be possible > through the > 4th IS and awkward thfough the 5th IS, or the axillary artery > exposed by > subclavicular incision. I certainly would graft it if it is the > cause of her > symptoms. John Flege> > > > **************Looking for simple > solutions to your real-life financial > challenges? Check out WalletPop for the > latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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@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@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@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> ----------------------------------------- From robertobattellini at hotmail.com Wed Oct 1 20:33:28 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Oct 1 13:34:16 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> Message-ID: Do mit through thoracotomy as we do, you can make a bigger one if you neeed, cannulate the groin artery and vein, you can cannulate VCS through the yugular vein in the neck.(here an anaesthesist does that per punction). Roberto> Date: Wed, 1 Oct 2008 16:13:06 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] TVR 1 year after CABG> CC: > > LV function ?> Moderate MR and high PA pressures do not go hand in hand . You need to see> the MR jet fully. Is it bouncing offa and reversing flow ?> I presume you will be repairing the Tricuspid valve and mitral valves or are> you planning to replace them ?I would have a look especially wrt to the RCA> graft..> Prasanna> On Wed, Oct 1, 2008 at 11:43 AM, erdin? naseri wrote:> > >> > Opinion requested regarding the following case:> > 51 Y/O male,CAH ( CABG 1 year ago)DM,COPD,ARF on top of chronic renal> > disease (undergoing HD for the last 1 month),frank ascites but hepatic> > function tests all right with slight increase in INR and normal> > USG.TTE:moderate LV function,moderate MR,PAP 60,severe TR,R chambers dilated> > .> > Planning to do heart cath and coronary angio, repeat TTE (personally review> > with cardiologist )and proceed with tricuspid and mitral surgery.> > erdinc> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From tacuff at swbell.net Wed Oct 1 12:26:02 2008 From: tacuff at swbell.net (Tea Acuff) Date: Wed Oct 1 14:27:33 2008 Subject: [HSF] circumflex in the groove Message-ID: <792473.62960.qm@web81606.mail.mud.yahoo.com> I was reading between the lines of Dr. Flege. There is no point in pushing the heart into the right chest if you are in the left, so his remarks are what I do through a sternotomy. A redo with its atrial adhesions make this technically more demanding and requires more dissection that may not be waranted. ? If the heart is flipped into the right chest after making ample space, one is looking at the AV groove. It is easy to see if the position is tolerated before you have to occlude anything. I just place a soft bull dog clamp or silastic tape around the proximal alone (as with all my off pump vessels) since we saw distal leasions with distal tapes early in midcabs. I don't think compression of the coronary sinus is an issue, just exposure of the circ with is variable in its ease (as is an intramuscular LAD?. ? tea ----- Original Message ---- From: erdin? naseri To: openheart-l@lists.hsforum.com Sent: Wednesday, October 1, 2008 11:11:46 AM Subject: RE: [HSF] circumflex in the groove Tea, If I understood correct you are? in favor of doing an off-pump CABG to CRX trunk.Though I have never attempted it I will pose 3questions: 1. How to control the prx and distal artery without occluding the CS. 2.If not possible, what would be the implications of occluding CS in a? severely tilted? beating heart ? 3.Is it possible to maintain? a stable hemodynamic condition in that position? erdinc> Date: Wed, 1 Oct 2008 08:57:18 -0700> From: tacuff@swbell.net> Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> CC: > > Exactly the same considerations and qualifications for off pump except no need to worry about canulae.> Tea> > Sent from my iPhone> > On Oct 1, 2008, at 8:21 AM, jbflegejr@aol.com wrote:> > Grafting the circumflex in the a-v groove in a patient with no previous operations need not be difficult. Open the pericardium on the right well back toward the phrenic nerve, open the right pleural cavity, cannulate for venous drainage as you might for a transplant (one cannula directly into the SVC and the other through the atrium close to the SVC) so that cannulas do not get in the way of rotating the heart into the right chest. Then rotate the heart to the right beneath the sternum into the right chest and that flattens out the lateral aspect of the LV and enables work on the circumflex without any more retraction and with very n ice exposure. Use of the bipolar cautery for hemostasis in the fat is helpful. John Flege> > > -----Original Message-----> From: Roberto Battellini > To: openheart-l@lists.hsforum.com> Sent: Tue, 30 Sep 2008 12:36 pm> Subject: RE: [HSF] circumflex in the groove> > > > > > > > > and read before the article written by John Flege, all the necessary details are > there.John is a cavalier and doesn?t mention his paper.I did this approach 4 > times on the beating heart with pleasure, but take care the aorta could be very > calcified and in that case go to the axillary.> Roberto> From: Jbflegejr@aol.com> Date: Tue, 30 Sep 2008 11:34:28 -0400> > Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> > CC: > > In a reoperation the circumflex in the AV groove is best approached by > left > thoracotomy. Since the IMA is in use, a S> VG or radial artery would be Ok > with > the proximal anastomosis to the descending aorta if it is not too > diseased, the > subclavian artery if you can reach it which should be possible > through the > 4th IS and awkward thfough the 5th IS, or the axillary artery > exposed by > subclavicular incision. I certainly would graft it if it is the > cause of her > symptoms. John Flege> > > > **************Looking for simple > solutions to your real-life financial > challenges? Check out WalletPop for the > latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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@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@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@lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email addr ess, 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@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 ----------------------------------------- From tacuff at swbell.net Wed Oct 1 12:27:44 2008 From: tacuff at swbell.net (Tea Acuff) Date: Wed Oct 1 14:29:15 2008 Subject: [HSF] circumflex in the groove Message-ID: <147027.9455.qm@web81601.mail.mud.yahoo.com> No. See repaly to Erdinc. Clear? tea ----- Original Message ---- From: Roberto Battellini To: openheart-l@lists.hsforum.com Sent: Wednesday, October 1, 2008 12:24:49 PM Subject: RE: [HSF] circumflex in the groove Tea, do you mean through thoracotomy? as for sternotomy and big rotation of the heart without cannulas the heart could stay empty... Roberto> Date: Wed, 1 Oct 2008 08:57:18 -0700> From: tacuff@swbell.net> Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> CC: > > Exactly the same considerations and qualifications for off pump except no need to worry about canulae.> Tea> > Sent from my iPhone> > On Oct 1, 2008, at 8:21 AM, jbflegejr@aol.com wrote:> > Grafting the circumflex in the a-v groove in a patient with no previous operations need not be difficult. Open the pericardium on the right well back toward the phrenic nerve, open the right pleural cavity, cannulate for venous drainage as you might for a transplant (one cannula directly into the SVC and the other through the atrium close to the SVC) so that cannulas do not get in the way of rotating the heart into the right chest. Then rotate the heart to the right beneath the sternum into the right chest and that flattens out the lateral aspect of the LV and enables work on the circumflex without any more retraction and with very nice exposure. Use of the bipolar cautery for hemostasis in the fat is helpful. John Flege> > > -----Original Message-----> From: Roberto Battellini > To: openheart-l@lists.hsforum.com> Sent: Tue, 30 Sep 2008 12:36 pm> Subject: RE: [HSF] circumflex in the groove> > > > > > > > > and read before the article written by John Flege, all the necessary details are > there.John is a cavalier and doesn?t mention his paper.I did this approach 4 > times on the beating heart with pleasure, but take care the aorta could be very > calcified and in that case go to the axillary.> Roberto> From: Jbflegejr@aol.com> Date: Tue, 30 Sep 2008 11:34:28 -0400> > Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L@lists.hsforum.com> > CC: > > In a reoperation the circumflex in the AV groove is best approached by > left > thoracotomy. Since the IMA is in use, a S> VG or radial artery would be Ok > with > the proximal anastomosis to the descending aorta if it is not too > diseased, the > subclavian artery if you can reach it which should be possible > through the > 4th IS and awkward thfough the 5th IS, or the axillary artery > exposed by > subclavicular incision. I certainly would graft it if it is the > cause of her > symptoms. John Flege> > > > **************Looking for simple > solutions to your real-life financial > challenges? Check out WalletPop for the > latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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@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@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@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@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 ----------------------------------------- From rwmfglycar at aol.com Wed Oct 1 17:01:32 2008 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Wed Oct 1 16:02:45 2008 Subject: [HSF] polybutester suture In-Reply-To: <89c4ed2d0810010623q126badfp2e7438e1d5676d21@mail.gmail.com> References: <7339CBB0-7DCA-416D-BCAF-7B48649195C6@bigpond.com><89c4ed2d0809300413q6e9700d3qde0d243f3d470f30@mail.gmail.com><6508E4BC-9DEE-4B91-8F96-FB0842B650D3@bigpond.com><8CAF11B88E847DF-4C0-BC9@FWM-M05.sysops.aol.com><8CAF1DEDE8442A2-16FC-12D7@webmail-me12.sysops.aol.com> <89c4ed2d0810010623q126badfp2e7438e1d5676d21@mail.gmail.com> Message-ID: <8CAF217A160292F-F54-221@webmail-db09.sysops.aol.com> Very nice prasanna Bob -----Original Message----- From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Wed, 1 Oct 2008 9:23 am Subject: Re: [HSF] polybutester suture When a resident does that I say a song told by my Teacher when we mistied knots - it is in Hindi and was a very popular song of the 70's - Hava me udathe jaaye means - In the wind blows (My red muslin cape). prasanna On Wed, Oct 1, 2008 at 6:45 PM, wrote: > Victor I have seen surgeons whose names you will know tie a nine throw knot > tower with air visible between throws. I haveseen a valve repair at a video > demonstation in which the goretex knots looked like a wheatfield. Just try > the experiment of asking a trainee to tie a three throw knot andthen scrape > his knotwith a forceps. > Bob > > > > > > > > > > I really cannot believe this thread. To be talking about technical issues > of knot tying amongst this selective group of highly skillful and > experienced surgeons. I am certain that all of you knew how to properly tie > a knot, regardless of the suture material many years ago.? > ? > Victor.? > Ps I remember some time around the middle 80's when a suture became > available to replace polypropelene for coronary artery anastomosis. It was > the kind without memory and easier to handle, alas it also tended to > stretch, thus either you had to tug a bit more than necessary on the > anastomotic suture possibly creating a purse string effect or you would end > up with a "leaky" anastomosis. Either way it did not last long in our > operating room.? > ? > On Sep 30, 2008, at 6:56 AM, rwmfglycar@aol.com wrote:? > ? > > The real secret of perfect knot tying is to apply just the right > amount > of?graduated pressure as each throw?is cinched down to > produce?enough > compression of the thread to overcome its > slipperiness.. The degree of > compression needed to counteract the > known slipperiness of the thread > varies from make to make. In the > assembly of our Quattro valve we had > sutures which held?adjacent > pericardial sheets in correct alignment. These > were exposed to the > circulation and if they unravelled and worked > themselves loose would > be emboli. Only three throws were allowed. A? > standard surgical > polyester suture was used. Each throw was square. The > sewer had to > pass a test: a normally serrated surgical forceps was scraped > firmly > back and forth across the knot 5 times without causing the knot to > > unravel.? > > The valve?wear tester was an ideal method of checking the quality of > > knots. Knots remained tied past 200 to 800 million cycles.? > > The forceps test is very useful for teaching trainees to tie proper > > knots. They are startled to see seven or more throws of a polyester > or > polypropylene suture start unravelling with the second or third > scrape.? > > This principle obviously?needs modification according to the suture > > used. I never used nor allowed more than 5 throws during valve > insertions. > I would include one double throw ("surgeon's knot") for > > polytetrafluorethylene sutures.? > > Bob? > >? > > -----Original Message-----? > > From: Donald Ross ? > > To: OpenHeart-L@lists.hsforum.com? > > Sent: Tue, 30 Sep 2008 8:12 am? > > Subject: Re: [HSF] polybutester suture? > >? > >? > > Perhaps you don't know how to tie a square knot; many surgeons think > it > is enough to put down alternate throws but the hands need to > cross or > exchange ends to properly square the knot.?? > > Don?? > > ?? > > On 30/09/2008, at 9:13 PM, Prasanna Simha M wrote:?? > > ?? > >> On the same note I had a peculiar problem. I used a regular brand of?? > >> Polybutylate ester suture and after tying 7 knots in a valve, after >> > > going?? > >> round the whole valve I found the entire knot unravelled despite > >> > squared?? > >> knots etc !! I was stunned .Has anyone seen this happening ? I was >> > > pretty?? > >> sure that I had tied down the sutures tight. I removed it and >> placed > > a know?? > >> suture.?? > >> prasanna?? > >> ?? > >> On Tue, Sep 30, 2008 at 9:46 AM, Donald Ross >> > > wrote:?? > >> ?? > >>> I just tried an alternative to prolene: "Vascufil" which is and >> >>> > entirely?? > >>> different polyme r.?? > >>> It has no memory which seems to make it less prone to tangling >> >>> > which is?? > >>> especially nice for coronary surgery and it is supposed to be free >>> > >> from the?? > >>> shredding you get after flogging prolene.?? > >>> Have any members had any experience or problems with this suture??? > >>> Don?? > >>> _______________________________________________?? > >>> OpenHeart-L mailing list?? > >>> ?? > >>> Send postings to:?? > >>> OpenHeart-L@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?? > >>> anddisclaimers posted at:?? > >>> http://www.hsforum.com/listdisclaim?? > >>> -----------------------------------------?? > >>> ?? > >> ?? > >> ?? > >> ?? > >> --> Prasanna Simha M?? > >> _______________________________________________?? > >> OpenHeart-L mailing list?? > >> ?? > >> Send postings to:?? > >> OpenHeart-L@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@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 > anddisclaimers posted at:?? > > http://www.hsforum.com/listdisclaim?? > > -----------------------------------------?? > >? > > _______________________________________________? > > OpenHeart-L mailing list? > >? > > Send postings to:? > > OpenHeart-L@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@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 > anddisclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From msfirst at gmail.com Wed Oct 1 17:44:04 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Wed Oct 1 20:34:53 2008 Subject: [HSF] Pacing wires In-Reply-To: <877082.37708.qm@web81601.mail.mud.yahoo.com> References: <877082.37708.qm@web81601.mail.mud.yahoo.com> Message-ID: While I can not speak for most academic institutions, thanks to the ACGME the residents are no longer involed in much day to day activities. Patients bleeding at night, for example, are delt with at the attending level as are H&Ps, consents, and most management issues. There are many nights the Attendings are the ones standing at the foot of the bed while the fellows are home getting their required 10 hrs off per shift. We have great fellows and they dont like it either..... but it is a new world order, as we have previously discussed. -m On Wed, Oct 1, 2008 at 1:11 PM, Tea Acuff wrote: > Note to michael: they don't call us professor > Tea > > Sent from my iPhone > > On Sep 30, 2008, at 9:11 PM, Michael Firstenberg > wrote: > > > "we are not usually there to manage it?????" > > > > sounds like you have a very very different post-operative care > > system then we do. > > > > > > -michael > > > > > > > > > > > > On Sep 30, 2008, at 12:04 AM, Ben Bidstrup wrote: > > > >> The lack of impact related to clopidogrel use may relate to > >> insensitivity to this drug. ASA is the same. Also may only need a > >> few hours for sufficient non poisoned platelets to be released into > >> the circulation. Also may reflect som egood surgical hameostasis at > >> the beginning of the operation. > >> We do all remember the cases that take 12 hours to close albeit for > >> a short period of time, and those that bleed in ICU and get lots of > >> products albeit for an even shorter time! We are not usually there > >> to manage it. > >> > >> > >> Ben Bidstrup FRACS FRCSEd FEBCTS > >> Cardiothoracic Surgeon > >> > >> > >> > >> On 30/09/2008, at 12:45 PM, Tea Acuff wrote: > >> > >>> Actually you do have experimental data, at least the kind that i > >>> think is of the era of Hunter and his devotees today. All his > >>> peers merely consulted the authoritative texts as proof or > >>> "reference". That you have not spent hours mopping up bleeding and > >>> associated disasters in this group of patients is very suggestive. > >>> I remember how we used to postpone surgery because of ASA, but no > >>> longer do. I just did an emergent CABG on chronic Plavix without > >>> signficant bleeding or plt use. I suspect we will have to do > >>> without a RCT of VAD explants with and without plavix, with and > >>> without ASA, with and without betablocker, etc and etc. > >>> > >>> tea > >>> > >>> > >>> > >>> ----- Original Message ---- > >>> From: Ani Anyanwu > >>> To: openheart-l@lists.hsforum.com > >>> Sent: Saturday, September 27, 2008 8:56:48 PM > >>> Subject: RE: [HSF] Pacing wires > >>> > >>> Tea > >>> > >>> Yes we have done redo roots on Plavix. > >>> > >>> My personal feeling (and I dont have data) is that plavix has > >>> little bearing on postoperative bleeding and I practically never > >>> stop it even for redos. Several of my patients with ventricular > >>> assist devices are on plavix and warfarin and they get called from > >>> home for transplant and we do the redo to take VAD out and heart > >>> transplant on plavix and warfarin - often this is the third or > >>> even fourth redo. Many of these patients we do not give platelets > >>> because we are worried about deleterious effects on the donor > >>> right heart so we give FFP to reverse the warfarin, wait do a TEG, > >>> pack, gelfoam thrombin etc and the majority we find we can control > >>> the bleeding without platelet transfusion. There are a couple very > >>> difficult VAD reop transplants that were troublesome though that > >>> ended up with lots of platelets and factor VII but we have only > >>> had one take back for bleeding in this group of patients over the > >>> last 2 years. > >>> > >>> Certainly for patients with coronary disease as the indication for > >>> surgery, I do not stop plavix - most these patients though I would > >>> do off-pump with bilateral ITAs and almost as a rule bleeding has > >>> not been a problem. > >>> > >>> Ani > >>> > >>> > >>> > >>> > >>> > >>> > >>>> Date: Sat, 27 Sep 2008 18:45:42 -0700> From: tacuff@swbell.net> > >>>> Subject: Re: [HSF] Pacing wires> To: OpenHeart- > >>>> L@lists.hsforum.com> CC: > > so you do a redo AVR root on Plavix? > >>>> > > tea> > > > ----- Original Message ----> From: Ani Anyanwu < > anianyanwu@hotmail.com > >>>> >> To: openheart-l@lists.hsforum.com> Sent: Saturday, September > >>>> 27, 2008 8:27:46 PM> Subject: RE: [HSF] Pacing wires> > All our > >>>> OPCABs are on plavix post op. Also we no longer stop plavix pre- > >>>> op on patients with intracoronary stents. If they have a pacing > >>>> wire, plavix has no bearing on their removal.> > Ani> > > > > > >>>> From: njucastro@gmail.com> To: OpenHeart-L@lists.hsforum.com> > >>>> Date: Sat, 27 Sep 2008 20:10:13 -0500> CC: > Subject: [HSF] > >>>> Pacing wires> > Hi all,> Follow up question and poll on pacing > >>>> wires. If a patient has pacing > wires in the RV myocardium and > >>>> he has somehow been started on plavix, > would you pull them or > >>>> just cut them?> > J Castro> Minneapolis MN> > Sent from my > >>>> iPhone> > On > >>> Sep 27, 2008, at 17:27, David Harris > >>> wrote:> > > The last case I had with a Calcified aorta needed 3 > >>> grafts, valve, > > and we replaced the ascending. There was one > >>> place to clamp, just > > below innominate. We got the cardiologist > >>> to first take him to the > > cath lab, and deploy 2 carotid > >>> filters, then proceeded directly. We > > cannulated femoral > >>> artery, and managed to clamp (it leaked a bit!). > > So we managed > >>> to shorten the procedure and avoid hypothermic arrest.> >> > The > >>> filters were then removed under imaging. The left one had no > > > >>> debris.> The right one`s wire fractured as we removed it, as the > > >>> > clamp had gone over it!! The cardiologist snared it and removed > >>> it > > the next day. It had a small bit of debris in it.> >> >> > > >>> --- On Tue, 23/9/08, hgrmd@aol.com wrote:> >> > > >>> From: hgrmd@aol.com > > Subject: Re: [HSF] Embol-x: > >>> Snaring bits of embolic material does > > not mean we are > >>> redu...> > To: OpenHeart-L@lists.hsforum.com> > Date: Tuesday, 23 > >>> September, 2008, 8:29 PM> >> > Michael,> > ? The handful of cases > >>> I've done, I've cannulated either femorally or> > axillary.? The > >>> aorta is replaced.?> >> > Hal> >> >> >> >> >> >> >> > ----- > >>> Original Message-----> > From: Michael Firstenberg >>> >> > To: OpenHeart-L@lists.hsforum.com> > Sent: Tue, 23 Sep 2008 > >>> 8:05 am> > Subject: Re: [HSF] Embol-x: Snaring bits of embolic > >>> material does > > not mean we> > are redu...> >> >> >> > hal> > so > >>> if you are doing a avr with an ugly aorta will you ax cannulate > >>> and>> > use dhca AND clean out or just replace the ascending?> >> > >>> > michael.> >> > On 9/23/08, Hgrmd@aol.com wrote:> > >>> >> Roberto,> >> If I encounter a totally calcified ascending > >>> aorta, I also use > >> DHCA to> > a> >> graft to the arch. Like > >>> you, I carefully scavenge out any debris > >> from> > the> >> arch > >>> prior to resuming CPB. I haven't used Embol-X on cases > >>> like> > that. I> >> would> >> be hesitant in directly inserting > >>> one into a graft, because I would> >> anticipate that getting > >>> hemostasis at the cannulation site might > >> prove> >> > >>> difficult.> >>> >> Hal> >>> >>> >>> >> **************Looking for > >>> simple solutions to your real-life > >> financial> >> challenges? > >>> Check out WalletPop for the latest news and > >> information, > >>> tips> >> and> >> calculators. ( > http://www.walletpop.com/?NCID=emlcntuswall00000001 > >>> > >> )> >> _______________________________________________> >> > >>> OpenHeart-L mailing list> >>> >> Send postings to:> >>> > OpenHeart-L@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@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@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@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@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 > >>> > -----------------------------------------> > >>> _________________________________________________________________> > >>> Get all your favourite content with the slick new MSN Toolbar - > >>> FREE> > >>> > http://clk.atdmt.com/UKM/go/111354027/direct/01/_______________________________________________ > >>> > OpenHeart-L mailing list> > Send postings to:> > OpenHeart-L@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@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 > >>> > ----------------------------------------- > >>> _________________________________________________________________ > >>> Win New York holidays with Kellogg's & Live Search > >>> > http://clk.atdmt.com/UKM/go/111354033/direct/01/_______________________________________________ > >>> OpenHeart-L mailing list > >>> > >>> Send postings to: > >>> OpenHeart-L@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@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@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@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@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 > ----------------------------------------- > From enaseri at hotmail.com.tr Thu Oct 2 09:19:54 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Thu Oct 2 04:20:22 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> Message-ID: Robertto, I was thinking to cannulate R subclavian vein for SVC drainage( any experience or information in this regard?).as for R thoracotomy I had a real disaster trying to repair and then replace tricuspid valve from r side.I will follow Hal's recommendations and cannulate femoral artery -vein and continue with sternotomy . erdinc PS:If the problem was adressed at the 1.st op then the EUroscore would be around 4% and now it is 51%( with all those comorbid factors) From robertobattellini at hotmail.com Thu Oct 2 11:27:23 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Thu Oct 2 04:28:11 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> Message-ID: Erdinc, Good idea, may be you do not get the cannula into the SVC, but if you have suction the result will be the same. Please, maintain me informed about this creative idea, and if it works, write a How to do it! Roberto> From: enaseri@hotmail.com.tr> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] TVR 1 year after CABG> Date: Thu, 2 Oct 2008 08:19:54 +0000> > > Robertto,> I was thinking to cannulate R subclavian vein for SVC drainage( any experience or information in this regard?).as for R thoracotomy I had a real disaster trying to repair and then replace tricuspid valve from r side.I will follow Hal's recommendations and cannulate femoral artery -vein and continue with sternotomy . > erdinc PS:If the problem was adressed at the 1.st op then the EUroscore would be around 4% and now it is 51%( with all those comorbid factors)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From robertobattellini at hotmail.com Thu Oct 2 11:33:39 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Thu Oct 2 04:34:07 2008 Subject: [HSF] ?AVR In-Reply-To: <82132.47249.qm@web26704.mail.ukl.yahoo.com> References: <000801c91e89$bb7b69b0$0201a8c0@yourg8he5gjrox> <82132.47249.qm@web26704.mail.ukl.yahoo.com> Message-ID: Dear all, late answer, but many times angio studies are not exact. Does anyone makes IVUS in these 40-50% stenosed artery cases? Roberto> Date: Sat, 27 Sep 2008 22:08:06 +0000> From: drdharris@yahoo.co.uk> Subject: RE: [HSF] ?AVR> To: OpenHeart-L@lists.hsforum.com> CC: > > Also depends on size of LAD: very large LAD, 50-60%, rather do vein. I would however not leave it. We often underestimate the extent of disease, or the patient may be in a phase where he is having more rapid plaque buildup.> > A year ago I did a patient who had slight irregularity of prox LAD (possibly 10%), large ramus with 60%, severe stenosis prox RCA. I felt uncomfortable about the LAD, as we all know it will usually also be diseased. Anyway, I did OPCAB, LIMA to ramus, RIMA to mid RCA. Now has recurrent angina, positive stress ECG. Angio shows both grafts open, but now 90% prox LAD, which was stented.> > --- On Thu, 25/9/08, Ajit Damle wrote:> > From: Ajit Damle > Subject: RE: [HSF] ?AVR> To: OpenHeart-L@lists.hsforum.com> Date: Thursday, 25 September, 2008, 12:08 AM> > Cleveland Clinic recommends that for an incidental grafting of LAD, LIMA> would be ok for stenoses>50%.> > Ajit> > -----Original Message-----> From: openheart-l-bounces@lists.hsforum.com> [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Ben Bidstrup> Sent: Wednesday, September 24, 2008 3:43 PM> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] ?AVR> > It will likely string.> > > Ben Bidstrup FRACS FRCSEd FEBCTS> Cardiothoracic Surgeon> > > > On 25/09/2008, at 5:15 AM, Ajit Damle wrote:> > > Why am I grafting 60% LIMA-LAD? I don't know. Conventional wisdom, I > > guess.> >> > Ajit> >> > -----Original Message-----> > From: openheart-l-bounces@lists.hsforum.com> > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Ani > > Anyanwu> > Sent: Wednesday, September 24, 2008 12:21 PM> > To: openheart-l@lists.hsforum.com> > Subject: RE: [HSF] ?AVR> >> > Tea> >> > Maybe give reasons for your advice? Why didn't you for instance say > > to stop> > at 'The sinuses look OK and I do>not think I will need to go below> the> > coronary ostia'.> >> > Why exactly do you advise grafting an asymptomatic 60% LAD with a > > LIMA in a> > 77 yr old man?> >> > Ani> >> >> >> >> >> Date: Wed, 24 Sep 2008 09:46:39 -0700> From: tacuff@swbell.net> > > >> Subject:> > Re: [HSF] ?AVR> To: OpenHeart-L@lists.hsforum.com> CC: > >> Stop at > > so far so> > good.> > Tea> > Sent from my iPhone> > On Sep 24, 2008,> at 9:47 AM, > > "Ajit> > Damle" wrote:> > I have an ascending> aortic > > aneurysm> > next week in a fit 77 yr man. I did his> AVR in 1994 with a > > Carbomedics> > 25mm. I noted at that time the ascending> aorta to be "mildly > > ectatic". Now> > the CT shows a 6.4 cms aneurysm starting> just above the coronary > > ostia and> > extending into mid-arch. I plan to excise> this under DHCA. His risk > > should> > be quite low. The sinuses look OK and I do> not think I will need to > > go> > below the coronary ostia. LAD has a 60% stenosis> and I will graft > > it with> > LIMA.> > So far so good. > > The question is what I do with> the > > Carbomedics> > aortic valve. This has> functioned just fine over the years, he has > > had no> > problem with> anti-coagulation. However, if I could replace it with > > a tissue> > valve, he> will not need coumadin.> > Replacing the valve does> add > > extra> > risk, which I do not know is worth> taking. Clearly, yes, if the > > replacement> > is straight forward. Indeed, in my> experience removing and > > replacing an> > aortic prosthesis has worked well. But> I will not know that till I > > start> > taking out the prosthesis and then it will> be too late.> > What > > > would you> > do?> > Ajit Damle> Fargo ND> > >> > _______________________________________________> OpenHeart-L mailing > > list> >> > Send postings to:> OpenHeart-L@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@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>> > -----------------------------------------> > _________________________________________________________________> > Discover Bird's Eye View now with Multimap from Live Search> >> http://clk.atdmt.com/UKM/go/111354026/direct/01/____________________________> > ___________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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@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@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@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> ----------------------------------------- From robertobattellini at hotmail.com Thu Oct 2 11:42:52 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Thu Oct 2 04:43:40 2008 Subject: [HSF] ?AVR In-Reply-To: <003001c91e54$7c864430$0201a8c0@yourg8he5gjrox> References: <008d01c91e49$a6bd00a0$6701a8c0@ee5d8243aab9404> <003001c91e54$7c864430$0201a8c0@yourg8he5gjrox> Message-ID: Ajit, sorry for the late question, can you tell me how did the case went? We have done a lot of these cases maintaining the old good integrated valve.Sometimes supracoronary replacement, sometimes a Kouchoukos operation and once a Cabrol operation. I have some photos. Roberto> From: damle@cableone.net> To: OpenHeart-L@lists.hsforum.com> Date: Wed, 24 Sep 2008 09:47:35 -0500> CC: > Subject: [HSF] ?AVR> > I have an ascending aortic aneurysm next week in a fit 77 yr man. I did his> AVR in 1994 with a Carbomedics 25mm. I noted at that time the ascending> aorta to be "mildly ectatic". Now the CT shows a 6.4 cms aneurysm starting> just above the coronary ostia and extending into mid-arch. I plan to excise> this under DHCA. His risk should be quite low. The sinuses look OK and I do> not think I will need to go below the coronary ostia. LAD has a 60% stenosis> and I will graft it with LIMA.> > So far so good. > > The question is what I do with the Carbomedics aortic valve. This has> functioned just fine over the years, he has had no problem with> anti-coagulation. However, if I could replace it with a tissue valve, he> will not need coumadin.> > Replacing the valve does add extra risk, which I do not know is worth> taking. Clearly, yes, if the replacement is straight forward. Indeed, in my> experience removing and replacing an aortic prosthesis has worked well. But> I will not know that till I start taking out the prosthesis and then it will> be too late.> > What would you do?