From prasannasimha at gmail.com Mon Jun 1 00:07:25 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 31 13:43:17 2009 Subject: [HSF] Fwd: Provena for Prasanna In-Reply-To: References: Message-ID: <89c4ed2d0905311037n158dfc4eo3087a714748460e1@mail.gmail.com> Guiseppe do you see the picture ? Prasanna ---------- Forwarded message ---------- From: Giuseppe Rescigno Date: Sun, May 31, 2009 at 8:09 PM Subject: Provena for Prasanna To: OpenHeart-L@lists.hsforum.com Cc: Prasanna Simha M Prasanna, the Provena is an external mesh that is used by the vascular surgeons when the find a bad saphenous vein that should be used in a fem-pop bypass. It allows to create a uniform conduit of a desired diameter. In this case a used a 4 mm mesh. I am enclosing the picture of the vein before putting it into the mesh. I am very proud as this is the first time that I find you unprepared on something going from the Florida frogs to the rare diseases of the Innuit population. Giuseppe -- Prasanna Simha M -------------- next part -------------- A non-text attachment was scrubbed... Name: DSC01648.jpg Type: image/jpeg Size: 189423 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090531/a21e34e2/DSC01648-0001.jpg From prasannasimha at gmail.com Mon Jun 1 07:37:38 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 31 21:15:49 2009 Subject: [HSF] Renal failure PVE In-Reply-To: References: Message-ID: <89c4ed2d0905311807w66cb1188sd1db3c34bbec7503@mail.gmail.com> But why go through the left chest in this case ? I would suspect that the abscess would actually be more difficult to see since it is at the PML base which would make it more out of the line of sight via the left chest. Prasanna On Mon, Jun 1, 2009 at 12:42 AM, wrote: > Ed Good luck. > Looks horrible but these cases can be done. I tested soaking the patch in > gentamycin with my pericardium and it gets bound to it and retains > antibacterial action on a petrie dish. > Use the pericardium liberally; it is stronger than the inflamed tissue you > will be stitching to . As we have been discussing this is all about > taking the tension off the tissues. Try to stitch the pericardium to > normal > tissue and then the valve to the pericardium. > Hans Borst used to mix fibrin glue with the antibiotic and fill the abscess > cavity with this and then close everything with the pericardial patch. > Left chest is no big deal. Check which rib aligns with the appendage and go > in over the top of that rib. You need a full incision. Too low is bad. > Make your incision from the tip of the appendage down to the pulmonary > veins. > Nearer the superior keeps you away from the circumflex. Have an air > evacuating line in the ascending aorta. Keep a vent through the valve that > keeps > the valve incompetent and eventually is removed from the tip of the > appendage as your incision is closed up this point. With my myocardial > protection > the heart would be beating at this stage. > Take a minute orienting yourself when you open the left atrium; look for > the aortic root, left and right commissures and think of the papillary > muscles as on the patient's left and the patient's right. (Forget about > which > is anterior and which posterior (that terminology is nonsense anyhow). > > > In a message dated 5/31/2009 7:42:00 P.M. South Africa Standard Time, > ebender001@me.com writes: > > Giuseppe: > Thanks for your comments. I am worried about using an unfamiliar approach > (for me) since I may need to reconstruct her LA-LV groove. I do not know > whether it will be more cumbersome from the left chest. I have attached a > picture (if it comes thru) to demonstrate the infected tissue and valve > and > its posterior extent. > Ed Bender, MD > > > > On 5/31/09 3:19 AM, "Giuseppe Rescigno" wrote: > > > Ed, > > > > I would offer surgery to this poor young woman as at this age she may > > tolerate this very very high risk procedure and it is worthwhile. > > > > Giuseppe > > > > PS Why not using left thoracotomy? > > > > > > Il giorno 31/mag/09, alle ore 01:51, Edward Bender ha scritto: > > > >> Should this patient be offered surgery? > >> 30 year old female with ESRD on dialysis for 5 years. Four years > >> ago she > >> developed MRSA mitral endocarditis. She underwent mitral valve > >> replacement > >> with a bioprosthesis. She developed early PVE requiring redo MVR 6 > >> weeks > >> after her first operation. She did well for several years but had > >> some sort > >> of ?abdominal catastrophe? 6 weeks ago requiring colon resection and > >> colostomy. She was admitted 1 week ago septic, new right > >> hemispheric CVA > >> leaving her with 2/5 strength on the left, and PA pressures about > >> 80% of > >> systemic. MRSA in blood. TEE shows vegetations on the Mosaic valve > >> leaflets, destruction of leaflets, a posterior abcess and > >> paravalvular leak. > >> The family has been switching between full speed ahead and > >> compassionate > >> care. Although it is an overestimate of mortality, Euroscore gives > >> her > >> about a 75% estimated mortality. How would you approach the > >> discussion with > >> this patient and her family? The patient follows commands but is > >> not very > >> verbal. The family is scattered, but there is one family member > >> with power > >> of attorney. > >> > >> Ed Bender, MD > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 > ----------------------------------------- > > **************An Excellent Credit Score is 750. See Yours in Just 2 Easy > Steps! > ( > http://pr.atwola.com/promoclk/100126575x1221823251x1201398665/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=May > ExcfooterNO62 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mon Jun 1 07:27:47 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 31 21:24:24 2009 Subject: [HSF] Image of the week: Giant Left Atrium In-Reply-To: <89c4ed2d0905311756r78ebfaf5idd12691a6f52cb8f@mail.gmail.com> References: <1386563229-1243788898-cardhu_decombobulator_blackberry.rim.net-1106819329-@bxe1016.bisx.prod.on.blackberry> <89c4ed2d0905310959x2f44fdf4ja6f89d863af8ba98@mail.gmail.com> <03f201c9e212$a723a6b0$13cde818@LIBERTAD> <89c4ed2d0905311756r78ebfaf5idd12691a6f52cb8f@mail.gmail.com> Message-ID: <89c4ed2d0905311757xac37c7dvf900ce883879eba@mail.gmail.com> Also remember that a giant LA by itself can cause LV dysfunction and releaving posterobasal compression itself helps to improve LV dysfunction. Prasanna On Mon, Jun 1, 2009 at 6:26 AM, Prasanna Simha M wrote: > If this patient has MS MR why not stabilize and try MVR LA reduction first. > His CVP is 12 so I would be loath to right him off to a transplant option > (in my place we would have to call him "inoperable". > Many of these patients with MS MR may have tachycardia induced myopathy due > to Afib and do surprisingly well. You may use an LVAD if you want with an > option of bridge to recovery. > I would still do a electroc or cryo maze in this patient and plicate the > atrium. This will give a smaller atrium for your VAD placement too if > required. > I am saying this because time and again we get such patients who initially > look terribly sick, have low EF's etc etc in the decompensated phase and > well they bounce back. > What is his heart rate ? I am sure his ventricular rate is pretty high. > (Remember the patient with the large LV - he followed up on Saturday. EF > has improved to 50 % and he is doing well. We are still "upping " his > Carvedilol and his LV size is progressively decreasing. > If you want to see something largr - well here it is !! > Keep glue and bovine pericardium ready in case you need it. > Incidentally you (as you have mentioned) may have a terrible problem of > pulmonary vein displacement which may even need tube graft replacement of > the atrium using a bovine pericardial roll. > Prasanna > > On Sun, May 31, 2009 at 11:26 PM, Ani Anyanwu wrote: > >> >> A pathologic finding I know prasanna and others are more familiar with but >> one that is alien in my practice. >> >> >> >> 59 year old man status post mitral valve repair for rheumatic valve >> disease 20 years ago. Now presents in stage D heart failure and currently >> admitted in CCU in low-output state dependent on continuous milrinone >> infusion. Echo shows severe biventricular dysfunction, severe MR and >> moderate MS. Etiology of cardiomyopathy unclear but may be rheumatic and >> seems distinct from valvular dysfunction. Hemodynamics include PCW 28, PA >> 70/30, RA 12. Currently being evaluated for cardiac transplantation. >> Conventional surgery (MVR) is an option but unlikely to impact (and may >> worsen) the biventricular dysfunction. Will likely need left ventricular >> assist device as bridge to transplantation. >> >> >> >> Representative CT images showing giant atrium are shown. Poses particular >> problems for LVAD implantation because LV apex is rotated posteriorly deep >> into left chest so may not be ammenable to standard LVAD implant techniques >> that rely on anterior position of LV apex. Also high thromboembolic >> potential with giant atrium. Will need a mitral valve replacement at time of >> LVAD. Transplantation equally challenging because of need to anastomose a >> giant atrium to a small donor atrium. Also the giant atrium has splayed and >> distorted position of great vessels. Because donor heart considerably >> smaller high chance of kinking or stretching vascular connections. Approach >> might have to be total cardiac excision and total implantation technique >> with great vessels all anastomosed independently using conduits or patches >> to facilitate as required as opposed to standard approach which involves >> atrial anastomosis of left +/- right atrium. >> >> >> >> Ani >> >> _________________________________________________________________ >> View your Twitter and Flickr updates from one place ? Learn more! >> http://clk.atdmt.com/UKM/go/137984870/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 From prasannasimha at gmail.com Mon Jun 1 07:38:12 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 31 21:37:12 2009 Subject: [HSF] Renal failure PVE In-Reply-To: <89c4ed2d0905311807w66cb1188sd1db3c34bbec7503@mail.gmail.com> References: <89c4ed2d0905311807w66cb1188sd1db3c34bbec7503@mail.gmail.com> Message-ID: <89c4ed2d0905311808j3a19baeek92b7f1bc1290edd6@mail.gmail.com> Also if you find abscesses near the aortomitral continuity etc options to extend become severely limited. On Mon, Jun 1, 2009 at 6:37 AM, Prasanna Simha M wrote: > But why go through the left chest in this case ? I would suspect that the > abscess would actually be more difficult to see since it is at the PML base > which would make it more out of the line of sight via the left chest. > Prasanna > > > On Mon, Jun 1, 2009 at 12:42 AM, wrote: > >> Ed Good luck. >> Looks horrible but these cases can be done. I tested soaking the patch >> in >> gentamycin with my pericardium and it gets bound to it and retains >> antibacterial action on a petrie dish. >> Use the pericardium liberally; it is stronger than the inflamed tissue >> you >> will be stitching to . As we have been discussing this is all about >> taking the tension off the tissues. Try to stitch the pericardium to >> normal >> tissue and then the valve to the pericardium. >> Hans Borst used to mix fibrin glue with the antibiotic and fill the >> abscess >> cavity with this and then close everything with the pericardial patch. >> Left chest is no big deal. Check which rib aligns with the appendage and >> go >> in over the top of that rib. You need a full incision. Too low is bad. >> Make your incision from the tip of the appendage down to the pulmonary >> veins. >> Nearer the superior keeps you away from the circumflex. Have an air >> evacuating line in the ascending aorta. Keep a vent through the valve >> that keeps >> the valve incompetent and eventually is removed from the tip of the >> appendage as your incision is closed up this point. With my myocardial >> protection >> the heart would be beating at this stage. >> Take a minute orienting yourself when you open the left atrium; look for >> the aortic root, left and right commissures and think of the papillary >> muscles as on the patient's left and the patient's right. (Forget about >> which >> is anterior and which posterior (that terminology is nonsense anyhow). >> >> >> In a message dated 5/31/2009 7:42:00 P.M. South Africa Standard Time, >> ebender001@me.com writes: >> >> Giuseppe: >> Thanks for your comments. I am worried about using an unfamiliar approach >> (for me) since I may need to reconstruct her LA-LV groove. I do not know >> whether it will be more cumbersome from the left chest. I have attached a >> picture (if it comes thru) to demonstrate the infected tissue and valve >> and >> its posterior extent. >> Ed Bender, MD >> >> >> >> On 5/31/09 3:19 AM, "Giuseppe Rescigno" wrote: >> >> > Ed, >> > >> > I would offer surgery to this poor young woman as at this age she may >> > tolerate this very very high risk procedure and it is worthwhile. >> > >> > Giuseppe >> > >> > PS Why not using left thoracotomy? >> > >> > >> > Il giorno 31/mag/09, alle ore 01:51, Edward Bender ha scritto: >> > >> >> Should this patient be offered surgery? >> >> 30 year old female with ESRD on dialysis for 5 years. Four years >> >> ago she >> >> developed MRSA mitral endocarditis. She underwent mitral valve >> >> replacement >> >> with a bioprosthesis. She developed early PVE requiring redo MVR 6 >> >> weeks >> >> after her first operation. She did well for several years but had >> >> some sort >> >> of ?abdominal catastrophe? 