> > Ajit Damle> Fargo ND> > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From prasannasimha at gmail.com Thu Oct 2 15:23:35 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Oct 2 05:25:44 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> Message-ID: <89c4ed2d0810020153ia5b2a0bgbc561c9126dbd690@mail.gmail.com> If you have vacuum assist you need to have only the femoral cannula. Open the RA and push another cnnula into the open end of the SVC. This also works well if you have not placed a percut jugular catheter. This works excellently . If it flops out, you can place a silk stitch at the base of the svc and snare it around the cannula. It stays put. In fact this allows for less instrumentation and holes to deal with later. Prasanna On Thu, Oct 2, 2008 at 1:57 PM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > Erdinc, > > Good idea, may be you do not get the cannula into the SVC, but if you have > suction the result will be the same. > Please, maintain me informed about this creative idea, and if it works, > write a How to do it! > Roberto> From: enaseri@hotmail.com.tr> To: openheart-l@lists.hsforum.com> > Subject: RE: [HSF] TVR 1 year after CABG> Date: Thu, 2 Oct 2008 08:19:54 > +0000> > > Robertto,> I was thinking to cannulate R subclavian vein for SVC > drainage( any experience or information in this regard?).as for R > thoracotomy I had a real disaster trying to repair and then replace > tricuspid valve from r side.I will follow Hal's recommendations and > cannulate femoral artery -vein and continue with sternotomy . > erdinc PS:If > the problem was adressed at the 1.st op then the EUroscore would be around > 4% and now it is 51%( with all those comorbid factors)> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From Hgrmd at aol.com Thu Oct 2 06:53:37 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Thu Oct 2 05:54:39 2008 Subject: [HSF] TVR 1 year after CABG Message-ID: Erdinc, For SVC drainage, we use a percutaneous, 17Fr, right IJ Biomedicus arterial cannula. Use fluoro to direct it into place. I'd also advise exchanging the wire contained in the kit for a stiff wire. The tip of the introducer is sharp, and can cause the wire to kink and possibly perforate the SVC (never happened to me, but I witnessed it happen to another surgeon). Hal **************Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) From damle at cableone.net Thu Oct 2 08:14:37 2008 From: damle at cableone.net (Ajit Damle) Date: Thu Oct 2 08:21:25 2008 Subject: [HSF] ?AVR In-Reply-To: Message-ID: <41F2B637F6C24797ADE6A84AE7B8F06B@yourg8he5gjrox> Roberto, I did not replace the aortic valve. Almost every surgeon I talked to recommended that I should leave the valve alone (except a surgeon at the Cleveland Clinic, who said that while I should do what I can do well, he would replace the valve with a biologic prosthesis and graft the LAD with LIMA). Pre-op, I reviewed the angiogram again with cardiology. The LAD lesion was felt to be @ 50%, and very suitable for stenting if needed. No IVUS was done at the time of angiography. I used a 30 mm Gelweave tube graft to replace the ascending aorta and the proximal arch (actually the floor of the aortic arch). Technically, the procedure was simple and straight forward. The patient did fine. The circ arrest time was 21 minutes. I do not use steroids, neither do I manage the pH, nor use retrograde cerebral perfusion, all because of lack of credible evidence. In the end, I did not graft the LAD (partly because of all the mutinous HSF surgeons!). The patient did very well. As always, I marvel how well these patients do in spite of having undergone circulatory arrest and the whole body and brain full of air. This 77 year old man was reading his newspaper 36 hours post-op! I would love to take credit for all this, but as it should, it goes to the master surgeons who taught us how to do this right. Ajit . -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Roberto Battellini Sent: Thursday, October 02, 2008 3:43 AM To: openheart-l@lists.hsforum.com Subject: RE: [HSF] ?AVR Ajit, sorry for the late question, can you tell me how did the case went? We have done a lot of these cases maintaining the old good integrated valve.Sometimes supracoronary replacement, sometimes a Kouchoukos operation and once a Cabrol operation. I have some photos. Roberto> From: damle@cableone.net> To: OpenHeart-L@lists.hsforum.com> Date: Wed, 24 Sep 2008 09:47:35 -0500> CC: > Subject: [HSF] ?AVR> > I have an ascending aortic aneurysm next week in a fit 77 yr man. I did his> AVR in 1994 with a Carbomedics 25mm. I noted at that time the ascending> aorta to be "mildly ectatic". Now the CT shows a 6.4 cms aneurysm starting> just above the coronary ostia and extending into mid-arch. I plan to excise> this under DHCA. His risk should be quite low. The sinuses look OK and I do> not think I will need to go below the coronary ostia. LAD has a 60% stenosis> and I will graft it with LIMA.> > So far so good. > > The question is what I do with the Carbomedics aortic valve. This has> functioned just fine over the years, he has had no problem with> anti-coagulation. However, if I could replace it with a tissue valve, he> will not need coumadin.> > Replacing the valve does add extra risk, which I do not know is worth> taking. Clearly, yes, if the replacement is straight forward. Indeed, in my> experience removing and replacing an aortic prosthesis has worked well. But> I will not know that till I start taking out the prosthesis and then it will> be too late.> > What would you do?> > Ajit Damle> Fargo ND> > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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 ----------------------------------------- From damle at cableone.net Thu Oct 2 08:31:37 2008 From: damle at cableone.net (Ajit Damle) Date: Thu Oct 2 08:38:31 2008 Subject: [HSF] Microplegia In-Reply-To: Message-ID: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox> Do you have experience with what is called microplegia? This is basically KCL and MgSO4 solution that is mixed with patients blood, rather than a crystalloid solution. The advantages are said to be less hemodilution (particularly for long cases), better K and glucose control and reduction in myocardial edema. A company, Quest Medical Systems, is touting this with a pump and delivery system, but it can be as easily done with a syringe pump, and very cheaply indeed. What is your experience and opinion? Ajit Damle From prasannasimha at gmail.com Thu Oct 2 19:21:02 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Oct 2 09:11:51 2008 Subject: [HSF] Microplegia In-Reply-To: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox> References: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox> Message-ID: <89c4ed2d0810020551t45c0150ex3701040cf9c32bef@mail.gmail.com> I think Hal uses that system. Supposed to reduce volume requirements. With 4:1 blood to cardioplegia systems is it really that big an issue especially since most of these can be manaed with a diuretic shot or hemofiltration. Incidentally I add Insulin to my cardioplegia so that it doesn't increasesystemic K values (6U of insulin in the 500 ml bag of cardioplegic solution that is destined to be diluted 1:4) Keeps glucose also down and keeps K rock steady despite huge volumes of cardioplegia in long cases. Also in the interim when field visibility is not a problem I perfuse cold normokalemic blood (usuaullay retrograde) continuously as recommended by Buckberg and with that we have a quiescent cold heart that doesnt beat. (I also have Esmolol and Adenosine in it) As I had said before I have once peged a heart for over 6 hours with it but weaned off with 3 mics dopa/dobut. Prasanna On Thu, Oct 2, 2008 at 6:01 PM, Ajit Damle wrote: > Do you have experience with what is called microplegia? This is basically > KCL and MgSO4 solution that is mixed with patients blood, rather than a > crystalloid solution. > > > > The advantages are said to be less hemodilution (particularly for long > cases), better K and glucose control and reduction in myocardial edema. A > company, Quest Medical Systems, is touting this with a pump and delivery > system, but it can be as easily done with a syringe pump, and very cheaply > indeed. > > > > What is your experience and opinion? > > > > Ajit Damle > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From rowlesjohn at aol.com Thu Oct 2 14:46:57 2008 From: rowlesjohn at aol.com (rowlesjohn@aol.com) Date: Thu Oct 2 09:46:35 2008 Subject: [HSF] Microplegia Message-ID: <636711257-1222955165-cardhu_decombobulator_blackberry.rim.net-818724023-@bxe141.bisx.prod.on.blackberry> QWppdA0KDQpXZSBoYXZlIHVzZWQgaXQgZm9yIHRoZSBwYXN0IHllYXJzIGFuZCBpdCBpcyBncmVh dC4gVGhlIHBlcmZ1c2lvbmlzdHMgaGF2ZSB0b3RhbCBjb250cm9sIG9mIGFsbCBpbmdyZWRpZW50 cyBhbmQgdGhlIGRlbGl2ZXJ5IHN5c3RlbSBpcyB2ZXJ5IHNhZmUgYW5kIHJlbGlhYmxlLiBQYXRp ZW50cyBoYXZlIGxlc3Mgd2VpZ2h0IGdhaW4gZnJvbSBmbHVpZCByZXRlbnRpb24gYW5kIEkgdGhp bmsgYSBsb3dlciByYXRlIG9mIEEgZmliIHBvc3Qgb3AgYnV0IEkgZG8gbm90IGhhdmUgc3BlY2lm aWMgZGF0YS4gDQoNCk9uIG9jY2FzaW9uIEkgaGF2ZSBoYWQgdmVyeSBsb25nIGNsYW1wIHRpbWVz ICg0IGhycykgYW5kIHRoZSBoZWFydHMgaGF2ZSBmdW5jdGlvbmVkIHN1cnByaXNpbmdseSB3ZWxs LiANCg0KSSB0aGluayB5b3Ugd2lsbCBiZSB2ZXJ5IGhhcHB5IGlmIHlvdSBhZG9wdCB0aGlzIHN5 c3RlbS4gDQoNCkpvaG4gUm93bGVzDQpXZW5hdGNoZWUsIFdBDQotLS0tLS1PcmlnaW5hbCBNZXNz YWdlLS0tLS0tDQpGcm9tOiBBaml0IERhbWxlDQpTZW5kZXI6IG9wZW5oZWFydC1sLWJvdW5jZXNA bGlzdHMuaHNmb3J1bS5jb20NClRvOiBPcGVuSGVhcnQtTEBsaXN0cy5oc2ZvcnVtLmNvbQ0KUmVw bHlUbzogT3BlbkhlYXJ0LUxAbGlzdHMuaHNmb3J1bS5jb20NClN1YmplY3Q6IFtIU0ZdIE1pY3Jv cGxlZ2lhDQpTZW50OiBPY3QgMiwgMjAwOCA1OjMxIEFNDQoNCkRvIHlvdSBoYXZlIGV4cGVyaWVu Y2Ugd2l0aCB3aGF0IGlzIGNhbGxlZCBtaWNyb3BsZWdpYT8gVGhpcyBpcyBiYXNpY2FsbHkNCktD TCBhbmQgTWdTTzQgc29sdXRpb24gdGhhdCBpcyBtaXhlZCB3aXRoIHBhdGllbnRzIGJsb29kLCBy YXRoZXIgdGhhbiBhDQpjcnlzdGFsbG9pZCBzb2x1dGlvbi4NCg0KIA0KDQpUaGUgYWR2YW50YWdl cyBhcmUgc2FpZCB0byBiZSBsZXNzIGhlbW9kaWx1dGlvbiAocGFydGljdWxhcmx5IGZvciBsb25n DQpjYXNlcyksIGJldHRlciBLIGFuZCBnbHVjb3NlIGNvbnRyb2wgYW5kIHJlZHVjdGlvbiBpbiBt eW9jYXJkaWFsIGVkZW1hLiBBDQpjb21wYW55LCBRdWVzdCBNZWRpY2FsIFN5c3RlbXMsIGlzIHRv dXRpbmcgdGhpcyB3aXRoIGEgcHVtcCBhbmQgZGVsaXZlcnkNCnN5c3RlbSwgYnV0IGl0IGNhbiBi ZSBhcyBlYXNpbHkgZG9uZSB3aXRoIGEgc3lyaW5nZSBwdW1wLCBhbmQgdmVyeSBjaGVhcGx5DQpp bmRlZWQuDQoNCiANCg0KV2hhdCBpcyB5b3VyIGV4cGVyaWVuY2UgYW5kIG9waW5pb24/DQoNCiAN Cg0KQWppdCBEYW1sZQ0KDQpfX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19f X19fX19fXw0KT3BlbkhlYXJ0LUwgbWFpbGluZyBsaXN0DQoNClNlbmQgcG9zdGluZ3MgdG86DQog T3BlbkhlYXJ0LUxAbGlzdHMuaHNmb3J1bS5jb20NCg0KVG8gVU5TVUJTQ1JJQkUsIHRvIENIQU5H RSBlbWFpbCBhZGRyZXNzLCBvciB0byB2aWV3IGFyY2hpdmVzOg0KaHR0cDovL21tcC5janAuY29t L21haWxtYW4vbGlzdGluZm8vb3BlbmhlYXJ0LWwNCg0KQWxsIG1lc3NhZ2VzIHRyYW5zbWl0dGVk IGJ5IHRoZSBPcGVuSGVhcnQtTCBhcmUgc3ViamVjdCB0byB0aGUgcG9saWNpZXMgYW5kIA0KZGlz Y2xhaW1lcnMgcG9zdGVkIGF0Og0KaHR0cDovL3d3dy5oc2ZvcnVtLmNvbS9saXN0ZGlzY2xhaW0N Ci0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tDQoNCg0KU2VudCBmcm9t IG15IFZlcml6b24gV2lyZWxlc3MgQmxhY2tCZXJyeQ== From prasannasimha at gmail.com Thu Oct 2 20:35:47 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Oct 2 10:06:05 2008 Subject: [HSF] Microplegia In-Reply-To: <636711257-1222955165-cardhu_decombobulator_blackberry.rim.net-818724023-@bxe141.bisx.prod.on.blackberry> References: <636711257-1222955165-cardhu_decombobulator_blackberry.rim.net-818724023-@bxe141.bisx.prod.on.blackberry> Message-ID: <89c4ed2d0810020705h71477c51tb47420b5ac88629d@mail.gmail.com> Does this system use propriety cartridges of the constituents ? prasanna On Thu, Oct 2, 2008 at 7:16 PM, wrote: > Ajit > > We have used it for the past years and it is great. The perfusionists have > total control of all ingredients and the delivery system is very safe and > reliable. Patients have less weight gain from fluid retention and I think a > lower rate of A fib post op but I do not have specific data. > > On occasion I have had very long clamp times (4 hrs) and the hearts have > functioned surprisingly well. > > I think you will be very happy if you adopt this system. > > John Rowles > Wenatchee, WA > ------Original Message------ > From: Ajit Damle > Sender: openheart-l-bounces@lists.hsforum.com > To: OpenHeart-L@lists.hsforum.com > ReplyTo: OpenHeart-L@lists.hsforum.com > Subject: [HSF] Microplegia > Sent: Oct 2, 2008 5:31 AM > > Do you have experience with what is called microplegia? This is basically > KCL and MgSO4 solution that is mixed with patients blood, rather than a > crystalloid solution. > > > > The advantages are said to be less hemodilution (particularly for long > cases), better K and glucose control and reduction in myocardial edema. A > company, Quest Medical Systems, is touting this with a pump and delivery > system, but it can be as easily done with a syringe pump, and very cheaply > indeed. > > > > What is your experience and opinion? > > > > Ajit Damle > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > > > Sent from my Verizon Wireless BlackBerry > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From tacuff at swbell.net Thu Oct 2 09:28:12 2008 From: tacuff at swbell.net (Tea Acuff) Date: Thu Oct 2 11:29:43 2008 Subject: [HSF] Pacing wires Message-ID: <431515.89310.qm@web81604.mail.mud.yahoo.com> They call me the same that you call your interns and residents, doctor. I just ask that they not call me at night just to "let me know" unless something important is going on. ? tea ----- Original Message ---- From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Wednesday, October 1, 2008 3:44:04 PM Subject: Re: [HSF] Pacing wires While I can not speak for most academic institutions, thanks to the ACGME the residents are no longer involed in much day to day activities.? Patients bleeding at night, for example, are delt with at the attending level as are H&Ps, consents, and most management issues.? There are many nights the Attendings are the ones standing at the foot of the bed while the fellows are home getting their required 10 hrs off per shift.? We have great fellows and they dont like it either..... but it is a new world order, as we have previously discussed. -m On Wed, Oct 1, 2008 at 1:11 PM, Tea Acuff wrote: > Note to michael: they don't call us professor > Tea > > Sent from my iPhone > > On Sep 30, 2008, at 9:11 PM, Michael Firstenberg > wrote: > > > "we are not usually there to manage it?????" > > > > sounds like you have a very very different post-operative care > > system then we do. > > > > > > -michael > > > > > > > > > > > > On Sep 30, 2008, at 12:04 AM, Ben Bidstrup wrote: > > > >> The lack of impact related to clopidogrel use may relate to > >> insensitivity to this drug. ASA is the same. Also may only need a > >> few hours for sufficient non poisoned platelets to be released into > >> the circulation. Also may reflect som egood surgical hameostasis at > >> the beginning of the operation. > >> We do all remember the cases that take 12 hours to close albeit for > >> a short period of time, and those that bleed in ICU and get lots of > >> products albeit for an even shorter time! We are not usually there > >> to manage it. > >> > >> > >> Ben Bidstrup FRACS FRCSEd FEBCTS > >> Cardiothoracic Surgeon > >> > >> > >> > >> On 30/09/2008, at 12:45 PM, Tea Acuff wrote: > >> > >>> Actually you do have experimental data, at least the kind that i > >>> think is of the era of Hunter and his devotees today. All his > >>> peers merely consulted the authoritative texts as proof or > >>> "reference". That you have not spent hours mopping up bleeding and > >>> associated disasters in this group of patients is very suggestive. > >>> I remember how we used to postpone surgery because of ASA, but no > >>> longer do. I just did an emergent CABG on chronic Plavix without > >>> signficant bleeding or plt use. I suspect we will have to do > >>> without a RCT of VAD explants with and without plavix, with and > >>> without ASA, with and without betablocker, etc and etc. > >>> > >>> tea > >>> > >>> > >>> > >>> ----- Original Message ---- > >>> From: Ani Anyanwu > >>> To: openheart-l@lists.hsforum.com > >>> Sent: Saturday, September 27, 2008 8:56:48 PM > >>> Subject: RE: [HSF] Pacing wires > >>> > >>> Tea > >>> > >>> Yes we have done redo roots on Plavix. > >>> > >>> My personal feeling (and I dont have data) is that plavix has > >>> little bearing on postoperative bleeding and I practically never > >>> stop it even for redos. Several of my patients with ventricular > >>> assist devices are on plavix and warfarin and they get called from > >>> home for transplant and we do the redo to take VAD out and heart > >>> transplant on plavix and warfarin - often this is the third or > >>> even fourth redo. Many of these patients we do not give platelets > >>> because we are worried about deleterious effects on the donor > >>> right heart so we give FFP to reverse the warfarin, wait do a TEG, > >>> pack, gelfoam thrombin etc and the majority we find we can control > >>> the bleeding without platelet transfusion. There are a couple very > >>> difficult VAD reop transplants that were troublesome though that > >>> ended up with lots of platelets and factor VII but we have only > >>> had one take back for bleeding in this group of patients over the > >>> last 2 years. > >>> > >>> Certainly for patients with coronary disease as the indication for > >>> surgery, I do not stop plavix - most these patients though I would > >>> do off-pump with bilateral ITAs and almost as a rule bleeding has > >>> not been a problem. > >>> > >>> Ani > >>> > >>> > >>> > >>> > >>> > >>> > >>>> Date: Sat, 27 Sep 2008 18:45:42 -0700> From: tacuff@swbell.net> > >>>> Subject: Re: [HSF] Pacing wires> To: OpenHeart- > >>>> L@lists.hsforum.com> CC: > > so you do a redo AVR root on Plavix? > >>>> >? > tea> > > > ----- Original Message ----> From: Ani Anyanwu < > anianyanwu@hotmail.com > >>>> >> To: openheart-l@lists.hsforum.com> Sent: Saturday, September > >>>> 27, 2008 8:27:46 PM> Subject: RE: [HSF] Pacing wires> > All our > >>>> OPCABs are on plavix post op. Also we no longer stop plavix pre- > >>>> op on patients with intracoronary stents. If they have a pacing > >>>> wire, plavix has no bearing on their removal.> > Ani> > > > > > >>>> From: njucastro@gmail.com> To: OpenHeart-L@lists.hsforum.com> > >>>> Date: Sat, 27 Sep 2008 20:10:13 -0500> CC: > Subject: [HSF] > >>>> Pacing wires> > Hi all,> Follow up question and poll on pacing > >>>> wires. If a patient has pacing > wires in the RV myocardium and > >>>> he has somehow been started on plavix, > would you pull them or > >>>> just cut them?> > J Castro> Minneapolis MN> > Sent from my > >>>> iPhone> > On > >>> Sep 27, 2008, at 17:27, David Harris > >>> wrote:> > > The last case I had with a Calcified aorta needed 3 > >>> grafts, valve, > > and we replaced the ascending. There was one > >>> place to clamp, just > > below innominate. We got the cardiologist > >>> to first take him to the > > cath lab, and deploy 2 carotid > >>> filters, then proceeded directly. We > > cannulated femoral > >>> artery, and managed to clamp (it leaked a bit!). > > So we managed > >>> to shorten the procedure and avoid hypothermic arrest.> >> > The > >>> filters were then removed under imaging. The left one had no > > > >>> debris.> The right one`s wire fractured as we removed it, as the > > >>> > clamp had gone over it!! The cardiologist snared it and removed > >>> it > > the next day. It had a small bit of debris in it.> >> >> > > >>> --- On Tue, 23/9/08, hgrmd@aol.com wrote:> >> > > >>> From: hgrmd@aol.com > > Subject: Re: [HSF] Embol-x: > >>> Snaring bits of embolic material does > > not mean we are > >>> redu...> > To: OpenHeart-L@lists.hsforum.com> > Date: Tuesday, 23 > >>> September, 2008, 8:29 PM> >> > Michael,> > ? The handful of cases > >>> I've done, I've cannulated either femorally or> > axillary.? The > >>> aorta is replaced.?> >> > Hal> >> >> >> >> >> >> >> > ----- > >>> Original Message-----> > From: Michael Firstenberg >>> >> > To: OpenHeart-L@lists.hsforum.com> > Sent: Tue, 23 Sep 2008 > >>> 8:05 am> > Subject: Re: [HSF] Embol-x: Snaring bits of embolic > >>> material does > > not mean we> > are redu...> >> >> >> > hal> > so > >>> if you are doing a avr with an ugly aorta will you ax cannulate > >>> and>> > use dhca AND clean out or just replace the ascending?> >> > >>> > michael.> >> > On 9/23/08, Hgrmd@aol.com wrote:> > >>> >> Roberto,> >> If I encounter a totally calcified ascending > >>> aorta, I also use > >> DHCA to> > a> >> graft to the arch. Like > >>> you, I carefully scavenge out any debris > >> from> > the> >> arch > >>> prior to resuming CPB. I haven't used Embol-X on cases > >>> like> > that. I> >> would> >> be hesitant in directly inserting > >>> one into a graft, because I would> >> anticipate that getting > >>> hemostasis at the cannulation site might > >> prove> >> > >>> difficult.> >>> >> Hal> >>> >>> >>> >> **************Looking for > >>> simple solutions to your real-life > >> financial> >> challenges? > >>> Check out WalletPop for the latest news and > >> information, > >>> tips> >> and> >> calculators. ( > http://www.walletpop.com/?NCID=emlcntuswall00000001 > >>>? > >> )> >> _______________________________________________> >> > >>> OpenHeart-L mailing list> >>> >> Send postings to:> >>> > OpenHeart-L@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@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@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@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@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 > >>> > -----------------------------------------> > >>> _________________________________________________________________> > >>> Get all your favourite content with the slick new MSN Toolbar - > >>> FREE> > >>> > http://clk.atdmt.com/UKM/go/111354027/direct/01/_______________________________________________ > >>> > OpenHeart-L mailing list> > Send postings to:> > OpenHeart-L@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@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 > >>> > ----------------------------------------- > >>> _________________________________________________________________ > >>> Win New York holidays with Kellogg's & Live Search > >>> > http://clk.atdmt.com/UKM/go/111354033/direct/01/_______________________________________________ > >>> OpenHeart-L mailing list > >>> > >>> Send postings to: > >>> OpenHeart-L@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@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@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@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@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@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 ----------------------------------------- From hgrmd at aol.com Thu Oct 2 16:57:31 2008 From: hgrmd at aol.com (hgrmd@aol.com) Date: Thu Oct 2 11:57:54 2008 Subject: [HSF] Microplegia In-Reply-To: <89c4ed2d0810020551t45c0150ex3701040cf9c32bef@mail.gmail.com> References: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox><89c4ed2d0810020551t45c0150ex3701040cf9c32bef@mail.gmail.com> Message-ID: <436048686-1222963044-cardhu_decombobulator_blackberry.rim.net-1951980896-@bxe149.bisx.prod.on.blackberry> TWljcm9wbGVnaWEgd29ya3Mgd2VsbCBmb3IgbWUuICBNeSBsb25nZXN0IGNsYW1wIHdhcyA0IGhy cywgMTUgbWluLiAgVGhlIHBhdGllbnQgY2FtZSBvZmYgQ1BCIHdpdGhvdXQgYSBwcm9ibGVtLg0K DQpIYWwNClNlbnQgZnJvbSBteSBWZXJpem9uIFdpcmVsZXNzIEJsYWNrQmVycnkNCg0KLS0tLS1P cmlnaW5hbCBNZXNzYWdlLS0tLS0NCkZyb206ICJQcmFzYW5uYSBTaW1oYSBNIiA8cHJhc2FubmFz aW1oYUBnbWFpbC5jb20+DQoNCkRhdGU6IFRodSwgMiBPY3QgMjAwOCAxODoyMTowMiANClRvOiA8 T3BlbkhlYXJ0LUxAbGlzdHMuaHNmb3J1bS5jb20+DQpTdWJqZWN0OiBSZTogW0hTRl0gTWljcm9w bGVnaWENCg0KDQpJIHRoaW5rIEhhbCB1c2VzIHRoYXQgc3lzdGVtLiBTdXBwb3NlZCB0byByZWR1 Y2Ugdm9sdW1lIHJlcXVpcmVtZW50cy4gV2l0aA0KNDoxIGJsb29kIHRvIGNhcmRpb3BsZWdpYSBz eXN0ZW1zIGlzIGl0IHJlYWxseSB0aGF0IGJpZyBhbiBpc3N1ZSBlc3BlY2lhbGx5DQpzaW5jZSBt b3N0IG9mIHRoZXNlIGNhbiBiZSBtYW5hZWQgd2l0aCBhIGRpdXJldGljIHNob3Qgb3IgaGVtb2Zp 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LS0tLS0tLS0tLS0tLS0tLS0tLS0tLQ0K From Jbflegejr at aol.com Thu Oct 2 13:44:37 2008 From: Jbflegejr at aol.com (Jbflegejr@aol.com) Date: Thu Oct 2 12:45:11 2008 Subject: [HSF] TVR 1 year after CABG Message-ID: Percutaneous cannulation of Right Internal Jugular vein vor SVC drainage is easy, safe and effective. Some vacumn is usually needed. John Flege **************Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) From drmitch at cox.net Thu Oct 2 14:55:08 2008 From: drmitch at cox.net (Mitch Lirtzman) Date: Thu Oct 2 14:55:38 2008 Subject: [HSF] Microplegia In-Reply-To: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox> References: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox> Message-ID: <6.2.1.2.2.20081002135000.01dcc680@pop.east.cox.net> Ajit, We use the Quest System in our hospital. By far a better system. Superb myocardial preservation, even on a prolonged pump run. If you wish, I can put you in touch with our perfusionist. Mitch LirtzmanAt 07:31 AM 10/2/2008, you wrote: >Do you have experience with what is called microplegia? This is basically >KCL and MgSO4 solution that is mixed with patients blood, rather than a >crystalloid solution. > > > >The advantages are said to be less hemodilution (particularly for long >cases), better K and glucose control and reduction in myocardial edema. A >company, Quest Medical Systems, is touting this with a pump and delivery >system, but it can be as easily done with a syringe pump, and very cheaply >indeed. > > > >What is your experience and opinion? > > > >Ajit Damle > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@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 >----------------------------------------- From prasannasimha at gmail.com Thu Oct 2 23:21:01 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Oct 2 16:00:01 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: Message-ID: <89c4ed2d0810020951n4c8c71dao66f481c4f00ef02f@mail.gmail.com> Percut venous drainage is easy to do provided the appropriate cannulae are available. Prasanna On Thu, Oct 2, 2008 at 10:14 PM, wrote: > Percutaneous cannulation of Right Internal Jugular vein vor SVC drainage is > easy, safe and effective. Some vacumn is usually needed. John Flege > > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips > and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From rowlesjohn at aol.com Thu Oct 2 21:45:56 2008 From: rowlesjohn at aol.com (rowlesjohn@aol.com) Date: Thu Oct 2 16:46:32 2008 Subject: [HSF] Microplegia In-Reply-To: <89c4ed2d0810020705h71477c51tb47420b5ac88629d@mail.gmail.com> References: <636711257-1222955165-cardhu_decombobulator_blackberry.rim.net-818724023-@bxe141.bisx.prod.on.blackberry><89c4ed2d0810020705h71477c51tb47420b5ac88629d@mail.gmail.com> Message-ID: 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bQ0KPiAtLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLQ0KPg0KDQoNCg0K LS0gDQpQcmFzYW5uYSBTaW1oYSBNDQpfX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19f X19fX19fX19fX19fXw0KT3BlbkhlYXJ0LUwgbWFpbGluZyBsaXN0DQoNClNlbmQgcG9zdGluZ3Mg dG86DQogT3BlbkhlYXJ0LUxAbGlzdHMuaHNmb3J1bS5jb20NCg0KVG8gVU5TVUJTQ1JJQkUsIHRv IENIQU5HRSBlbWFpbCBhZGRyZXNzLCBvciB0byB2aWV3IGFyY2hpdmVzOg0KaHR0cDovL21tcC5j anAuY29tL21haWxtYW4vbGlzdGluZm8vb3BlbmhlYXJ0LWwNCg0KQWxsIG1lc3NhZ2VzIHRyYW5z bWl0dGVkIGJ5IHRoZSBPcGVuSGVhcnQtTCBhcmUgc3ViamVjdCB0byB0aGUgcG9saWNpZXMgYW5k IA0KZGlzY2xhaW1lcnMgcG9zdGVkIGF0Og0KaHR0cDovL3d3dy5oc2ZvcnVtLmNvbS9saXN0ZGlz Y2xhaW0NCi0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tDQo= From BAins24221 at aol.com Thu Oct 2 19:39:16 2008 From: BAins24221 at aol.com (BAins24221@aol.com) Date: Thu Oct 2 18:39:30 2008 Subject: [HSF] Microplegia Message-ID: The Quest MPS is a very flexible system. Any drug concentration (for the most part), any temperature, any delivery pressure desired is available. Drug concentrations are delivered at the desired concentration regardless of variability of pump flow. One of my favorite features is the "Auto" button, when turned on will vary the pump flow to keep the chosen pressure constant, elimenating over pressurization of vessels/heart. Our pump runs are about 2 hours and we give a lot of cardioplegia with much less than 100 ml of additives per case. Surgeons do not see edema of the heart. We also eliminated the large heater/coolers in the OR. I use a Medtronic ECMO heater to warm or cool the patient and the Quest pump mounted ice cooler for the cardioplegia. We drift our patients (34 esoph) and warm them slowly and deliver cardioplegia at 34 deg to arrest, 20 deg subsequent (usually) and 37 for last dose. Above all, this system is very safe. Bill Ainsley CCP **************Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) From msfirst at gmail.com Thu Oct 2 19:55:36 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Thu Oct 2 18:56:05 2008 Subject: [HSF] Prosthetic Valve Stenosis Message-ID: I was recently asked to see a 40 year/old who had a tissue valve in 2003/4 (unknown type/location) for endocarditis. She has lupus (on prednisone chronically 30mg PO BID) and renal failure (Cr=4 and dialyized a few times byt not chronically). Her symtpoms are minimal and may be related to her ESRD. Her valve area by TTE is 0.9 and her gradients are mean/peak 39/69 with good LV function - but I dont have sizes. I am inclined to wait and let her medical problems be better defined/controlled. Any thoughts? -michael From tacuff at swbell.net Thu Oct 2 18:40:56 2008 From: tacuff at swbell.net (Tea Acuff) Date: Thu Oct 2 20:41:27 2008 Subject: [HSF] Microplegia Message-ID: <31555.67963.qm@web81608.mail.mud.yahoo.com> And I play soccer with one of the engineers who helped developed it. He must be better engineer than I am a soccer player. Tea Sent from my iPhone On Oct 2, 2008, at 5:39 PM, BAins24221@aol.com wrote: The Quest MPS is a very flexible system. Any drug concentration (for the most part), any temperature, any delivery pressure desired is available. Drug concentrations are delivered at the desired concentration regardless of variability of pump flow. One of my favorite features is the "Auto" button, when turned on will vary the pump flow to keep the chosen pressure constant, elimenating over pressurization of vessels/heart. Our pump runs are about 2 hours and we give a lot of cardioplegia with much less than 100 ml of additives per case. Surgeons do not see edema of the heart. We also eliminated the large heater/coolers in the OR. I use a Medtronic ECMO heater to warm or cool the patient and the Quest pump mounted ice cooler for the cardioplegia. We drift our patients (34 esoph) and warm them slowly and deliver cardioplegia at 34 deg to arrest, 20 deg subsequent (usually) and 37 for last dose. Above all, this system is very safe. Bill Ainsley CCP **************Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From rwmfglycar at aol.com Thu Oct 2 21:42:36 2008 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Thu Oct 2 20:43:12 2008 Subject: [HSF] Prosthetic Valve Stenosis In-Reply-To: References: Message-ID: <8CAF3081095B6AE-1554-30E9@Webmail-mg03.sim.aol.com> While you are waiting for her medical problems to be attended to, make further efforts to find out from the hospital previously attended??what brand and size of valve was placed and particularly what early postop? and later?echo's??showed and take a very careful look at the latest echo to see if there is evidence of pannus or thrombus or restricted leaflet motion. (Most routine echo's will not be good enough for analysing the leaflets). Bob -----Original Message----- From: Michael Firstenberg To: openheart-l Sent: Thu, 2 Oct 2008 6:55 pm Subject: [HSF] Prosthetic Valve Stenosis I was recently asked to see a 40 year/old who had a tissue valve in 2003/4 (unknown type/location) for endocarditis. She has lupus (on prednisone chronically 30mg PO BID) and renal failure (Cr=4 and dialyized a few times byt not chronically). Her symtpoms are minimal and may be related to her ESRD. Her valve area by TTE is 0.9 and her gradients are mean/peak 39/69 with good LV function - but I dont have sizes. I am inclined to wait and let her medical problems be better defined/controlled. Any thoughts? -michael _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From tacuff at swbell.net Thu Oct 2 19:48:00 2008 From: tacuff at swbell.net (Tea Acuff) Date: Thu Oct 2 21:48:29 2008 Subject: [HSF] slippery ideas or sloppy thinkers? Message-ID: <983606.56418.qm@web81606.mail.mud.yahoo.com> I am sure even some of our nonUSA readers are noticing the "acutely" ill monetary system in the USA and will be reminded by woes in their own country of the impact of USA on the world, be it perceived as empire colonization or globalization?effects. ? I have been reading an interesting book, The Forgotten Man, about the Great Depression. The nice thing about it is the documentation of individual players and their ideas and actions in a real world but one remote from our experience. The patterns of those ideas even if not their definitions are amazingly similar to some of the arguments that we in the USA are "emergently" addressing and rethinking in our provocative proposed intervention in the modern US marketplace. My point of this thread is not an economic discussion per se but a hypothesis of extreme hubris on my part as it implies (but in no way proves) that I understand "essences" of economic theory as well as that of medicine at large. What impresses me is that the slippery (or sloppy) idea of economic health is very similar to the parallel ideas in medicine. Further, the "solutions" and "needs" and "consequences", despite ones underlying bias are quite similar. For example, like in medicine, the monetary or credit crisis is or was leveraged in terms of access (need or greed depending on the position of the player)?and the solution is largely defined by the experts (economic or medical) as more money for the system. The threat is framed in the context of business as usual and the loss of control of that business as usual. Exactly how is "usual" good, economic?or medical, health in the big picture??Most importantly the bigger picture is almost completely obscure due to the smaller adgendas inherent in each and multiple protagonist's world views and the unknown of?new or future change. As?I have said before it is common for us to look at the past and wonder why those people were such morons, while we educated moderns are left confused with uncertainty?and partial or ideological adgendas of the "complex" problems in the present. Perhaps this is why Dr. Frater seems so prescient. He has seen many of the present medical dilemmas played out in several different contexts and time frames. tea From robertobattellini at hotmail.com Fri Oct 3 11:34:37 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri Oct 3 04:35:06 2008 Subject: [HSF] ?AVR In-Reply-To: <41F2B637F6C24797ADE6A84AE7B8F06B@yourg8he5gjrox> References: <41F2B637F6C24797ADE6A84AE7B8F06B@yourg8he5gjrox> Message-ID: Well done! I?ll send some photos to your email, as I cannot post them in HSF for lack of how to do it. Roberto> From: damle@cableone.net> To: OpenHeart-L@lists.hsforum.com> Subject: RE: [HSF] ?AVR> Date: Thu, 2 Oct 2008 07:14:37 -0500> CC: > > Roberto,> > > > I did not replace the aortic valve. Almost every surgeon I talked to> recommended that I should leave the valve alone (except a surgeon at the> Cleveland Clinic, who said that while I should do what I can do well, he> would replace the valve with a biologic prosthesis and graft the LAD with> LIMA).> > > > Pre-op, I reviewed the angiogram again with cardiology. The LAD lesion was> felt to be @ 50%, and very suitable for stenting if needed. No IVUS was> done at the time of angiography. I used a 30 mm Gelweave tube graft to> replace the ascending aorta and the proximal arch (actually the floor of the> aortic arch). Technically, the procedure was simple and straight forward.> The patient did fine. The circ arrest time was 21 minutes. I do not use> steroids, neither do I manage the pH, nor use retrograde cerebral perfusion,> all because of lack of credible evidence. > > > > In the end, I did not graft the LAD (partly because of all the mutinous HSF> surgeons!). The patient did very well. As always, I marvel how well these> patients do in spite of having undergone circulatory arrest and the whole> body and brain full of air. This 77 year old man was reading his newspaper> 36 hours post-op! I would love to take credit for all this, but as it> should, it goes to the master surgeons who taught us how to do this right.> > > > Ajit> > > > .> > > > -----Original Message-----> From: openheart-l-bounces@lists.hsforum.com> [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Roberto> Battellini> Sent: Thursday, October 02, 2008 3:43 AM> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] ?AVR> > > > > > Ajit,> > sorry for the late question, can you tell me how did the case went?> > > > We have done a lot of these cases maintaining the old good integrated> valve.Sometimes supracoronary replacement, sometimes a Kouchoukos operation> and once a Cabrol operation. I have some photos.> > > > Roberto> From: damle@cableone.net> To: OpenHeart-L@lists.hsforum.com> Date:> Wed, 24 Sep 2008 09:47:35 -0500> CC: > Subject: [HSF] ?AVR> > I have an> ascending aortic aneurysm next week in a fit 77 yr man. I did his> AVR in> 1994 with a Carbomedics 25mm. I noted at that time the ascending> aorta to> be "mildly ectatic". Now the CT shows a 6.4 cms aneurysm starting> just> above the coronary ostia and extending into mid-arch. I plan to excise> this> under DHCA. His risk should be quite low. The sinuses look OK and I do> not> think I will need to go below the coronary ostia. LAD has a 60% stenosis>> and I will graft it with LIMA.> > So far so good. > > The question is what I> do with the Carbomedics aortic valve. This has> functioned just fine over> the years, he has had no problem with> anti-coagulation. However, if I could> replace it with a tissue valve, he> will not need coumadin.> > Replacing the> valve does add extra risk, which I do not know is worth> taking. Clearly,> yes, if the replacement is straight forward. Indeed, in my> experience> removing and replacing an aortic prosthesis has worked well. But> I will not> know that till I start taking out the prosthesis and then it will> be too> late.> > What would you do?> > Ajit Damle> Fargo ND> > >> _______________________________________________> OpenHeart-L mailing list> >> Send postings to:> OpenHeart-L@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@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@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> ----------------------------------------- From robertobattellini at hotmail.com Fri Oct 3 11:52:17 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri Oct 3 04:52:46 2008 Subject: [HSF] Microplegia-TEA- OT In-Reply-To: <31555.67963.qm@web81608.mail.mud.yahoo.com> References: <31555.67963.qm@web81608.mail.mud.yahoo.com> Message-ID: Tea, come and play soccer with our joungs in Leipzig, they do it every Wednesday. Roberto> Date: Thu, 2 Oct 2008 17:40:56 -0700> From: tacuff@swbell.net> Subject: Re: [HSF] Microplegia> To: OpenHeart-L@lists.hsforum.com> CC: > > And I play soccer with one of the engineers who helped developed it. He must be better engineer than I am a soccer player.> Tea> > Sent from my iPhone> > On Oct 2, 2008, at 5:39 PM, BAins24221@aol.com wrote:> > The Quest MPS is a very flexible system. Any drug concentration (for the > most part), any temperature, any delivery pressure desired is available. Drug > concentrations are delivered at the desired concentration regardless of > variability of pump flow. One of my favorite features is the "Auto" button, when > turned on will vary the pump flow to keep the chosen pressure constant, > elimenating over pressurization of vessels/heart. Our pump runs are about 2 hours > and we give a lot of cardioplegia with much less than 100 ml of additives > per case. Surgeons do not see edema of the heart. We also eliminated the > large heater/coolers in the OR. I use a Medtronic ECMO heater to warm or cool > the patient and the Quest pump mounted ice cooler for the cardioplegia. We > drift our patients (34 esoph) and warm them slowly and deliver cardioplegia at > 34 deg to arrest, 20 deg subsequent (usually) and 37 for last dose. Above > all, this system is very safe.> Bill Ainsley CCP> > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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> ----------------------------------------- From tacuff at swbell.net Fri Oct 3 06:30:32 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Oct 3 08:32:02 2008 Subject: [HSF] Microplegia-TEA- OT Message-ID: <63382.80092.qm@web81606.mail.mud.yahoo.com> I would love to. What would the German description be for my performance which will lacking in both style and substance? Tea Sent from my iPhone On Oct 3, 2008, at 3:52 AM, Roberto Battellini wrote: Tea, come and play soccer with our joungs in Leipzig, they do it every Wednesday. Roberto> Date: Thu, 2 Oct 2008 17:40:56 -0700> From: tacuff@swbell.net> Subject: Re: [HSF] Microplegia> To: OpenHeart-L@lists.hsforum.com> CC: > > And I play soccer with one of the engineers who helped developed it. He must be better engineer than I am a soccer player.> Tea> > Sent from my iPhone> > On Oct 2, 2008, at 5:39 PM, BAins24221@aol.com wrote:> > The Quest MPS is a very flexible system. Any drug concentration (for the > most part), any temperature, any delivery pressure desired is available. Drug > concentrations are delivered at the desired concentration regardless of > variability of pump flow. One of my favorite features is the "Auto" button, when > turned on will vary the pump flow to keep the chosen pressure constant, > elimenating over pressurization of vessels/heart. Our pump runs are about 2 hours > and we give a lot of cardioplegia with much less than 100 ml of additives > per case. Surgeons do not see edema of the heart. We also eliminated the > large heater/coolers in the OR. I use a Medtronic ECMO heater to warm or cool > the patient and the Quest pump mounted ice cooler for the cardioplegia. We > drift our patients (34 esoph) and warm them slowly and deliver cardioplegia at > 34 deg to arrest, 20 deg subsequent (usually) and 37 for last dose. Above > all, this system is very safe.> Bill Ainsley CCP> > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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@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 ----------------------------------------- From wftjrtyler at aol.com Fri Oct 3 10:00:56 2008 From: wftjrtyler at aol.com (wftjrtyler@aol.com) Date: Fri Oct 3 09:01:44 2008 Subject: [HSF] slippery ideas or sloppy thinkers? In-Reply-To: <983606.56418.qm@web81606.mail.mud.yahoo.com> References: <983606.56418.qm@web81606.mail.mud.yahoo.com> Message-ID: <8CAF36F3553A35D-D3C-408D@webmail-da19.sysops.aol.com> Damn....i "got" this one!.......respectfully,bill turner -----Original Message----- From: Tea Acuff To: OpenHeart-L Sent: Thu, 2 Oct 2008 8:48 pm Subject: [HSF] slippery ideas or sloppy thinkers? I am sure even some of our nonUSA readers are noticing the "acutely" ill monetary system in the USA and will be reminded by woes in their own country of the impact of USA on the world, be it perceived as empire colonization or globalization?effects. ? I have been reading an interesting book, The Forgotten Man, about the Great Depression. The nice thing about it is the documentation of individual players and their ideas and actions in a real world but one remote from our experience. The patterns of those ideas even if not their definitions are amazingly similar to some of the arguments that we in the USA are "emergently" addressing and rethinking in our provocative proposed intervention in the modern US marketplace. My point of this thread is not an economic discussion per se but a hypothesis of extreme hubris on my part as it implies (but in no way proves) that I understand "essences" of economic theory as well as that of medicine at large. What impresses me is that the slippery (or sloppy) idea of economic health is very similar to the parallel ideas in medicine. Further, the "solutions" and "needs" and "consequences", despite ones underlying bias are quite similar. For example, like in medicine, the monetary or credit crisis is or was leveraged in terms of access (need or greed depending on the position of the player)?and the solution is largely defined by the experts (economic or medical) as more money for the system. The threat is framed in the context of business as usual and the loss of control of that business as usual. Exactly how is "usual" good, economic?or medical, health in the big picture??Most importantly the bigger picture is almost completely obscure due to the smaller adgendas inherent in each and multiple protagonist's world views and the unknown of?new or future change. As?I have said before it is common for us to look at the past and wonder why those people were such morons, while we educated moderns are left confused with uncertainty?and partial or ideological adge ndas of the "complex" problems in the present. Perhaps this is why Dr. Frater seems so prescient. He has seen many of the present medical dilemmas played out in several different contexts and time frames. tea _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From msfirst at gmail.com Fri Oct 3 10:54:21 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Fri Oct 3 09:54:51 2008 Subject: [HSF] slippery ideas or sloppy thinkers? In-Reply-To: <8CAF36F3553A35D-D3C-408D@webmail-da19.sysops.aol.com> References: <983606.56418.qm@web81606.mail.mud.yahoo.com> <8CAF36F3553A35D-D3C-408D@webmail-da19.sysops.aol.com> Message-ID: those who dont learn from the mistakes in history are doomed to repeat them. many of the problems that we see in the world really should not come as any surprise - predictable outcomes to flawed thinking and practice (especially when there is no oversight) -michael On Fri, Oct 3, 2008 at 9:00 AM, wrote: > Damn....i "got" this one!.......respectfully,bill turner > > > -----Original Message----- > From: Tea Acuff > To: OpenHeart-L > Sent: Thu, 2 Oct 2008 8:48 pm > Subject: [HSF] slippery ideas or sloppy thinkers? > > > > I am sure even some of our nonUSA readers are noticing the "acutely" ill > monetary system in the USA and will be reminded by woes in their own > country of > the impact of USA on the world, be it perceived as empire colonization or > globalization?effects. ? I have been reading an interesting book, The > Forgotten > Man, about the Great Depression. The nice thing about it is the > documentation of > individual players and their ideas and actions in a real world but one > remote > from our experience. The patterns of those ideas even if not their > definitions > are amazingly similar to some of the arguments that we in the USA are > "emergently" addressing and rethinking in our provocative proposed > intervention > in the modern US marketplace. > > My point of this thread is not an economic discussion per se but a > hypothesis of > extreme hubris on my part as it implies (but in no way proves) that I > understand > "essences" of economic theory as well as that of medicine at large. What > impresses me is that the slippery (or sloppy) idea of economic health is > very > similar to the parallel ideas in medicine. Further, the "solutions" and > "needs" > and "consequences", despite ones underlying bias are quite similar. For > example, > like in medicine, the monetary or credit crisis is or was leveraged in > terms of > access (need or greed depending on the position of the player)?and the > solution > is largely defined by the experts (economic or medical) as more money for > the > system. The threat is framed in the context of business as usual and the > loss of > control of that business as usual. Exactly how is "usual" good, economic?or > medical, health in the big picture??Most importantly the bigger picture is > almost completely > obscure due to the smaller adgendas inherent in each and multiple > protagonist's > world views and the unknown of?new or future change. As?I have said before > it is > common for us to look at the past and wonder why those people were such > morons, > while we educated moderns are left confused with uncertainty?and partial or > ideological adge > ndas of the "complex" problems in the present. Perhaps this is > why Dr. Frater seems so prescient. He has seen many of the present medical > dilemmas played out in several different contexts and time frames. > > tea > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > From msfirst at gmail.com Fri Oct 3 10:57:49 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Fri Oct 3 10:03:44 2008 Subject: [HSF] Microplegia-TEA- OT In-Reply-To: <63382.80092.qm@web81606.mail.mud.yahoo.com> References: <63382.80092.qm@web81606.mail.mud.yahoo.com> Message-ID: tea - I think they would call it American style. -michael On Fri, Oct 3, 2008 at 8:30 AM, Tea Acuff wrote: > I would love to. What would the German description be for my performance > which will lacking in both style and substance? > Tea > > Sent from my iPhone > > On Oct 3, 2008, at 3:52 AM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > > > Tea, > come and play soccer with our joungs in Leipzig, they do it every > Wednesday. > > Roberto> Date: Thu, 2 Oct 2008 17:40:56 -0700> From: tacuff@swbell.net> > Subject: Re: [HSF] Microplegia> To: OpenHeart-L@lists.hsforum.com> CC: > > > And I play soccer with one of the engineers who helped developed it. He must > be better engineer than I am a soccer player.> Tea> > Sent from my iPhone> > > On Oct 2, 2008, at 5:39 PM, BAins24221@aol.com wrote:> > The Quest MPS is > a very flexible system. Any drug concentration (for the > most part), any > temperature, any delivery pressure desired is available. Drug > > concentrations are delivered at the desired concentration regardless of > > variability of pump flow. One of my favorite features is the "Auto" button, > when > turned on will vary the pump flow to keep the chosen pressure > constant, > elimenating over pressurization of vessels/heart. Our pump runs > are about 2 hours > and we give a lot of cardioplegia with much less than > 100 ml of additives > per case. Surgeons do not see edema of the heart. We > also > eliminated the > large heater/coolers in the OR. I use a Medtronic ECMO > heater to warm or cool > the patient and the Quest pump mounted ice cooler > for the cardioplegia. We > drift our patients (34 esoph) and warm them > slowly and deliver cardioplegia at > 34 deg to arrest, 20 deg subsequent > (usually) and 37 for last dose. Above > all, this system is very safe.> Bill > Ainsley CCP> > > > **************Looking for simple solutions to your > real-life financial > challenges? Check out WalletPop for the latest news > and information, tips and > calculators. ( > http://www.walletpop.com/?NCID=emlcntuswall00000001)> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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@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@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@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 > ----------------------------------------- > From DukeB60 at aol.com Fri Oct 3 11:04:43 2008 From: DukeB60 at aol.com (DukeB60@aol.com) Date: Fri Oct 3 10:05:13 2008 Subject: [HSF] Case Message-ID: 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA 0.6cm2, normal CA's, chronic persistent AF, moderate MR. Referred for AVR. Would members of the Forum also do a Maze and if so what lesion set. Would members also perform a mitral repair. Annulus not heavily calcified, no leaflet prolapse, annular dilation. LA not dilated. **************Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) From msfirst at gmail.com Fri Oct 3 11:41:33 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Fri Oct 3 10:42:01 2008 Subject: [HSF] Case In-Reply-To: References: Message-ID: my take on these types of patients is that the MR, if the valve and annulus are normal, is a functon of the AS and gets better over time. Based upon the info provided, I would do an AVR and a PVI - but I am sure others would be much more aggressive.......... also depends on the eye-ball test. -michael On Fri, Oct 3, 2008 at 10:04 AM, wrote: > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > 0.6cm2, > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. Would > members of the Forum also do a Maze and if so what lesion set. Would > members > also perform a mitral repair. Annulus not heavily calcified, no leaflet > prolapse, annular dilation. LA not dilated. > > > > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips > and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > From aseem70 at yahoo.com Fri Oct 3 08:54:19 2008 From: aseem70 at yahoo.com (ASEEM PAWAR) Date: Fri Oct 3 10:54:49 2008 Subject: [HSF] post OPCAB left limb paralysis Message-ID: <977938.22480.qm@web56807.mail.re3.yahoo.com> Dear forum members, Need your inputs regarding- A 60 yr old male/ diabetic since 5-7 years. Underwent OPCAB X 4, smooth intra-op period but developed only?left lower limb paralysis (cannot move his leg from hip, sensation ok) the other limbs are normal. No signs of other neuro or sensorium deficeits. Now 40 days post op with no clear improvement CT spine normal.Patient had heart block pre-op and continuous cough in the post op period- no other abnormality pre or post op. Possible mechanism? treatment pathway. thanks, -aseem From mwertheimer at mahealthcare.com Fri Oct 3 11:04:59 2008 From: mwertheimer at mahealthcare.com (Wertheimer MD, Mark) Date: Fri Oct 3 11:05:50 2008 Subject: [HSF] post OPCAB left limb paralysis In-Reply-To: <977938.22480.qm@web56807.mail.re3.yahoo.com> Message-ID: <24B3DAEBFBF6C84DA2C938DD0E68D36D0122F4BF@svwcexc3.mahc.local> ? CVA,? MRI brain -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of ASEEM PAWAR Sent: Friday, October 03, 2008 9:54 AM To: OpenHeart-L@lists.hsforum.com Subject: [HSF] post OPCAB left limb paralysis Dear forum members, Need your inputs regarding- A 60 yr old male/ diabetic since 5-7 years. Underwent OPCAB X 4, smooth intra-op period but developed only?left lower limb paralysis (cannot move his leg from hip, sensation ok) the other limbs are normal. No signs of other neuro or sensorium deficeits. Now 40 days post op with no clear improvement CT spine normal.Patient had heart block pre-op and continuous cough in the post op period- no other abnormality pre or post op. Possible mechanism? treatment pathway. thanks, -aseem _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Fri Oct 3 21:39:37 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 11:10:20 2008 Subject: [HSF] post OPCAB left limb paralysis In-Reply-To: <977938.22480.qm@web56807.mail.re3.yahoo.com> References: <977938.22480.qm@web56807.mail.re3.yahoo.com> Message-ID: <89c4ed2d0810030809w372787byd5f9360aa0f9a03f@mail.gmail.com> CVA cortical in lower limb area ? prasanna On Fri, Oct 3, 2008 at 8:24 PM, ASEEM PAWAR wrote: > Dear forum members, > Need your inputs regarding- > A 60 yr old male/ diabetic since 5-7 years. Underwent OPCAB X 4, smooth > intra-op period but developed only left lower limb paralysis (cannot move > his leg from hip, sensation ok) the other limbs are normal. No signs of > other neuro or sensorium deficeits. Now 40 days post op with no clear > improvement > CT spine normal.Patient had heart block pre-op and continuous cough in the > post op period- no other abnormality pre or post op. > Possible mechanism? treatment pathway. > thanks, > -aseem > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From ichfno at aol.com Fri Oct 3 19:20:01 2008 From: ichfno at aol.com (ichfno@aol.com) Date: Fri Oct 3 11:21:14 2008 Subject: New [HSF] Case Message-ID: What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? WNovick -----Original Message----- From: Michael Firstenberg Sent: October 03, 2008 5:41 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Case my take on these types of patients is that the MR, if the valve and annulus are normal, is a functon of the AS and gets better over time. Based upon the info provided, I would do an AVR and a PVI - but I am sure others would be much more aggressive.......... also depends on the eye-ball test. -michael On Fri, Oct 3, 2008 at 10:04 AM, wrote: > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > 0.6cm2, > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. Would > members of the Forum also do a Maze and if so what lesion set. Would > members > also perform a mitral repair. Annulus not heavily calcified, no leaflet > prolapse, annular dilation. LA not dilated. > > > > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips > and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 ----------------------------------------- From prasannasimha at gmail.com Fri Oct 3 22:00:52 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 11:37:01 2008 Subject: [HSF] Case In-Reply-To: References: Message-ID: <89c4ed2d0810030830w3ad5bab3v55f9ccb75ce04b9@mail.gmail.com> MR like this settls usually with AVR if it is 1-2. The funny thing is why is there no annular dilatation. Prasanna On Fri, Oct 3, 2008 at 7:34 PM, wrote: > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > 0.6cm2, > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. Would > members of the Forum also do a Maze and if so what lesion set. Would > members > also perform a mitral repair. Annulus not heavily calcified, no leaflet > prolapse, annular dilation. LA not dilated. > > > > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips > and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From robertobattellini at hotmail.com Fri Oct 3 19:00:24 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri Oct 3 12:00:51 2008 Subject: [HSF] Case In-Reply-To: <89c4ed2d0810030830w3ad5bab3v55f9ccb75ce04b9@mail.gmail.com> References: <89c4ed2d0810030830w3ad5bab3v55f9ccb75ce04b9@mail.gmail.com> Message-ID: We would do biatrial cryoablation with cryocath and TEE preoperative to decide if a mutral ring or not. Roberto> Date: Fri, 3 Oct 2008 21:00:52 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Case> CC: > > MR like this settls usually with AVR if it is 1-2. The funny thing is why is> there no annular dilatation.> Prasanna> > On Fri, Oct 3, 2008 at 7:34 PM, wrote:> > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA> > 0.6cm2,> > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. Would> > members of the Forum also do a Maze and if so what lesion set. Would> > members> > also perform a mitral repair. Annulus not heavily calcified, no leaflet> > prolapse, annular dilation. LA not dilated.> >> >> >> >> >> > **************Looking for simple solutions to your real-life financial> > challenges? Check out WalletPop for the latest news and information, tips> > and> > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From robertobattellini at hotmail.com Fri Oct 3 19:02:19 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri Oct 3 12:02:48 2008 Subject: [HSF] post OPCAB left limb paralysis In-Reply-To: <89c4ed2d0810030809w372787byd5f9360aa0f9a03f@mail.gmail.com> References: <977938.22480.qm@web56807.mail.re3.yahoo.com> <89c4ed2d0810030809w372787byd5f9360aa0f9a03f@mail.gmail.com> Message-ID: Did you perform proximal veins with lateral Clamp? Was the aorta atheromatous? Roberto> Date: Fri, 3 Oct 2008 20:39:37 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] post OPCAB left limb paralysis> CC: > > CVA cortical in lower limb area ?> prasanna> > On Fri, Oct 3, 2008 at 8:24 PM, ASEEM PAWAR wrote:> > > Dear forum members,> > Need your inputs regarding-> > A 60 yr old male/ diabetic since 5-7 years. Underwent OPCAB X 4, smooth> > intra-op period but developed only left lower limb paralysis (cannot move> > his leg from hip, sensation ok) the other limbs are normal. No signs of> > other neuro or sensorium deficeits. Now 40 days post op with no clear> > improvement> > CT spine normal.Patient had heart block pre-op and continuous cough in the> > post op period- no other abnormality pre or post op.> > Possible mechanism? treatment pathway.> > thanks,> > -aseem> >> >> >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From prasannasimha at gmail.com Fri Oct 3 22:51:28 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 12:21:56 2008 Subject: [HSF] Case In-Reply-To: References: Message-ID: <89c4ed2d0810030921k5bae3664sf59d132e965f2237@mail.gmail.com> If there is atrial fibrillation I would do emaze (biatrial) . Fixing the mitral depends on the extent of MR Grade 1-2 /4 usuallydoesnt need fixing if the LA is small and P A pressures are normal. If in doubt do an angiographic assessment of MR. Prasanna On Fri, Oct 3, 2008 at 7:34 PM, wrote: > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > 0.6cm2, > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. Would > members of the Forum also do a Maze and if so what lesion set. Would > members > also perform a mitral repair. Annulus not heavily calcified, no leaflet > prolapse, annular dilation. LA not dilated. > > > > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips > and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Fri Oct 3 23:00:41 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 12:31:01 2008 Subject: New [HSF] Case In-Reply-To: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> References: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> Message-ID: <89c4ed2d0810030930pa405933sbf49908ee989f764@mail.gmail.com> Incidentally what is the aortic root size. Some of these children may have an 18 mm Annulus even at this age and if that is so fixing it may actually be enough(Like a Florida sleeve) prasanna On Fri, Oct 3, 2008 at 9:58 PM, Prasanna Simha M wrote: > This patient has demonstrated "leakability of all the valves. I think it is > important to fix everything. MV repair + TV repair is required. I would > start Losartan . There is increasing evidence that Losartan can actually > reverse the changes of Marfans and decrease the progression of AI and aortic > dilatation so much soo that some Marfans centres think it will be the "magic > bullet" for Marfans. The effect is seen with Losartan and not with ACE > Inhibitors. The exact cause is not known but some changes occur in the > molecular level preventing the dilatation etc. > I have fixed one childs nitral and tricusid and am observing his aortic now > for 2 years and is stable. > Prasanna > > On Fri, Oct 3, 2008 at 8:50 PM, wrote: > >> What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? >> >> WNovick >> >> -----Original Message----- >> From: Michael Firstenberg >> Sent: October 03, 2008 5:41 PM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Case >> >> my take on these types of patients is that the MR, if the valve and >> annulus >> are normal, is a functon of the AS and gets better over time. Based upon >> the info provided, I would do an AVR and a PVI - but I am sure others >> would >> be much more aggressive.......... also depends on the eye-ball test. >> >> >> -michael >> >> On Fri, Oct 3, 2008 at 10:04 AM, wrote: >> >> > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA >> > 0.6cm2, >> > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. >> Would >> > members of the Forum also do a Maze and if so what lesion set. Would >> > members >> > also perform a mitral repair. Annulus not heavily calcified, no >> leaflet >> > prolapse, annular dilation. LA not dilated. >> > >> > >> > >> > >> > >> > **************Looking for simple solutions to your real-life financial >> > challenges? Check out WalletPop for the latest news and information, >> tips >> > and >> > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@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@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From prasannasimha at gmail.com Fri Oct 3 22:58:28 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 12:35:40 2008 Subject: New [HSF] Case In-Reply-To: References: Message-ID: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> This patient has demonstrated "leakability of all the valves. I think it is important to fix everything. MV repair + TV repair is required. I would start Losartan . There is increasing evidence that Losartan can actually reverse the changes of Marfans and decrease the progression of AI and aortic dilatation so much soo that some Marfans centres think it will be the "magic bullet" for Marfans. The effect is seen with Losartan and not with ACE Inhibitors. The exact cause is not known but some changes occur in the molecular level preventing the dilatation etc. I have fixed one childs nitral and tricusid and am observing his aortic now for 2 years and is stable. Prasanna On Fri, Oct 3, 2008 at 8:50 PM, wrote: > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? > > WNovick > > -----Original Message----- > From: Michael Firstenberg > Sent: October 03, 2008 5:41 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Case > > my take on these types of patients is that the MR, if the valve and annulus > are normal, is a functon of the AS and gets better over time. Based upon > the info provided, I would do an AVR and a PVI - but I am sure others would > be much more aggressive.......... also depends on the eye-ball test. > > > -michael > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > 0.6cm2, > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > Would > > members of the Forum also do a Maze and if so what lesion set. Would > > members > > also perform a mitral repair. Annulus not heavily calcified, no leaflet > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > challenges? Check out WalletPop for the latest news and information, > tips > > and > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Fri Oct 3 21:56:19 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 12:37:05 2008 Subject: New [HSF] Case In-Reply-To: References: Message-ID: <89c4ed2d0810030826m33d1ff8fo5cfe4f53a8a4c132@mail.gmail.com> Aortic root dimensions with the AI ? Prasanna On Fri, Oct 3, 2008 at 8:50 PM, wrote: > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? > > WNovick > > -----Original Message----- > From: Michael Firstenberg > Sent: October 03, 2008 5:41 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Case > > my take on these types of patients is that the MR, if the valve and annulus > are normal, is a functon of the AS and gets better over time. Based upon > the info provided, I would do an AVR and a PVI - but I am sure others would > be much more aggressive.......... also depends on the eye-ball test. > > > -michael > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > 0.6cm2, > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > Would > > members of the Forum also do a Maze and if so what lesion set. Would > > members > > also perform a mitral repair. Annulus not heavily calcified, no leaflet > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > challenges? Check out WalletPop for the latest news and information, > tips > > and > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M From ichfno at aol.com Fri Oct 3 21:12:33 2008 From: ichfno at aol.com (ichfno@aol.com) Date: Fri Oct 3 13:14:14 2008 Subject: New [HSF] Case Message-ID: 18mm, 1+ only at this time. -----Original Message----- From: Prasanna Simha M Sent: October 03, 2008 6:26 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: New [HSF] Case Aortic root dimensions with the AI ? Prasanna On Fri, Oct 3, 2008 at 8:50 PM, wrote: > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? > > WNovick > > -----Original Message----- > From: Michael Firstenberg > Sent: October 03, 2008 5:41 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Case > > my take on these types of patients is that the MR, if the valve and annulus > are normal, is a functon of the AS and gets better over time. Based upon > the info provided, I would do an AVR and a PVI - but I am sure others would > be much more aggressive.......... also depends on the eye-ball test. > > > -michael > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > 0.6cm2, > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > Would > > members of the Forum also do a Maze and if so what lesion set. Would > > members > > also perform a mitral repair. Annulus not heavily calcified, no leaflet > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > challenges? Check out WalletPop for the latest news and information, > tips > > and > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Fri Oct 3 23:57:11 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 13:32:58 2008 Subject: New [HSF] Case In-Reply-To: References: Message-ID: <89c4ed2d0810031027w43a43498kb7f9b703eb72be18@mail.gmail.com> I think it is worth sleeving the Florida way.(Tom Martin's technique) Would fix the AR and prevent further dilatation. 