6 weeks ago requiring colon resection and >> >> colostomy. She was admitted 1 week ago septic, new right >> >> hemispheric CVA >> >> leaving her with 2/5 strength on the left, and PA pressures about >> >> 80% of >> >> systemic. MRSA in blood. TEE shows vegetations on the Mosaic valve >> >> leaflets, destruction of leaflets, a posterior abcess and >> >> paravalvular leak. >> >> The family has been switching between full speed ahead and >> >> compassionate >> >> care. Although it is an overestimate of mortality, Euroscore gives >> >> her >> >> about a 75% estimated mortality. How would you approach the >> >> discussion with >> >> this patient and her family? The patient follows commands but is >> >> not very >> >> verbal. The family is scattered, but there is one family member >> >> with power >> >> of attorney. >> >> >> >> Ed Bender, MD >> >> _______________________________________________ >> >> OpenHeart-L mailing list >> >> >> >> Send postings to: >> >> OpenHeart-L@lists.hsforum.com >> >> >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> >> http://mmp.cjp.com/mailman/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 >> ----------------------------------------- >> >> **************An Excellent Credit Score is 750. See Yours in Just 2 Easy >> Steps! >> ( >> http://pr.atwola.com/promoclk/100126575x1221823251x1201398665/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=May >> ExcfooterNO62 >> ) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 Mon Jun 1 07:26:16 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 31 22:06:38 2009 Subject: [HSF] Image of the week: Giant Left Atrium In-Reply-To: References: <1386563229-1243788898-cardhu_decombobulator_blackberry.rim.net-1106819329-@bxe1016.bisx.prod.on.blackberry> <89c4ed2d0905310959x2f44fdf4ja6f89d863af8ba98@mail.gmail.com> <03f201c9e212$a723a6b0$13cde818@LIBERTAD> Message-ID: <89c4ed2d0905311756r78ebfaf5idd12691a6f52cb8f@mail.gmail.com> If this patient has MS MR why not stabilize and try MVR LA reduction first. His CVP is 12 so I would be loath to right him off to a transplant option (in my place we would have to call him "inoperable". Many of these patients with MS MR may have tachycardia induced myopathy due to Afib and do surprisingly well. You may use an LVAD if you want with an option of bridge to recovery. I would still do a electroc or cryo maze in this patient and plicate the atrium. This will give a smaller atrium for your VAD placement too if required. I am saying this because time and again we get such patients who initially look terribly sick, have low EF's etc etc in the decompensated phase and well they bounce back. What is his heart rate ? I am sure his ventricular rate is pretty high. (Remember the patient with the large LV - he followed up on Saturday. EF has improved to 50 % and he is doing well. We are still "upping " his Carvedilol and his LV size is progressively decreasing. If you want to see something largr - well here it is !! Keep glue and bovine pericardium ready in case you need it. Incidentally you (as you have mentioned) may have a terrible problem of pulmonary vein displacement which may even need tube graft replacement of the atrium using a bovine pericardial roll. Prasanna On Sun, May 31, 2009 at 11:26 PM, Ani Anyanwu wrote: > > A pathologic finding I know prasanna and others are more familiar with but > one that is alien in my practice. > > > > 59 year old man status post mitral valve repair for rheumatic valve disease > 20 years ago. Now presents in stage D heart failure and currently admitted > in CCU in low-output state dependent on continuous milrinone infusion. Echo > shows severe biventricular dysfunction, severe MR and moderate MS. Etiology > of cardiomyopathy unclear but may be rheumatic and seems distinct from > valvular dysfunction. Hemodynamics include PCW 28, PA 70/30, RA 12. > Currently being evaluated for cardiac transplantation. Conventional surgery > (MVR) is an option but unlikely to impact (and may worsen) the biventricular > dysfunction. Will likely need left ventricular assist device as bridge to > transplantation. > > > > Representative CT images showing giant atrium are shown. Poses particular > problems for LVAD implantation because LV apex is rotated posteriorly deep > into left chest so may not be ammenable to standard LVAD implant techniques > that rely on anterior position of LV apex. Also high thromboembolic > potential with giant atrium. Will need a mitral valve replacement at time of > LVAD. Transplantation equally challenging because of need to anastomose a > giant atrium to a small donor atrium. Also the giant atrium has splayed and > distorted position of great vessels. Because donor heart considerably > smaller high chance of kinking or stretching vascular connections. Approach > might have to be total cardiac excision and total implantation technique > with great vessels all anastomosed independently using conduits or patches > to facilitate as required as opposed to standard approach which involves > atrial anastomosis of left +/- right atrium. > > > > Ani > > _________________________________________________________________ > View your Twitter and Flickr updates from one place ? Learn more! > http://clk.atdmt.com/UKM/go/137984870/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 -------------- next part -------------- A non-text attachment was scrubbed... Name: giant LA emla.jpg Type: image/jpeg Size: 126540 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090601/44d6e0d8/giantLAemla-0001.jpg From prasannasimha at gmail.com Mon Jun 1 08:54:12 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 31 22:24:49 2009 Subject: [HSF] Image of the week: Giant Left Atrium In-Reply-To: <557691.31915.qm@web81601.mail.mud.yahoo.com> References: <1386563229-1243788898-cardhu_decombobulator_blackberry.rim.net-1106819329-@bxe1016.bisx.prod.on.blackberry> <89c4ed2d0905310959x2f44fdf4ja6f89d863af8ba98@mail.gmail.com> <03f201c9e212$a723a6b0$13cde818@LIBERTAD> <89c4ed2d0905311756r78ebfaf5idd12691a6f52cb8f@mail.gmail.com> <557691.31915.qm@web81601.mail.mud.yahoo.com> Message-ID: <89c4ed2d0905311924u49f0623er9bc6b4a4b622687a@mail.gmail.com> A dilated LA is a dilated LA (so alsoall dilated structures in the body). Problem is when you have a thin large LA - compresses carddiac structures causing compressive effects - lungs and bronchi - lung collapse - Recurrent laryngeal - be prepared for aspiration etc , LV - LV dysfunction , Afib - higher LCOS, difficult to deair effectively etc thin atria sutring can be troublesome 9I had one patient die of persistent bleeding which was controlled with great difficulty. and so on and so forth. Nice to see , difficult multifactorial problems associated with it. Prasanna On Mon, Jun 1, 2009 at 7:47 AM, Tea Acuff wrote: > What's the big deal a dilated LA is a dilated LA right? > tea > > > > > ________________________________ > From: Prasanna Simha M > To: OpenHeart-L@lists.hsforum.com > Sent: Sunday, May 31, 2009 7:56:16 PM > Subject: Re: [HSF] Image of the week: Giant Left Atrium > > If this patient has MS MR why not stabilize and try MVR LA reduction first. > His CVP is 12 so I would be loath to right him off to a transplant option > (in my place we would have to call him "inoperable". > Many of these patients with MS MR may have tachycardia induced myopathy due > to Afib and do surprisingly well. You may use an LVAD if you want with an > option of bridge to recovery. > I would still do a electroc or cryo maze in this patient and plicate the > atrium. This will give a smaller atrium for your VAD placement too if > required. > I am saying this because time and again we get such patients who initially > look terribly sick, have low EF's etc etc in the decompensated phase and > well they bounce back. > What is his heart rate ? I am sure his ventricular rate is pretty high. > (Remember the patient with the large LV - he followed up on Saturday. EF > has improved to 50 % and he is doing well. We are still "upping " his > Carvedilol and his LV size is progressively decreasing. > If you want to see something largr - well here it is !! > Keep glue and bovine pericardium ready in case you need it. > Incidentally you (as you have mentioned) may have a terrible problem of > pulmonary vein displacement which may even need tube graft replacement of > the atrium using a bovine pericardial roll. > Prasanna > > On Sun, May 31, 2009 at 11:26 PM, Ani Anyanwu >wrote: > > > > > A pathologic finding I know prasanna and others are more familiar with > but > > one that is alien in my practice. > > > > > > > > 59 year old man status post mitral valve repair for rheumatic valve > disease > > 20 years ago. Now presents in stage D heart failure and currently > admitted > > in CCU in low-output state dependent on continuous milrinone infusion. > Echo > > shows severe biventricular dysfunction, severe MR and moderate MS. > Etiology > > of cardiomyopathy unclear but may be rheumatic and seems distinct from > > valvular dysfunction. Hemodynamics include PCW 28, PA 70/30, RA 12. > > Currently being evaluated for cardiac transplantation. Conventional > surgery > > (MVR) is an option but unlikely to impact (and may worsen) the > biventricular > > dysfunction. Will likely need left ventricular assist device as bridge to > > transplantation. > > > > > > > > Representative CT images showing giant atrium are shown. Poses particular > > problems for LVAD implantation because LV apex is rotated posteriorly > deep > > into left chest so may not be ammenable to standard LVAD implant > techniques > > that rely on anterior position of LV apex. Also high thromboembolic > > potential with giant atrium. Will need a mitral valve replacement at time > of > > LVAD. Transplantation equally challenging because of need to anastomose a > > giant atrium to a small donor atrium. Also the giant atrium has splayed > and > > distorted position of great vessels. Because donor heart considerably > > smaller high chance of kinking or stretching vascular connections. > Approach > > might have to be total cardiac excision and total implantation technique > > with great vessels all anastomosed independently using conduits or > patches > > to facilitate as required as opposed to standard approach which involves > > atrial anastomosis of left +/- right atrium. > > > > > > > > Ani > > > > _________________________________________________________________ > > View your Twitter and Flickr updates from one place ? Learn more! > > http://clk.atdmt.com/UKM/go/137984870/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 > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 donross at bigpond.com Mon Jun 1 15:45:54 2009 From: donross at bigpond.com (Donald Ross) Date: Mon Jun 1 00:47:08 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <40096296-5B94-4908-A559-0021BFF2A992@mac.com> <972F1EF0-1F6E-4377-8FE0-151B7F829FDF@mac.com> <110C27E6-78BD-4961-A7DB-59D76CD05A39@gmail.com> Message-ID: <66CB025E-C5EE-41D3-B0B1-766DA4A3964C@bigpond.com> Are you sure your name isn't Unbeweglichberg ? Don On 01/06/2009, at 5:20 AM, Michael Firstenberg wrote: > assistance like CPB? > > -michael > > > On May 31, 2009, at 1:22 PM, Giuseppe Rescigno wrote: > >> Michael, >> >> I don't want to say that it was the anestesist fault... but some >> assistance with hostile hearts