18 mm would very like last till adulthood or at least allow reaching adulthood. On Fri, Oct 3, 2008 at 10:42 PM, wrote: > 18mm, 1+ only at this time. > > -----Original Message----- > From: Prasanna Simha M > Sent: October 03, 2008 6:26 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: New [HSF] Case > > Aortic root dimensions with the AI ? > Prasanna > > On Fri, Oct 3, 2008 at 8:50 PM, wrote: > > > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? > > > > WNovick > > > > -----Original Message----- > > From: Michael Firstenberg > > Sent: October 03, 2008 5:41 PM > > To: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Case > > > > my take on these types of patients is that the MR, if the valve and > annulus > > are normal, is a functon of the AS and gets better over time. Based upon > > the info provided, I would do an AVR and a PVI - but I am sure others > would > > be much more aggressive.......... also depends on the eye-ball test. > > > > > > -michael > > > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > > 0.6cm2, > > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > > Would > > > members of the Forum also do a Maze and if so what lesion set. Would > > > members > > > also perform a mitral repair. Annulus not heavily calcified, no > leaflet > > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > > challenges? Check out WalletPop for the latest news and information, > > tips > > > and > > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001 > ) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@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@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@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 > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sat Oct 4 00:17:40 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 13:48:04 2008 Subject: New [HSF] Case In-Reply-To: <89c4ed2d0810031027w43a43498kb7f9b703eb72be18@mail.gmail.com> References: <89c4ed2d0810031027w43a43498kb7f9b703eb72be18@mail.gmail.com> Message-ID: <89c4ed2d0810031047q4d115a35k1a6b3330f751afbc@mail.gmail.com> I did a child with VSD AR who had severe AR some time back. The annulus was18 mm and there was sinotubular dilatation. In that case I repaired prolapsed leaflets, fixed his ventriculoaortic junction and d the STjunction and resuspended his cusps. He is doing well. He was also 2 years when I did the surgery and is growing well.No gradients . He was very sick before surgery and has a trememdous growth spurt (he is now 6 years old).I think it is worth fixing these annuli to small adult sizes especially looking at the parents bodily habitus/size. Prasanna On Fri, Oct 3, 2008 at 10:57 PM, Prasanna Simha M wrote: > I think it is worth sleeving the Florida way.(Tom Martin's technique) > Would fix the AR and prevent further dilatation. 18 mm would very like last > till adulthood or at least allow reaching adulthood. > > > On Fri, Oct 3, 2008 at 10:42 PM, wrote: > >> 18mm, 1+ only at this time. >> >> -----Original Message----- >> From: Prasanna Simha M >> Sent: October 03, 2008 6:26 PM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: New [HSF] Case >> >> Aortic root dimensions with the AI ? >> Prasanna >> >> On Fri, Oct 3, 2008 at 8:50 PM, wrote: >> >> > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? >> > >> > WNovick >> > >> > -----Original Message----- >> > From: Michael Firstenberg >> > Sent: October 03, 2008 5:41 PM >> > To: OpenHeart-L@lists.hsforum.com >> > Subject: Re: [HSF] Case >> > >> > my take on these types of patients is that the MR, if the valve and >> annulus >> > are normal, is a functon of the AS and gets better over time. Based >> upon >> > the info provided, I would do an AVR and a PVI - but I am sure others >> would >> > be much more aggressive.......... also depends on the eye-ball test. >> > >> > >> > -michael >> > >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote: >> > >> > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA >> > > 0.6cm2, >> > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. >> > Would >> > > members of the Forum also do a Maze and if so what lesion set. Would >> > > members >> > > also perform a mitral repair. Annulus not heavily calcified, no >> leaflet >> > > prolapse, annular dilation. LA not dilated. >> > > >> > > >> > > >> > > >> > > >> > > **************Looking for simple solutions to your real-life financial >> > > challenges? Check out WalletPop for the latest news and information, >> > tips >> > > and >> > > calculators. ( >> http://www.walletpop.com/?NCID=emlcntuswall00000001) >> > > _______________________________________________ >> > > OpenHeart-L mailing list >> > > >> > > Send postings to: >> > > OpenHeart-L@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@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@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 >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From ecdouville at orclinic.com Fri Oct 3 12:09:29 2008 From: ecdouville at orclinic.com (Douville, Chuck) Date: Fri Oct 3 14:15:27 2008 Subject: FW: New [HSF] Case References: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> Message-ID: Prasanna is losartan also believed to alter the natural history of aortic dilatation in non-Marfan's patients. I believe you suggested this previously, but I want to make sure. Are you using both losartan and beta blockade in your aneurysm patients? thx chuckdouville ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M Sent: Fri 10/3/2008 9:28 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: New [HSF] Case This patient has demonstrated "leakability of all the valves. I think it is important to fix everything. MV repair + TV repair is required. I would start Losartan . There is increasing evidence that Losartan can actually reverse the changes of Marfans and decrease the progression of AI and aortic dilatation so much soo that some Marfans centres think it will be the "magic bullet" for Marfans. The effect is seen with Losartan and not with ACE Inhibitors. The exact cause is not known but some changes occur in the molecular level preventing the dilatation etc. I have fixed one childs nitral and tricusid and am observing his aortic now for 2 years and is stable. Prasanna On Fri, Oct 3, 2008 at 8:50 PM, wrote: > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? > > WNovick > > -----Original Message----- > From: Michael Firstenberg > Sent: October 03, 2008 5:41 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Case > > my take on these types of patients is that the MR, if the valve and annulus > are normal, is a functon of the AS and gets better over time. Based upon > the info provided, I would do an AVR and a PVI - but I am sure others would > be much more aggressive.......... also depends on the eye-ball test. > > > -michael > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > 0.6cm2, > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > Would > > members of the Forum also do a Maze and if so what lesion set. Would > > members > > also perform a mitral repair. Annulus not heavily calcified, no leaflet > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > challenges? Check out WalletPop for the latest news and information, > tips > > and > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From dukeb60 at aol.com Fri Oct 3 15:32:01 2008 From: dukeb60 at aol.com (Edward P. Raines) Date: Fri Oct 3 14:33:27 2008 Subject: [HSF] Case In-Reply-To: References: Message-ID: <8CAF39D75C310E1-DF8-16E@WEBMAIL-DZ15.sysops.aol.com> michael, ???? why would you do a PVI in a patient with longstanding persistent AF?? What would the potential cure rate be with such an approach? -----Original Message----- From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Fri, 3 Oct 2008 9:41 am Subject: Re: [HSF] Case my take on these types of patients is that the MR, if the valve and annulus are normal, is a functon of the AS and gets better over time. Based upon the info provided, I would do an AVR and a PVI - but I am sure others would be much more aggressive.......... also depends on the eye-ball test. -michael On Fri, Oct 3, 2008 at 10:04 AM, wrote: > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > 0.6cm2, > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. Would > members of the Forum also do a Maze and if so what lesion set. Would > members > also perform a mitral repair. Annulus not heavily calcified, no leaflet > prolapse, annular dilation. LA not dilated. > > > > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips > and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 ----------------------------------------- From prasannasimha at gmail.com Sat Oct 4 01:05:13 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 14:35:32 2008 Subject: FW: New [HSF] Case In-Reply-To: References: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> Message-ID: <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> I am not sure about Non Marfans patients.I have shifted to Losartan in them too though I am not sure there is evidence there (for eg Bicuspid valves - some evidence of benefit there too). Beta blockers have been found to be inferior compared to Losartan in "preventing" progression of disease while beta blockers eem to "slow " down the disease. There are theories that the action is realted to metalloproteinases etc etc which seem to also be invoved in bicuspids etc.. Currently I use Losartan with beta blockers. Prasanna On Fri, Oct 3, 2008 at 11:39 PM, Douville, Chuck wrote: > Prasanna is losartan also believed to alter the natural history of aortic > dilatation in non-Marfan's patients. I believe you suggested this > previously, but I want to make sure. Are you using both losartan and beta > blockade in your aneurysm patients? thx chuckdouville > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M > Sent: Fri 10/3/2008 9:28 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: New [HSF] Case > > > > This patient has demonstrated "leakability of all the valves. I think it is > important to fix everything. MV repair + TV repair is required. I would > start Losartan . There is increasing evidence that Losartan can actually > reverse the changes of Marfans and decrease the progression of AI and > aortic > dilatation so much soo that some Marfans centres think it will be the > "magic > bullet" for Marfans. The effect is seen with Losartan and not with ACE > Inhibitors. The exact cause is not known but some changes occur in the > molecular level preventing the dilatation etc. > I have fixed one childs nitral and tricusid and am observing his aortic now > for 2 years and is stable. > Prasanna > > On Fri, Oct 3, 2008 at 8:50 PM, wrote: > > > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? > > > > WNovick > > > > -----Original Message----- > > From: Michael Firstenberg > > Sent: October 03, 2008 5:41 PM > > To: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Case > > > > my take on these types of patients is that the MR, if the valve and > annulus > > are normal, is a functon of the AS and gets better over time. Based upon > > the info provided, I would do an AVR and a PVI - but I am sure others > would > > be much more aggressive.......... also depends on the eye-ball test. > > > > > > -michael > > > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > > 0.6cm2, > > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > > Would > > > members of the Forum also do a Maze and if so what lesion set. Would > > > members > > > also perform a mitral repair. Annulus not heavily calcified, no > leaflet > > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > > challenges? Check out WalletPop for the latest news and information, > > tips > > > and > > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001 > ) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@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@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@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 > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sat Oct 4 01:06:18 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 14:36:42 2008 Subject: [HSF] Case In-Reply-To: <8CAF39D75C310E1-DF8-16E@WEBMAIL-DZ15.sysops.aol.com> References: <8CAF39D75C310E1-DF8-16E@WEBMAIL-DZ15.sysops.aol.com> Message-ID: <89c4ed2d0810031136i3c282055j4fd51f1bc53d347b@mail.gmail.com> Around 40-60 % if only left atrial lesions are used. Biatrial gives a 90 +% conversion. Prasanna On Sat, Oct 4, 2008 at 12:02 AM, Edward P. Raines wrote: > > michael, > > ???? why would you do a PVI in a patient with longstanding persistent AF?? > What would the potential cure rate be with such an approach? > > > > > > > -----Original Message----- > From: Michael Firstenberg > To: OpenHeart-L@lists.hsforum.com > Sent: Fri, 3 Oct 2008 9:41 am > Subject: Re: [HSF] Case > > > > my take on these types of patients is that the MR, if the valve and annulus > are normal, is a functon of the AS and gets better over time. Based upon > the info provided, I would do an AVR and a PVI - but I am sure others would > be much more aggressive.......... also depends on the eye-ball test. > > > -michael > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > 0.6cm2, > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > Would > > members of the Forum also do a Maze and if so what lesion set. Would > > members > > also perform a mitral repair. Annulus not heavily calcified, no leaflet > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > challenges? Check out WalletPop for the latest news and information, > tips > > and > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sat Oct 4 01:11:40 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 14:41:58 2008 Subject: FW: New [HSF] Case In-Reply-To: <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> References: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> Message-ID: <89c4ed2d0810031141q677d9e0brcca6281cb6b6a805@mail.gmail.com> Incidentally in hypertensive aortic dilatation beta blockade monotherapywas found to be superior to Losartan monotherapy though both decreased progression of dilatation. Prasanna On Sat, Oct 4, 2008 at 12:05 AM, Prasanna Simha M wrote: > I am not sure about Non Marfans patients.I have shifted to Losartan in them > too though I am not sure there is evidence there (for eg Bicuspid valves - > some evidence of benefit there too). Beta blockers have been found to be > inferior compared to Losartan in "preventing" progression of disease while > beta blockers eem to "slow " down the disease. There are theories that the > action is realted to metalloproteinases etc etc which seem to also be > invoved in bicuspids etc.. > Currently I use Losartan with beta blockers. > Prasanna > > > On Fri, Oct 3, 2008 at 11:39 PM, Douville, Chuck wrote: > >> Prasanna is losartan also believed to alter the natural history of aortic >> dilatation in non-Marfan's patients. I believe you suggested this >> previously, but I want to make sure. Are you using both losartan and beta >> blockade in your aneurysm patients? thx chuckdouville >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M >> Sent: Fri 10/3/2008 9:28 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: New [HSF] Case >> >> >> >> This patient has demonstrated "leakability of all the valves. I think it >> is >> important to fix everything. MV repair + TV repair is required. I would >> start Losartan . There is increasing evidence that Losartan can actually >> reverse the changes of Marfans and decrease the progression of AI and >> aortic >> dilatation so much soo that some Marfans centres think it will be the >> "magic >> bullet" for Marfans. The effect is seen with Losartan and not with ACE >> Inhibitors. The exact cause is not known but some changes occur in the >> molecular level preventing the dilatation etc. >> I have fixed one childs nitral and tricusid and am observing his aortic >> now >> for 2 years and is stable. >> Prasanna >> >> On Fri, Oct 3, 2008 at 8:50 PM, wrote: >> >> > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? >> > >> > WNovick >> > >> > -----Original Message----- >> > From: Michael Firstenberg >> > Sent: October 03, 2008 5:41 PM >> > To: OpenHeart-L@lists.hsforum.com >> > Subject: Re: [HSF] Case >> > >> > my take on these types of patients is that the MR, if the valve and >> annulus >> > are normal, is a functon of the AS and gets better over time. Based >> upon >> > the info provided, I would do an AVR and a PVI - but I am sure others >> would >> > be much more aggressive.......... also depends on the eye-ball test. >> > >> > >> > -michael >> > >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote: >> > >> > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA >> > > 0.6cm2, >> > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. >> > Would >> > > members of the Forum also do a Maze and if so what lesion set. Would >> > > members >> > > also perform a mitral repair. Annulus not heavily calcified, no >> leaflet >> > > prolapse, annular dilation. LA not dilated. >> > > >> > > >> > > >> > > >> > > >> > > **************Looking for simple solutions to your real-life financial >> > > challenges? Check out WalletPop for the latest news and information, >> > tips >> > > and >> > > calculators. ( >> http://www.walletpop.com/?NCID=emlcntuswall00000001) >> > > _______________________________________________ >> > > OpenHeart-L mailing list >> > > >> > > Send postings to: >> > > OpenHeart-L@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@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@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 >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From prasannasimha at gmail.com Sat Oct 4 01:13:16 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 14:43:41 2008 Subject: FW: New [HSF] Case In-Reply-To: <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> References: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> Message-ID: <89c4ed2d0810031143l4cba0920k35e50811a508f389@mail.gmail.com> And TGF beta. Prasanna On Sat, Oct 4, 2008 at 12:05 AM, Prasanna Simha M wrote: > I am not sure about Non Marfans patients.I have shifted to Losartan in them > too though I am not sure there is evidence there (for eg Bicuspid valves - > some evidence of benefit there too). Beta blockers have been found to be > inferior compared to Losartan in "preventing" progression of disease while > beta blockers eem to "slow " down the disease. There are theories that the > action is realted to metalloproteinases etc etc which seem to also be > invoved in bicuspids etc.. > Currently I use Losartan with beta blockers. > Prasanna > > > On Fri, Oct 3, 2008 at 11:39 PM, Douville, Chuck wrote: > >> Prasanna is losartan also believed to alter the natural history of aortic >> dilatation in non-Marfan's patients. I believe you suggested this >> previously, but I want to make sure. Are you using both losartan and beta >> blockade in your aneurysm patients? thx chuckdouville >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M >> Sent: Fri 10/3/2008 9:28 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: New [HSF] Case >> >> >> >> This patient has demonstrated "leakability of all the valves. I think it >> is >> important to fix everything. MV repair + TV repair is required. I would >> start Losartan . There is increasing evidence that Losartan can actually >> reverse the changes of Marfans and decrease the progression of AI and >> aortic >> dilatation so much soo that some Marfans centres think it will be the >> "magic >> bullet" for Marfans. The effect is seen with Losartan and not with ACE >> Inhibitors. The exact cause is not known but some changes occur in the >> molecular level preventing the dilatation etc. >> I have fixed one childs nitral and tricusid and am observing his aortic >> now >> for 2 years and is stable. >> Prasanna >> >> On Fri, Oct 3, 2008 at 8:50 PM, wrote: >> >> > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? >> > >> > WNovick >> > >> > -----Original Message----- >> > From: Michael Firstenberg >> > Sent: October 03, 2008 5:41 PM >> > To: OpenHeart-L@lists.hsforum.com >> > Subject: Re: [HSF] Case >> > >> > my take on these types of patients is that the MR, if the valve and >> annulus >> > are normal, is a functon of the AS and gets better over time. Based >> upon >> > the info provided, I would do an AVR and a PVI - but I am sure others >> would >> > be much more aggressive.......... also depends on the eye-ball test. >> > >> > >> > -michael >> > >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote: >> > >> > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA >> > > 0.6cm2, >> > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. >> > Would >> > > members of the Forum also do a Maze and if so what lesion set. Would >> > > members >> > > also perform a mitral repair. Annulus not heavily calcified, no >> leaflet >> > > prolapse, annular dilation. LA not dilated. >> > > >> > > >> > > >> > > >> > > >> > > **************Looking for simple solutions to your real-life financial >> > > challenges? Check out WalletPop for the latest news and information, >> > tips >> > > and >> > > calculators. ( >> http://www.walletpop.com/?NCID=emlcntuswall00000001) >> > > _______________________________________________ >> > > OpenHeart-L mailing list >> > > >> > > Send postings to: >> > > OpenHeart-L@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@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@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 >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From dukeb60 at aol.com Fri Oct 3 15:43:21 2008 From: dukeb60 at aol.com (Edward P. Raines) Date: Fri Oct 3 14:44:05 2008 Subject: [HSF] Case In-Reply-To: <89c4ed2d0810031136i3c282055j4fd51f1bc53d347b@mail.gmail.com> References: <8CAF39D75C310E1-DF8-16E@WEBMAIL-DZ15.sysops.aol.com> <89c4ed2d0810031136i3c282055j4fd51f1bc53d347b@mail.gmail.com> Message-ID: <8CAF39F0AC83E61-DF8-248@WEBMAIL-DZ15.sysops.aol.com> What would your "left atrial lesions" consist of?? Simple eyeglass PVI?? Connecting lesion?? Box?? Isthmus?? LA Appendage lesion?? Ligament of Marshall?? Ganglia? -----Original Message----- From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Fri, 3 Oct 2008 1:36 pm Subject: Re: [HSF] Case Around 40-60 % if only left atrial lesions are used. Biatrial gives a 90 +% conversion. Prasanna On Sat, Oct 4, 2008 at 12:02 AM, Edward P. Raines wrote: > > michael, > > ???? why would you do a PVI in a patient with longstanding persistent AF?? > What would the potential cure rate be with such an approach? > > > > > > > -----Original Message----- > From: Michael Firstenberg > To: OpenHeart-L@lists.hsforum.com > Sent: Fri, 3 Oct 2008 9:41 am > Subject: Re: [HSF] Case > > > > my take on these types of patients is that the MR, if the valve and annulus > are normal, is a functon of the AS and gets better over time. Based upon > the info provided, I would do an AVR and a PVI - but I am sure others would > be much more aggressive.......... also depends on the eye-ball test. > > > -michael > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > 0.6cm2, > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > Would > > members of the Forum also do a Maze and if so what lesion set. Would > > members > > also perform a mitral repair. Annulus not heavily calcified, no leaflet > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > challenges? Check out WalletPop for the latest news and information, > tips > > and > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From msfirst at gmail.com Fri Oct 3 16:31:30 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Fri Oct 3 15:31:51 2008 Subject: [HSF] Case In-Reply-To: <8CAF39F0AC83E61-DF8-248@WEBMAIL-DZ15.sysops.aol.com> References: <8CAF39D75C310E1-DF8-16E@WEBMAIL-DZ15.sysops.aol.com> <89c4ed2d0810031136i3c282055j4fd51f1bc53d347b@mail.gmail.com> <8CAF39F0AC83E61-DF8-248@WEBMAIL-DZ15.sysops.aol.com> Message-ID: if I am not going after the mitral (or tricuspid), I see no reason to open the LA/RA for an ablative procedure. On Fri, Oct 3, 2008 at 2:43 PM, Edward P. Raines wrote: > What would your "left atrial lesions" consist of?? Simple eyeglass PVI?? > Connecting lesion?? Box?? Isthmus?? LA Appendage lesion?? Ligament of > Marshall?? Ganglia? > > > > > > -----Original Message----- > From: Prasanna Simha M > To: OpenHeart-L@lists.hsforum.com > Sent: Fri, 3 Oct 2008 1:36 pm > Subject: Re: [HSF] Case > > > > Around 40-60 % if only left atrial lesions are used. Biatrial gives a 90 +% > conversion. > Prasanna > > On Sat, Oct 4, 2008 at 12:02 AM, Edward P. Raines wrote: > > > > > michael, > > > > ???? why would you do a PVI in a patient with longstanding persistent > AF?? > > What would the potential cure rate be with such an approach? > > > > > > > > > > > > > > -----Original Message----- > > From: Michael Firstenberg > > To: OpenHeart-L@lists.hsforum.com > > Sent: Fri, 3 Oct 2008 9:41 am > > Subject: Re: [HSF] Case > > > > > > > > my take on these types of patients is that the MR, if the valve and > annulus > > are normal, is a functon of the AS and gets better over time. Based upon > > the info provided, I would do an AVR and a PVI - but I am sure others > would > > be much more aggressive.......... also depends on the eye-ball test. > > > > > > -michael > > > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > > 0.6cm2, > > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > > Would > > > members of the Forum also do a Maze and if so what lesion set. Would > > > members > > > also perform a mitral repair. Annulus not heavily calcified, no > leaflet > > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > > challenges? Check out WalletPop for the latest news and information, > > tips > > > and > > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001 > ) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@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@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@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 > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > From tacuff at swbell.net Fri Oct 3 14:08:35 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Oct 3 16:09:06 2008 Subject: FW: New [HSF] Case Message-ID: <814925.10981.qm@web81603.mail.mud.yahoo.com> ??? is this one of your songs? tea ----- Original Message ---- From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Friday, October 3, 2008 1:43:16 PM Subject: Re: FW: New [HSF] Case And TGF beta. Prasanna On Sat, Oct 4, 2008 at 12:05 AM, Prasanna Simha M wrote: > I am not sure about Non Marfans patients.I have shifted to Losartan in them > too though I am not sure there is evidence there (for eg Bicuspid valves - > some evidence of benefit there too). Beta blockers have been found to be > inferior compared to Losartan in "preventing" progression of disease while > beta blockers eem to "slow " down the disease. There are theories that the > action is realted to metalloproteinases etc etc which seem to also be > invoved in bicuspids etc.. > Currently I use Losartan with beta blockers. > Prasanna > > > On Fri, Oct 3, 2008 at 11:39 PM, Douville, Chuck wrote: > >> Prasanna is losartan also believed to alter the natural history of aortic >> dilatation in non-Marfan's patients. I believe you suggested this >> previously, but I want to make sure. Are you using both losartan and beta >> blockade in your aneurysm patients? thx chuckdouville >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M >> Sent: Fri 10/3/2008 9:28 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: New [HSF] Case >> >> >> >> This patient has demonstrated "leakability of all the valves. I think it >> is >> important to fix everything. MV repair + TV repair is required. I would >> start Losartan . There is increasing evidence that Losartan can actually >> reverse the changes of Marfans and decrease the progression of AI and >> aortic >> dilatation so much soo that some Marfans centres think it will be the >> "magic >> bullet" for Marfans. The effect is seen with Losartan and not with ACE >> Inhibitors. The exact cause is not known but some changes occur in the >> molecular level preventing the dilatation etc. >> I have fixed one childs nitral and tricusid and am observing his aortic >> now >> for 2 years and is stable. >> Prasanna >> >> On Fri, Oct 3, 2008 at 8:50 PM, wrote: >> >> > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? >> > >> > WNovick >> > >> > -----Original Message----- >> > From: Michael Firstenberg >> > Sent: October 03, 2008 5:41 PM >> > To: OpenHeart-L@lists.hsforum.com >> > Subject: Re: [HSF] Case >> > >> > my take on these types of patients is that the MR, if the valve and >> annulus >> > are normal, is a functon of the AS and gets better over time.? Based >> upon >> > the info provided, I would do an AVR and a PVI - but I am sure others >> would >> > be much more aggressive.......... also depends on the eye-ball test. >> > >> > >> > -michael >> > >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote: >> > >> > > 75 yo. female, normal LV, severe AS with? 80mmHg. peak gradient, AVA >> > > 0.6cm2, >> > > normal CA's, chronic persistent AF, moderate? MR.? Referred for AVR. >> >? Would >> > > members of the Forum also do a Maze? and if so what lesion set.? Would >> > > members >> > > also perform a mitral? repair.? Annulus not heavily calcified, no >> leaflet >> > > prolapse, annular? dilation.? LA not dilated. >> > > >> > > >> > > >> > > >> > > >> > > **************Looking for simple solutions to your real-life financial >> > > challenges?? Check out WalletPop for the latest news and information, >> > tips >> > > and >> > > calculators.? ? ? ( >> http://www.walletpop.com/?NCID=emlcntuswall00000001) >> > > _______________________________________________ >> > > OpenHeart-L mailing list >> > > >> > > Send postings to: >> > >? OpenHeart-L@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@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@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 >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >>? OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From tacuff at swbell.net Fri Oct 3 14:11:12 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Oct 3 16:12:44 2008 Subject: FW: New [HSF] Case Message-ID: <280579.42452.qm@web81602.mail.mud.yahoo.com> Reference? tea ----- Original Message ---- From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Friday, October 3, 2008 1:41:40 PM Subject: Re: FW: New [HSF] Case Incidentally in hypertensive aortic dilatation beta blockade monotherapywas found to be superior to Losartan monotherapy though both decreased progression of dilatation. Prasanna On Sat, Oct 4, 2008 at 12:05 AM, Prasanna Simha M wrote: > I am not sure about Non Marfans patients.I have shifted to Losartan in them > too though I am not sure there is evidence there (for eg Bicuspid valves - > some evidence of benefit there too). Beta blockers have been found to be > inferior compared to Losartan in "preventing" progression of disease while > beta blockers eem to "slow " down the disease. There are theories that the > action is realted to metalloproteinases etc etc which seem to also be > invoved in bicuspids etc.. > Currently I use Losartan with beta blockers. > Prasanna > > > On Fri, Oct 3, 2008 at 11:39 PM, Douville, Chuck wrote: > >> Prasanna is losartan also believed to alter the natural history of aortic >> dilatation in non-Marfan's patients. I believe you suggested this >> previously, but I want to make sure. Are you using both losartan and beta >> blockade in your aneurysm patients? thx chuckdouville >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M >> Sent: Fri 10/3/2008 9:28 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: New [HSF] Case >> >> >> >> This patient has demonstrated "leakability of all the valves. I think it >> is >> important to fix everything. MV repair + TV repair is required. I would >> start Losartan . There is increasing evidence that Losartan can actually >> reverse the changes of Marfans and decrease the progression of AI and >> aortic >> dilatation so much soo that some Marfans centres think it will be the >> "magic >> bullet" for Marfans. The effect is seen with Losartan and not with ACE >> Inhibitors. The exact cause is not known but some changes occur in the >> molecular level preventing the dilatation etc. >> I have fixed one childs nitral and tricusid and am observing his aortic >> now >> for 2 years and is stable. >> Prasanna >> >> On Fri, Oct 3, 2008 at 8:50 PM, wrote: >> >> > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? >> > >> > WNovick >> > >> > -----Original Message----- >> > From: Michael Firstenberg >> > Sent: October 03, 2008 5:41 PM >> > To: OpenHeart-L@lists.hsforum.com >> > Subject: Re: [HSF] Case >> > >> > my take on these types of patients is that the MR, if the valve and >> annulus >> > are normal, is a functon of the AS and gets better over time.? Based >> upon >> > the info provided, I would do an AVR and a PVI - but I am sure others >> would >> > be much more aggressive.......... also depends on the eye-ball test. >> > >> > >> > -michael >> > >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote: >> > >> > > 75 yo. female, normal LV, severe AS with? 80mmHg. peak gradient, AVA >> > > 0.6cm2, >> > > normal CA's, chronic persistent AF, moderate? MR.? Referred for AVR. >> >? Would >> > > members of the Forum also do a Maze? and if so what lesion set.? Would >> > > members >> > > also perform a mitral? repair.? Annulus not heavily calcified, no >> leaflet >> > > prolapse, annular? dilation.? LA not dilated. >> > > >> > > >> > > >> > > >> > > >> > > **************Looking for simple solutions to your real-life financial >> > > challenges?? Check out WalletPop for the latest news and information, >> > tips >> > > and >> > > calculators.? ? ? ( >> http://www.walletpop.com/?NCID=emlcntuswall00000001) >> > > _______________________________________________ >> > > OpenHeart-L mailing list >> > > >> > > Send postings to: >> > >? OpenHeart-L@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@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@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 >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >>? OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From tacuff at swbell.net Fri Oct 3 14:12:40 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Oct 3 16:14:02 2008 Subject: [HSF] Case Message-ID: <671492.55789.qm@web81602.mail.mud.yahoo.com> Just for fun can you describe the group of?fruit to which you compare this orange? ? tea ----- Original Message ---- From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Friday, October 3, 2008 1:36:18 PM Subject: Re: [HSF] Case Around 40-60 % if only left atrial lesions are used. Biatrial gives a 90 +% conversion. Prasanna On Sat, Oct 4, 2008 at 12:02 AM, Edward P. Raines wrote: > > michael, > > ???? why would you do a PVI in a patient with longstanding persistent AF?? > What would the potential cure rate be with such an approach? > > > > > > > -----Original Message----- > From: Michael Firstenberg > To: OpenHeart-L@lists.hsforum.com > Sent: Fri, 3 Oct 2008 9:41 am > Subject: Re: [HSF] Case > > > > my take on these types of patients is that the MR, if the valve and annulus > are normal, is a functon of the AS and gets better over time.? Based upon > the info provided, I would do an AVR and a PVI - but I am sure others would > be much more aggressive.......... also depends on the eye-ball test. > > > -michael > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > 75 yo. female, normal LV, severe AS with? 80mmHg. peak gradient, AVA > > 0.6cm2, > > normal CA's, chronic persistent AF, moderate? MR.? Referred for AVR. >? Would > > members of the Forum also do a Maze? and if so what lesion set.? Would > > members > > also perform a mitral? repair.? Annulus not heavily calcified, no leaflet > > prolapse, annular? dilation.? LA not dilated. > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > challenges?? Check out WalletPop for the latest news and information, > tips > > and > > calculators.? ? ? (http://www.walletpop.com/?NCID=emlcntuswall00000001) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > >? OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From tacuff at swbell.net Fri Oct 3 14:13:32 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Oct 3 16:14:04 2008 Subject: [HSF] Case Message-ID: <552385.96117.qm@web81604.mail.mud.yahoo.com> So that is the line in the sand, er heart? ? tea ----- Original Message ---- From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Friday, October 3, 2008 2:31:30 PM Subject: Re: [HSF] Case if I am not going after the mitral (or tricuspid), I see no reason to open the LA/RA for an ablative procedure. On Fri, Oct 3, 2008 at 2:43 PM, Edward P. Raines wrote: > What would your "left atrial lesions" consist of?? Simple eyeglass PVI?? > Connecting lesion?? Box?? Isthmus?? LA Appendage lesion?? Ligament of > Marshall?? Ganglia? > > > > > > -----Original Message----- > From: Prasanna Simha M > To: OpenHeart-L@lists.hsforum.com >? Sent: Fri, 3 Oct 2008 1:36 pm > Subject: Re: [HSF] Case > > > > Around 40-60 % if only left atrial lesions are used. Biatrial gives a 90 +% > conversion. > Prasanna > > On Sat, Oct 4, 2008 at 12:02 AM, Edward P. Raines wrote: > > > > > michael, > > > > ???? why would you do a PVI in a patient with longstanding persistent > AF?? > > What would the potential cure rate be with such an approach? > > > > > > > > > > > > > > -----Original Message----- > > From: Michael Firstenberg > > To: OpenHeart-L@lists.hsforum.com > > Sent: Fri, 3 Oct 2008 9:41 am > > Subject: Re: [HSF] Case > > > > > > > > my take on these types of patients is that the MR, if the valve and > annulus > > are normal, is a functon of the AS and gets better over time.? Based upon > > the info provided, I would do an AVR and a PVI - but I am sure others > would > > be much more aggressive.......... also depends on the eye-ball test. > > > > > > -michael > > > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > > > 75 yo. female, normal LV, severe AS with? 80mmHg. peak gradient, AVA > > > 0.6cm2, > > > normal CA's, chronic persistent AF, moderate? MR.? Referred for AVR. > >? Would > > > members of the Forum also do a Maze? and if so what lesion set.? Would > > > members > > > also perform a mitral? repair.? Annulus not heavily calcified, no > leaflet > > > prolapse, annular? dilation.? LA not dilated. > > > > > > > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > > challenges?? Check out WalletPop for the latest news and information, > > tips > > > and > > > calculators.? ? ? (http://www.walletpop.com/?NCID=emlcntuswall00000001 > ) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > >? OpenHeart-L@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@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@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 > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: >? OpenHeart-L@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@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@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 ----------------------------------------- From tacuff at swbell.net Fri Oct 3 14:18:31 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Oct 3 16:19:01 2008 Subject: [HSF] slippery ideas or sloppy thinkers? Message-ID: <946132.19734.qm@web81606.mail.mud.yahoo.com> Ah, yes, the over sight. Who (a)?should provide over sight of whom (b)?for the benefit of?whom (c)? Don't forget this is, by the rules set earlier, not an economic question but a medical one also? (Or visa versa). ? tea ----- Original Message ---- From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Friday, October 3, 2008 8:54:21 AM Subject: Re: [HSF] slippery ideas or sloppy thinkers? those who dont learn from the mistakes in history are doomed to repeat them. many of the problems that we see in the world really should not come as any surprise - predictable outcomes to flawed thinking and practice (especially when there is no oversight) -michael On Fri, Oct 3, 2008 at 9:00 AM, wrote: > Damn....i "got" this one!.......respectfully,bill turner > > > -----Original Message----- > From: Tea Acuff > To: OpenHeart-L > Sent: Thu, 2 Oct 2008 8:48 pm > Subject: [HSF] slippery ideas or sloppy thinkers? > > > > I am sure even some of our nonUSA readers are noticing the "acutely" ill > monetary system in the USA and will be reminded by woes in their own > country of > the impact of USA on the world, be it perceived as empire colonization or > globalization?effects. ? I have been reading an interesting book, The > Forgotten > Man, about the Great Depression. The nice thing about it is the > documentation of > individual players and their ideas and actions in a real world but one > remote > from our experience. The patterns of those ideas even if not their > definitions > are amazingly similar to some of the arguments that we in the USA are > "emergently" addressing and rethinking in our provocative proposed > intervention > in the modern US marketplace. > > My point of this thread is not an economic discussion per se but a > hypothesis of > extreme hubris on my part as it implies (but in no way proves) that I > understand > "essences" of economic theory as well as that of medicine at large. What > impresses me is that the slippery (or sloppy) idea of economic health is > very > similar to the parallel ideas in medicine. Further, the "solutions" and > "needs" > and "consequences", despite ones underlying bias are quite similar. For > example, > like in medicine, the monetary or credit crisis is or was leveraged in > terms of > access (need or greed depending on the position of the player)?and the > solution > is largely defined by the experts (economic or medical) as more money for > the > system. The threat is framed in the context of business as usual and the > loss of > control of that business as usual. Exactly how is "usual" good, economic?or > medical, health in the big picture??Most importantly the bigger picture is > almost completely >? obscure due to the smaller adgendas inherent in each and multiple > protagonist's > world views and the unknown of?new or future change. As?I have said before > it is > common for us to look at the past and wonder why those people were such > morons, > while we educated moderns are left confused with uncertainty?and partial or > ideological adge > ndas of the "complex" problems in the present. Perhaps this is > why Dr. Frater seems so prescient. He has seen many of the present medical > dilemmas played out in several different contexts and time frames. > > tea > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: >? OpenHeart-L@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@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@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 ----------------------------------------- From tacuff at swbell.net Fri Oct 3 14:19:17 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Oct 3 16:20:47 2008 Subject: [HSF] Microplegia-TEA- OT Message-ID: <322797.55974.qm@web81608.mail.mud.yahoo.com> Good. Perhaps very good. ? tea ----- Original Message ---- From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Friday, October 3, 2008 8:57:49 AM Subject: Re: [HSF] Microplegia-TEA- OT tea - I think they would call it American style. -michael On Fri, Oct 3, 2008 at 8:30 AM, Tea Acuff wrote: > I would love to. What would the German description be for my performance > which will lacking in both style and substance? > Tea > > Sent from my iPhone > >? On Oct 3, 2008, at 3:52 AM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > > > Tea, > come and play soccer with our joungs in Leipzig, they do it every > Wednesday. > > Roberto> Date: Thu, 2 Oct 2008 17:40:56 -0700> From: tacuff@swbell.net> > Subject: Re: [HSF] Microplegia> To: OpenHeart-L@lists.hsforum.com> CC: > > > And I play soccer with one of the engineers who helped developed it. He must > be better engineer than I am a soccer player.> Tea> > Sent from my iPhone> > > On Oct 2, 2008, at 5:39 PM, BAins24221@aol.com wrote:> > The Quest MPS is > a very flexible system. Any drug concentration (for the > most part), any > temperature, any delivery pressure desired is available. Drug > > concentrations are delivered at the desired concentration regardless of > > variability of pump flow. One of my favorite features is the "Auto" button, > when > turned on will vary the pump flow to keep the chosen pressure > constant, > elimenating over pressurization of vessels/heart. Our pump runs > are about 2 hours > and we give a lot of cardioplegia with much less than > 100 ml of additives > per case. Surgeons do not see edema of the heart. We > also >? eliminated the > large heater/coolers in the OR. I use a Medtronic ECMO > heater to warm or cool > the patient and the Quest pump mounted ice cooler > for the cardioplegia. We > drift our patients (34 esoph) and warm them > slowly and deliver cardioplegia at > 34 deg to arrest, 20 deg subsequent > (usually) and 37 for last dose. Above > all, this system is very safe.> Bill > Ainsley CCP> > > > **************Looking for simple solutions to your > real-life financial > challenges? Check out WalletPop for the latest news > and information, tips and > calculators. ( > http://www.walletpop.com/?NCID=emlcntuswall00000001)> > _______________________________________________> OpenHeart-L mailing list> > > Send postings to:> OpenHeart-L@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@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@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@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@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 ----------------------------------------- From tacuff at swbell.net Fri Oct 3 14:32:49 2008 From: tacuff at swbell.net (Tea Acuff) Date: Fri Oct 3 16:33:17 2008 Subject: [HSF] Microplegia-TEA- OT Message-ID: <605004.34664.qm@web81603.mail.mud.yahoo.com> Good. Maybe very good. Tea Sent from my iPhone On Oct 3, 2008, at 8:57 AM, "Michael Firstenberg" wrote: > tea - > > I think they would call it American style. > > -michael > > On Fri, Oct 3, 2008 at 8:30 AM, Tea Acuff wrote: > >> I would love to. What would the German description be for my >> performance >> which will lacking in both style and substance? >> Tea >> >> Sent from my iPhone >> >> On Oct 3, 2008, at 3:52 AM, Roberto Battellini < >> robertobattellini@hotmail.com> wrote: >> >> >> Tea, >> come and play soccer with our joungs in Leipzig, they do it every >> Wednesday. >> >> Roberto> Date: Thu, 2 Oct 2008 17:40:56 -0700> From: tacuff@swbell.net >> > >> Subject: Re: [HSF] Microplegia> To: OpenHeart-L@lists.hsforum.com> >> CC: > > >> And I play soccer with one of the engineers who helped developed >> it. He must >> be better engineer than I am a soccer player.> Tea> > Sent from my >> iPhone> > >> On Oct 2, 2008, at 5:39 PM, BAins24221@aol.com wrote:> > The Quest >> MPS is >> a very flexible system. Any drug concentration (for the > most >> part), any >> temperature, any delivery pressure desired is available. Drug > >> concentrations are delivered at the desired concentration >> regardless of > >> variability of pump flow. One of my favorite features is the "Auto" >> button, >> when > turned on will vary the pump flow to keep the chosen pressure >> constant, > elimenating over pressurization of vessels/heart. Our >> pump runs >> are about 2 hours > and we give a lot of cardioplegia with much >> less than >> 100 ml of additives > per case. Surgeons do not see edema of the >> heart. We >> also >> eliminated the > large heater/coolers in the OR. I use a Medtronic >> ECMO >> heater to warm or cool > the patient and the Quest pump mounted ice >> cooler >> for the cardioplegia. We > drift our patients (34 esoph) and warm >> them >> slowly and deliver cardioplegia at > 34 deg to arrest, 20 deg >> subsequent >> (usually) and 37 for last dose. Above > all, this system is very >> safe.> Bill >> Ainsley CCP> > > > **************Looking for simple solutions to your >> real-life financial > challenges? Check out WalletPop for the >> latest news >> and information, tips and > calculators. ( >> http://www.walletpop.com/?NCID=emlcntuswall00000001)> >> _______________________________________________> OpenHeart-L >> mailing list> > >> Send postings to:> OpenHeart-L@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@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@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@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@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 > ----------------------------------------- From donross at bigpond.com Sat Oct 4 09:05:03 2008 From: donross at bigpond.com (Donald Ross) Date: Fri Oct 3 18:05:50 2008 Subject: [HSF] slippery ideas or sloppy thinkers? In-Reply-To: <946132.19734.qm@web81606.mail.mud.yahoo.com> References: <946132.19734.qm@web81606.mail.mud.yahoo.com> Message-ID: <5F50012F-363D-40E1-8411-A04C0D5E5078@bigpond.com> tea ( HSF economic consultant), What veracity do you ascribe to the theory bandied about that the prime reason for sub prime defaults is the cost of health care? ( Rhetorical question for most US cardiac surgeons, I suspect.) Don On 04/10/2008, at 6:18 AM, Tea Acuff wrote: > Ah, yes, the over sight. Who (a) should provide over sight of whom > (b) for the benefit of whom (c)? Don't forget this is, by the rules > set earlier, not an economic question but a medical one also? (Or > visa versa). > > tea > > > > ----- Original Message ---- > From: Michael Firstenberg > To: OpenHeart-L@lists.hsforum.com > Sent: Friday, October 3, 2008 8:54:21 AM > Subject: Re: [HSF] slippery ideas or sloppy thinkers? > > those who dont learn from the mistakes in history are doomed to > repeat them. > > many of the problems that we see in the world really should not come > as any > surprise - predictable outcomes to flawed thinking and practice > (especially > when there is no oversight) > > -michael > > On Fri, Oct 3, 2008 at 9:00 AM, wrote: > >> Damn....i "got" this one!.......respectfully,bill turner >> >> >> -----Original Message----- >> From: Tea Acuff >> To: OpenHeart-L >> Sent: Thu, 2 Oct 2008 8:48 pm >> Subject: [HSF] slippery ideas or sloppy thinkers? >> >> >> >> I am sure even some of our nonUSA readers are noticing the >> "acutely" ill >> monetary system in the USA and will be reminded by woes in their own >> country of >> the impact of USA on the world, be it perceived as empire >> colonization or >> globalization?effects. ? I have been reading an interesting book, The >> Forgotten >> Man, about the Great Depression. The nice thing about it is the >> documentation of >> individual players and their ideas and actions in a real world but >> one >> remote >> from our experience. The patterns of those ideas even if not their >> definitions >> are amazingly similar to some of the arguments that we in the USA are >> "emergently" addressing and rethinking in our provocative proposed >> intervention >> in the modern US marketplace. >> >> My point of this thread is not an economic discussion per se but a >> hypothesis of >> extreme hubris on my part as it implies (but in no way proves) that I >> understand >> "essences" of economic theory as well as that of medicine at large. >> What >> impresses me is that the slippery (or sloppy) idea of economic >> health is >> very >> similar to the parallel ideas in medicine. Further, the "solutions" >> and >> "needs" >> and "consequences", despite ones underlying bias are quite similar. >> For >> example, >> like in medicine, the monetary or credit crisis is or was leveraged >> in >> terms of >> access (need or greed depending on the position of the player)?and >> the >> solution >> is largely defined by the experts (economic or medical) as more >> money for >> the >> system. The threat is framed in the context of business as usual >> and the >> loss of >> control of that business as usual. Exactly how is "usual" good, >> economic?or >> medical, health in the big picture??Most importantly the bigger >> picture is >> almost completely >> obscure due to the smaller adgendas inherent in each and multiple >> protagonist's >> world views and the unknown of?new or future change. As?I have said >> before >> it is >> common for us to look at the past and wonder why those people were >> such >> morons, >> while we educated moderns are left confused with uncertainty?and >> partial or >> ideological adge >> ndas of the "complex" problems in the present. Perhaps this is >> why Dr. Frater seems so prescient. He has seen many of the present >> medical >> dilemmas played out in several different contexts and time frames. >> >> tea >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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@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@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 > ----------------------------------------- From anianyanwu at hotmail.com Sat Oct 4 00:01:03 2008 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Fri Oct 3 19:01:52 2008 Subject: [HSF] Microplegia In-Reply-To: References: Message-ID: > Surgeons do not see edema of the heart. > Bill Ainsley CCP How does a surgeon see edema of the heart? Is the something your surgeons saw, or said they saw, before you used 'microplegia'? Ani > From: BAins24221@aol.com> Date: Thu, 2 Oct 2008 18:39:16 -0400> Subject: Re: [HSF] Microplegia> To: OpenHeart-L@lists.hsforum.com> CC: > > The Quest MPS is a very flexible system. Any drug concentration (for the > most part), any temperature, any delivery pressure desired is available. Drug > concentrations are delivered at the desired concentration regardless of > variability of pump flow. One of my favorite features is the "Auto" button, when > turned on will vary the pump flow to keep the chosen pressure constant, > elimenating over pressurization of vessels/heart. Our pump runs are about 2 hours > and we give a lot of cardioplegia with much less than 100 ml of additives > per case. Surgeons do not see edema of the heart. We also eliminated the > large heater/coolers in the OR. I use a Medtronic ECMO heater to warm or cool > the patient and the Quest pump mounted ice cooler for the cardioplegia. We > drift our patients (34 esoph) and warm them slowly and deliver cardioplegia at > 34 deg to arrest, 20 deg subsequent (usually) and 37 for last dose. Above > all, this system is very safe.> Bill Ainsley CCP> > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- _________________________________________________________________ Make a mini you and download it into Windows Live Messenger http://clk.atdmt.com/UKM/go/111354029/direct/01/ From anianyanwu at hotmail.com Sat Oct 4 00:29:06 2008 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Fri Oct 3 19:29:35 2008 Subject: [HSF] Case In-Reply-To: <8CAF39F0AC83E61-DF8-248@WEBMAIL-DZ15.sysops.aol.com> References: <8CAF39D75C310E1-DF8-16E@WEBMAIL-DZ15.sysops.aol.com> <89c4ed2d0810031136i3c282055j4fd51f1bc53d347b@mail.gmail.com> <8CAF39F0AC83E61-DF8-248@WEBMAIL-DZ15.sysops.aol.com> Message-ID: It gets very confusing now there are several cases being discussed as 'case'. In reference to your original case, Ed, what is the mechanism of the MR and what is the LV dimension and contractility like? If type IIIB or LV dysfunction then I would do annuloplasty. We found a higher operative and late mortality in our aortic valve patients with moderate or greater MR in which the mitral was not operated as compared to those who had annuloplasty. If there is a IIIB mechanism, it is unlikely to improve, at least acutely, with AVR. As regards maze, as we discussed previously, PVI is probably little more effective than toss of coin in chronic persistent a-fib. If undergoing concurrent mitral would probably do cryomaze, if not nothing. Of course the decision of concurrent procedures is not abolute and the above assumes optimal patient and surgical conditions. Ani > To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Case> Date: Fri, 3 Oct 2008 14:43:21 -0400> From: dukeb60@aol.com> CC: > > What would your "left atrial lesions" consist of?? Simple eyeglass PVI?? Connecting lesion?? Box?? Isthmus?? LA Appendage lesion?? Ligament of Marshall?? Ganglia?> > > > > > -----Original Message-----> From: Prasanna Simha M > To: OpenHeart-L@lists.hsforum.com> Sent: Fri, 3 Oct 2008 1:36 pm> Subject: Re: [HSF] Case> > > > Around 40-60 % if only left atrial lesions are used. Biatrial gives a 90 +%> conversion.> Prasanna> > On Sat, Oct 4, 2008 at 12:02 AM, Edward P. Raines wrote:> > >> > michael,> >> > ???? why would you do a PVI in a patient with longstanding persistent AF??> > What would the potential cure rate be with such an approach?> >> >> >> >> >> >> > -----Original Message-----> > From: Michael Firstenberg > > To: OpenHeart-L@lists.hsforum.com> > Sent: Fri, 3 Oct 2008 9:41 am> > Subject: Re: [HSF] Case> >> >> >> > my take on these types of patients is that the MR, if the valve and annulus> > are normal, is a functon of the AS and gets better over time. Based upon> > the info provided, I would do an AVR and a PVI - but I am sure others would> > be much more aggressive.......... also depends on the eye-ball test.> >> >> > -michael> >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote:> >> > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA> > > 0.6cm2,> > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR.> > Would> > > members of the Forum also do a Maze and if so what lesion set. Would> > > members> > > also perform a mitral repair. Annulus not heavily calcified, no leaflet> > > prolapse, annular dilation. LA not dilated.> > >> > >> > >> > >> > >> > > **************Looking for simple solutions to your real-life financial> > > challenges? Check out WalletPop for the latest news and information,> > tips> > > and> > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> > > _______________________________________________> > > OpenHeart-L mailing list> > >> > > Send postings to:> > > OpenHeart-L@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@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@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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> ----------------------------------------- _________________________________________________________________ Discover Bird's Eye View now with Multimap from Live Search http://clk.atdmt.com/UKM/go/111354026/direct/01/ From prasannasimha at gmail.com Sat Oct 4 08:25:34 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 3 21:55:51 2008 Subject: FW: New [HSF] Case In-Reply-To: <280579.42452.qm@web81602.mail.mud.yahoo.com> References: <280579.42452.qm@web81602.mail.mud.yahoo.com> Message-ID: <89c4ed2d0810031855w4b638c68gf628f4ba65220735@mail.gmail.com> It was an article in Circulation. I will have to dig it out. Prasanna On Sat, Oct 4, 2008 at 1:41 AM, Tea Acuff wrote: > Reference? > tea > > > > ----- Original Message ---- > From: Prasanna Simha M > To: OpenHeart-L@lists.hsforum.com > Sent: Friday, October 3, 2008 1:41:40 PM > Subject: Re: FW: New [HSF] Case > > Incidentally in hypertensive aortic dilatation beta blockade monotherapywas > found to be superior to Losartan monotherapy though both decreased > progression of dilatation. > Prasanna > > On Sat, Oct 4, 2008 at 12:05 AM, Prasanna Simha M > wrote: > > > I am not sure about Non Marfans patients.I have shifted to Losartan in > them > > too though I am not sure there is evidence there (for eg Bicuspid valves > - > > some evidence of benefit there too). Beta blockers have been found to be > > inferior compared to Losartan in "preventing" progression of disease > while > > beta blockers eem to "slow " down the disease. There are theories that > the > > action is realted to metalloproteinases etc etc which seem to also be > > invoved in bicuspids etc.. > > Currently I use Losartan with beta blockers. > > Prasanna > > > > > > On Fri, Oct 3, 2008 at 11:39 PM, Douville, Chuck < > ecdouville@orclinic.com>wrote: > > > >> Prasanna is losartan also believed to alter the natural history of > aortic > >> dilatation in non-Marfan's patients. I believe you suggested this > >> previously, but I want to make sure. Are you using both losartan and > beta > >> blockade in your aneurysm patients? thx chuckdouville > >> > >> ________________________________ > >> > >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha > M > >> Sent: Fri 10/3/2008 9:28 AM > >> To: OpenHeart-L@lists.hsforum.com > >> Subject: Re: New [HSF] Case > >> > >> > >> > >> This patient has demonstrated "leakability of all the valves. I think it > >> is > >> important to fix everything. MV repair + TV repair is required. I would > >> start Losartan . There is increasing evidence that Losartan can actually > >> reverse the changes of Marfans and decrease the progression of AI and > >> aortic > >> dilatation so much soo that some Marfans centres think it will be the > >> "magic > >> bullet" for Marfans. The effect is seen with Losartan and not with ACE > >> Inhibitors. The exact cause is not known but some changes occur in the > >> molecular level preventing the dilatation etc. > >> I have fixed one childs nitral and tricusid and am observing his aortic > >> now > >> for 2 years and is stable. > >> Prasanna > >> > >> On Fri, Oct 3, 2008 at 8:50 PM, wrote: > >> > >> > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? > >> > > >> > WNovick > >> > > >> > -----Original Message----- > >> > From: Michael Firstenberg > >> > Sent: October 03, 2008 5:41 PM > >> > To: OpenHeart-L@lists.hsforum.com > >> > Subject: Re: [HSF] Case > >> > > >> > my take on these types of patients is that the MR, if the valve and > >> annulus > >> > are normal, is a functon of the AS and gets better over time. Based > >> upon > >> > the info provided, I would do an AVR and a PVI - but I am sure others > >> would > >> > be much more aggressive.......... also depends on the eye-ball test. > >> > > >> > > >> > -michael > >> > > >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > >> > > >> > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > >> > > 0.6cm2, > >> > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > >> > Would > >> > > members of the Forum also do a Maze and if so what lesion set. > Would > >> > > members > >> > > also perform a mitral repair. Annulus not heavily calcified, no > >> leaflet > >> > > prolapse, annular dilation. LA not dilated. > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > **************Looking for simple solutions to your real-life > financial > >> > > challenges? Check out WalletPop for the latest news and > information, > >> > tips > >> > > and > >> > > calculators. ( > >> http://www.walletpop.com/?NCID=emlcntuswall00000001) > >> > > _______________________________________________ > >> > > OpenHeart-L mailing list > >> > > > >> > > Send postings to: > >> > > OpenHeart-L@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@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@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 > >> > ----------------------------------------- > >> > > >> > >> > >> > >> -- > >> Prasanna Simha M > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@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@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 > >> ----------------------------------------- > >> > > > > > > > > -- > > Prasanna Simha M > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From smschwartz at mac.com Fri Oct 3 21:05:18 2008 From: smschwartz at mac.com (Steven Schwartz) Date: Fri Oct 3 23:05:49 2008 Subject: New [HSF] Case In-Reply-To: <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> References: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> Message-ID: <3D0F9F90-1849-4B37-A3F5-7C17642FA9E4@mac.com> Prasanna, Is this effect unique to losartan, or is it a characteristic of the A2RB class? Would valsartan have the same benefit (it's what some of our cardiologists are using for patients with asc. aneurysms)? Steven Schwartz On Oct 3, 2008, at 11:35 AM, Prasanna Simha M wrote: > I am not sure about Non Marfans patients.I have shifted to Losartan > in them > too though I am not sure there is evidence there (for eg Bicuspid > valves - > some evidence of benefit there too). Beta blockers have been found > to be > inferior compared to Losartan in "preventing" progression of disease > while > beta blockers eem to "slow " down the disease. There are theories > that the > action is realted to metalloproteinases etc etc which seem to also be > invoved in bicuspids etc.. > Currently I use Losartan with beta blockers. > Prasanna > > On Fri, Oct 3, 2008 at 11:39 PM, Douville, Chuck >wrote: > >> Prasanna is losartan also believed to alter the natural history of >> aortic >> dilatation in non-Marfan's patients. I believe you suggested this >> previously, but I want to make sure. Are you using both losartan >> and beta >> blockade in your aneurysm patients? thx chuckdouville >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna >> Simha M >> Sent: Fri 10/3/2008 9:28 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: New [HSF] Case >> >> >> >> This patient has demonstrated "leakability of all the valves. I >> think it is >> important to fix everything. MV repair + TV repair is required. I >> would >> start Losartan . There is increasing evidence that Losartan can >> actually >> reverse the changes of Marfans and decrease the progression of AI and >> aortic >> dilatation so much soo that some Marfans centres think it will be the >> "magic >> bullet" for Marfans. The effect is seen with Losartan and not with >> ACE >> Inhibitors. The exact cause is not known but some changes occur in >> the >> molecular level preventing the dilatation etc. >> I have fixed one childs nitral and tricusid and am observing his >> aortic now >> for 2 years and is stable. >> Prasanna >> >> On Fri, Oct 3, 2008 at 8:50 PM, wrote: >> >>> What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? >>> >>> WNovick >>> >>> -----Original Message----- >>> From: Michael Firstenberg >>> Sent: October 03, 2008 5:41 PM >>> To: OpenHeart-L@lists.hsforum.com >>> Subject: Re: [HSF] Case >>> >>> my take on these types of patients is that the MR, if the valve and >> annulus >>> are normal, is a functon of the AS and gets better over time. >>> Based upon >>> the info provided, I would do an AVR and a PVI - but I am sure >>> others >> would >>> be much more aggressive.......... also depends on the eye-ball test. >>> >>> >>> -michael >>> >>> On Fri, Oct 3, 2008 at 10:04 AM, wrote: >>> >>>> 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, >>>> AVA >>>> 0.6cm2, >>>> normal CA's, chronic persistent AF, moderate MR. Referred for >>>> AVR. >>> Would >>>> members of the Forum also do a Maze and if so what lesion set. >>>> Would >>>> members >>>> also perform a mitral repair. Annulus not heavily calcified, no >> leaflet >>>> prolapse, annular dilation. LA not dilated. >>>> >>>> >>>> >>>> >>>> >>>> **************Looking for simple solutions to your real-life >>>> financial >>>> challenges? Check out WalletPop for the latest news and >>>> information, >>> tips >>>> and >>>> calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001 >> ) >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From stevecx at jlonline.com Sat Oct 4 14:48:08 2008 From: stevecx at jlonline.com (=?utf-8?B?6ZmI6ZGr?=) Date: Sat Oct 4 01:48:49 2008 Subject: [HSF] how to put IABP in cse with AAA References: <983606.56418.qm@web81606.mail.mud.yahoo.com> Message-ID: <000701c925e4$c9dbdb90$6401a8c0@D1CQVL1X> Dear members: 70 years male with triple CAD and angina with not very good targe vessels, and AAA below renal artery ( 50-55mm, no symptoms ) extended to rigt eliac artery. Both femal artery pulse are OK , need triple bypass. He LVEF 32% and need IABP. Can be still insert from left fem? Or something else? thanks in advance Steve From stevecx at jlonline.com Sat Oct 4 14:52:49 2008 From: stevecx at jlonline.com (=?utf-8?B?6ZmI6ZGr?