may help. >> >> Giuseppe >> >> Il giorno 31/mag/09, alle ore 17:29, Michael Firstenberg ha scritto: >> >>> Can you please elaborate on why it is the Anesthesist's fault that >>> you could not get to the diagnonal? >>> >>> -michael >>> >>> >>> >>> On May 31, 2009, at 10:24 AM, Giuseppe Rescigno wrote: >>> >>>> Ani, >>>> >>>> it was just a joke! I know that you could not remember >>>> everything! The provena patient was a 84 yo lady, who had a >>>> severe left main stenosis (85%) a good LAD, a nice first diagonal >>>> (70% stenosis) occluded CX and RCA without any significant >>>> branch. EF around 30% with a 4 mm vena contracta mitral regurg. >>>> She is 145 cm, 45 Kg. She seemed to me quite frail so I decided >>>> to do just a Lima_lad plus a vein on the diagonal OPCAB, without >>>> correcting the mitral (sorry Hal!) . The saphenous veins were >>>> bilaterally dilated with some varicosities. I preferred to avoid >>>> a double mammary harvesting, and the Allen test was doubtful. Our >>>> vascular surgeons use the Provena sometimes so I found that this >>>> was the best option in this particular case. BTW I was unable to >>>> expose the diagonal as the heart was dilated (and the anesthesist >>>> not very compliant). So I did an on-pump heart beating CABG. The >>>> final flows were massive for both grafts (around 60 mL). Now she >>>> is extubated and doing well. In case of good outcome I plan to >>>> ask for a CT scan of the grafts. >>>> >>>> Giuseppe >>>> >>>> >>>> >>>> Il giorno 31/mag/09, alle ore 13:26, Ani Anyanwu ha scritto: >>>> >>>>> >>>>> Sorry Giuseppe - could not remember all responses. Whats up with >>>>> that provena business though? Did the patient not have any >>>>> arterial conduits? Are there any data on patency yet? >>>>> >>>>> >>>>> >>>>> Ani >>>>> >>>>> >>>>> >>>>> >>>>>> From: grescigno@mac.com >>>>>> Subject: Re: [HSF] Conduit choice >>>>>> Date: Sun, 31 May 2009 10:23:50 +0200 >>>>>> To: OpenHeart-L@lists.hsforum.com >>>>>> CC: >>>>>> >>>>>> Ani >>>>>> I suggested exactly what you have done! >>>>>> >>>>>> Giuseppe >>>>> >>>>> Ani >>>>>> >>>>>> >>>>>> >>>>>> Il giorno 30/mag/09, alle ore 21:35, Ani Anyanwu ha scritto: >>>>>> >>>>>>> >>>>>>> Just feedback on this patient I posted a few weeks ago - 41 yr >>>>>>> old >>>>>>> amputee with severe diabetes and endstage renal disease and >>>>>>> fistula >>>>>>> problems. >>>>>>> >>>>>>> >>>>>>> >>>>>>> I operated on him 3 weeks ago. Did 3 vessel OPCAB with bilateral >>>>>>> skeletonized internal mammary artery grafts - LIMA-LAD and >>>>>>> RIMA Y >>>>>>> graft off LIMA to OM and PDA. I was not bold enough to procure a >>>>>>> radial artery especially as no forum member supported that other >>>>>>> than Don. I went along with the minority opinion as most had >>>>>>> suggested vein grafts (I think only Mitch and Roberto suggested >>>>>>> bilateral IMA grafts). >>>>>>> >>>>>>> >>>>>>> >>>>>>> Kept him on insulin infusion for first four days. Mobilized >>>>>>> after a >>>>>>> week. Patient did okay and no wound problems so far and back >>>>>>> home >>>>>>> and doing okay. Obviously I will let you know if his wound falls >>>>>>> apart as still early days. >>>>>>> >>>>>>> >>>>>>> >>>>>>> Thanks for all input. >>>>>>> >>>>>>> >>>>>>> >>>>>>> Ani >>>>>>> >>>>>>> >>>>>>> >>>>>>> >>>>>>> >>>>>>> >>>>>>> From: anianyanwu@hotmail.com >>>>>>> To: openheart-l@lists.hsforum.com >>>>>>> Subject: RE: [HSF] Conduit choice >>>>>>> Date: Thu, 7 May 2009 20:41:57 +0000 >>>>>>> >>>>>>> >>>>>>> >>>>>>> Patient 41 years old, previous multivessel PCI in 2007 now >>>>>>> instent >>>>>>> occlusion of RCA and Cx, also severe proximal LAD lesion (he >>>>>>> never >>>>>>> turned up for his LAD stent - maybe fortunately; four stents >>>>>>> placed >>>>>>> in Cx first week, four in RCA two weeks after and then was to >>>>>>> have >>>>>>> LAD staged two weeks later and never came back till now). For >>>>>>> full >>>>>>> revascularization would need bypass to LAD, OM and PDA +/-PLV. >>>>>>> EF 45%. >>>>>>> >>>>>>> Patient has diabetes since age 10 with multiple end-organ >>>>>>> complications. Renal failure on dialysis for 2 years, >>>>>>> retinopathy >>>>>>> with laser treatment, arteriopathy with severe peripheral >>>>>>> vascular >>>>>>> disease. Has had below knee amputation on right side and toe >>>>>>> amputations on left. No distal pulses in left leg. Used to smoke >>>>>>> but stopped few years ago. He is being considered for pancreatic >>>>>>> and kidney transplant but needs heart fixed first. Has AV >>>>>>> fistula >>>>>>> in left forearm which failed. Right arm untouched so far. Being >>>>>>> dialysed via catheter while awaiting plan for new fistula (they >>>>>>> wont do that either till heart fixed). He is terrified about >>>>>>> losing >>>>>>> his left leg or needing more amputated off his right or having a >>>>>>> chronic ulcer due to non-healing of surgical incision and says >>>>>>> he >>>>>>> does not want his legs cut. As amputee very dependent on upper >>>>>>> torso to mobilize. >>>>>>> >>>>>>> What conduits would you use and in what configuration? >>>>>>> >>>>>>> Thanks >>>>>>> >>>>>>> Ani >>>>>>> >>>>>>> >>>>>>> >>>>>>> Share your photos with Windows Live Photos ? Free. Try it Now! >>>>>>> _________________________________________________________________ >>>>>>> View your Twitter and Flickr updates from one place ? Learn >>>>>>> more! >>>>>>> http://clk.atdmt.com/UKM/go/137984870/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 >>>>>> ----------------------------------------- >>>>> >>>>> >>>>> _________________________________________________________________ >>>>> View your Twitter and Flickr updates from one place ? Learn more! >>>>> http://clk.atdmt.com/UKM/go/137984870/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 grescigno at mac.com Mon Jun 1 10:21:22 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Mon Jun 1 03:28:33 2009 Subject: [HSF] Provena for Prasanna In-Reply-To: References: Message-ID: <8CB947BC-A781-48DA-B532-EA1C383ED09C@mac.com> Dwight, the first diagonal was very high and the mammary so thin that I wanted to get the best result on Lad. From time to time I do a Y graft with a Lima but this was not the case. Vascular surgeons are quite happy about provena (I should say that they have no choice unless of using 2 radials end to end. The flow through the vein was around 60 mL(mean) and PI 1.6. I will keep you informed about controls Giuseppe Il giorno 01/giu/09, alle ore 00:39, Dwight Hand ha scritto: > > Giuseppe, > Why use an inferior conduit (dilated, aneurysmal SVG), now encased > in Provena mesh, as a coronary bypass graft? Was the LAD stenosis > located so far distally that a skeletonized LIMA could not be > sequenced first to the diagonal and then to the LAD? Any short > term, intermediate, or long term follow-up on Provena mesh incased > SVG in CABG? > Dwight > >> To: OpenHeart-L@lists.hsforum.com >> From: grescigno@mac.com >> Date: Sun, 31 May 2009 16:39:00 +0200 >> CC: >> Subject: [HSF] Provena for Prasanna >> >> Prasanna, >> >> the Provena is an external mesh that is used by the vascular surgeons >> when the find a bad saphenous vein that should be used in a fem-pop >> bypass. It allows to create a uniform conduit of a desired diameter. >> In this case a used a 4 mm mesh. I am enclosing the picture of the >> vein before putting it into the mesh. I am very proud as this is the >> first time that I find you unprepared on something going from the >> Florida frogs to the rare diseases of the Innuit population. >> >> Giuseppe >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mon Jun 1 12:46:07 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Mon Jun 1 05:46:35 2009 Subject: [HSF] Valve in-a-valve In-Reply-To: <545719.94210.qm@web81605.mail.mud.yahoo.com> References: <545719.94210.qm@web81605.mail.mud.yahoo.com> Message-ID: Hal, 3 or 4 cases with good result are nothing but a good beginning. We need more time, more cases. Roberto > Date: Sun, 31 May 2009 12:47:30 -0700 > From: tacuff@swbell.net > Subject: Re: [HSF] Prosthesis Choice > To: OpenHeart-L@lists.hsforum.com > CC: > > There you go again, Bob. We have a nice category like prosthetic valve implant and you start taking it apart to suit your purpose. Would you stay on subject please. > > tea > > > > ________________________________ > From: "Rwmfglycar@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Sunday, May 31, 2009 2:27:08 PM > Subject: Re: [HSF] Prosthesis Choice > > Much will depend on what size valve was put in first. Note thjat with a > coronal frame this could be stretched but with a metal ring in the structure > at the base this will not be expandable.I have seen onecase in which the > residual gradient after the valve in valve was placed, was clearly > unacceptably high > Bob > > > In a message dated 5/31/2009 6:52:36 P.M. South Africa Standard Time, > Hgrmd@aol.com writes: > > >From what I saw and heard at Carpentier's last meeting, the "valve in > valve" solution is still a ways off. Cribier was at the meeting and it > was his > opinion that a good prosthesis for "valve in valve" had not yet been > invented. Since he started the whole field, I think you have to take him > at his > word. Fred Mohr has been enthusiastic about this approach, but I'm not > sure if this enthusiasm is backed up by actual clinical experience. > Maybe > Roberto could enlighten us. > > Hal > > > In a message dated 5/31/2009 12:21:23 A.M. Eastern Daylight Time, > gabuin@intramed.net writes: > > I will choose a biological device because you have the advantage of no > anticoagulate this kind of patient and if the valve become stenotic in a > few > years, you can replace it with a "valve into a valve" percutaneously. > > ----- Original Message ----- > From: "Ani Anyanwu" > To: > Sent: Saturday, May 30, 2009 4:22 PM > Subject: RE: [HSF] Prosthesis Choice > > > > Thought we should talk about a real patients to give a break from the > theoretical stuff. Would be keen to hear thoughts from forum members on > this > case. > > > > 39 year old male with lupus erythematosus. Chronic renal failure on > hemodialysis for 10 years. Plagued by problems with access for dialysis > mainly related to fistula non function and line sepsis. Has so far > declined > peritoneal dialysis. Avascular necrosis of both hips which causes severe > pain so cannot walk and uses an electric wheelchair to mobilize for many > years. Also has long history of hypertension with resultant left > ventricular > hypertrophy. Echocardiogram done end of last year showed no valve > dysfunctions of note. He is on a list for a cadaveric renal transplant > and > has some other medical problems which I wont detail but enough to say he > does have high need for medical care interventions. > > > > Presented last week again with fevers. Blood cultures positive for Staph > lugdunensis. Echocardiogram shows mitral valve endocarditis with > vegetations > on anterior leaflet, vegetations and perforation and possible abscess on > posterior leaflet. Severe mitral regurgitation likely Carpentier Type I. > Anterior leaflet much thickened compared to echo last year - vegetation > on > anterior leaflet about 1.7cm long and prolapses into LV with each beat. > Additionally has aortic valve vegetations on left and non-coronary cusps > with moderate regurgitation. There does not seem to be annular abscess. > There is also a 2cm right atrial mass at the junction of the superior > cava > and right atrium - close to but not obviously attached to a 'permcath' > dialysis catheter in situ in the atrium, entering form the left > subclavian > vein. No embolic phenomenom. > > > > Surgery is indicated for control of sepsis as still has fevers despite > appropriate antimicrobial therapy and also for increasing heart failure. > Obviously the catheter has to come out and probably perioneal dialysis > should be employed for a while at least. Also despite his chronic disease > he > is relatively very functional and no reason to believe he cannot expect > mid > to long-term survival. My questions arise as to choice of prosthesis in > this > patient. The mitral valve may potentially be repairable by pericardial > patch > of anterior leaflet and some form of resection+/-sliding+/-patch of > posterior leaflet but will depend on OR findings. Aortic lealfets > destroyed > so will need to be replaced. Plan to operate in 48 hrs (because of > weekend > rather than any medical reason). > > > > 1) Assuming mitral valve is repairable (regardless of your opinion on > repair > in this scenario) what prosthesis would you use for the aortic valve? > > 2) Assuming both mitral and aortic valve need to be replaced what > prosthesis > would you choose? > > > > Thanks > > > > Ani > > > > _________________________________________________________________ > Beyond Hotmail ? see what else you can do with Windows Live. > http://clk.atdmt.com/UKM/go/134665375/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 > ----------------------------------------- > > > ---------------------------------------------------------------------------- > ---- > > > > No virus found in this incoming message. > Checked by AVG - www.avg.com > Version: 8.5.339 / Virus Database: 270.12.46/2143 - Release Date: > 05/30/09 > > 05:53:00 > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > **************Obama Urges Homeowners to Refi! $133K Mortgage for $679/Mo > CALCULATE NEW PAYMENT > (http://pr.atwola.com/promoclk/10012 > 6575x1221359311x1201370063/aol?redir=https://www.lowermybills.com/servlet/LMBServlet?the_action=N > avigateHomeLoansAdRedirect&sourceid=lmb-17065-34614&moid=20187) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > **************An Excellent Credit Score is 750. See Yours in Just 2 Easy > Steps! > (http://pr.atwola.com/promoclk/100126575x1221823251x1201398665/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=May > ExcfooterNO62) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mon Jun 1 16:16:58 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Mon Jun 1 11:17:52 2009 Subject: [HSF] Image of the week: Giant Left Atrium In-Reply-To: <89c4ed2d0905311756r78ebfaf5idd12691a6f52cb8f@mail.gmail.com> References: <1386563229-1243788898-cardhu_decombobulator_blackberry.rim.net-1106819329-@bxe1016.bisx.prod.on.blackberry> <89c4ed2d0905310959x2f44fdf4ja6f89d863af8ba98@mail.gmail.com> <03f201c9e212$a723a6b0$13cde818@LIBERTAD> <89c4ed2d0905311756r78ebfaf5idd12691a6f52cb8f@mail.gmail.com> Message-ID: Prasanna Thanks for the images and the tips. Do you have any images of your patient post-intervention? With regards to my patient, I agree with you about possibility of improving with conventional surgery. All patients post VAD will have a trial of recovery and if he does recover we would take out VAD. It is though extremely unlikely in this case I suspect. He would have an MVR, tricuspid repair and single vessel CABG at time of VAD implant. The other reason we often do conventional surgery at time of VAD implant is that if the VAD were to be infected, explantation of VAD may sometimes be an option even if cardiac function still suboptimal. What kind of left atrial incision would you make to approach the mitral valve here? ALso can you elaborate more on your method of LA plication - i think you have described it to us before. Are there drawbacks to plication (esp hemorrhage - as you know VADs, especially reoperative VADs, are bloody operations as they are, so wouldnt want to add more bleeding sources if I can avoid it)? Could one rather than plicate just reconstruct a new LA roof using bovine pericarium to divert blood from the four veins to the valve? What to do with that giant LAA? The neck is about 7cm wide so I assume usual approaches cant fix this one, so (and Tea may like this) evidence of fallacy of our categorical discusssions on techniques of LAA closure. Do you though find any direct postoperative benefit you can relate to your LA reduction procedures? Finally what is the usefullness of doing a maze in such a patient - have you seen sustained conversions in such a setting with restored functionality of the atria - his atrium must have been this big for decades now? Patients ventricular rate is 80s or 90s in atrial fibrillation. I think the transplant would be even more of a challenge than MVR and VAD, but at least at this operation I could get an idea as to how distorted the anatomy is. Thanks Ani > From: prasannasimha@gmail.com > Date: Mon, 1 Jun 2009 06:26:16 +0530 > Subject: Re: [HSF] Image of the week: Giant Left Atrium > To: OpenHeart-L@lists.hsforum.com > CC: > > If this patient has MS MR why not stabilize and try MVR LA reduction first. > His CVP is 12 so I would be loath to right him off to a transplant option > (in my place we would have to call him "inoperable". > Many of these patients with MS MR may have tachycardia induced myopathy due > to Afib and do surprisingly well. You may use an LVAD if you want with an > option of bridge to recovery. > I would still do a electroc or cryo maze in this patient and plicate the > atrium. This will give a smaller atrium for your VAD placement too if > required. > I am saying this because time and again we get such patients who initially > look terribly sick, have low EF's etc etc in the decompensated phase and > well they bounce back. > What is his heart rate ? I am sure his ventricular rate is pretty high. > (Remember the patient with the large LV - he followed up on Saturday. EF > has improved to 50 % and he is doing well. We are still "upping " his > Carvedilol and his LV size is progressively decreasing. > If you want to see something largr - well here it is !! > Keep glue and bovine pericardium ready in case you need it. > Incidentally you (as you have mentioned) may have a terrible problem of > pulmonary vein displacement which may even need tube graft replacement of > the atrium using a bovine pericardial roll. > Prasanna > > On Sun, May 31, 2009 at 11:26 PM, Ani Anyanwu wrote: > > > > > A pathologic finding I know prasanna and others are more familiar with but > > one that is alien in my practice. > > > > > > > > 59 year old man status post mitral valve repair for rheumatic valve disease > > 20 years ago. Now presents in stage D heart failure and currently admitted > > in CCU in low-output state dependent on continuous milrinone infusion. Echo > > shows severe biventricular dysfunction, severe MR and moderate MS. Etiology > > of cardiomyopathy unclear but may be rheumatic and seems distinct from > > valvular dysfunction. Hemodynamics include PCW 28, PA 70/30, RA 12. > > Currently being evaluated for cardiac transplantation. Conventional surgery > > (MVR) is an option but unlikely to impact (and may worsen) the biventricular > > dysfunction. Will likely need left ventricular assist device as bridge to > > transplantation. > > > > > > > > Representative CT images showing giant atrium are shown. Poses particular > > problems for LVAD implantation because LV apex is rotated posteriorly deep > > into left chest so may not be ammenable to standard LVAD implant techniques > > that rely on anterior position of LV apex. Also high thromboembolic > > potential with giant atrium. Will need a mitral valve replacement at time of > > LVAD. Transplantation equally challenging because of need to anastomose a > > giant atrium to a small donor atrium. Also the giant atrium has splayed and > > distorted position of great vessels. Because donor heart considerably > > smaller high chance of kinking or stretching vascular connections. Approach > > might have to be total cardiac excision and total implantation technique > > with great vessels all anastomosed independently using conduits or patches > > to facilitate as required as opposed to standard approach which involves > > atrial anastomosis of left +/- right atrium. > > > > > > > > Ani > > > > _________________________________________________________________ > > View your Twitter and Flickr updates from one place ? Learn more! > > http://clk.atdmt.com/UKM/go/137984870/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 _________________________________________________________________ Share your photos with Windows Live Photos ? Free. http://clk.atdmt.com/UKM/go/134665338/direct/01/ From prasannasimha at gmail.com Mon Jun 1 22:59:16 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Jun 1 12:35:41 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> Message-ID: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- Prasanna Simha M -- Prasanna Simha M From TSalerno at med.miami.edu Mon Jun 1 13:40:20 2009 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Mon Jun 1 12:40:59 2009 Subject: [HSF] News on promotion Message-ID: Congratulations! Well deserved Tomas ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: OpenHeart-L Sent: Mon Jun 01 12:29:16 2009 Subject: [HSF] News on promotion I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- 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 Michael.Crittenden at va.gov Mon Jun 1 12:39:29 2009 From: Michael.Crittenden at va.gov (Crittenden, Michael D. (STL)) Date: Mon Jun 1 12:41:04 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: <694803DBB928D340937CEA75F9B1F8DA05F9CA1F@VHAV15MSGA2.v15.med.va.gov> Congratulations Prasanna. Your promotion is well deserved. -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Monday, June 01, 2009 11:29 AM To: OpenHeart-L Subject: [HSF] News on promotion I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- 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 hgrmd at aol.com Mon Jun 1 17:44:35 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Mon Jun 1 12:46:14 2009 Subject: [HSF] News on promotion In-Reply-To: References: Message-ID: <1594609306-1243874664-cardhu_decombobulator_blackberry.rim.net-82482947-@bxe1016.bisx.prod.on.blackberry> Prasanna, Congrats, couldn't happened to a nicer or more deserving individual. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: "Salerno, Tomas" Date: Mon, 1 Jun 2009 12:40:20 To: 'OpenHeart-L@lists.hsforum.com' Subject: Re: [HSF] News on promotion Congratulations! Well deserved Tomas ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: OpenHeart-L Sent: Mon Jun 01 12:29:16 2009 Subject: [HSF] News on promotion I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- 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 dukeb60 at aol.com Mon Jun 1 12:46:07 2009 From: dukeb60 at aol.com (Edward P. Raines) Date: Mon Jun 1 12:47:29 2009 Subject: [HSF] News on promotion In-Reply-To: <694803DBB928D340937CEA75F9B1F8DA05F9CA1F@VHAV15MSGA2.v15.med.va.gov> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> <694803DBB928D340937CEA75F9B1F8DA05F9CA1F@VHAV15MSGA2.v15.med.va.gov> Message-ID: <006465C2-BB2A-4513-9799-22785A7B168B@aol.com> Congratulations. Overdue probably Sent from my iPhone On Jun 1, 2009, at 11:39 AM, "Crittenden, Michael D. (STL)" wrote: > Congratulations Prasanna. Your promotion is well deserved. > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna > Simha M > Sent: Monday, June 01, 2009 11:29 AM > To: OpenHeart-L > Subject: [HSF] News on promotion > > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in > my > Institute and Rajiv Gandhi Medical University (All medical , dental > and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 > ----------------------------------------- From prasannasimha at gmail.com Mon Jun 1 23:22:14 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Jun 1 12:53:18 2009 Subject: [HSF] Image of the week: Giant Left Atrium In-Reply-To: References: <1386563229-1243788898-cardhu_decombobulator_blackberry.rim.net-1106819329-@bxe1016.bisx.prod.on.blackberry> <89c4ed2d0905310959x2f44fdf4ja6f89d863af8ba98@mail.gmail.com> <03f201c9e212$a723a6b0$13cde818@LIBERTAD> <89c4ed2d0905311756r78ebfaf5idd12691a6f52cb8f@mail.gmail.com> Message-ID: <89c4ed2d0906010952v216db76cs1055c657d77ebc24@mail.gmail.com> I will dig out the photographs and the discussion. LA plication is usually straight forward provided you dont make the mistake that I did once and lost the patient - do notextensively dissect any adhesions , open both pleurae if you need "mobility" as the atria are thin and adhesiolysis will make you regret it as tissues will bleed.if you need to adhesiolyse do not do finger disscetion but use sharp dissection of adhesions leaving the adventitial "film" (I hope you get what I mean) over the atrial tissue as denudation of that will make life horrible. You can go via the conventional left atrial incision but excise a good strip of the "left atrial bulge ". Plicate within the atria. I have emazed these patients and while they have a lower persistantconversion rate (around 60 %) those who convert have dramatic continued reduction in size on follow up and non converters at least have a good rate control. I would suture the left atrial appendage from inside (You can easily do a