=) Date: Sat Oct 4 01:53:27 2008 Subject: [HSF] TVR 1 year after CABG References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> Message-ID: <005301c925e5$70dadd60$6401a8c0@D1CQVL1X> re-do TVR through r-thoracotomy will be much easy then re-sternotomy. this is what we do: cannulate the fem-artery r-antirior thoracotomy, do not need to do amy dissection. just put pruse string suture close to IVC, and use two-stage venous cannular ( the one we use for CABG ) in to IVC ( deeper and can have good drannage ), and another pruse string suture close to SVC to cannulate SVC. Go on bypass and open the RA in the beating heart, put two soft suctions on the RA, and you will have a good view to the tricuspid valve. Just do TVR with all the native valve in. hope this helps steve ----- Original Message ----- From: "erdin? naseri" To: Sent: Thursday, October 02, 2008 4:19 PM Subject: RE: [HSF] TVR 1 year after CABG > > Robertto, > I was thinking to cannulate R subclavian vein for SVC drainage( any experience or information in this regard?).as for R thoracotomy I had a real disaster trying to repair and then replace tricuspid valve from r side.I will follow Hal's recommendations and cannulate femoral artery -vein and continue with sternotomy . > erdinc PS:If the problem was adressed at the 1.st op then the EUroscore would be around 4% and now it is 51%( with all those comorbid factors) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > From benjamin.bidstrup at bigpond.com Sat Oct 4 17:21:56 2008 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Sat Oct 4 02:22:40 2008 Subject: [HSF] how to put IABP in cse with AAA In-Reply-To: <000701c925e4$c9dbdb90$6401a8c0@D1CQVL1X> References: <983606.56418.qm@web81606.mail.mud.yahoo.com> <000701c925e4$c9dbdb90$6401a8c0@D1CQVL1X> Message-ID: Why does he need IABP? I would check with CT angio. If he needs a baloon to come off, then insert via ascending aorta. Needs a longish piece of 8 mm graft. Attach to asc aorta and bring out through lower end of sternotomy with balloon in. Then when you remove it, small incision, remove balloon and tie off graft. There are several other ways as well. Ben Bidstrup FRACS FRCSEd FEBCTS Cardiothoracic Surgeon On 04/10/2008, at 3:48 PM, ?? wrote: > Dear members: > > 70 years male with triple CAD and angina with not very good targe > vessels, and AAA below renal artery ( 50-55mm, no symptoms ) > extended to rigt eliac artery. Both femal artery pulse are OK , need > triple bypass. He LVEF 32% and need IABP. Can be still insert from > left fem? Or something else? > > thanks in advance > > Steve _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Sat Oct 4 11:57:40 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sat Oct 4 04:58:12 2008 Subject: [HSF] how to put IABP in cse with AAA In-Reply-To: References: <983606.56418.qm@web81606.mail.mud.yahoo.com> <000701c925e4$c9dbdb90$6401a8c0@D1CQVL1X> Message-ID: With not very good target vessels as you say, I guess the grafts cannot be done on the beating heart, but may be one vessel yes, and you reduce your clamping time.Give a lot of blood CPL ante-retrograde and with 32% you?ll not need IABP. i?ve done e.g 3 bypasses with only clamping for Cx 10 minutes in 15% EF, with LIMA-LAD and 2 veins under lateral clamping in normal aorta.In abnormal aorta you can anastomose the proximals to the axillary artery as flege did, or on the left carotid one of them, or the right vein on a piece of RIMA, or just do a RIMA to RCA. There are many ways.Also an IABP can be inserted through the subclavian artery, through a prosthesis, it is several times published. Roberto> From: benjamin.bidstrup@bigpond.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] how to put IABP in cse with AAA> Date: Sat, 4 Oct 2008 16:21:56 +1000> CC: > > Why does he need IABP?> > I would check with CT angio. If he needs a baloon to come off, then > insert via ascending aorta. Needs a longish piece of 8 mm graft. > Attach to asc aorta and bring out through lower end of sternotomy with > balloon in. Then when you remove it, small incision, remove balloon > and tie off graft.> There are several other ways as well.> > > > Ben Bidstrup FRACS FRCSEd FEBCTS> Cardiothoracic Surgeon> > > > On 04/10/2008, at 3:48 PM, ?? wrote:> > > Dear members:> >> > 70 years male with triple CAD and angina with not very good targe > > vessels, and AAA below renal artery ( 50-55mm, no symptoms ) > > extended to rigt eliac artery. Both femal artery pulse are OK , need > > triple bypass. He LVEF 32% and need IABP. Can be still insert from > > left fem? Or something else?> >> > thanks in advance> >> > Steve _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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> ----------------------------------------- From stevecx at jlonline.com Sat Oct 4 18:11:53 2008 From: stevecx at jlonline.com (=?utf-8?B?6ZmI6ZGr?=) Date: Sat Oct 4 05:13:08 2008 Subject: =?utf-8?Q?Re:_=5BHSF=5D_how_to_put_IABP_in_cse?= =?utf-8?Q?_with_AAA=28=CA=BC=CE=AA=CA=BC=29?= References: <983606.56418.qm@web81606.mail.mud.yahoo.com><000701c925e4$c9dbdb90$6401a8c0@D1CQVL1X> Message-ID: <009b01c92601$5df59c50$6401a8c0@D1CQVL1X> thank you very much for your advice, Ben. I will let you know how he will be doing. Thanks again Steve ----- Original Message ----- From: "roberto battellini" To: Sent: Saturday, October 04, 2008 4:57 PM Subject: RE: [HSF] how to put IABP in cse with AAA(???) > > With not very good target vessels as you say, I guess the grafts cannot be done on the beating heart, but may be one vessel yes, and you reduce your clamping time.Give a lot of blood CPL ante-retrograde and with 32% you?ll not need IABP. > i?ve done e.g 3 bypasses with only clamping for Cx 10 minutes in 15% EF, with LIMA-LAD and 2 veins under lateral clamping in normal aorta.In abnormal aorta you can anastomose the proximals to the axillary artery as flege did, or on the left carotid one of them, or the right vein on a piece of RIMA, or just do a RIMA to RCA. There are many ways.Also an IABP can be inserted through the subclavian artery, through a prosthesis, it is several times published. > Roberto> From: benjamin.bidstrup@bigpond.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] how to put IABP in cse with AAA> Date: Sat, 4 Oct 2008 16:21:56 +1000> CC: > > Why does he need IABP?> > I would check with CT angio. If he needs a baloon to come off, then > insert via ascending aorta. Needs a longish piece of 8 mm graft. > Attach to asc aorta and bring out through lower end of sternotomy with > balloon in. Then when you remove it, small incision, remove balloon > and tie off graft.> There are several other ways as well.> > > > Ben Bidstrup FRACS FRCSEd FEBCTS> Cardiothoracic Surgeon> > > > On 04/10/2008, at 3:48 PM, ?? wrote:> > > Dear members:> >> > 70 years male with triple CAD and angina with not very good targe > > vessels, and AAA below renal artery ( 50-55mm, no symptoms ) > > extended to rigt eliac artery. Both femal artery pulse are OK , need > > triple bypass. He LVEF 32% and need IABP. Can be still insert from > > left fem? Or something else?> >> > thanks in advance> >> > Steve _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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@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@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 > ----------------------------------------- From tacuff at swbell.net Sat Oct 4 08:53:17 2008 From: tacuff at swbell.net (Tea Acuff) Date: Sat Oct 4 10:54:47 2008 Subject: [HSF] Case Message-ID: <83689.55349.qm@web81608.mail.mud.yahoo.com> Now that is some "less coarse" (finer) information. In your "AVR's" is that separated from thick AS hypertrophies from dilating AI'S as to the consequence of associated MR? do you think or have information that such ventricles behavior differently. That is, the point we should keep our eye on is the original status of the subject not just the status of combinations of?our procedures. Your PVI argument is interesting. Would you pay a dollar for a chance to "flip a coin" to win two dollars? How about a hundred dollars? tea ----- Original Message ---- From: Ani Anyanwu To: openheart-l@lists.hsforum.com Sent: Friday, October 3, 2008 6:29:06 PM Subject: RE: [HSF] Case It gets very confusing now there are several cases being discussed as 'case'. In reference to your original case, Ed, what is the mechanism of the MR and what is the LV dimension and contractility like? If type IIIB or LV dysfunction then I would do annuloplasty. We found a higher operative and late mortality in our aortic valve patients with moderate or greater MR in which the mitral was not operated as compared to those who had annuloplasty. If there is a IIIB mechanism, it is unlikely to improve, at least acutely, with AVR. As regards maze, as we discussed previously, PVI is probably little more effective than toss of coin in chronic persistent a-fib. If undergoing concurrent mitral would probably do cryomaze, if not nothing. Of course the decision of concurrent procedures is not abolute and the above assumes optimal patient and surgical conditions. Ani > To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Case> Date: Fri, 3 Oct 2008 14:43:21 -0400> From: dukeb60@aol.com> CC: > > What would your "left atrial lesions" consist of?? Simple eyeglass PVI?? Connecting lesion?? Box?? Isthmus?? LA Appendage lesion?? Ligament of Marshall?? Ganglia?> > > > > > -----Original Message-----> From: Prasanna Simha M > To: OpenHeart-L@lists.hsforum.com> Sent: Fri, 3 Oct 2008 1:36 pm> Subject: Re: [HSF] Case> > > > Around 40-60 % if only left atrial lesions are used. Biatrial gives a 90 +%> conversion.> Prasanna> > On Sat, Oct 4, 2008 at 12:02 AM, Edward P. Raines wrote:> > >> > michael,> >> > ???? why would you do a PVI in a patient with longstanding persistent AF??> > What would the potential cure rate be with such an approach?> >> >> >> >> >> >> > -----Original Message-----> > From: Michael Firstenberg > > To: OpenHeart-L@lists.hsforum.com> > Sent: Fri, 3 Oct 2008 9:41 am> > Subject: Re: [HSF] Case> >> >> >> > my take on these types of patients is that the MR, if the valve and annulus> > are normal, is a functon of the AS and gets better over time. Based upon> > the info provided, I would do an AVR and a PVI - but I am sure others would> > be much more aggressive.......... also depends on the eye-ball test.> >> >> > -michael> >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote:> >> > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA> > > 0.6cm2,> > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR.> > Would> > > members of the Forum also do a Maze and if so what lesion set. Would> > > members> > > also perform a mitral repair. Annulus not heavily calcified, no leaflet> > > prolapse, annular dilation. LA not dilated.> > >> > >> > >> > >> > >> > > **************Looking for simple solutions to your real-life financial> > > challenges? Check out WalletPop for the latest news and information,> > tips> > > and> > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> > > _______________________________________________> > > OpenHeart-L mailing list> > >> > > Send postings to:> > > OpenHeart-L@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@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@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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> ----------------------------------------- _________________________________________________________________ Discover Bird's Eye View now with Multimap from Live Search http://clk.atdmt.com/UKM/go/111354026/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Sat Oct 4 21:40:17 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 4 11:10:46 2008 Subject: New [HSF] Case In-Reply-To: <3D0F9F90-1849-4B37-A3F5-7C17642FA9E4@mac.com> References: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> <3D0F9F90-1849-4B37-A3F5-7C17642FA9E4@mac.com> Message-ID: <89c4ed2d0810040810h55871e55r464e6304a0a49100@mail.gmail.com> I am not sure. All the studies (a lot of human trials are going on) are with Losartan. I think it may ultimately be a class effect. Some pediatricians involved in these ongoing trials have told me that they have been stunned by the results even at the early stage. It may change the management and natural history of Marfans. Prasanna On Sat, Oct 4, 2008 at 8:35 AM, Steven Schwartz wrote: > Prasanna, > Is this effect unique to losartan, or is it a characteristic of the A2RB > class? > Would valsartan have the same benefit (it's what some of our cardiologists > are using for patients with asc. aneurysms)? > Steven Schwartz > > > On Oct 3, 2008, at 11:35 AM, Prasanna Simha M wrote: > > I am not sure about Non Marfans patients.I have shifted to Losartan in >> them >> too though I am not sure there is evidence there (for eg Bicuspid valves - >> some evidence of benefit there too). Beta blockers have been found to be >> inferior compared to Losartan in "preventing" progression of disease while >> beta blockers eem to "slow " down the disease. There are theories that the >> action is realted to metalloproteinases etc etc which seem to also be >> invoved in bicuspids etc.. >> Currently I use Losartan with beta blockers. >> Prasanna >> >> On Fri, Oct 3, 2008 at 11:39 PM, Douville, Chuck > >wrote: >> >> Prasanna is losartan also believed to alter the natural history of aortic >>> dilatation in non-Marfan's patients. I believe you suggested this >>> previously, but I want to make sure. Are you using both losartan and beta >>> blockade in your aneurysm patients? thx chuckdouville >>> >>> ________________________________ >>> >>> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha >>> M >>> Sent: Fri 10/3/2008 9:28 AM >>> To: OpenHeart-L@lists.hsforum.com >>> Subject: Re: New [HSF] Case >>> >>> >>> >>> This patient has demonstrated "leakability of all the valves. I think it >>> is >>> important to fix everything. MV repair + TV repair is required. I would >>> start Losartan . There is increasing evidence that Losartan can actually >>> reverse the changes of Marfans and decrease the progression of AI and >>> aortic >>> dilatation so much soo that some Marfans centres think it will be the >>> "magic >>> bullet" for Marfans. The effect is seen with Losartan and not with ACE >>> Inhibitors. The exact cause is not known but some changes occur in the >>> molecular level preventing the dilatation etc. >>> I have fixed one childs nitral and tricusid and am observing his aortic >>> now >>> for 2 years and is stable. >>> Prasanna >>> >>> On Fri, Oct 3, 2008 at 8:50 PM, wrote: >>> >>> What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? >>>> >>>> WNovick >>>> >>>> -----Original Message----- >>>> From: Michael Firstenberg >>>> Sent: October 03, 2008 5:41 PM >>>> To: OpenHeart-L@lists.hsforum.com >>>> Subject: Re: [HSF] Case >>>> >>>> my take on these types of patients is that the MR, if the valve and >>>> >>> annulus >>> >>>> are normal, is a functon of the AS and gets better over time. Based >>>> upon >>>> the info provided, I would do an AVR and a PVI - but I am sure others >>>> >>> would >>> >>>> be much more aggressive.......... also depends on the eye-ball test. >>>> >>>> >>>> -michael >>>> >>>> On Fri, Oct 3, 2008 at 10:04 AM, wrote: >>>> >>>> 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA >>>>> 0.6cm2, >>>>> normal CA's, chronic persistent AF, moderate MR. Referred for AVR. >>>>> >>>> Would >>>> >>>>> members of the Forum also do a Maze and if so what lesion set. Would >>>>> members >>>>> also perform a mitral repair. Annulus not heavily calcified, no >>>>> >>>> leaflet >>> >>>> prolapse, annular dilation. LA not dilated. >>>>> >>>>> >>>>> >>>>> >>>>> >>>>> **************Looking for simple solutions to your real-life financial >>>>> challenges? Check out WalletPop for the latest news and information, >>>>> >>>> tips >>>> >>>>> and >>>>> calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001 >>>>> >>>> ) >>> >>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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@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 >>>> ----------------------------------------- >>>> >>>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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 >>> ----------------------------------------- >>> >>> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 > anddisclaimers posted at: > > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sat Oct 4 21:41:24 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 4 11:17:09 2008 Subject: New [HSF] Case In-Reply-To: References: Message-ID: <89c4ed2d0810040811u19bea5bbh94bd23066d8def1a@mail.gmail.com> Bill, What did you do ? Prasanna On Fri, Oct 3, 2008 at 10:42 PM, wrote: > 18mm, 1+ only at this time. > > -----Original Message----- > From: Prasanna Simha M > Sent: October 03, 2008 6:26 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: New [HSF] Case > > Aortic root dimensions with the AI ? > Prasanna > > On Fri, Oct 3, 2008 at 8:50 PM, wrote: > > > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? > > > > WNovick > > > > -----Original Message----- > > From: Michael Firstenberg > > Sent: October 03, 2008 5:41 PM > > To: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Case > > > > my take on these types of patients is that the MR, if the valve and > annulus > > are normal, is a functon of the AS and gets better over time. Based upon > > the info provided, I would do an AVR and a PVI - but I am sure others > would > > be much more aggressive.......... also depends on the eye-ball test. > > > > > > -michael > > > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > > 0.6cm2, > > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > > Would > > > members of the Forum also do a Maze and if so what lesion set. Would > > > members > > > also perform a mitral repair. Annulus not heavily calcified, no > leaflet > > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > > challenges? Check out WalletPop for the latest news and information, > > tips > > > and > > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001 > ) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@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@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@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 > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From tacuff at swbell.net Sat Oct 4 09:43:18 2008 From: tacuff at swbell.net (Tea Acuff) Date: Sat Oct 4 11:44:50 2008 Subject: [HSF] slippery ideas or sloppy thinkers? Message-ID: <15866.80760.qm@web81606.mail.mud.yahoo.com> It is nice to be such a highly paid consultant! ? This argument seems agenda driven to me. It sure it might happen and likely does, but: ? 1)As you can tell by our discussions almost everyone gets even complex care whether they pay or not. 2)I know of no case where those debts per se have been paid by taking away a persons house, car or lively hood. 3)There is continuous pressure by advertising to "cash out" ones house equity for expenses (college, credit cards, ?medical and just "peace of mind") making?the person?more subprime or less protected (mortgage wise) than originally. 3)Most (but not all) of the loss of income likely occurs from sequelae of the disease and not from a successful treatment.? 3)?If the above would occur it would likely effect non subprime lenders nearly equally also. Those with assets, not just those that have leveraged lots of "wealthy" things, pay off their houses. Lots of "rich" people lose their houses due to loss of income including health wise. My area and the very expensive houses?(not the same) are scattered with foreclosures. New subdivisions (new land or refurbished older neighborhoods) are hard hit since most would rather buy the new house across the street than the 3 year old house for sale. It took me a year to sell my house after i (stupidly) moved first. ? How many doctors do you know that can afford loss of their job for a year or just relocation of their job? Some of us are the worst except that we have reasonably secure (if declining)?income. But back to my original musing, should we have medical and/or economic oversight or should we be the overseers? Or both? Maybe Ani and his boss would volunteer. What about our patients? Should we and they all go to jail together or only the "guilty" decided by the lawyers?in the government? ? tea ----- Original Message ---- From: Donald Ross To: OpenHeart-L@lists.hsforum.com Sent: Friday, October 3, 2008 5:05:03 PM Subject: Re: [HSF] slippery ideas or sloppy thinkers? tea ( HSF economic consultant), What veracity do you ascribe to the theory bandied about that the? prime reason for sub prime defaults is the cost of health care? ( Rhetorical question for most US cardiac surgeons, I suspect.) Don On 04/10/2008, at 6:18 AM, Tea Acuff wrote: > Ah, yes, the over sight. Who (a) should provide over sight of whom? > (b) for the benefit of whom (c)? Don't forget this is, by the rules? > set earlier, not an economic question but a medical one also? (Or? > visa versa). > > tea > > > > ----- Original Message ---- > From: Michael Firstenberg > To: OpenHeart-L@lists.hsforum.com > Sent: Friday, October 3, 2008 8:54:21 AM > Subject: Re: [HSF] slippery ideas or sloppy thinkers? > > those who dont learn from the mistakes in history are doomed to? > repeat them. > > many of the problems that we see in the world really should not come? > as any > surprise - predictable outcomes to flawed thinking and practice? > (especially > when there is no oversight) > > -michael > > On Fri, Oct 3, 2008 at 9:00 AM, wrote: > >> Damn....i "got" this one!.......respectfully,bill turner >> >> >> -----Original Message----- >> From: Tea Acuff >> To: OpenHeart-L >> Sent: Thu, 2 Oct 2008 8:48 pm >> Subject: [HSF] slippery ideas or sloppy thinkers? >> >> >> >> I am sure even some of our nonUSA readers are noticing the? >> "acutely" ill >> monetary system in the USA and will be reminded by woes in their own >> country of >> the impact of USA on the world, be it perceived as empire? >> colonization or >> globalization?effects. ? I have been reading an interesting book, The >> Forgotten >> Man, about the Great Depression. The nice thing about it is the >> documentation of >> individual players and their ideas and actions in a real world but? >> one >> remote >> from our experience. The patterns of those ideas even if not their >> definitions >> are amazingly similar to some of the arguments that we in the USA are >> "emergently" addressing and rethinking in our provocative proposed >> intervention >> in the modern US marketplace. >> >> My point of this thread is not an economic discussion per se but a >> hypothesis of >> extreme hubris on my part as it implies (but in no way proves) that I >> understand >> "essences" of economic theory as well as that of medicine at large.? >> What >> impresses me is that the slippery (or sloppy) idea of economic? >> health is >> very >> similar to the parallel ideas in medicine. Further, the "solutions"? >> and >> "needs" >> and "consequences", despite ones underlying bias are quite similar.? >> For >> example, >> like in medicine, the monetary or credit crisis is or was leveraged? >> in >> terms of >> access (need or greed depending on the position of the player)?and? >> the >> solution >> is largely defined by the experts (economic or medical) as more? >> money for >> the >> system. The threat is framed in the context of business as usual? >> and the >> loss of >> control of that business as usual. Exactly how is "usual" good,? >> economic?or >> medical, health in the big picture??Most importantly the bigger? >> picture is >> almost completely >>? obscure due to the smaller adgendas inherent in each and multiple >> protagonist's >> world views and the unknown of?new or future change. As?I have said? >> before >> it is >> common for us to look at the past and wonder why those people were? >> such >> morons, >> while we educated moderns are left confused with uncertainty?and? >> partial or >> ideological adge >> ndas of the "complex" problems in the present. Perhaps this is >> why Dr. Frater seems so prescient. He has seen many of the present? >> medical >> dilemmas played out in several different contexts and time frames. >> >> tea >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >>? OpenHeart-L@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@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@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@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@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 ----------------------------------------- From prasannasimha at gmail.com Sat Oct 4 21:46:48 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 4 12:14:35 2008 Subject: FW: New [HSF] Case In-Reply-To: <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> References: <89c4ed2d0810030928je8e97tdd627a8757703a8@mail.gmail.com> <89c4ed2d0810031135i4d397641vd5ac968027c88ce8@mail.gmail.com> Message-ID: <89c4ed2d0810040816i421285fr14e3f7ae1141042c@mail.gmail.com> Matt P, Habashi J, Carrel T, Cameron DE, Van Eyk JE, Dietz HC. Recent advances in understanding Marfan syndrome: should we now treat surgical patients with losartan? J Thorac Cardiovasc Surg 2008;135:389-94. This is a recent article worth reading. Prasanna On Sat, Oct 4, 2008 at 12:05 AM, Prasanna Simha M wrote: > I am not sure about Non Marfans patients.I have shifted to Losartan in them > too though I am not sure there is evidence there (for eg Bicuspid valves - > some evidence of benefit there too). Beta blockers have been found to be > inferior compared to Losartan in "preventing" progression of disease while > beta blockers eem to "slow " down the disease. There are theories that the > action is realted to metalloproteinases etc etc which seem to also be > invoved in bicuspids etc.. > Currently I use Losartan with beta blockers. > Prasanna > > > On Fri, Oct 3, 2008 at 11:39 PM, Douville, Chuck wrote: > >> Prasanna is losartan also believed to alter the natural history of aortic >> dilatation in non-Marfan's patients. I believe you suggested this >> previously, but I want to make sure. Are you using both losartan and beta >> blockade in your aneurysm patients? thx chuckdouville >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M >> Sent: Fri 10/3/2008 9:28 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: New [HSF] Case >> >> >> >> This patient has demonstrated "leakability of all the valves. I think it >> is >> important to fix everything. MV repair + TV repair is required. I would >> start Losartan . There is increasing evidence that Losartan can actually >> reverse the changes of Marfans and decrease the progression of AI and >> aortic >> dilatation so much soo that some Marfans centres think it will be the >> "magic >> bullet" for Marfans. The effect is seen with Losartan and not with ACE >> Inhibitors. The exact cause is not known but some changes occur in the >> molecular level preventing the dilatation etc. >> I have fixed one childs nitral and tricusid and am observing his aortic >> now >> for 2 years and is stable. >> Prasanna >> >> On Fri, Oct 3, 2008 at 8:50 PM, wrote: >> >> > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? >> > >> > WNovick >> > >> > -----Original Message----- >> > From: Michael Firstenberg >> > Sent: October 03, 2008 5:41 PM >> > To: OpenHeart-L@lists.hsforum.com >> > Subject: Re: [HSF] Case >> > >> > my take on these types of patients is that the MR, if the valve and >> annulus >> > are normal, is a functon of the AS and gets better over time. Based >> upon >> > the info provided, I would do an AVR and a PVI - but I am sure others >> would >> > be much more aggressive.......... also depends on the eye-ball test. >> > >> > >> > -michael >> > >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote: >> > >> > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA >> > > 0.6cm2, >> > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. >> > Would >> > > members of the Forum also do a Maze and if so what lesion set. Would >> > > members >> > > also perform a mitral repair. Annulus not heavily calcified, no >> leaflet >> > > prolapse, annular dilation. LA not dilated. >> > > >> > > >> > > >> > > >> > > >> > > **************Looking for simple solutions to your real-life financial >> > > challenges? Check out WalletPop for the latest news and information, >> > tips >> > > and >> > > calculators. ( >> http://www.walletpop.com/?NCID=emlcntuswall00000001) >> > > _______________________________________________ >> > > OpenHeart-L mailing list >> > > >> > > Send postings to: >> > > OpenHeart-L@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@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@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 >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From ICHFNO at aol.com Sat Oct 4 15:57:34 2008 From: ICHFNO at aol.com (ICHFNO@aol.com) Date: Sat Oct 4 14:58:39 2008 Subject: New [HSF] Case Message-ID: Prasanna; The child is coming to clinic on Monday, which is when I will see the echo myself for the first time. With all this information on Losartan, I am wondering if the best bet would be to repair the MV/TV and do Florida Sleeve and start Losartan postop. Perhaps Tom could comment on how many FS's he has done in children under age 5. Bill In a message dated 10/4/2008 10:18:53 A.M. Central Daylight Time, prasannasimha@gmail.com writes: Bill, What did you do ? Prasanna On Fri, Oct 3, 2008 at 10:42 PM, wrote: > 18mm, 1+ only at this time. > > -----Original Message----- > From: Prasanna Simha M > Sent: October 03, 2008 6:26 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: New [HSF] Case > > Aortic root dimensions with the AI ? > Prasanna > > On Fri, Oct 3, 2008 at 8:50 PM, wrote: > > > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI? > > > > WNovick > > > > -----Original Message----- > > From: Michael Firstenberg > > Sent: October 03, 2008 5:41 PM > > To: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Case > > > > my take on these types of patients is that the MR, if the valve and > annulus > > are normal, is a functon of the AS and gets better over time. Based upon > > the info provided, I would do an AVR and a PVI - but I am sure others > would > > be much more aggressive.......... also depends on the eye-ball test. > > > > > > -michael > > > > On Fri, Oct 3, 2008 at 10:04 AM, wrote: > > > > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA > > > 0.6cm2, > > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR. > > Would > > > members of the Forum also do a Maze and if so what lesion set. Would > > > members > > > also perform a mitral repair. Annulus not heavily calcified, no > leaflet > > > prolapse, annular dilation. LA not dilated. > > > > > > > > > > > > > > > > > > **************Looking for simple solutions to your real-life financial > > > challenges? Check out WalletPop for the latest news and information, > > tips > > > and > > > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001 > ) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@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@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@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 > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- **************New MapQuest Local shows what's happening at your destination. Dining, Movies, Events, News & more. Try it out! (http://local.mapquest.com/?ncid=emlcntnew00000001) From robertobattellini at hotmail.com Sat Oct 4 22:11:02 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sat Oct 4 15:11:30 2008 Subject: [HSF] Microplegia In-Reply-To: <436048686-1222963044-cardhu_decombobulator_blackberry.rim.net-1951980896-@bxe149.bisx.prod.on.blackberry> References: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox><89c4ed2d0810020551t45c0150ex3701040cf9c32bef@mail.gmail.com> <436048686-1222963044-cardhu_decombobulator_blackberry.rim.net-1951980896-@bxe149.bisx.prod.on.blackberry> Message-ID: Prasanna, it was for sure a child?s heart...not a 3 vessel with 3 valves in a big heart... tell us the case Roberto> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Microplegia> From: hgrmd@aol.com> Date: Thu, 2 Oct 2008 15:57:31 +0000> CC: > > Microplegia works well for me. My longest clamp was 4 hrs, 15 min. The patient came off CPB without a problem.> > Hal> Sent from my Verizon Wireless BlackBerry> > -----Original Message-----> From: "Prasanna Simha M" > > Date: Thu, 2 Oct 2008 18:21:02 > To: > Subject: Re: [HSF] Microplegia> > > I think Hal uses that system. Supposed to reduce volume requirements. With> 4:1 blood to cardioplegia systems is it really that big an issue especially> since most of these can be manaed with a diuretic shot or hemofiltration.> Incidentally I add Insulin to my cardioplegia so that it doesn't> increasesystemic K values (6U of insulin in the 500 ml bag of cardioplegic> solution that is destined to be diluted 1:4) Keeps glucose also down and> keeps K rock steady despite huge volumes of cardioplegia in long cases. Also> in the interim when field visibility is not a problem I perfuse cold> normokalemic blood (usuaullay retrograde) continuously as recommended by> Buckberg and with that we have a quiescent cold heart that doesnt beat. (I> also have Esmolol and Adenosine in it) As I had said before I have once> peged a heart for over 6 hours with it but weaned off with 3 mics> dopa/dobut.> Prasanna> > On Thu, Oct 2, 2008 at 6:01 PM, Ajit Damle wrote:> > > Do you have experience with what is called microplegia? This is basically> > KCL and MgSO4 solution that is mixed with patients blood, rather than a> > crystalloid solution.> >> >> >> > The advantages are said to be less hemodilution (particularly for long> > cases), better K and glucose control and reduction in myocardial edema. A> > company, Quest Medical Systems, is touting this with a pump and delivery> > system, but it can be as easily done with a syringe pump, and very cheaply> > indeed.> >> >> >> > What is your experience and opinion?> >> >> >> > Ajit Damle> >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From robertobattellini at hotmail.com Sat Oct 4 22:13:33 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sat Oct 4 15:13:59 2008 Subject: [HSF] Microplegia-TEA- OT-Tea In-Reply-To: <63382.80092.qm@web81606.mail.mud.yahoo.com> References: <63382.80092.qm@web81606.mail.mud.yahoo.com> Message-ID: Elegant Fussball Come and try I?ll be your tourist Guide in Leipzig. May be you give a talk about OPCAB Roberto > Date: Fri, 3 Oct 2008 05:30:32 -0700 > From: tacuff@swbell.net > Subject: Re: [HSF] Microplegia-TEA- OT > To: OpenHeart-L@lists.hsforum.com > CC: > > I would love to. What would the German description be for my performance which will lacking in both style and substance? > Tea > > Sent from my iPhone > > On Oct 3, 2008, at 3:52 AM, Roberto Battellini wrote: > > > Tea, > come and play soccer with our joungs in Leipzig, they do it every Wednesday. > > Roberto> Date: Thu, 2 Oct 2008 17:40:56 -0700> From: tacuff@swbell.net> Subject: Re: [HSF] Microplegia> To: OpenHeart-L@lists.hsforum.com> CC:>> And I play soccer with one of the engineers who helped developed it. He must be better engineer than I am a soccer player.> Tea>> Sent from my iPhone>> On Oct 2, 2008, at 5:39 PM, BAins24221@aol.com wrote:>> The Quest MPS is a very flexible system. Any drug concentration (for the> most part), any temperature, any delivery pressure desired is available. Drug> concentrations are delivered at the desired concentration regardless of> variability of pump flow. One of my favorite features is the "Auto" button, when> turned on will vary the pump flow to keep the chosen pressure constant,> elimenating over pressurization of vessels/heart. Our pump runs are about 2 hours> and we give a lot of cardioplegia with much less than 100 ml of additives> per case. Surgeons do not see edema of the heart. We also > eliminated the> large heater/coolers in the OR. I use a Medtronic ECMO heater to warm or cool> the patient and the Quest pump mounted ice cooler for the cardioplegia. We> drift our patients (34 esoph) and warm them slowly and deliver cardioplegia at> 34 deg to arrest, 20 deg subsequent (usually) and 37 for last dose. Above> all, this system is very safe.> Bill Ainsley CCP>>>> **************Looking for simple solutions to your real-life financial> challenges? Check out WalletPop for the latest news and information, tips and> calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> _______________________________________________> OpenHeart-L mailing list>> Send postings to:> OpenHeart-L@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@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@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@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 > ----------------------------------------- From robertobattellini at hotmail.com Sat Oct 4 22:21:27 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sat Oct 4 15:22:15 2008 Subject: [HSF] Prosthetic Valve Stenosis In-Reply-To: References: Message-ID: We need a complet protocol of the TEE, and also a Thorax and Abdomen CT. 40 years and prosthetic valve endocarditis require a special study and planning for eventual reoperation. Maintain us informed. Roberto> Date: Thu, 2 Oct 2008 18:55:36 -0400> From: msfirst@gmail.com> To: OpenHeart-L@lists.hsforum.com> CC: > Subject: [HSF] Prosthetic Valve Stenosis> > I was recently asked to see a 40 year/old who had a tissue valve in 2003/4> (unknown type/location) for endocarditis. She has lupus (on prednisone> chronically 30mg PO BID) and renal failure (Cr=4 and dialyized a few times> byt not chronically). Her symtpoms are minimal and may be related to her> ESRD. Her valve area by TTE is 0.9 and her gradients are mean/peak 39/69> with good LV function - but I dont have sizes. I am inclined to wait and> let her medical problems be better defined/controlled. Any thoughts?> > > -michael> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From prasannasimha at gmail.com Sun Oct 5 01:51:59 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 4 15:22:18 2008 Subject: [HSF] Microplegia In-Reply-To: References: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox> <89c4ed2d0810020551t45c0150ex3701040cf9c32bef@mail.gmail.com> <436048686-1222963044-cardhu_decombobulator_blackberry.rim.net-1951980896-@bxe149.bisx.prod.on.blackberry> Message-ID: <89c4ed2d0810041221t5448b84bw2d05250c51e65ad3@mail.gmail.com> Roberto it was not !! Incidentally children have a more difficult time with cardioplegia compared to adults.(You should see the myocardial edema that can occur in them - visible that Ani was enquiring about !! This is related to the immaturity of their cellular membranes etc. The case was a Ross in an adult patient and the RCA button dehisced (I had told about that and actually discussed the case with the list members) requiring me to fashion a flange for the RCA and reconstructing the button. . It gave some problems during the reconstruction but at the end of the day patient did well but required a very long time in an already difficult case (left coronary ostium was not single had two ostia and one had an intramural course) .The RCA also had an additional conal branch just besides it which was harvested with it !! So the coronary transfer had to be perfect. . Prasanna On Sun, Oct 5, 2008 at 12:41 AM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > Prasanna, > it was for sure a child?s heart...not a 3 vessel with 3 valves in a big > heart... > tell us the case > Roberto> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] > Microplegia> From: hgrmd@aol.com> Date: Thu, 2 Oct 2008 15:57:31 +0000> > CC: > > Microplegia works well for me. My longest clamp was 4 hrs, 15 min. > The patient came off CPB without a problem.> > Hal> Sent from my Verizon > Wireless BlackBerry> > -----Original Message-----> From: "Prasanna Simha M" From robertobattellini at hotmail.com Sat Oct 4 22:36:16 2008 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sat Oct 4 15:37:07 2008 Subject: [HSF] The Ross Operation in 2008 In-Reply-To: References: <640456.15923.qm@web30208.mail.mud.yahoo.com><7385A503-7345-40E2-8076-5544B432842F@bigpond.com> <1734996540-1221866350-cardhu_decombobulator_blackberry.rim.net-391958763-@bxe263.bisx.prod.on.blackberry> Message-ID: Zhou, sorry for the late answer. IABP introduction can provoke strokes in a calcified aorta...or if the cardiologist let air go on the IABP line by washing it. Myself I had a IABP dissection (Type B) last week for the first time in my life in a sever atherosclerotic patient in a coronary reoperation for grafts failure and one graft big aneurysm.Still on ICU. All can happen. Roberto> From: donross@bigpond.com> Subject: Re: [HSF] The Ross Operation in 2008> Date: Sat, 20 Sep 2008 09:45:03 +1000> To: OpenHeart-L@lists.hsforum.com> CC: > > Z,> It is probable he had both a pre and peri/post op embolic stroke.> The CT is not sensitive enough to pick up small infarcts.> Don> On 20/09/2008, at 9:17 AM, zzhoumd@pol.net wrote:> > >> > Don,> >> > I did a emergent CABG about two weeks ago for a 75 yo patient with> > Ostium Cx disease and unstable angina. Cardiologist placed a IABP > > get patient stablized during night, then next morning, when I was > > going to take him to OR, he appeared having some speech problem. I > > did CT (old infarct), carotid ultrasound (no stenosis) and neuro > > consul cleared him for surgery. Post-operative he could not move > > the right arm. Neuro thought he had clinical stroke although CT > > head did show any change.> >> > Do you consider this a post operative stroke or pre operative stroke?> >> > Z Zhou> >> >> >> >> > Sent via BlackBerry by AT&T> >> > -----Original Message-----> > From: Donald Ross > >> > Date: Sat, 20 Sep 2008 08:14:38> > To: > > Subject: Re: [HSF] The Ross Operation in 2008> >> >> > Michael,> > Of course all your points are correct but especially ( if more> > correct is possible) the one about a trip to Sydney.> > Having over 1000 cabg cases without a stroke is to some extent a> > fluke ( one patient had a stroke the night before surgery)> > It is also an embarrassment because its unbelievability precludes> > publication. One is suspected of being a liar or suffering from a> > selective memory.> > Providing I am not a total bullshit artist there must be something> > going on here which is leaving my patients clear headed and stroke > > free.> > I hate the term "no brainer" but for the wont of a better one, it is.> > Don> > On 20/09/2008, at 12:40 AM, Michael Firstenberg wrote:> >> >> I always second guess people who report "zero" complications -> >> particularly> >> in large series. We live in an imperfect world and patients are> >> going to> >> have major complications during their hospital stay (or even after> >> they> >> leave our grasp but within 30 days) that often will have nothing to> >> do with> >> their heart surgery. I am sure if you took 1000 patients "waiting> >> for CABG"> >> that, because of their over vascular disease problems, some of them> >> will> >> have small strokes/TIA/etc if for no other reason then it is their> >> time.> >> Remember people have strokes without having a CABG first. Besides> >> how many> >> of these "strokes" are from the cardiologists ramming a catheter in> >> their> >> aorta and the symptoms are not manifest until after a little> >> heparin +/-> >> pump +/- general anesthesia with a little hypotension?> >>> >>> >> besides, I would take a trip to Sydney to cut my stroke rate down> >> (a long> >> vacation may even reduce my own risk for having a stroke)> >>> >>> >> -michael> >>> >>> >>> >> On Fri, Sep 19, 2008 at 2:46 AM, Donald Ross > >> wrote:> >>> >>>> >>> Ani> >>>> >>>> >>>>> >>>> the aortic cases have been selected out for whatever reason as a> >>>> not> >>>> ideal for anaortic.> >>>>> >>> I know this paper is full of holes and it didn't take you long to> >>> find> >>> them.> >>> With 3 of the 5 surgeons there was a bias as you mentioned above> >>> with the> >>> other two doing all cases anaortic, with a lot of the high risk> >>> patients> >>> being moved in their direction, so it is a real mixed bag and> >>> therefore the> >>> conclusions are of dubiously value.> >>> As to a prospective trial; I could never, with a clear conscience,> >>> unnecessarily clamp an aorta and since only about 10% of cases> >>> need an> >>> aortic top end it would take years to get meaningful numbers.> >>> The other Donald didn't do any trials on his outrageous operation> >>> and it is> >>> still alive so I will just have to hope for a similar result.> >>> Don> >>>> >>>> >>>>> >>>>> >>>>> >>>>> >>>> From: donross@bigpond.com> Subject: Re: [HSF] The Ross Operation> >>>> in 2008>> >>>>> Date: Fri, 19 Sep 2008 15:56:40 +1000> To: OpenHeart-> >>>>> L@lists.hsforum.com>> >>>>> CC: > > Ben,> Do you read the local journal?> Did you see this:>> >>>>> Original> >>>>> Article> Anaortic Techniques Reduce Neurological Morbidity>> >>>>> After Off-Pump> >>>>> Coronary Artery Bypass Surgery> Michael P. Vallely, PhD,> >>>>> FRACS?, Kieron> >>>>> Potger, BSc, CCP, Darryl > McMillan, CCP,> Jonathan M. Hemli, MB> >>>>> BS, MSc,> >>>>> PeterW. Brady, FRACS,> R. John L. Brereton, FRACS, David> >>>>> Marshman, FRACS,>> >>>>> Manu N. Mathur, FRACS and Donald E. Ross, FRACS> Department of> >>>>> Cardiothoracic Surgery, Royal North Shore Hospital, > Sydney, NSW,> >>>>> Australia> Background: Stroke remains one of the most devastating> >>>>> complications > of cardiac surgery. Advocates of off-pump> > >>>>> coronary> >>>>> revascularisation (OPCAB) maintain that post-operative > > >>>>> neurologic> >>>>> morbidity is reduced by avoiding aortic> cannulation and cross-> >>>>> clamping, and> >>>>> by eliminating the systemic > effects of cardiopulmonary> >>>>> bypass.We sought to> >>>>> determine> whether completing off-pump coronary surgery without> >>>>> any aortic >> >>>>> manipulation ("anaortic" technique) afforded> any additional> >>>>> neurological> >>>>> protection, as compared to off-pump > grafting in which the> >>>>> aorta was> >>>>> utilised for graft> inflow.> Methods:Acomprehensive review of> >>>>> prospectively> >>>>> collected data was > undertaken of all patients> >>>>> undergoingOPCABin> our> >>>>> institution between January 2002 and December 2006. Cases >> >>>>> requiring> >>>>> intra-operative conversion to cardiopulmonary> bypass were> >>>>> excluded from> >>>>> further analysis. Patients having OPCAB > surgery with aortic> >>>>> manipulation> >>>>> were compared> to those having OPCAB surgery without aortic> >>>>> manipulation.> >>>>> Multiple > logistic regression was used to identify possible>> >>>>> predictors of> >>>>> post-operative neurologic morbidity, with particular > focus on> >>>>> the role of> >>>>> aortic manipulation.> Results: During the period of review, 1758> >>>>> patients> >>>>> underwent OPCAB, > of which 1201 (68.3%) were completed without>> >>>>> aortic> >>>>> manipulation, constituting the "anaortic" cohort. This > group> >>>>> was compared> >>>>> with the remaining 557 patients, which> included fashioning at> >>>>> least one> >>>>> aorto-conduit anastomosis, utilising > either a side-biting> >>>>> aortic clamp or> >>>>> a no-clamp> proximal anastomotic device. The two groups of> >>>>> patients were> >>>>> well- > matched with respect to risk factors for adverse>> >>>>> neurologic> >>>>> outcomes. Nine patients sustained focal neurological > deficits> >>>>> (transient> >>>>> or permanent) in the peri-operative> period, constituting a> >>>>> stroke rate of> >>>>> 0.51% for the entire series. > The incidence of peri-operative> >>>>> neurological> >>>>> deficit in the> anaortic group was 0.25% compared with 1.1% in> >>>>> the aortic >> >>>>> manipulation group (odds ratio (OR) 0.23, 95% confidence>> >>>>> interval (CI)> >>>>> 0.06?0.92, p = 0.037). Advanced age was also > associated with> >>>>> peri-operative neurological injury (OR 1.1, 95%> CI 1.01?1.20,> >>>>> p = 0.017).>> >>>>> Conclusions: Off-pump coronary artery surgery is associated with> >>>>> a > low> >>>>> incidence of peri-operative stroke. Completing> the surgical> >>>>> procedure> >>>>> without manipulating the ascending aorta in > any way> >>>>> ("anaortic" technique)> >>>>> offers additional> neurological protection and should be the> >>>>> goal in all> >>>>> suitable off- > pump coronary cases.> (Heart, Lung and Circulation> >>>>> 2008;17:299?304)> (c) 2007 Australasian Society of Cardiac and> >>>>> Thoracic> >>>>> Surgeons and the > Cardiac Society of Australia and> New> >>>>> Zealand. Published> >>>>> by Elsevier Inc. All rights reserved.> On 19/09/2008, at 10:56> >>>>> AM, Ben> >>>>> Bidstrup wrote:> > > Have you worked out how many cases would be> >>>>> needed to> >>>>> prove that > > there was a significant drop from a rate of say> >>>>> even 1.0%? It> >>>>> is > > around 8000 patients.> >> >> > Ben Bidstrup FRACS FRCSEd> >>>>> FEBCTS> >> >>>>> Cardiothoracic Surgeon> >> >> >> > On 19/09/2008, at 9:31 AM,> >>>>> Martin Misfeld> >>>>> wrote:> >> >> Ani,> >>> >> The perioperative stroke rate in> >>>>> between 0.5 to> >>>>> 0.8 % for isolated > >> CABG. I do not think that this is a high> >>>>> number,> >>>>> however, I still > >> think that this rate can even be decreased> >>>>> with> >>>>> anaortic OPCAB.> >>> >> Martin> >>> >>> >>> >>> >> --- On Thu,> >>>>> 9/18/08, Ani> >>>>> Anyanwu wrote:> >>> >>> From: Ani> >>>>> Anyanwu <> >>>>> anianyanwu@hotmail.com>> >>> Subject: RE: [HSF] The Ross> >>>>> Operation in> >>>>> 2008> >>> To: openheart-l@lists.hsforum.com> >>> Date: Thursday,> >>>>> September 18, 2008, 1:26 PM> >>> Martin> >>>> >>> By inference> >>>>> this means> >>>>> you were concerned with your rate> >>> or impact of stroke after> >>>>> conventional CABG? What was your> >>> rate of stroke and what do> >>>>> you expect> >>>>> to reduce it to by> >>> instituting anaortic OPCAB?> >>>> >>>> >>>>> Ani> >>>> >>>>> >>>>>>>>>>>>>>>>> Date: Thu, 18 Sep 2008 01:27:52 -0700> From:> >>>> >>>>> martinmisfeld@yahoo.com> Subject: RE: [HSF] The Ross> >>>> >>>>> Operation in> >>>>> 2008> To: OpenHeart-L@lists.hsforum.com>> >>> CC: > > Hi Any,>> >>>>> Good to> >>>>> hear from you, too! With> >>> regard to neurological> >>>>> complications, I think> >>>>> OPCAB only> >>> makes sence, when performed anaortic. I do not> >>>>> see any> >>>> >>>>> advantage in OPCAB in comparison to conventional CABG (with> >>>> >>>>> all the> >>>>> techniques to prevent a stroke i.e. epiaortic> >>> scanning),> >>>>> when you use a> >>>>> side clamp to perform the proximal> >>> anastomosis. I just hate> >>>>> the> >>>>> situation of seeing a patients> >>> having a stoke post CABG> >>>>> with the "heart> >>>>> being> >>> repaired", but suffering from a stroke. This has such> >>>>> a> >>> big> >>>>> impact for the rest of the patients life and his> >>> family.> >> >>>>> Martin> > >> >>>>>> --- On Wed,> >>> 9/17/08, Ani Anyanwu >> >>>>>>>>>> >>>>> wrote:> > > From: Ani Anyanwu> >>> > >> >>>>> Subject:> >>>>> RE: [HSF]> >>> The Ross Operation in 2008> > To:> >>> openheart-> >>>>> l@lists.hsforum.com> > Date: Wednesday,> >>> September 17, 2008,> >>>>> 11:11> >>>>> PM> > Hi Martin> >> >>>>> Good to see you on HSF! Martin why> >>>>> exactly did> >>>>> you> >>> (or your> > team at luebeck) see a need to offer> >>>> >>>>> anaortic> >>>>> OPCAB surgery?> > Please excuse me if you> >>> already told me> >>>>> when we met> >>>>> last> > year as I have a> >>> feeling I may have asked you this> >>>>> then.> > >> >>>>>>>>>> Ani> > > > > > > > > > >> >>> Date: Tue, 16 Sep 2008> >>>>>>>>>> 22:39:12 -0700>> >>>>> From:> >> >>> martinmisfeld@yahoo.com> Subject: Re: [HSF] The> >>>>> Ross>>> >>>>>>>>> Operation in 2008> To:> >>> OpenHeart-L@lists.hsforum.com>>> >>>>>>>>>> CC: >> >>>>>>>>>> Don,> > I agree with what you`ve said.> > First> >>> of all> >>>>>>>>>> with the> >>>>> "paradise"! > Secondly, I>> >>>> know a few surgeons in Germany,> >>>>> who started> >>>>> to perform> >>> OPCAB> > procedures and went to a department,> >>>> >>>>> specialized on these> > operations, watching the> >>> experience> >>>>> surgeon to> >>>>> perform the> > OPCABs. In the> >>> best cenario, they spent two> >>>>> weeks and> >>>>> also> >> >>> assisted a few cases. After they went back to> >>>>> their> >>>> >>>>> hospital> > and they went through some/all of the same> >>>> >>>>> pitfalls,> >> >>>>> experience surgeons already went through,> >>> when they> >> >>>>> developed theis> >>>>> technique. You learn an> >>> operation especially> > by avoiding> >>>>> potential>> >>>>>>>> mistakes. So I believe, complexe> > operations and> >>>> >>>>>>>> techniques can> >>>>> not be learnt by just watching> >> >>> someone else doing it> >>>>> ("he makes it> >>>>> look so> >>> easy",> > but it is not!) and also not by just> >>>> >>>>> getting a> >>>>> brief> > surgical experience. > With the> >>> anaortic OPCAB> >>>>> technique,> > I> >>>>> learnt in Sydney, I now> >>> feel very confident to start a> >> >>>>> proper> >>>>> anaortic> >>> OPCAB program back home (so far we just did> > a> >>>>> few> >>>> >>>>> OPCAB cases each year) and I also feel confident to> >> >>>> >>>>> teach my junior> >>>>> colleages this procedure. However, for> >>> the> > first two> >>>>> weeks an> >>>>> anesthetist from Royal North> >>> Shore> > Hospital will come> >>>>> with me to> >>>>> make shure,> >>> that the anestetic> > regime will also run> >>>>> smoothly.> >>>>>> >>>>> Martin> >> > > > > --- On> >>> Thu, 9/11/08, Donald Ross> >> >>> <> >>>>> donross@bigpond.com> wrote:> > > From:>> >>>> Donald Ross <> >>>>> donross@bigpond.com>> >> >>> Subject:> > Re: [HSF] The Ross> >>>>> Operation in> >>>>> 2008>> >>>> To:> > OpenHeart-L@lists.hsforum.com> >> >>> Date:> >>>>> Thursday,> > September 11, 2008, 7:41 AM>> >>>> Martin's> >>>>> experience> >> >>>>> learning this, one of> >>> our most> > challenging >> > >> >>>>> operations> >>> ,> >>>>> is illustrative.> > His professor> > should> >>> qualify as one> >>>>> of Ani's> >>>>> reference> >> >> >>> surgeons if > > anyone does so Martin,> >>>>> after> >>>> >>>>> assisting> > with 80 cases is> > clearly able> >>>>> to> >>>>> continue> > to> >>>>> reproduce the excellent> >>> results of his> >> > mentor.> >> >>>>> This kind> >>>> >>>>> of thorough learning is surely> > mandatory for an>> >>>>> >>>>> operation > > with> >>>>> the> > potential to kill> >>> and maim young patients, as> >> >>>>> many> >> >>>>> surgeons> >>>>> who learnt the Ross operation on the fly,> >>> >>>>>>>> can> >>>>> attest.> > As the operation was developed by>> >>>> pioneers who> >>>>> now get> >> >>>>> consistent > >> >>> results,> > such disasters were inevitable> >>>>> but that> >>>> >>>>> should no> >> > longer be > > the case if> >>> potential> >>>>> devotees go about>> >>>>>> getting appropriate>> >>>>>> experience from a> > master even> >>>>>> if> >>> that> >>>>> means spending a> > considerable> > >> >>>> time in out of the> >>>>> way places.>> >>>>>> When> >> >>> Martin decided to become an expert, dare I say>> >>>>>>>>>>>>>> >>>>> reference, > > anaortic arterial opcab surgeon> >>> he> >> >>>>> certainly embraced> >>>>> that> > philosophy >> >>>> and> > brought himself to our unit in> >>>>> Sydney> >>>> >>>>> where, after a>> > > few > > months, he is> >>> going solo as> >>>>> well as> >> >>>>> repairing the> >> >>> occasional aortic > >> > valve.> > ( I>> >>>>>>>> think the> >>>>> opportunity to spend a year in> > paradise> >>> had> > something> >>>>>>> to do> >>>>> with> >> >>> it.)> > Don> > On 10/09/2008, at 2:57 PM,> >>>> >>>>> Martin> >> >>>>> Misfeld wrote:> > > > >> >>> NFA,> >> > >> > > Prof. Sievers>> >>>>>>>> started> >>>>> the Ross operation> > in the early> >> >>> 90`s and he > > > now> >>>>> has the> >> >>>>> experience> >>> in Ross procedures of more than> > 16> > years.>> >>>>>>>> He > >> >>>>>> may has operated more than 400> >> >>> cases over the years> >> >>>>>> with an > >> >>>>>>>>>>>> increase in numbers over the last couple of years.> >>>> >>>>>>>>>>>> At>> > >> >>>>> our center we > > > are> >>> currently two surgeons> > who> >>>>> perform the> >>>>> Ross>> >>>> procedure.> > > It> > took myself to> >>> assist> >>>>> around 80> >>>>> cases, before I> >> > started> >>> to > > > perform the> >>>>> operation by my> >>>>> own,> >> >>> initially under> > supervision and > > >>> >>>>> >>>>> around 40 cases> >>>>> now alone. We still debate a lot>> >>>>>> about small > > >> >>>>> issues of the> >>>>> right> >>> way to> > perform this operation and> > in every> >>>> >>>>> case > >> >> >>>>>> I perform now, there is still> >>> something to learn>> > >> >>>>>> about.> >>> >>>>>>>>>>>> I also would like to> > draw you> >>> attention to the> >>>>>>>>>>>> paper> > we> >>>>> are just >> >> >>>>> submitting about our own results with> >>>>> regard>> >>>> to>> >>>>>> follow-up etc. I > > > also would> >>> like> > to refer to some> >>>>>> of our> >>>>> previous> >> >>> publications:>> > > >> > > - Bechtel> >>> JF,> >>>>> Stierle U,> >>>>> Sievers> > HH.Fifty-two> >> >>> months' mean follow > > >> > up> >>>>> of> >>>> >>>>> decellularized SynerGraft-treated pulmonary> >>> >>>> valve> >>>>> allografts. > >> >>>>>> J Heart Valve Dis.> >>> 2008> > Jan;17(1):98-104; discussion> >> >>>>>> 104.>>> >>>>>>>>>>>>>>> - Hanke T, Stierle U, Boehm> >>> JO, Botha CA,> >> >>>>>>>>>>>>>>> Matthias> >> >>>>> Bechtel JF, >> >>>>> Erasmi A,> > Misfeld M, Hemmer W, Rein JG,>> >>>>>>>>> >>>>> Robinson DR,> > Lange R,> > H?rer > >> >>>> J, Moritz A, Ozaslan> >>>>> F, Wahlers> >>>>> T,> > Franke UF,> >>> Hetzer> > R, H?bler M, > > >> > Ziemer>> >>>>>>>> G, Graf B,> >>>>> Ross DN, Sievers HH; German Ross > >>> >>>>> Registry.Autograft> >>>>> regurgitation and aortic> >>> root>> > > dimensions after > > >> >>>>> the> >>>> >>>>> Ross procedure: the> > German Ross Registry> >> >>> experience.> >>>>>>>>>>> >>>>> Circulation. 2007 Sep> >>> 11;116(11 Suppl):I251-8.> >> > >> >>> >>>>>>>>> -> >>>>> Sievers HH, Hanke T, Stierle U, Bechtel> > MF,> >>> Graf B,> >> >>>>> Robinson DR,> >>>>>>>> Ross> >> >>> DN.> > > A critical reappraisal of the Ross>> >>>>> >>>>> operation:> > renaissance of the > >> >>>>>> subcoronary> >>>>> implantation> >>>>> technique?> >>> Circulation. 2006>> > > Jul 4;114(1 > >> >>>>> >>>>> Suppl):I504-11.> >> > >> > > -> >>> Duebener LF, Stierle U,> >>>>> Erasmi A,> >> >>>>> Bechtel MF,>> >>>> Zurakowski D, B?hm > > > JO,> > Botha> >>>> >>>>> CA, Hemmer W,> >>>>> Rein JG, Sievers HH; German> >> >> >>> Ross > > > Registry.Ross> >>>>> procedure> >>>>> and left>> >>>> ventricular mass> > regression. > >> >>>>>>> >>>>> Circulation.> >>>>> 2005 Aug 30;112(9> >>> Suppl):I415-22.> >> > >> > > - B?hm> >>>> >>>>> JO, Botha> >>>>> CA, Hemmer W, Schmidtke> > C, Bechtel>> >>>> JF, Stierle U, > >> >>>>>> Rein JG,>> >>>>>> Sievers> >>> HH.Hemodynamic performance following> > the> >>> >>>>>>>>> Ross > >> >>>>>> operation: comparison of two> >>> different> > techniques.J> >> >>>>>> Heart Valve> >>>>>>>>>>>> Dis. 2004> > Mar;13(2):174-80; discussion> >>> 180-1.> >> >>>>>>>>>>>>> Comment>> >>>>>> in:> > > J> >>> Heart Valve Dis. 2004> > Sep;13(5):871-2.> >>> >>>>>>>>>>>>> -> >>>>> Bechtel JF,> > Bartels C,> >>> Schmidtke C, Skibba W,> >> >> >>>>> M?ller-Steinhardt> >>>>>> M, Kl?ter H, Sievers> > HH.Anti-HLA>> >>>>>>>> class I> >>>>> antibodies> > and pulmonary >> > >> >>>> homograft function> >>>>> after the Ross> >>>>> procedure.> >> >>> Ann> > Thorac Surg. 2001 > > >> >> >>> Jun;71> >>>>> (6):2003-7.>> >>>>>>>>>> - N?tzold> >>> A,> > H?ppe M, Schmidtke C, Bl?mer P,> >>>>>>>>>> Uhlig> >> >>>> >>>>> T, Sievers> > > > > HH.Quality of life in> >>> aortic valve> >> >>>>> replacement:>> >>>>>> pulmonary >> >>>>> autografts> > versus mechanical prostheses.>> >>>>>>>>> J Am> >>>>> Coll> > Cardiol.> > 2001 > > > Jun> >>> 1;37(7):1963-6.> > >>> >> >>>>>>>>>>>>>>> >>>>> Martin> > >> >> > >>> >>>>>>>>>>> --- On Tue,> >> >>> 9/9/08,> >>>>> Nasser F> >>>>> Abou'Seada> >> >> >>> > > > wrote:>>>> >>>>>>>>>>>>>>> From: Nasser F> >> >>> Abou'Seada> >> >>> <> >>>>> nfaabouseada@gmail.com>>> > > >>> >>> Subject: RE: [HSF] The Ross> >>>>> Operation in> > 2008>> >>>>>> To: OpenHeart-> >>>>> L@lists.hsforum.com>> >>> >>>>>>>>>>> Date: Tuesday, September 9, 2008, 5:30> >>> AM>> > > >>> >>>>>>>>>>> Dear Martin> >>>>> ....> >> >>>>> .... Thank> > you for the information about> >>>> >>>>> the> >> >>>>> Cryolife.>> > > >> Great> >>> input about the> > >> duch-> >> >>>>> german> >>>> >>>>> registery. Still.... how many years> > did> >> >>> it> > >>> >>>>> take ? or else> >>>>> what> >> >>>>>>> were your numbers for the last year ? 520> >>>> >>>>> cases> >> >> >>>>> over how> > >> many> >>> years ?? one> >> > >> surgeon in your>> >>>>>>>> center> >>>>> or multiple ones ??> > .....> > how> >>> many> > >> years for> >> >>>>> follow> >>> >>>>>>>>>> up ?? what was the main followup> >> >>> issues> >> >>>>>>>>>> encountered ? any>> >>>>>>>>>>>> issues> > during the> > >> learning curve> >>> ?? ...> >>>>>>>>>>>> your> >> >>>>> input would be great in> > view> >>> of> > >>> > the number of>> >>>>>>>>>>>>> >>>>> cases you are doing.>> > > >>>> >>>>>> NFA> > >>>> > >> >>>>>>>>>> >>>>> -----Original> >> >>> Message-----> > >> From:> >> >>>> >>>>> openheart-l-bounces@lists.hsforum.com> > >>>> >>>> [mailto:> >>>>> openheart-l-bounces@lists.hsforum.com] On>> >>>>>> Behalf Of> > >>> >>>>> Martin Misfeld>> >>>>>>>> Sent: Monday, September 08, 2008> >>>> >>>>> 10:24 PM> >> >>>>>>>>> To:> >>> OpenHeart-L@lists.hsforum.com> > >> Subject:>> >>>>> >>>>>>>>> RE:> >>>>> [HSF] The Ross Operation in 2008> >> >>>>>>>>>>> NFA,> >>> >>>>>>>>>>>>>> We> >> >>>>> have now performed> >>> more than 520 Ross> > procedures at> >> >>>>> our>> >>>>>>> >>>>> center and in our> > >>> >> >>> German-Dutch Ross Registry, we> >>>>> have data of> >>>>> around>> >>>>>> 1500> > >> cases.> >> >>>>> If you are> >> >>>>> experienced/interested in the> >>> Ross> > operation,>> > > >>> >>>>> you> >>>> >>>>> might know,> > >> that there> > will be a> >>> "Ross Meeting"> >>>>> from> > the> >> >>>>> 10th>> >>>>>> to 11th of October in> >> >> >>>>> Kenneaw, GA> >>>>> hosted by> >>>>> CryoLife. "The> >>> Ross>> > > Summit 2008.> > >>> >>> Towards a> >>>>> pulmonary>>> >>>>>>>>> autograft> >>> renaissance". (see CTS Net).> > Dr.> >> >>>> >>>>>>>>> Ross, Dr.>> >>>>>>>> Northrup III,> > Prof.>> >>>>>> Yacoub, as well as Prof> >>>>>>>> Sievers will>> >>>>>>>>>> present the> > most> > >> recent> >>> data.>> > > >>> > >>> >>>>>>>>>> Just> >>>> >>>>> briefly, with regard to> > the homografts: We> >> >>> usually> >>>>> use> > >>> >> >>>>> cryopreserved>> >>>>>> homografts. We changed the> > way we> >>>> >>>>> prepare> >>>>> the> > homografts a> > >>> >> >>> few times. From> > >> suturing> >>>>> a Gore> >>>> >>>>> membrane> > to replace the muscle,> > over> >>> using> > >>> > a> >>>>> glutaraldehyde> >> >>>>> fixed autologuous> > pericardial patch> >>>>> for> >>>> >>>>> its> > replacement to> >> > >> just> >>> resecting as> > >> much> >>>>> muscle as>> >>>>>>>>>> possible. So far the use of a> > pericardial>> >>>>>>>>> >>>>>>>>>> patch seems> >>>>> to be> > >>> >>> the best option> > with regard to the> >>>>> development> >>> of>> >>>>>> homograft>> > > >>> >>> stenosis.> > >>> > >>> > Kind> >>>> >>>>>> regards,> > >>>> >>>>>>>> Martin> >> >>> Misfeld> > >>> > >>> >>> >>>>>>>>>>>>>> ---> >>>>>>>> On> >>>> >>>>> Tue,> > 9/2/08, Nasser F Abou'Seada> >> >>>>>>>> >>>>> > >>>>> wrote:>> >>>>>>>>>>>>> From: Nasser F> >>> Abou'Seada> >> > >>>> >>>>>>>> <> >>>>> nfaabouseada@gmail.com>> >> >> >>>>>> Subject: RE: [HSF] The Ross> >>>>> Operation in>> >>>> 2008> > >>> To:> >> >>> OpenHeart-> >>>>> L@lists.hsforum.com> > >>>> >>> Date:> > Tuesday, September 2,> >>>>> 2008,> >>>>> 4:54 AM> >> >>> Certainly>> > > >> one would like to>> >>>>>>>> >>>>> know> > more> >>>>> about your> >>> practice.> > >>> Would> > you> >> >>>>>>> >>>>> elaborate more on> >>>>> your practice -> >> >>> Ross> > Experience -> > >> number of>> >>>>>>>> cases> >> >>>>> /> > >>> year ... results ..> >>> homograft used ?> > fresh,> >> >>>>> cryo ....>> >>>>>>>>>>>> etc ...> >> > >>>> >> >>>>>> NFA> >> > >>>> >> >>>>>>> >>>>> -----Original> > Message-----> >> >>>>>> From:> >> >>> > >>>>> openheart-l-> >>>>> bounces@lists.hsforum.com> >> >>>>>>>>> >>> [mailto:openheart-l-> >>>>> bounces@lists.hsforum.com]> >>> >>>> On> > >> Behalf Of Martin> >>> >>>>>>>>>>>>> Misfeld> > >>> Sent:> >>> Monday, September 01,> > 2008> >>>>>>>>>>>>> 9:58 PM> >>> >>>>>>>>>>> To:> > OpenHeart-L@lists.hsforum.com>> >>>>>>> Subject:> >> >>>>>>>>>>> RE:> >>>>> [HSF] The Ross> >>> Operation in 2008> >> > >>>> >> >>>>>> Dear> >>>>> NFA,> >> >> >>>>>>>>>>>>>>>>> The center is the> > University> >>> Clinic of> >> >>>>>>>>>>>>>>>>> Luebeck,> >> >>>>>>>>>>>>> Germany.> > >>> Head of department>> >>>>>>>>> Prof. Dr.> >>>>>>>>>>>>> Hans-H-> >>>>> Sievers.>> >>>>>>>>> Based in our center is the> >>> German-> >>>>> Dutch>> > >> >>>>> Ross-Registry,> >> >>>>> where we have> >> > >>> Ross> >>> data> >>>>> of 9 German> >>>>> Centers and Ross data> > of> >> >>> the> > >> Erasmus Medical>> >>>>>>>>>>>>>>>> >>>>> Center, Rotterdam. Completeness of FU> >>> data>> > > (around> >> >>>>>>> 1500> >>>>> Ross> >>> patients> >> > >>> included) is more> >>> than 96%.> >>>>> Part of> >>>>> these>> > > results have>> >>>>>> been published> >> > >>>> >>>> >>>>> recently> >>>>> (Hanke T, et al. Circulation> >> >> >>>>> 2007;116:I251-8).> >> >>>>>>>>>>> >>>>>>>>>>>>>> Martin> > >>>>> >>>>>>>>>>>>>>>>> >>>>>>>>>>>>> --- On> >>>>>>>>>>>>>> Tue,> >>>> >>>>> 9/2/08, Nasser F> > Abou'Seada> >> >>>>>>>> >>>>> > >>> >>>>>>>>>>>>> wrote:> > >>>> >> >>>>>>> From:> > Nasser F Abou'Seada>>> >>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>> > > >>>>>> >>>> Subject: RE: [HSF]> >>>>>>>> The Ross> >>>>> Operation in> >> >>> 2008>> > > >>>> To:> >>> OpenHeart-> >>>>> L@lists.hsforum.com>> > >> >>>>>>> Date: Tuesday, September 2,> >>>>> 2008,> >>> >>>>>>>> 12:38 AM> > Dear> > >> Martin> >>> Please>> > > >>>>> >>>>>>>> elaborate more> >>>> >>>>> .....> >> > >>>> May we ask what> >>> centre is that ?> >> >> >>>>>>>>>>>>> >>>>>>>>>>>> NFA> >> > >>>>>> >>>>>>>> -----Original> >> >>>> >>>>>>>>>>>> Message-----> > >>>>> >>>>> From:> >>> >>>> openheart-l-bounces@lists.hsforum.com> >> >>> >>>>>>>>>>>>>>>>>>>> [mailto:openheart-l-bounces@lists.hsforum.com] On>>> >>>>>>>>>>>>>> Behalf Of> >> >>>>>>> Martin> > Misfeld> >> >>>>>>>> >>>>>>>>>>>>>> Sent: Monday,> >>>>> September> > 01, 2008> >>> 5:51 PM> > >>>> To:> >> >>> OpenHeart-> >>>>> L@lists.hsforum.com> > >>>>>> >>>> Subject: Re: [HSF] The Ross> >>>>> Operation> >>>>> in> >> >>> 2008>> > > >>>>> >> >>>>>>> Dear> > Micheal,> >>> >>>>>>>>>>>>>>>>>>>>> >>>>> Coming> >>> from a center where the Ross> > procedure> >> >>>> >>>>> is> > >>> >>>>> routinuously> >> >>>>>>>>> performed, these are our> >>>> >>>>> indications/CI:> >>> >>>>>>>>>>>>>>>>>>>> - patients age> > < 60 years>> >>>>>>>> - no markly> >>>>> reduced> > LV-Fx>> >>>>>>>> - no extensive CAD> >> >> >>>>>>> - no> >>>>> connective tissue disorder>> >>>>>>>>>> - no active rheumatic> >>>> >>>>> arthritis> >> > >>>> - no severe> >>> deformatiion of the> >>>>> aortic>> > > root>> >>>>>>>>>>>>>> - no structural defects> > of the> >>> PV> > >>>>> >>> >>>>>>>>>>>>>>>>>>>>>>>> >>>>> I need to mention, that we> >>> exclusively>> > > perform> > >>>> >>>>>>>> the> >> >>>>>>>>>> Ross> >> >>>>>>> procedure in the> >> >> >>>>>>> original/> >>>>>>>>>> subcoronary> >>>>> technique (501>> >>>> cases)> > with> > >> the> >>> following>>> >>>>>>>>>>>> >>>>> results> >>> (completeness of FU:> > 98.2%):> >> >>>>>>>>>>>>>>>> >>>>> - early>> >>>>>>>> mortality 0.4%> > >>>> - valve> >> >>> related mortality 0.2%/> >>>>>>>> patient> >> >>>>> year> >>> >>>>>>>> - freedom from re-OP (autograft):> >>> 94.1%>> >>>>>> @> >> >>>>> 10ys> > >>>> -> >>> freedom from> > re-Op (homograft): 96.3% @>> >>>>>>>>>> 10ys>> >>>>>>>>>>>> - cumulative> >>> survival: 93.8% @ 10ys>> > >>> >>>>>>>>>>>>>>>>>>>>>>>>>> >>>>> Looking at>> >>>> the patients who had the> > operations>>> >>>>>>>>>>>>> more> >> >>>>>>>> than> >>> 10> >> > >>>> years ago (80> >> >>>>>>>>> pts), we> >>>>>>>> saw in 5> >>>>> pts AR >/=> >>> 2/4, in 7> > pts> > HS> > >>>> >>> 10mmHg and in> >>>>> 6 pts> >> >> >>>>>>>>> HR> >>>> /= 2/4, respectively.