linear closure. Do not try to dissect the appendage externally - it may look tempting but can be particularly messy. I at times just dissect enough in that region to remove the "ankylosis" that tethers the mitral annulus preventing good exposure but usually this is not a problem as the atrium is so book you can virtually sit inside and operate. I would use bovine pericardial well technique only as a last option if you have a bleeding mess. These patients can easily hold a liter of blood inside and it is worth asking the prfusionist how much his level rises. Youcan bag a couple of units of blood and also hemofilter and have enough blood to spare after decreasing the size of the atrium !!! Direct benefits are - improved lung function (you will see the right lowr lobe especially open up.Be prepared to bronchsocope if there are retained plugs. Less bronchospasm and earlier ventilator wean comapred to patients who do not get a reduction and also lower embolic risk periop (the large LA can hold air pockets which can be difficult to deair. Use CO2 liberally once the main procedure is over to displace air out of the pulmonary veins. > > Prasanna > > > > Thanks for the images and the tips. Do you have any images of your patient > post-intervention? > > > > With regards to my patient, I agree with you about possibility of improving > with conventional surgery. All patients post VAD will have a trial of > recovery and if he does recover we would take out VAD. It is though > extremely unlikely in this case I suspect. He would have an MVR, tricuspid > repair and single vessel CABG at time of VAD implant. The other reason we > often do conventional surgery at time of VAD implant is that if the VAD were > to be infected, explantation of VAD may sometimes be an option even if > cardiac function still suboptimal. What kind of left atrial incision would > you make to approach the mitral valve here? ALso can you elaborate more on > your method of LA plication - i think you have described it to us before. > Are there drawbacks to plication (esp hemorrhage - as you know VADs, > especially reoperative VADs, are bloody operations as they are, so wouldnt > want to add more bleeding sources if I can avoid it)? Could one rather than > plicate just reconstruct a new LA roof using bovine pericarium to divert > blood from the four veins to the valve? What to do with that giant LAA? The > neck is about 7cm wide so I assume usual approaches cant fix this one, so > (and Tea may like this) evidence of fallacy of our categorical discusssions > on techniques of LAA closure. Do you though find any direct postoperative > benefit you can relate to your LA reduction procedures? Finally what is the > usefullness of doing a maze in such a patient - have you seen sustained > conversions in such a setting with restored functionality of the atria - his > atrium must have been this big for decades now? Patients ventricular rate is > 80s or 90s in atrial fibrillation. > > > > > > I think the transplant would be even more of a challenge than MVR and VAD, > but at least at this operation I could get an idea as to how distorted the > anatomy is. > > > > Thanks > > > > Ani > > > From: prasannasimha@gmail.com > > Date: Mon, 1 Jun 2009 06:26:16 +0530 > > Subject: Re: [HSF] Image of the week: Giant Left Atrium > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > If this patient has MS MR why not stabilize and try MVR LA reduction > first. > > His CVP is 12 so I would be loath to right him off to a transplant option > > (in my place we would have to call him "inoperable". > > Many of these patients with MS MR may have tachycardia induced myopathy > due > > to Afib and do surprisingly well. You may use an LVAD if you want with an > > option of bridge to recovery. > > I would still do a electroc or cryo maze in this patient and plicate the > > atrium. This will give a smaller atrium for your VAD placement too if > > required. > > I am saying this because time and again we get such patients who > initially > > look terribly sick, have low EF's etc etc in the decompensated phase and > > well they bounce back. > > What is his heart rate ? I am sure his ventricular rate is pretty high. > > (Remember the patient with the large LV - he followed up on Saturday. EF > > has improved to 50 % and he is doing well. We are still "upping " his > > Carvedilol and his LV size is progressively decreasing. > > If you want to see something largr - well here it is !! > > Keep glue and bovine pericardium ready in case you need it. > > Incidentally you (as you have mentioned) may have a terrible problem of > > pulmonary vein displacement which may even need tube graft replacement of > > the atrium using a bovine pericardial roll. > > Prasanna > > > > On Sun, May 31, 2009 at 11:26 PM, Ani Anyanwu >wrote: > > > > > > > > A pathologic finding I know prasanna and others are more familiar with > but > > > one that is alien in my practice. > > > > > > > > > > > > 59 year old man status post mitral valve repair for rheumatic valve > disease > > > 20 years ago. Now presents in stage D heart failure and currently > admitted > > > in CCU in low-output state dependent on continuous milrinone infusion. > Echo > > > shows severe biventricular dysfunction, severe MR and moderate MS. > Etiology > > > of cardiomyopathy unclear but may be rheumatic and seems distinct from > > > valvular dysfunction. Hemodynamics include PCW 28, PA 70/30, RA 12. > > > Currently being evaluated for cardiac transplantation. Conventional > surgery > > > (MVR) is an option but unlikely to impact (and may worsen) the > biventricular > > > dysfunction. Will likely need left ventricular assist device as bridge > to > > > transplantation. > > > > > > > > > > > > Representative CT images showing giant atrium are shown. Poses > particular > > > problems for LVAD implantation because LV apex is rotated posteriorly > deep > > > into left chest so may not be ammenable to standard LVAD implant > techniques > > > that rely on anterior position of LV apex. Also high thromboembolic > > > potential with giant atrium. Will need a mitral valve replacement at > time of > > > LVAD. Transplantation equally challenging because of need to anastomose > a > > > giant atrium to a small donor atrium. Also the giant atrium has splayed > and > > > distorted position of great vessels. Because donor heart considerably > > > smaller high chance of kinking or stretching vascular connections. > Approach > > > might have to be total cardiac excision and total implantation > technique > > > with great vessels all anastomosed independently using conduits or > patches > > > to facilitate as required as opposed to standard approach which > involves > > > atrial anastomosis of left +/- right atrium. > > > > > > > > > > > > Ani > > > > > > _________________________________________________________________ > > > View your Twitter and Flickr updates from one place ? Learn more! > > > http://clk.atdmt.com/UKM/go/137984870/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 > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > > http://clk.atdmt.com/UKM/go/134665338/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 -------------- next part -------------- A non-text attachment was scrubbed... Name: laplication prepost.jpg Type: image/jpeg Size: 66518 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090601/40677f74/laplicationprepost-0001.jpg From tusharnalini at gmail.com Mon Jun 1 23:21:42 2009 From: tusharnalini at gmail.com (Tushar Shah) Date: Mon Jun 1 13:00:14 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: Jai Ho, Prof. Prasanna! Tushar On Mon, Jun 1, 2009 at 9:59 PM, Prasanna Simha M wrote: > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > Institute and Rajiv Gandhi Medical University (All medical , dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 fc2020 at columbia.edu Mon Jun 1 14:05:18 2009 From: fc2020 at columbia.edu (Faisal H. Cheema, M.D.) Date: Mon Jun 1 13:06:46 2009 Subject: [HSF] News on promotion In-Reply-To: <006465C2-BB2A-4513-9799-22785A7B168B@aol.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> <694803DBB928D340937CEA75F9B1F8DA05F9CA1F@VHAV15MSGA2.v15.med.va.gov> <006465C2-BB2A-4513-9799-22785A7B168B@aol.com> Message-ID: Great news, indeed! Congratulations PROFESSOR SIMHA! On Jun 1, 2009, at 12:46 PM, Edward P. Raines wrote: > Congratulations. Overdue probably > > Sent from my iPhone > > On Jun 1, 2009, at 11:39 AM, "Crittenden, Michael D. (STL)" > wrote: > >> Congratulations Prasanna. Your promotion is well deserved. >> >> -----Original Message----- >> From: openheart-l-bounces@lists.hsforum.com >> [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna >> Simha M >> Sent: Monday, June 01, 2009 11:29 AM >> To: OpenHeart-L >> Subject: [HSF] News on promotion >> >> I would like to share with the HSF fraternity that I have today been >> promoted as a full Professor in Cardiothoracic and Vascular Surgery >> in >> my >> Institute and Rajiv Gandhi Medical University (All medical , >> dental and >> allied health science courses in my state come under this >> university). >> HSF and Mark Levinson in particular have helped me a lot through this >> process. >> Prasanna >> -- >> 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 >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, 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 > ----------------------------------------- > ---------------------------------------------------- Faisal H. Cheema, M.D. Associate Research Scientist, Division of Cardiothoracic Surgery Director, CAPTURE ? Columbia Presbyterian Tissue Repository College of Physicians and Surgeons of Columbia University - New York Presbyterian Hospital, MHB 7 GN 435, 177 Fort Washington Ave, New York, NY 10032 Office: (212) 305 5108, Pager: (917) 899 4698, Fax: (212) 342 5309, Cell: (917) 499 5115 From ceyildiz at yeditepe.edu.tr Mon Jun 1 21:06:37 2009 From: ceyildiz at yeditepe.edu.tr (Cenk Eray Yildiz) Date: Mon Jun 1 13:09:04 2009 Subject: [HSF] =?iso-8859-9?q?=DDLT=3A_OpenHeart-L_Digest=2C_Vol_60=2C_Is?= =?iso-8859-9?q?sue_3?= In-Reply-To: <20090601165337.4CFF8169DE8@lists.hsforum.com> References: <20090601165337.4CFF8169DE8@lists.hsforum.com> Message-ID: <36E3B2724BDDB1469E239F1445E1CD36A2544A57EC@mailbox1.yeditepe.idr> Please, don't sent me e-mail anymore,ok. ________________________________________ Kimden: openheart-l-bounces@lists.hsforum.com [openheart-l-bounces@lists.hsforum.com], openheart-l-request@lists.hsforum.com [openheart-l-request@lists.hsforum.com] Ad?na Tarih: 01 Haziran 2009 Pazartesi 19:53 Kime: openheart-l@lists.hsforum.com Konu: OpenHeart-L Digest, Vol 60, Issue 3 Send OpenHeart-L mailing list submissions to openheart-l@lists.hsforum.com To subscribe or unsubscribe via the World Wide Web, visit http://mmp.cjp.com/mailman/listinfo/openheart-l or, via email, send a message with subject or body 'help' to openheart-l-request@lists.hsforum.com You can reach the person managing the list at openheart-l-owner@lists.hsforum.com When replying, please edit your Subject line so it is more specific than "Re: Contents of OpenHeart-L digest..." -- This message was scanned by Yeditepe Guvercin and is believed to be clean. Click here to report this message as spam. http://guvercin.yeditepe.edu.tr/cgi-bin/learn-msg.cgi?id=B55E327E40.D20C5 "Bu mesaj (ve ekleri) gizli bilgi i?ermektedir ve sadece g?nderilen ki?iye y?neliktir. Bu e-mailin muhatab? de?ilseniz veya i?eri?i ile ilginiz yoksa, Yeditepe ?niversitesinin onay? olmaks?z?n bu mesaj?n okunmas?, de?i?tirilmesi, kopyalanmas?, ???nc? ki?ilere a??klanmas?, yay?nlanmas?, if?a edilmesi veya iletilmesi yasakt?r. Bu mesaj?n g?nderilmek istendi?i ki?i de?ilseniz (ya da bu e-posta'y? yanl??l?kla ald?ysan?z), l?tfen yollayan ki?iyi hemen haberdar ediniz ve mesaj? sisteminizden derhal siliniz. E-mail iletiminin g?venli veya hatas?z oldu?unun garantisi olmad???ndan ge? veya eksik iletim veya i?erik ve bilgilerde eksiklik, kay?p, de?i?iklik veya vir?s olabilir. Bu nedenle, bu mesaj?n iletiminden dolay?, Yeditepe ?niversitesi , i?erikteki hata, eksiklik, do?rulu?un ve gizlili?in ihlalinden veya bu yolla bilgi payla??m?, iletimi, depolanmas? gibi herhangi bir kullan?m?ndan hi?bir ?ekilde sorumlu de?ildir. Bu mesaj?n i?eri?i yazar?na ait olup, ?niversitemizin g?r??lerini i?ermeyebilir. Bu mesaj?n i?eri?inde ge?en ?niversitemizin ad veya nan?ma yarat?lan fikri ve s?nai haklar ?niversitemize