> >> >> >>>>>>>>>>>>> Kind> >>>> >>>>> regards,>> > > >>>>> >> >>>>>>> Martin> > Misfeld> >>> >>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>> --- On> >>> Mon, 9/1/08, Michael Firstenberg>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>> <> >>>>> msfirst@gmail.com> wrote:> >> >> >>>>>>>>>>>>>> From:> >>>> >>>>> Michael> >> >>>>> Firstenberg> > >>>> >> >>> > > >>>>>>> >>>>> >>>>> Subject:> >>>>> [HSF] The Ross Operation in> > 2008>> >>>>>>>>>>> To:> >>>> >>>>> "openheart-l"> >>> >>>>>>>>>>>>>> >> > >> >>>>>>>> Date:> >>>>> Monday, September 1, 2008,>> >>>> 3:38> > PM> > >> Since we are> >>>>> on> >>> the>> >>>>>> topic> > >>>>> and since I> >>> have> > never> > >>> been> >>> >>>>>>>>>>>>> a> >> >>>>> fan> >> >>>>>>>> of the Ross in> >> >> >>>>>>>> adult patients> >>>>> (i.e. >20>> >>>>>>>> yrs/old).> > > > What> > >> does>> >>>>>>>>> the> > >>>>> >>>> >>>>>>>> group> >>> >>>>>>>>>>> - particularly> >>> those> >> > >>>>> who still> >>>> >>>>>>>>>>> perform this> >>>>> operation ->> > > feel are> >> >>>>> the approapriate> >> >>> >>>>>>>>>>>>>> >>>>> indications.> >> >> >>>>>>>> In addition, regardless of> >>>>> whether>> >>>> you>> >>>>>>>> believe> > >>>> >>> the>> > > >>>>>> >>> "literature" or> >>>>>>>> not,>> > >>> >>>>>>>>>>>>> what is the general thoughts on>> >>>> how> > long> > >>> >>>>>>>>>>>>> (i.e.> >>>> >>>>>>>>>>>> freedom> > >>>> from>> >>>>>>>>>>> re-op and> >>> >>>>>>>>>>>>>>>>>>>>>> probably> >>>>> more important> >>> freedom from> > mod/sev>> > > >> AI> >>> ->> >>>>>>>>>> which> >>>>> is>> > >> >>>>>>>> a completely> >> >> >>>>>>>> different> >>>>> concept) they> >>>>> should> >> >>> last?> > >>>>>> >> >> >>>>>>>>>>>>>>>>>> >>> -> >>>>> michael> >> >>>>>>>>>>>>>>>>>>>> _______________________________________________>>> >>>>>>>>>>>>>>>> OpenHeart-L mailing> >>> list> >> > >>>>>> >>> >>>>>>>>>>>>>>>>>>>>>>>> Send> >> >>>>> postings to:> >> >>>>>>>>>>> >>> OpenHeart-L@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@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> >> >>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>> -----------------------------------------> >> >> >>>>>>>> >>>>> Internal Virus> >>>>> Database is out of> >>> date.>> > > >>>> Checked by AVG> >>> -> >> >>>>> http://www.avg.com> > >>>>> >>> Version:> > 8.0.138 / Virus> >>>>> Database:>> >>>>>>>>>> 270.6.9/1635 -> >> > >>> Release>> >>>>>>>> Date:> >> >>>>>>>>>> 8/26/2008> >>> >>>>>>>>>>>> 7:29 AM> >> >> >>>>>>>>>>>>>>>>>> >>>> >>>>> _______________________________________________> >>> >>>>>>>>> >>>>> OpenHeart-L> >>>>> mailing list> >>> >>>>>>>>>>>>>> Send> >>> postings> > to:> >> >>>>>>>>>>>>>>>> >>>>> OpenHeart-L@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@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> >>> >>>>>>>>>>>>>>>>> -----------------------------------------> >> >> > >>>>>>>>>>>>>>>>> >>>>>>> >>>>> Internal Virus Database is out of date.>>> >>>>>>>> Checked by> >>>>> AVG -> >>>> >>>>> http://www.avg.com>> > > >>> Version:> >>> 8.0.138 / Virus> >>>>> Database:>> >> >>>>>> 270.6.9/1635> >>> -> > >> Release> >> > >>>> >>> Date:> >>>>>> 8/26/2008> > >>>> >>>>> 7:29> > AM>> >>>>>>>>>>>>>>>>> >>>> >>>>> _______________________________________________> >>> >>>>>>>> >>>>> OpenHeart-L> >>>>> mailing list> >> >> >>>>>>>>>>> Send postings to:>>> >>>>>>>>> >>>>> OpenHeart-L@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@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@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@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@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@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>>>> >>>>>>>>> -----------------------------------------> >> >>>> >>>>> _________________________________________________________________> > >>>>> >> >>>>>>>>> Get> >>>>> all your favourite content with the slick new> >>> MSN> >> >>>>> Toolbar - FREE> >>> >>>>>>>> http://clk.atdmt.com/UKM/go/111354027/direct/01/ > >>>> >>>>> _______________________________________________>> >>>> OpenHeart-> >>>>> L mailing> >>>>> list> > > > Send> >>> postings to:> > OpenHeart-> >>>>> L@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@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>> >>>> >>>>> -----------------------------------------> >>>> >>>>> _________________________________________________________________>> >>>>>>>> Make> >>>>> a mini you and download it into Windows Live Messenger> >>>> >>>>> http://clk.atdmt.com/UKM/go/111354029/direct/01/ > >>>> >>>>> _______________________________________________> >>> OpenHeart-L> >>>>> mailing> >>>>> list> >>>> >>> Send postings to:> >>> OpenHeart-> >>>>> L@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@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@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@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>> >>>>> -----------------------------------------> >>>>>> >>>> _________________________________________________________________> >>>> Make a mini you and download it into Windows Live Messenger> >>>> http://clk.atdmt.com/UKM/go/111354029/direct/01/> >>>> _______________________________________________> >>>>> >>>> OpenHeart-L mailing list> >>>>> >>>> Send postings to:> >>>> OpenHeart-L@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@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> >>> anddisclaimers posted at:> >>>> >>> http://www.hsforum.com/listdisclaim> >>> -----------------------------------------> >>>> >> _______________________________________________> >> OpenHeart-L mailing list> >>> >> Send postings to:> >> OpenHeart-L@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@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@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@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> ----------------------------------------- From msfirst at gmail.com Sat Oct 4 19:15:55 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Sat Oct 4 18:16:29 2008 Subject: [HSF] Tissue Bentall's Message-ID: <65ED6B70-4D54-4495-8EBC-FEB11021339F@gmail.com> ok, before everyone chimes in about valve sparing roots and such - the question is regarding tissue valve conduits. I was trained that you basically sew the valve cuff to the end of the graft - simple, running 4-0 proline. My question is (and I always think this as I lower the valve/conduit into position) - when the valve needs to get changed, what is the easiest approach to replacing the valve. Or do you just take the whole thing down? Are there any tricks that people do to set themselves up for the next (inevitable) operation? -michael From msfirst at gmail.com Sat Oct 4 19:34:40 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Sat Oct 4 18:35:15 2008 Subject: [HSF] slippery ideas or sloppy thinkers? In-Reply-To: <15866.80760.qm@web81606.mail.mud.yahoo.com> References: <15866.80760.qm@web81606.mail.mud.yahoo.com> Message-ID: It is easy that the cost of health care - and all of us rich doctors - gets blamed for everything. I heard it is also our fault that N/S Korea and Iran/Iraq dont get along. The logic is simple - health care is expensive, everyone needs either insurance or actual health care and everyone has a hard time appreciating something that they dont sense the value in. Why does a CT scan cost $2000??? Besides, doctors makes gobs of money and are an easy target - our lobby groups pale in comparison to trial lawyers, rich wall street bankers, and such. People dont mind getting ripped off on their new housing loans or their credit card debt as long as they can buy stuff with it - like a brand new TV that is bigger than the neighbors to watch football (monthly cable bills per person often are >$150 a month). Health care - yuck - needles, pills, tests, rich annoying snobby doctors, big bills..... and what do you get for it? Bad news.... you need your chest ripped open, you need a colostomy, you need chemotherapy, yuck yuck yuck. Who care that we give people life? Besides what do we get? I wont go into it (may give Hal a seizure and I am sure his insurance plan wont cover the burr holes in his brain) but I friend of mine is looking at medical schools - $250,000 for 4 years... to start! and then 40k a year for 10 years? Give me a break... We are easy targets. While we also make bad economic decisions, we probably are a little best off than most - but my guess is a little more fiscally responsible than most? In America every problem is someone else's fault........ To address some of the other musings on this - we do have economic and medical oversight - more than any other industry (except maybe nuclear power plants or the airline industry) - but at the end of the day, we can not afford what we want nor what we needed - hence blame someone. -michael On Oct 4, 2008, at 11:43 AM, Tea Acuff wrote: > It is nice to be such a highly paid consultant! > > This argument seems agenda driven to me. It sure it might happen and > likely does, but: > > 1)As you can tell by our discussions almost everyone gets even > complex care whether they pay or not. > 2)I know of no case where those debts per se have been paid by > taking away a persons house, car or lively hood. > 3)There is continuous pressure by advertising to "cash out" ones > house equity for expenses (college, credit cards, medical and just > "peace of mind") making the person more subprime or less protected > (mortgage wise) than originally. > 3)Most (but not all) of the loss of income likely occurs from > sequelae of the disease and not from a successful treatment. > 3) If the above would occur it would likely effect non subprime > lenders nearly equally also. Those with assets, not just those that > have leveraged lots of "wealthy" things, pay off their houses. Lots > of "rich" people lose their houses due to loss of income including > health wise. My area and the very expensive houses (not the same) > are scattered with foreclosures. New subdivisions (new land or > refurbished older neighborhoods) are hard hit since most would > rather buy the new house across the street than the 3 year old house > for sale. It took me a year to sell my house after i (stupidly) > moved first. > > How many doctors do you know that can afford loss of their job for a > year or just relocation of their job? Some of us are the worst > except that we have reasonably secure (if declining) income. But > back to my original musing, should we have medical and/or economic > oversight or should we be the overseers? Or both? Maybe Ani and his > boss would volunteer. What about our patients? Should we and they > all go to jail together or only the "guilty" decided by the lawyers > in the government? > > tea > > > > ----- Original Message ---- > From: Donald Ross > To: OpenHeart-L@lists.hsforum.com > Sent: Friday, October 3, 2008 5:05:03 PM > Subject: Re: [HSF] slippery ideas or sloppy thinkers? > > tea ( HSF economic consultant), > What veracity do you ascribe to the theory bandied about that the > prime reason for sub prime defaults is the cost of health care? > ( Rhetorical question for most US cardiac surgeons, I suspect.) > Don > > On 04/10/2008, at 6:18 AM, Tea Acuff wrote: > >> Ah, yes, the over sight. Who (a) should provide over sight of whom >> (b) for the benefit of whom (c)? Don't forget this is, by the rules >> set earlier, not an economic question but a medical one also? (Or >> visa versa). >> >> tea >> >> >> >> ----- Original Message ---- >> From: Michael Firstenberg >> To: OpenHeart-L@lists.hsforum.com >> Sent: Friday, October 3, 2008 8:54:21 AM >> Subject: Re: [HSF] slippery ideas or sloppy thinkers? >> >> those who dont learn from the mistakes in history are doomed to >> repeat them. >> >> many of the problems that we see in the world really should not come >> as any >> surprise - predictable outcomes to flawed thinking and practice >> (especially >> when there is no oversight) >> >> -michael >> >> On Fri, Oct 3, 2008 at 9:00 AM, wrote: >> >>> Damn....i "got" this one!.......respectfully,bill turner >>> >>> >>> -----Original Message----- >>> From: Tea Acuff >>> To: OpenHeart-L >>> Sent: Thu, 2 Oct 2008 8:48 pm >>> Subject: [HSF] slippery ideas or sloppy thinkers? >>> >>> >>> >>> I am sure even some of our nonUSA readers are noticing the >>> "acutely" ill >>> monetary system in the USA and will be reminded by woes in their own >>> country of >>> the impact of USA on the world, be it perceived as empire >>> colonization or >>> globalization?effects. ? I have been reading an interesting book, >>> The >>> Forgotten >>> Man, about the Great Depression. The nice thing about it is the >>> documentation of >>> individual players and their ideas and actions in a real world but >>> one >>> remote >>> from our experience. The patterns of those ideas even if not their >>> definitions >>> are amazingly similar to some of the arguments that we in the USA >>> are >>> "emergently" addressing and rethinking in our provocative proposed >>> intervention >>> in the modern US marketplace. >>> >>> My point of this thread is not an economic discussion per se but a >>> hypothesis of >>> extreme hubris on my part as it implies (but in no way proves) >>> that I >>> understand >>> "essences" of economic theory as well as that of medicine at large. >>> What >>> impresses me is that the slippery (or sloppy) idea of economic >>> health is >>> very >>> similar to the parallel ideas in medicine. Further, the "solutions" >>> and >>> "needs" >>> and "consequences", despite ones underlying bias are quite similar. >>> For >>> example, >>> like in medicine, the monetary or credit crisis is or was leveraged >>> in >>> terms of >>> access (need or greed depending on the position of the player)?and >>> the >>> solution >>> is largely defined by the experts (economic or medical) as more >>> money for >>> the >>> system. The threat is framed in the context of business as usual >>> and the >>> loss of >>> control of that business as usual. Exactly how is "usual" good, >>> economic?or >>> medical, health in the big picture??Most importantly the bigger >>> picture is >>> almost completely >>> obscure due to the smaller adgendas inherent in each and multiple >>> protagonist's >>> world views and the unknown of?new or future change. As?I have said >>> before >>> it is >>> common for us to look at the past and wonder why those people were >>> such >>> morons, >>> while we educated moderns are left confused with uncertainty?and >>> partial or >>> ideological adge >>> ndas of the "complex" problems in the present. Perhaps this is >>> why Dr. Frater seems so prescient. He has seen many of the present >>> medical >>> dilemmas played out in several different contexts and time frames. >>> >>> tea >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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@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@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@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 > ----------------------------------------- From anianyanwu at hotmail.com Sun Oct 5 00:18:26 2008 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sat Oct 4 19:19:13 2008 Subject: [HSF] Tissue Bentall's In-Reply-To: <65ED6B70-4D54-4495-8EBC-FEB11021339F@gmail.com> References: <65ED6B70-4D54-4495-8EBC-FEB11021339F@gmail.com> Message-ID: Dr Griepp in my center has a simple method of doing this - he disarticulates the stent from the sewing ring and leaves the ring in-situ. He then used a running 3/0 prolene suture and sutures the new valve to the old cuff. Takes him half an hour. Ani > From: msfirst@gmail.com> To: OpenHeart-L@lists.hsforum.com> Date: Sat, 4 Oct 2008 18:15:55 -0400> CC: > Subject: [HSF] Tissue Bentall's> > ok, before everyone chimes in about valve sparing roots and such - the > question is regarding tissue valve conduits. I was trained that you > basically sew the valve cuff to the end of the graft - simple, running > 4-0 proline. My question is (and I always think this as I lower the > valve/conduit into position) - when the valve needs to get changed, > what is the easiest approach to replacing the valve. Or do you just > take the whole thing down? Are there any tricks that people do to set > themselves up for the next (inevitable) operation?> > > -michael> > > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- _________________________________________________________________ Get all your favourite content with the slick new MSN Toolbar - FREE http://clk.atdmt.com/UKM/go/111354027/direct/01/ From enaseri at hotmail.com.tr Sun Oct 5 08:14:22 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sun Oct 5 03:15:20 2008 Subject: [HSF] Microplegia In-Reply-To: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox> References: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox> Message-ID: Ajit, we have been using microplegia for almost all our cases in the last 10 years.Patients hemodiluted blood taken from the aortic sump needle for induction and from recirculation line of CPBpump for the rest of the case ,25-30 mEql Lt KCL+10 cc %10HCO3/lt+5 cc ?%MgSO4/lt) Erdinc> From: damle@cableone.net> To: OpenHeart-L@lists.hsforum.com> Date: Thu, 2 Oct 2008 07:31:37 -0500> CC: > Subject: [HSF] Microplegia> > Do you have experience with what is called microplegia? This is basically> KCL and MgSO4 solution that is mixed with patients blood, rather than a> crystalloid solution.> > > > The advantages are said to be less hemodilution (particularly for long> cases), better K and glucose control and reduction in myocardial edema. A> company, Quest Medical Systems, is touting this with a pump and delivery> system, but it can be as easily done with a syringe pump, and very cheaply> indeed.> > > > What is your experience and opinion?> > > > Ajit Damle> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From enaseri at hotmail.com.tr Sun Oct 5 08:18:56 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sun Oct 5 03:19:44 2008 Subject: [HSF] Microplegia In-Reply-To: <89c4ed2d0810020551t45c0150ex3701040cf9c32bef@mail.gmail.com> References: <5348EFFB5C604C1EA8EF76B7A314FE7C@yourg8he5gjrox> <89c4ed2d0810020551t45c0150ex3701040cf9c32bef@mail.gmail.com> Message-ID: Prasanna, with our technique of continous all routes blood cardioplegia we still need inotropic support in very long cases ( despite yours). Probably the reason for less inotropic in your cases our esmolol and adenosine contents .Though adenosine is not available here , can you please send the doses. erdinc> Date: Thu, 2 Oct 2008 18:21:02 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Microplegia> CC: > > I think Hal uses that system. Supposed to reduce volume requirements. With> 4:1 blood to cardioplegia systems is it really that big an issue especially> since most of these can be manaed with a diuretic shot or hemofiltration.> Incidentally I add Insulin to my cardioplegia so that it doesn't> increasesystemic K values (6U of insulin in the 500 ml bag of cardioplegic> solution that is destined to be diluted 1:4) Keeps glucose also down and> keeps K rock steady despite huge volumes of cardioplegia in long cases. Also> in the interim when field visibility is not a problem I perfuse cold> normokalemic blood (usuaullay retrograde) continuously as recommended by> Buckberg and with that we have a quiescent cold heart that doesnt beat. (I> also have Esmolol and Adenosine in it) As I had said before I have once> peged a heart for over 6 hours with it but weaned off with 3 mics> dopa/dobut.> Prasanna> > On Thu, Oct 2, 2008 at 6:01 PM, Ajit Damle wrote:> > > Do you have experience with what is called microplegia? This is basically> > KCL and MgSO4 solution that is mixed with patients blood, rather than a> > crystalloid solution.> >> >> >> > The advantages are said to be less hemodilution (particularly for long> > cases), better K and glucose control and reduction in myocardial edema. A> > company, Quest Medical Systems, is touting this with a pump and delivery> > system, but it can be as easily done with a syringe pump, and very cheaply> > indeed.> >> >> >> > What is your experience and opinion?> >> >> >> > Ajit Damle> >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From enaseri at hotmail.com.tr Sun Oct 5 08:23:14 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sun Oct 5 03:24:02 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> Message-ID: Robertto we use gravity assisted venous drainage and I don't know the technical details of the suction assisted one. Is it possible with the oxygenators we are using.Please inform me in this regard. erdinc> From: robertobattellini@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] TVR 1 year after CABG> Date: Thu, 2 Oct 2008 10:27:23 +0200> > > Erdinc,> > Good idea, may be you do not get the cannula into the SVC, but if you have suction the result will be the same.> Please, maintain me informed about this creative idea, and if it works, write a How to do it!> Roberto> From: enaseri@hotmail.com.tr> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] TVR 1 year after CABG> Date: Thu, 2 Oct 2008 08:19:54 +0000> > > Robertto,> I was thinking to cannulate R subclavian vein for SVC drainage( any experience or information in this regard?).as for R thoracotomy I had a real disaster trying to repair and then replace tricuspid valve from r side.I will follow Hal's recommendations and cannulate femoral artery -vein and continue with sternotomy . > erdinc PS:If the problem was adressed at the 1.st op then the EUroscore would be around 4% and now it is 51%( with all those comorbid factors)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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@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> ----------------------------------------- From enaseri at hotmail.com.tr Sun Oct 5 08:25:33 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sun Oct 5 03:26:22 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: Message-ID: Hal, what is R IJ arterial cannulae? erdinc> From: Hgrmd@aol.com> Date: Thu, 2 Oct 2008 05:53:37 -0400> Subject: Re: [HSF] TVR 1 year after CABG> To: OpenHeart-L@lists.hsforum.com> CC: > > Erdinc,> For SVC drainage, we use a percutaneous, 17Fr, right IJ Biomedicus > arterial cannula. Use fluoro to direct it into place. I'd also advise exchanging > the wire contained in the kit for a stiff wire. The tip of the introducer is > sharp, and can cause the wire to kink and possibly perforate the SVC (never > happened to me, but I witnessed it happen to another surgeon).> > Hal> > > > **************Looking for simple solutions to your real-life financial > challenges? Check out WalletPop for the latest news and information, tips and > calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From enaseri at hotmail.com.tr Sun Oct 5 08:37:28 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sun Oct 5 03:37:57 2008 Subject: [HSF] post OPCAB left limb paralysis In-Reply-To: <977938.22480.qm@web56807.mail.re3.yahoo.com> References: <977938.22480.qm@web56807.mail.re3.yahoo.com> Message-ID: Aseem, I had a similar patient about one months ago:Off-pump CABG X 4 or 5 , very stable intraop hemodynamics and tissue perfusion ( good urination , MAP>60,good ABG,good mixed venous blood gas).In total very smooth and uneventful operation but woke up with total paralysis of the L upper extremity.Saw him last week ,still has 50-70% motor loss specially in the proximal muscles .EMG showed no brachial plexus injury ,nl cranial CT. erdinc> Date: Fri, 3 Oct 2008 07:54:19 -0700> From: aseem70@yahoo.com> To: OpenHeart-L@lists.hsforum.com> CC: > Subject: [HSF] post OPCAB left limb paralysis> > Dear forum members,> Need your inputs regarding-> A 60 yr old male/ diabetic since 5-7 years. Underwent OPCAB X 4, smooth intra-op period but developed only left lower limb paralysis (cannot move his leg from hip, sensation ok) the other limbs are normal. No signs of other neuro or sensorium deficeits. Now 40 days post op with no clear improvement> CT spine normal.Patient had heart block pre-op and continuous cough in the post op period- no other abnormality pre or post op.> Possible mechanism? treatment pathway.> thanks,> -aseem> > > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From enaseri at hotmail.com.tr Sun Oct 5 08:37:57 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sun Oct 5 03:38:46 2008 Subject: [HSF] post OPCAB left limb paralysis In-Reply-To: <977938.22480.qm@web56807.mail.re3.yahoo.com> References: <977938.22480.qm@web56807.mail.re3.yahoo.com> Message-ID: Aseem, I had a similar patient about one months ago:Off-pump CABG X 4 or 5 , very stable intraop hemodynamics and tissue perfusion ( good urination , MAP>60,good ABG,good mixed venous blood gas).In total very smooth and uneventful operation but woke up with total paralysis of the L upper extremity.Saw him last week ,still has 50-70% motor loss specially in the proximal muscles .EMG showed no brachial plexus injury ,nl cranial CT. erdinc> Date: Fri, 3 Oct 2008 07:54:19 -0700> From: aseem70@yahoo.com> To: OpenHeart-L@lists.hsforum.com> CC: > Subject: [HSF] post OPCAB left limb paralysis> > Dear forum members,> Need your inputs regarding-> A 60 yr old male/ diabetic since 5-7 years. Underwent OPCAB X 4, smooth intra-op period but developed only left lower limb paralysis (cannot move his leg from hip, sensation ok) the other limbs are normal. No signs of other neuro or sensorium deficeits. Now 40 days post op with no clear improvement> CT spine normal.Patient had heart block pre-op and continuous cough in the post op period- no other abnormality pre or post op.> Possible mechanism? treatment pathway.> thanks,> -aseem> > > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From enaseri at hotmail.com.tr Sun Oct 5 08:48:53 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sun Oct 5 03:49:30 2008 Subject: New [HSF] Case In-Reply-To: <89c4ed2d0810031047q4d115a35k1a6b3330f751afbc@mail.gmail.com> References: <89c4ed2d0810031027w43a43498kb7f9b703eb72be18@mail.gmail.com> <89c4ed2d0810031047q4d115a35k1a6b3330f751afbc@mail.gmail.com> Message-ID: Prasanna, For florida sleeve you have to resuture the coronary button holes beneath the coronaries . 1.What if they are not translocated upward? 2. Theoretically, if you create large holes for the coronaries the the aorta may bulge from that holes and who knows to what extension and if you create too tight holes they may lead to ostial stenosis. erdinc > Date: Fri, 3 Oct 2008 23:17:40 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: New [HSF] Case> CC: > > I did a child with VSD AR who had severe AR some time back. The annulus> was18 mm and there was sinotubular dilatation. In that case I repaired> prolapsed leaflets, fixed his ventriculoaortic junction and d the STjunction> and resuspended his cusps. He is doing well. He was also 2 years when I did> the surgery and is growing well.No gradients . He was very sick before> surgery and has a trememdous growth spurt (he is now 6 years old).I think it> is worth fixing these annuli to small adult sizes especially looking at the> parents bodily habitus/size.> Prasanna> > On Fri, Oct 3, 2008 at 10:57 PM, Prasanna Simha M> wrote:> > > I think it is worth sleeving the Florida way.(Tom Martin's technique)> > Would fix the AR and prevent further dilatation. 18 mm would very like last> > till adulthood or at least allow reaching adulthood.> >> >> > On Fri, Oct 3, 2008 at 10:42 PM, wrote:> >> >> 18mm, 1+ only at this time.> >>> >> -----Original Message-----> >> From: Prasanna Simha M > >> Sent: October 03, 2008 6:26 PM> >> To: OpenHeart-L@lists.hsforum.com> >> Subject: Re: New [HSF] Case> >>> >> Aortic root dimensions with the AI ?> >> Prasanna> >>> >> On Fri, Oct 3, 2008 at 8:50 PM, wrote:> >>> >> > What to do in 2 y.o., Marfan's with 3+ MR, 3+ TR, 1+ AI and PI?> >> >> >> > WNovick> >> >> >> > -----Original Message-----> >> > From: Michael Firstenberg > >> > Sent: October 03, 2008 5:41 PM> >> > To: OpenHeart-L@lists.hsforum.com> >> > Subject: Re: [HSF] Case> >> >> >> > my take on these types of patients is that the MR, if the valve and> >> annulus> >> > are normal, is a functon of the AS and gets better over time. Based> >> upon> >> > the info provided, I would do an AVR and a PVI - but I am sure others> >> would> >> > be much more aggressive.......... also depends on the eye-ball test.> >> >> >> >> >> > -michael> >> >> >> > On Fri, Oct 3, 2008 at 10:04 AM, wrote:> >> >> >> > > 75 yo. female, normal LV, severe AS with 80mmHg. peak gradient, AVA> >> > > 0.6cm2,> >> > > normal CA's, chronic persistent AF, moderate MR. Referred for AVR.> >> > Would> >> > > members of the Forum also do a Maze and if so what lesion set. Would> >> > > members> >> > > also perform a mitral repair. Annulus not heavily calcified, no> >> leaflet> >> > > prolapse, annular dilation. LA not dilated.> >> > >> >> > >> >> > >> >> > >> >> > >> >> > > **************Looking for simple solutions to your real-life financial> >> > > challenges? Check out WalletPop for the latest news and information,> >> > tips> >> > > and> >> > > calculators. (> >> http://www.walletpop.com/?NCID=emlcntuswall00000001)> >> > > _______________________________________________> >> > > OpenHeart-L mailing list> >> > >> >> > > Send postings to:> >> > > OpenHeart-L@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@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@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> >> > -----------------------------------------> >> >> >>> >>> >>> >> --> >> Prasanna Simha M> >> _______________________________________________> >> OpenHeart-L mailing list> >>> >> Send postings to:> >> OpenHeart-L@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@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> >> -----------------------------------------> >>> >> >> >> > --> > Prasanna Simha M> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@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> ----------------------------------------- From aseem70 at yahoo.com Sun Oct 5 01:52:22 2008 From: aseem70 at yahoo.com (ASEEM PAWAR) Date: Sun Oct 5 03:53:49 2008 Subject: [HSF] RCA from left coronary cusp Message-ID: <190103.99851.qm@web56806.mail.re3.yahoo.com> dear forum members, need ur opinion on this maybe 'straight forward' case- a 65 year old male, 10 yrs diabetic,hypertensive, non smoker. had inferior MI on the 18th of lst month. Angio- RCA 70%, prox. Circ 50-60% and looks big, LAD 90% and RCA arising from left coronary cusp. how did he get an inferior MI? any possibility of steal-? with vein graft to Cx/OM if RCA arising from seperate ostia in left cusp. regards, -aseem ? From prasannasimha at gmail.com Sun Oct 5 14:00:57 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Oct 5 03:57:16 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> Message-ID: <89c4ed2d0810050030h4dd51ce0o4d542fba6edbf7cf@mail.gmail.com> It is easy Erdinc , you can use a closed oxygenator. if you do not have a c;losed oxygenator you need to convert the open one to a closed one using duct tape or opsite/ioban to seal all ope spots. Prasanna On Sun, Oct 5, 2008 at 12:53 PM, erdin? naseri wrote: > > Robertto > we use gravity assisted venous drainage and I don't know the technical > details of the suction assisted one. Is it possible with the oxygenators we > are using.Please inform me in this regard. > erdinc> From: robertobattellini@hotmail.com> To: > openheart-l@lists.hsforum.com> Subject: RE: [HSF] TVR 1 year after CABG> > Date: Thu, 2 Oct 2008 10:27:23 +0200> > > Erdinc,> > Good idea, may be you > do not get the cannula into the SVC, but if you have suction the result will > be the same.> Please, maintain me informed about this creative idea, and if > it works, write a How to do it!> Roberto> From: enaseri@hotmail.com.tr> > To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] TVR 1 year after > CABG> Date: Thu, 2 Oct 2008 08:19:54 +0000> > > Robertto,> I was thinking to > cannulate R subclavian vein for SVC drainage( any experience or information > in this regard?).as for R thoracotomy I had a real disaster trying to repair > and then replace tricuspid valve from r side.I will follow Hal's > recommendations and cannulate femoral artery -vein and continue with > sternotomy . > erdinc PS:If the problem was adressed at the 1.st op then > the EUroscore would be around 4% and now it is 51%( with all > those comorbid factors)> _______________________________________________> > OpenHeart-L mailing list> > Send postings to:> > OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M From enaseri at hotmail.com.tr Sun Oct 5 09:04:45 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sun Oct 5 04:05:02 2008 Subject: [HSF] TVR 1 year after CABG In-Reply-To: <89c4ed2d0810050030h4dd51ce0o4d542fba6edbf7cf@mail.gmail.com> References: <89c4ed2d0809301931q68730d26o7a0c9ab9029d16ff@mail.gmail.com> <89c4ed2d0810010343q389b6972rb40dc3f1f6ea500a@mail.gmail.com> <89c4ed2d0810050030h4dd51ce0o4d542fba6edbf7cf@mail.gmail.com> Message-ID: Prasanna, We tape all the connections .I have 2 questions: 1. Can we seal the attachments with silicon gun? 2.How much negative pressure and to where should we apply(I mean to which port?) erdinc> Date: Sun, 5 Oct 2008 13:00:57 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] TVR 1 year after CABG> CC: > > It is easy Erdinc , you can use a closed oxygenator. if you do not have a> c;losed oxygenator you need to convert the open one to a closed one using> duct tape or opsite/ioban to seal all ope spots.> Prasanna> > On Sun, Oct 5, 2008 at 12:53 PM, erdin? naseri wrote:> > >> > Robertto> > we use gravity assisted venous drainage and I don't know the technical> > details of the suction assisted one. Is it possible with the oxygenators we> > are using.Please inform me in this regard.> > erdinc> From: robertobattellini@hotmail.com> To:> > openheart-l@lists.hsforum.com> Subject: RE: [HSF] TVR 1 year after CABG>> > Date: Thu, 2 Oct 2008 10:27:23 +0200> > > Erdinc,> > Good idea, may be you> > do not get the cannula into the SVC, but if you have suction the result will> > be the same.> Please, maintain me informed about this creative idea, and if> > it works, write a How to do it!> Roberto> From: enaseri@hotmail.com.tr>> > To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] TVR 1 year after> > CABG> Date: Thu, 2 Oct 2008 08:19:54 +0000> > > Robertto,> I was thinking to> > cannulate R subclavian vein for SVC drainage( any experience or information>