ait olup, maddi ve manevi t?m haklar? sakl?d?r." "This Message (including any attachments) contains confidential information and is intended only for the individual named. If you are not the named adressee or not related with the content of this Message, you are forbidden to read, disseminate, distribute, copy, reproduce or modify this mail by Yeditepe University. Please notfy the sender immediately if you have received this e-mail by mistake and delete this e-mail from your system. E-mail transmisson can not be guaranteed to be secure or error-free as the mail may arrive late or incomplete or the information could be intercepted, corrupted, lost, destroyed, amended, , or contain viruses. Yeditepe University therefore does not accept liability for any errors, loss of integrity or confidentiality or ommissions in the contents of this Message or for the information transmission, reception, storage of use of such in any way whatsoever, which arise as a result of e-mail transmission. Any opinions expressed in this message are those of the author and may not necessarily reflect the opinions of Our University. Copyright in documents created by or on behalf of our University remains vested in us, and we assert all of our moral and intellectual property rights." -- This message was scanned by Yeditepe Guvercin and is believed to be clean. -------------- next part -------------- Today's Topics: 1. Re: News on promotion (Salerno, Tomas) 2. RE: News on promotion (Crittenden, Michael D. (STL)) 3. Re: News on promotion (hgrmd@aol.com) 4. Re: News on promotion (Edward P. Raines) 5. Re: Image of the week: Giant Left Atrium (Prasanna Simha M) -------------- next part -------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To unsubscribe, change email address, or view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by this listServ are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From alaudito at cedarsurg.com Mon Jun 1 17:11:32 2009 From: alaudito at cedarsurg.com (alaudito@cedarsurg.com) Date: Mon Jun 1 13:11:44 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com><89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: <452161851-1243876275-cardhu_decombobulator_blackberry.rim.net-439764297-@bxe1249.bisx.prod.on.blackberry> Q29uZ3JhdHVsYXRpb25zIHRvIHlvdS4NCldlbGwgZGVzZXJ2ZWQuLi4NCkFudG9uaW8NClNlbnQg ZnJvbSBteSBWZXJpem9uIFdpcmVsZXNzIEJsYWNrQmVycnkNCg0KLS0tLS1PcmlnaW5hbCBNZXNz YWdlLS0tLS0NCkZyb206IFByYXNhbm5hIFNpbWhhIE0gPHByYXNhbm5hc2ltaGFAZ21haWwuY29t Pg0KDQpEYXRlOiBNb24sIDEgSnVuIDIwMDkgMjE6NTk6MTYgDQpUbzogT3BlbkhlYXJ0LUw8T3Bl bkhlYXJ0LUxAbGlzdHMuaHNmb3J1bS5jb20+DQpTdWJqZWN0OiBbSFNGXSBOZXdzIG9uIHByb21v dGlvbg0KDQoNCkkgd291bGQgbGlrZSB0byBzaGFyZSB3aXRoIHRoZSBIU0YgZnJhdGVybml0eSB0 aGF0IEkgaGF2ZSB0b2RheSBiZWVuDQpwcm9tb3RlZCBhcyBhIGZ1bGwgUHJvZmVzc29yIGluIENh cmRpb3Rob3JhY2ljIGFuZCBWYXNjdWxhciBTdXJnZXJ5IGluIG15DQpJbnN0aXR1dGUgYW5kIFJh aml2IEdhbmRoaSAgTWVkaWNhbCBVbml2ZXJzaXR5IChBbGwgbWVkaWNhbCAsIGRlbnRhbCBhbmQN CmFsbGllZCBoZWFsdGggc2NpZW5jZSBjb3Vyc2VzIGluIG15IHN0YXRlIGNvbWUgdW5kZXIgdGhp cyB1bml2ZXJzaXR5KS4NCkhTRiBhbmQgTWFyayBMZXZpbnNvbiBpbiBwYXJ0aWN1bGFyIGhhdmUg aGVscGVkIG1lIGEgbG90IHRocm91Z2ggdGhpcw0KcHJvY2Vzcy4NClByYXNhbm5hDQotLSANClBy YXNhbm5hIFNpbWhhIE0NCg0KDQoNCi0tIA0KUHJhc2FubmEgU2ltaGEgTQ0KX19fX19fX19fX19f X19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX18NCk9wZW5IZWFydC1MIG1haWxpbmcg bGlzdA0KDQpTZW5kIHBvc3RpbmdzIHRvOg0KIE9wZW5IZWFydC1MQGxpc3RzLmhzZm9ydW0uY29t DQoNClRvIFVOU1VCU0NSSUJFLCB0byBDSEFOR0UgZW1haWwgYWRkcmVzcywgb3IgdG8gdmlldyBh cmNoaXZlczoNCmh0dHA6Ly9tbXAuY2pwLmNvbS9tYWlsbWFuL2xpc3RpbmZvL29wZW5oZWFydC1s DQoNCkFsbCBtZXNzYWdlcyB0cmFuc21pdHRlZCBieSB0aGUgT3BlbkhlYXJ0LUwgYXJlIHN1Ympl Y3QgdG8gdGhlIHBvbGljaWVzIGFuZCANCmRpc2NsYWltZXJzIHBvc3RlZCBhdDoNCmh0dHA6Ly93 d3cuaHNmb3J1bS5jb20vbGlzdGRpc2NsYWltDQotLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0t LS0tLS0tLS0tLS0tLQ0KDQo= From tacuff at swbell.net Mon Jun 1 11:16:14 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon Jun 1 13:16:42 2009 Subject: [HSF] News on promotion Message-ID: <159524.6506.qm@web81601.mail.mud.yahoo.com> I don't suppose my double talk helped any as you fly way above it. Congratulations, Professor. We respect you highly. Tea Sent from my iPhone On Jun 1, 2009, at 11:29 AM, Prasanna Simha M wrote: I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- 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 ecdouville at orclinic.com Mon Jun 1 11:19:41 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Mon Jun 1 13:21:33 2009 Subject: [HSF] News on promotion References: Message-ID: Prasanna i have learned a lot from you over the past years and the thoughtful posts you always place. Congratulations to you, and also to the leaders of your institution, for recognizing this. chuckdouville ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Salerno, Tomas Sent: Mon 6/1/2009 9:40 AM To: 'OpenHeart-L@lists.hsforum.com' Subject: Re: [HSF] News on promotion Congratulations! Well deserved Tomas ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: OpenHeart-L Sent: Mon Jun 01 12:29:16 2009 Subject: [HSF] News on promotion I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- 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 prasannasimha at gmail.com Mon Jun 1 23:54:14 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Jun 1 13:25:07 2009 Subject: [HSF] News on promotion In-Reply-To: <159524.6506.qm@web81601.mail.mud.yahoo.com> References: <159524.6506.qm@web81601.mail.mud.yahoo.com> Message-ID: <89c4ed2d0906011024h188b5655icb8d1c8818389f7a@mail.gmail.com> You know Tea you gave a "dig" at me as "Professor" just yesterday (wrt the suturing the RA discussion). Since I knew it (the promotion) was coming I had a silent chuckle !! Thanks to all the members for the good wishes and I hope I work hard to be worthy of the post. Prasanna On Mon, Jun 1, 2009 at 10:46 PM, Tea Acuff wrote: > > I don't suppose my double talk helped any as you fly way above it. > Congratulations, Professor. We respect you highly. > Tea > > > Sent from my iPhone > > On Jun 1, 2009, at 11:29 AM, Prasanna Simha M > wrote: > > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > Institute and Rajiv Gandhi Medical University (All medical , dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 prasannasimha at gmail.com Mon Jun 1 23:58:51 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Jun 1 13:29:43 2009 Subject: Fwd: [HSF] LA Plication Reduction Plasty In-Reply-To: <4564611C.8040605@gmail.com> References: <20061122044114.46193.qmail@web81603.mail.mud.yahoo.com> <4564611C.8040605@gmail.com> Message-ID: <89c4ed2d0906011028t7f50fb5ds6399ee26962fa5a@mail.gmail.com> Old discussion on plication ---------- Forwarded message ---------- From: prasannasimha Date: Wed, Nov 22, 2006 at 8:09 PM Subject: Re: [HSF] LA Plication Reduction Plasty To: OpenHeart-L@lists.hsforum.com These are the lines in a poorly made diagram. My scanner is giving problems. Last few days has been an electronic nightmare !! Hope you get the idea with the figure Prasanna Tea Acuff wrote: Can you draw a picture? It is hard to see what was where? tea ----- Original Message ---- From: prasannasimha To: OpenHeart-L@lists.hsforum.com Sent: Tuesday, November 21, 2006 8:45:56 PM Subject: Re: [HSF] LA Plication Reduction Plasty Nasser , this is an old picture of a case which required a replacement and excision of the LA was also done. I did not excise the LA in the case that was discussed but just plicate-imbricated it. I also had conserved his native valve. Prasanna psimha wrote: I use the technique described by Kawazoe which involves interpulmonary vein plication, plication between the pulmonary veins and the mitral annulus and at the roof of the LA. I usually do not do this unless the LA is really huge and papery thin or with an associated cardiovocal syndrome as I have seen that these LA's can and will reduce in size with establishment of sinus rhythm and correction of the mitral disease.. I also at times resected a patch of LA from the inferior end of the atriotomy extending to the area between the pulmonary veins but after the case with the papery thin LA which bled and was difficult to get hemostasis, I am plicating extensively rather than excising in such LA's - easier and less of a bother. Plication involves both plication and inverting so the exposed internal surface is only one suture line. I think I sent a set of pictures once. In that I had also excised the LA. Some people use a method described by Batista - explant the heart , trim the LA and auto transplant it back. I am wary of doing such an extensive procedure when an easier alternative exists. People who have done it say that replacement is very easy though I have not heard about a repair being done and tested. On the other hand - how difficult is it to expose the mitral valve in a giant LA - the Giant LA allows the mitral valve to be easily exposed any way. Prasanna Nasser F. Abou'Seada wrote: Dear Prasanna ... would you elaborate more on your technique doing left atrial "placation reduction plasty" ..? NFA -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l -bounces@lists.hsforum.com] On Behalf Of prasannasimha Sent: Monday, November 20, 2006 12:57 PM To: Michael Kuiper Cc: OpenHeart-L@lists.hsforum.com; ccm Subject: [HSF] Re: ccmlquiz20/11/2006 That was a giant LA in a patient with MR with Cardiovocal syndrome (Ortner's Syndrome) This is his X Ray immediately post op after an MVR + Electocautery Maze + Kawazoe procedure (Left atrial plication reduction plasty ) done on the 15th. Prasanna Michael Kuiper wrote: not immediately.... it may be the heart... ----- Original Message ----- From: "prasannasimha" To: ; "ccm" Sent: Monday, November 20, 2006 6:43 PM Subject: ccmlquiz20/11/2006 Will you put a chest tube in this patient ? Prasanna __________ NOD32 1873 (20061120) Informatie __________ Dit bericht is gecontroleerd door het NOD32 Antivirus Systeem.http://www.nod32.nl _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives:http://mmp.cjp.com/mailman/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 -------------- next part -------------- A non-text attachment was scrubbed... Name: KAWAZOE lines.jpg Type: image/jpeg Size: 43703 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090601/1d531b41/KAWAZOElines-0001.jpg From msfirst at gmail.com Mon Jun 1 14:26:08 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Mon Jun 1 13:34:47 2009 Subject: [HSF] News on promotion In-Reply-To: <159524.6506.qm@web81601.mail.mud.yahoo.com> References: <159524.6506.qm@web81601.mail.mud.yahoo.com> Message-ID: Wait a minute!!!! All of this time we were relying on the wisdom, advice, and vision of someone who are not a full professor???? That is great news Congrats and obviously well deserving. Are you still going to associate with us rugrats as you look down from your throne in the Irovy Tower? -michael On Mon, Jun 1, 2009 at 1:16 PM, Tea Acuff wrote: > > I don't suppose my double talk helped any as you fly way above it. > Congratulations, Professor. We respect you highly. > Tea > > > Sent from my iPhone > > On Jun 1, 2009, at 11:29 AM, Prasanna Simha M > wrote: > > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > Institute and Rajiv Gandhi Medical University (All medical , dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 > ----------------------------------------- > From prasannasimha at gmail.com Mon Jun 1 23:59:42 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Jun 1 13:36:19 2009 Subject: Fwd: [HSF] LA Plication Reduction Plasty In-Reply-To: <4563B9E4.6010803@gmail.com> References: <001301c70daa$91ec91b0$0401a8c0@OEM> <4563B75E.4060506@sify.com> <4563B9E4.6010803@gmail.com> Message-ID: <89c4ed2d0906011029j698b4118r9452d24772240f6c@mail.gmail.com> For Ani 's case - old pictures ---------- Forwarded message ---------- From: prasannasimha Date: Wed, Nov 22, 2006 at 8:15 AM Subject: Re: [HSF] LA Plication Reduction Plasty To: OpenHeart-L@lists.hsforum.com Nasser , this is an old picture of a case which required a replacement and excision of the LA was also done. I did not excise the LA in the case that was discussed but just plicate-imbricated it. I also had conserved his native valve. Prasanna psimha wrote: > I use the technique described by Kawazoe which involves interpulmonary vein > plication, plication between the pulmonary veins and the mitral annulus and > at the roof of the LA. I usually do not do this unless the LA is really huge > and papery thin or with an associated cardiovocal syndrome as I have seen > that these LA's can and will reduce in size with establishment of sinus > rhythm and correction of the mitral disease.. I also at times resected a > patch of LA from the inferior end of the atriotomy extending to the area > between the pulmonary veins but after the case with the papery thin LA which > bled and was difficult to get hemostasis, I am plicating extensively rather > than excising in such LA's - easier and less of a bother. Plication involves > both plication and inverting so the exposed internal surface is only one > suture line. I think I sent a set of pictures once. In that I had also > excised the LA. > Some people use a method described by Batista - explant the heart , trim > the LA and auto transplant it back. I am wary of doing such an extensive > procedure when an easier alternative exists. People who have done it say > that replacement is very easy though I have not heard about a repair being > done and tested. On the other hand - how difficult is it to expose the > mitral valve in a giant LA - the Giant LA allows the mitral valve to be > easily exposed any way. > Prasanna > Nasser F. Abou'Seada wrote: > >> Dear Prasanna ... >> would you elaborate more on your technique doing left atrial "placation >> reduction plasty" ..? >> >> NFA >> >> >> >>> -----Original Message----- >>> From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l- >>> bounces@lists.hsforum.com] On Behalf Of prasannasimha >>> Sent: Monday, November 20, 2006 12:57 PM >>> To: Michael Kuiper >>> Cc: OpenHeart-L@lists.hsforum.com; ccm >>> Subject: [HSF] Re: ccmlquiz20/11/2006 >>> >>> That was a giant LA in a patient with MR with Cardiovocal syndrome >>> (Ortner's Syndrome) >>> This is his X Ray immediately post op after an MVR + Electocautery Maze >>> + Kawazoe procedure (Left atrial plication reduction plasty ) done on >>> the 15th. >>> >>> Prasanna >>> >>> Michael Kuiper wrote: >>> >>> >>>> not immediately.... it may be the heart... >>>> >>>> ----- Original Message ----- From: "prasannasimha" >>>> >>>> To: ; "ccm" >>>> Sent: Monday, November 20, 2006 6:43 PM >>>> Subject: ccmlquiz20/11/2006 >>>> >>>> >>>> >>>> >>>>> Will you put a chest tube in this patient ? >>>>> >>>>> Prasanna >>>>> >>>>> >>>>> >>>>> >>>>> __________ NOD32 1873 (20061120) Informatie __________ >>>>> >>>>> Dit bericht is gecontroleerd door het NOD32 Antivirus Systeem. >>>>> http://www.nod32.nl >>>>> >>>>> >>>>> >>>>> >>>> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 -------------- next part -------------- A non-text attachment was scrubbed... Name: La plication.jpg Type: image/jpeg Size: 106004 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090601/a7275a57/Laplication-0001.jpg From tacuff at swbell.net Mon Jun 1 11:43:50 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon Jun 1 13:44:22 2009 Subject: [HSF] News on promotion Message-ID: <15122.88352.qm@web81602.mail.mud.yahoo.com> That is why I had to say that we respect you despite your new title! Tea Sent from my iPhone On Jun 1, 2009, at 12:24 PM, Prasanna Simha M wrote: You know Tea you gave a "dig" at me as "Professor" just yesterday (wrt the suturing the RA discussion). Since I knew it (the promotion) was coming I had a silent chuckle !! Thanks to all the members for the good wishes and I hope I work hard to be worthy of the post. Prasanna On Mon, Jun 1, 2009 at 10:46 PM, Tea Acuff wrote: I don't suppose my double talk helped any as you fly way above it. Congratulations, Professor. We respect you highly. Tea Sent from my iPhone On Jun 1, 2009, at 11:29 AM, Prasanna Simha M wrote: I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- 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 _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Tue Jun 2 00:16:29 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Jun 1 13:47:17 2009 Subject: [HSF] News on promotion In-Reply-To: References: <159524.6506.qm@web81601.mail.mud.yahoo.com> Message-ID: <89c4ed2d0906011046j7dcfbff5vde8ee92d54422b85@mail.gmail.com> As far a sitting in the Ivory tower there is an ancient rite done by the Karate master when his student becomes a Sensei (getting his black belt and becoming the "little master"). The teacher brings out his old black belt awarded to him by his teacher - the black color being worn out and now speckled white to indicate that the teacher at last becomes a true student at that time.He changes and wears the worn out black - white belt while presenting the new black belt to his student. It drove me to tears during my Son's black belt awarding ceremony. Prasanna On Mon, Jun 1, 2009 at 10:56 PM, Michael Firstenberg wrote: > Wait a minute!!!! > All of this time we were relying on the wisdom, advice, and vision of > someone who are not a full professor???? > > > That is great news > Congrats and obviously well deserving. > Are you still going to associate with us rugrats as you look down from your > throne in the Irovy Tower? > > -michael > > > > > On Mon, Jun 1, 2009 at 1:16 PM, Tea Acuff wrote: > > > > > I don't suppose my double talk helped any as you fly way above it. > > Congratulations, Professor. We respect you highly. > > Tea > > > > > > Sent from my iPhone > > > > On Jun 1, 2009, at 11:29 AM, Prasanna Simha M > > wrote: > > > > I would like to share with the HSF fraternity that I have today been > > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > > Institute and Rajiv Gandhi Medical University (All medical , dental and > > allied health science courses in my state come under this university). > > HSF and Mark Levinson in particular have helped me a lot through this > > process. > > Prasanna > > -- > > 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 > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mon Jun 1 18:50:35 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Mon Jun 1 13:51:53 2009 Subject: [HSF] Valve in-a-valve In-Reply-To: References: <545719.94210.qm@web81605.mail.mud.yahoo.com> Message-ID: <748443300-1243878625-cardhu_decombobulator_blackberry.rim.net-2143713635-@bxe1016.bisx.prod.on.blackberry> Roberto, Out of the more than 200 AVI's that Tommy has done, I would expect more than 3 or 4 valve in valves. Have any of them not gone well? Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Roberto Battellini Date: Mon, 1 Jun 2009 11:46:07 To: lists HSF Subject: RE: [HSF] Valve in-a-valve Hal, 3 or 4 cases with good result are nothing but a good beginning. We need more time, more cases. Roberto > Date: Sun, 31 May 2009 12:47:30 -0700 > From: tacuff@swbell.net > Subject: Re: [HSF] Prosthesis Choice > To: OpenHeart-L@lists.hsforum.com > CC: > > There you go again, Bob. We have a nice category like prosthetic valve implant and you start taking it apart to suit your purpose. Would you stay on subject please. > > tea > > > >________________________________ > From: "Rwmfglycar@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Sunday, May 31, 2009 2:27:08 PM > Subject: Re: [HSF] Prosthesis Choice > > Much will depend on what size valve was put in first. Note thjat with a > coronal frame this could be stretched but with a metal ring in the structure > at the base this will not be expandable.I have seen onecase in which the > residual gradient after the valve in valve was placed, was clearly > unacceptably high > Bob > > > In a message dated 5/31/2009 6:52:36 P.M. South Africa Standard Time, > Hgrmd@aol.com writes: > > >From what I saw and heard at Carpentier's last meeting, the "valve in > valve" solution is still a ways off. Cribier was at the meeting and it > was his > opinion that a good prosthesis for "valve in valve" had not yet been > invented. Since he started the whole field, I think you have to take him > at his > word. Fred Mohr has been enthusiastic about this approach, but I'm not > sure if this enthusiasm is backed up by actual clinical experience. > Maybe > Roberto could enlighten us. > > Hal > > > In a message dated 5/31/2009 12:21:23 A.M. Eastern Daylight Time, > gabuin@intramed.net writes: > > I will choose a biological device because you have the advantage of no > anticoagulate this kind of patient and if the valve become stenotic in a > few > years, you can replace it with a "valve into a valve" percutaneously. > > ----- Original Message ----- > From: "Ani Anyanwu" > To: > Sent: Saturday, May 30, 2009 4:22 PM > Subject: RE: [HSF] Prosthesis Choice > > > > Thought we should talk about a real patients to give a break from the > theoretical stuff. Would be keen to hear thoughts from forum members on > this > case. > > > > 39 year old male with lupus erythematosus. Chronic renal failure on > hemodialysis for 10 years. Plagued by problems with access for dialysis > mainly related to fistula non function and line sepsis. Has so far > declined > peritoneal dialysis. Avascular necrosis of both hips which causes severe > pain so cannot walk and uses an electric wheelchair to mobilize for many > years. Also has long history of hypertension with resultant left > ventricular > hypertrophy. Echocardiogram done end of last year showed no valve > dysfunctions of note. He is on a list for a cadaveric renal transplant > and > has some other medical problems which I wont detail but enough to say he > does have high need for medical care interventions. > > > > Presented last week again with fevers. Blood cultures positive for Staph > lugdunensis. Echocardiogram shows mitral valve endocarditis with > vegetations > on anterior leaflet, vegetations and perforation and possible abscess on > posterior leaflet. Severe mitral regurgitation likely Carpentier Type I. > Anterior leaflet much thickened compared to echo last year - vegetation > on > anterior leaflet about 1.7cm long and prolapses into LV with each beat. > Additionally has aortic valve vegetations on left and non-coronary cusps > with moderate regurgitation. There does not seem to be annular abscess. > There is also a 2cm right atrial mass at the junction of the superior > cava > and right atrium - close to but not obviously attached to a 'permcath' > dialysis catheter in situ in the atrium, entering form the left > subclavian > vein. No embolic phenomenom. > > > > Surgery is indicated for control of sepsis as still has fevers despite > appropriate antimicrobial therapy and also for increasing heart failure. > Obviously the catheter has to come out and probably perioneal dialysis > should be employed for a while at least. Also despite his chronic disease > he > is relatively very functional and no reason to believe he cannot expect > mid > to long-term survival. My questions arise as to choice of prosthesis in > this > patient. The mitral valve may potentially be repairable by pericardial > patch > of anterior leaflet and some form of resection+/-sliding+/-patch of > posterior leaflet but will depend on OR findings. Aortic lealfets > destroyed > so will need to be replaced. Plan to operate in 48 hrs (because of > weekend > rather than any medical reason). > > > > 1) Assuming mitral valve is repairable (regardless of your opinion on > repair > in this scenario) what prosthesis would you use for the aortic valve? > > 2) Assuming both mitral and aortic valve need to be replaced what > prosthesis > would you choose? > > > > Thanks > > > > Ani > > > >_________________________________________________________________ > Beyond Hotmail ? see what else you can do with Windows Live. > http://clk.atdmt.com/UKM/go/134665375/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 > ----------------------------------------- > > > ---------------------------------------------------------------------------- > ---- > > > > No virus found in this incoming message. > Checked by AVG - www.avg.com > Version: 8.5.339 / Virus Database: 270.12.46/2143 - Release Date: > 05/30/09 > > 05:53:00 > >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > **************Obama Urges Homeowners to Refi! $133K Mortgage for $679/Mo > CALCULATE NEW PAYMENT > (http://pr.atwola.com/promoclk/10012 > 6575x1221359311x1201370063/aol?redir=https://www.lowermybills.com/servlet/LMBServlet?the_action=N > avigateHomeLoansAdRedirect&sourceid=lmb-17065-34614&moid=20187) >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > **************An Excellent Credit Score is 750. See Yours in Just 2 Easy > Steps! > (http://pr.atwola.com/promoclk/100126575x1221823251x1201398665/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=May > ExcfooterNO62) >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 valdretemd at shaw.ca Mon Jun 1 11:51:13 2009 From: valdretemd at shaw.ca (V. Aldrete, M.D.) Date: Mon Jun 1 13:52:47 2009 Subject: [HSF] Image of the week: Giant Left Atrium In-Reply-To: <89c4ed2d0906010952v216db76cs1055c657d77ebc24@mail.gmail.com> References: <1386563229-1243788898-cardhu_decombobulator_blackberry.rim.net-1106819329-@bxe1016.bisx.prod.on.blackberry> <89c4ed2d0905310959x2f44fdf4ja6f89d863af8ba98@mail.gmail.com> <03f201c9e212$a723a6b0$13cde818@LIBERTAD> <89c4ed2d0905311756r78ebfaf5idd12691a6f52cb8f@mail.gmail.com> <89c4ed2d0906010952v216db76cs1055c657d77ebc24@mail.gmail.com> Message-ID: <4904AC9E-EA81-4101-866D-1ACC1DD23DA6@shaw.ca> Hi Prassana, Is this the photo you wanted? -------------- next part -------------- A non-text attachment was scrubbed... Name: La plication.jpg Type: image/jpeg Size: 70834 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090601/b720e061/Laplication-0001.jpg -------------- next part -------------- On 1-Jun-09, at 9:52 AM, Prasanna Simha M wrote: > I will dig out the photographs and the discussion. > LA plication is usually straight forward provided you dont make the > mistake > that I did once and lost the patient - do notextensively dissect any > adhesions , open both pleurae if you need "mobility" as the atria > are thin > and adhesiolysis will make you regret it as tissues will bleed.if > you need > to adhesiolyse do not do finger disscetion but use sharp dissection of > adhesions leaving the adventitial "film" (I hope you get what I > mean) over > the atrial tissue as denudation of that will make life horrible. > You can go via the conventional left atrial incision but excise a > good strip > of the "left atrial bulge ". Plicate within the atria. > I have emazed these patients and while they have a lower > persistantconversion rate (around 60 %) those who convert have > dramatic > continued reduction in size on follow up and non converters at least > have a > good rate control. > I would suture the left atrial appendage from inside (You can easily > do a > linear closure. Do not try to dissect the appendage externally - it > may look > tempting but can be particularly messy. I at times just dissect > enough in > that region to remove the "ankylosis" that tethers the mitral annulus > preventing good exposure but usually this is not a problem as the > atrium is > so book you can virtually sit inside and operate. > I would use bovine pericardial well technique only as a last option > if you > have a bleeding mess. > These patients can easily hold a liter of blood inside and it is worth > asking the prfusionist how much his level rises. Youcan bag a > couple of > units of blood and also hemofilter and have enough blood to spare > after > decreasing the size of the atrium !!! > Direct benefits are - improved lung function (you will see the right > lowr > lobe especially open up.Be prepared to bronchsocope if there are > retained > plugs. Less bronchospasm and earlier ventilator wean comapred to > patients > who do not get a reduction and also lower embolic risk periop (the > large LA > can hold air pockets which can be difficult to deair. Use CO2 > liberally once > the main procedure is over to displace air out of the pulmonary veins. > >> >> Prasanna >> >> >> >> Thanks for the images and the tips. Do you have any images of your >> patient >> post-intervention? >> >> >> >> With regards to my patient, I agree with you about possibility of >> improving >> with conventional surgery. All patients post VAD will have a trial of >> recovery and if he does recover we would take out VAD. It is though >> extremely unlikely in this case I suspect. He would have an MVR, >> tricuspid >> repair and single vessel CABG at time of VAD implant. The other >> reason we >> often do conventional surgery at time of VAD implant is that if the >> VAD were >> to be infected, explantation of VAD may sometimes be an option even >> if >> cardiac function still suboptimal. What kind of left atrial >> incision would >> you make to approach the mitral valve here? ALso can you elaborate >> more on >> your method of LA plication - i think you have described it to us >> before. >> Are there drawbacks to plication (esp hemorrhage - as you know VADs, >> especially reoperative VADs, are bloody operations as they are, so >> wouldnt >> want to add more bleeding sources if I can avoid it)? Could one >> rather than >> plicate just reconstruct a new LA roof using bovine pericarium to >> divert >> blood from the four veins to the valve? What to do with that giant >> LAA? The >> neck is about 7cm wide so I assume usual approaches cant fix this >> one, so >> (and Tea may like this) evidence of fallacy of our categorical >> discusssions >> on techniques of LAA closure. Do you though find any direct >> postoperative >> benefit you can relate to your LA reduction procedures? Finally >> what is the >> usefullness of doing a maze in such a patient - have you seen >> sustained >> conversions in such a setting with restored functionality of the >> atria - his >> atrium must have been this big for decades now? Patients >> ventricular rate is >> 80s or 90s in atrial fibrillation. >> >> >> >> >> >> I think the transplant would be even more of a challenge than MVR >> and VAD, >> but at least at this operation I could get an idea as to how >> distorted the >> anatomy is. >> >> >> >> Thanks >> >> >> >> Ani >> >>> From: prasannasimha@gmail.com >>> Date: Mon, 1 Jun 2009 06:26:16 +0530 >>> Subject: Re: [HSF] Image of the week: Giant Left Atrium >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> If this patient has MS MR why not stabilize and try MVR LA reduction >> first. >>> His CVP is 12 so I would be loath to right him off to a transplant >>> option >>> (in my place we would have to call him "inoperable". >>> Many of these patients with MS MR may have tachycardia induced >>> myopathy >> due >>> to Afib and do surprisingly well. You may use an LVAD if you want >>> with an >>> option of bridge to recovery. >>> I would still do a electroc or cryo maze in this patient and >>> plicate the >>> atrium. This will give a smaller atrium for your VAD placement too >>> if >>> required. >>> I am saying this because time and again we get such patients who >> initially >>> look terribly sick, have low EF's etc etc in the decompensated >>> phase and >>> well they bounce back. >>> What is his heart rate ? I am sure his ventricular rate is pretty >>> high. >>> (Remember the patient with the large LV - he followed up on >>> Saturday. EF >>> has improved to 50 % and he is doing well. We are still "upping " >>> his >>> Carvedilol and his LV size is progressively decreasing. >>> If you want to see something largr - well here it is !! >>> Keep glue and bovine pericardium ready in case you need it. >>> Incidentally you (as you have mentioned) may have a terrible >>> problem of >>> pulmonary vein displacement which may even need tube graft >>> replacement of >>> the atrium using a bovine pericardial roll. >>> Prasanna >>> >>> On Sun, May 31, 2009 at 11:26 PM, Ani Anyanwu >>> >> wrote: >>> >>>> >>>> A pathologic finding I know prasanna and others are more familiar >>>> with >> but >>>> one that is alien in my practice. >>>> >>>> >>>> >>>> 59 year old man status post mitral valve repair for rheumatic valve >> disease >>>> 20 years ago. Now presents in stage D heart failure and currently >> admitted >>>> in CCU in low-output state dependent on continuous milrinone >>>> infusion. >> Echo >>>> shows severe biventricular dysfunction, severe MR and moderate MS. >> Etiology >>>> of cardiomyopathy unclear but may be rheumatic and seems distinct >>>> from >>>> valvular dysfunction. Hemodynamics include PCW 28, PA 70/30, RA 12. >>>> Currently being evaluated for cardiac transplantation. Conventional >> surgery >>>> (MVR) is an option but unlikely to impact (and may worsen) the >> biventricular >>>> dysfunction. Will likely need left ventricular assist device as >>>> bridge >> to >>>> transplantation. >>>> >>>> >>>> >>>> Representative CT images showing giant atrium are shown. Poses >> particular >>>> problems for LVAD implantation because LV apex is rotated >>>> posteriorly >> deep >>>> into left chest so may not be ammenable to standard LVAD implant >> techniques >>>> that rely on anterior position of LV apex. Also high thromboembolic >>>> potential with giant atrium. Will need a mitral valve replacement >>>> at >> time of >>>> LVAD. Transplantation equally challenging because of need to >>>> anastomose >> a >>>> giant atrium to a small donor atrium. Also the giant atrium has >>>> splayed >> and >>>> distorted position of great vessels. Because donor heart >>>> considerably >>>> smaller high chance of kinking or stretching vascular connections. >> Approach >>>> might have to be total cardiac excision and total implantation >> technique >>>> with great vessels all anastomosed independently using conduits or >> patches >>>> to facilitate as required as opposed to standard approach which >> involves >>>> atrial anastomosis of left +/- right atrium. >>>> >>>> >>>> >>>> Ani >>>> >>>> _________________________________________________________________ >>>> View your Twitter and Flickr updates from one place ? Learn more! >>>> http://clk.atdmt.com/UKM/go/137984870/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 >> >> _________________________________________________________________ >> Share your photos with Windows Live Photos ? Free. >> >> http://clk.atdmt.com/UKM/go/134665338/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 > prepost.jpg>_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 valdretemd at shaw.ca Mon Jun 1 12:02:08 2009 From: valdretemd at shaw.ca (V. Aldrete, M.D.) Date: Mon Jun 1 14:02:26 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906011024h188b5655icb8d1c8818389f7a@mail.gmail.com> References: <159524.6506.qm@web81601.mail.mud.yahoo.com> <89c4ed2d0906011024h188b5655icb8d1c8818389f7a@mail.gmail.com> Message-ID: <012A471C-9E00-4899-8ED7-C16741205ABF@shaw.ca> As far as I am concerned, you already have. Many of us in this forum have learned much from you. Thank you! Victor On 1-Jun-09, at 10:24 AM, Prasanna Simha M wrote: > You know Tea you gave a "dig" at me as "Professor" just yesterday > (wrt the > suturing the RA discussion). Since I knew it (the promotion) was > coming I > had a silent chuckle !! > Thanks to all the members for the good wishes and I hope I work hard > to be > worthy of the post. > Prasanna > On Mon, Jun 1, 2009 at 10:46 PM, Tea Acuff wrote: > >> >> I don't suppose my double talk helped any as you fly way above it. >> Congratulations, Professor. We respect you highly. >> Tea >> >> >> Sent from my iPhone >> >> On Jun 1, 2009, at 11:29 AM, Prasanna Simha M > > >> wrote: >> >> I would like to share with the HSF fraternity that I have today been >> promoted as a full Professor in Cardiothoracic and Vascular Surgery >> in my >> Institute and Rajiv Gandhi Medical University (All medical , >> dental and >> allied health science courses in my state come under this >> university). >> HSF and Mark Levinson in particular have helped me a lot through this >> process. >> Prasanna >> -- >> 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 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Tue Jun 2 00:32:37 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Jun 1 14:10:18 2009 Subject: [HSF] Image of the week: Giant Left Atrium In-Reply-To: <4904AC9E-EA81-4101-866D-1ACC1DD23DA6@shaw.ca> References: <1386563229-1243788898-cardhu_decombobulator_blackberry.rim.net-1106819329-@bxe1016.bisx.prod.on.blackberry> <89c4ed2d0905310959x2f44fdf4ja6f89d863af8ba98@mail.gmail.com> <03f201c9e212$a723a6b0$13cde818@LIBERTAD> <89c4ed2d0905311756r78ebfaf5idd12691a6f52cb8f@mail.gmail.com> <89c4ed2d0906010952v216db76cs1055c657d77ebc24@mail.gmail.com> <4904AC9E-EA81-4101-866D-1ACC1DD23DA6@shaw.ca> Message-ID: <89c4ed2d0906011102l350950fm18cf89b9b12c82da@mail.gmail.com> Yes. I am also enclosing another pcitrure showing the extent of lower lobe collpase that can be "opened up" after plicating the left atrium. The ling cleared out over a few days. Prasanna On Mon, Jun 1, 2009 at 11:21 PM, V. Aldrete, M.D. wrote: > Hi Prassana, > > Is this the photo you wanted? > > > > On 1-Jun-09, at 9:52 AM, Prasanna Simha M wrote: > > I will dig out the photographs and the discussion. >> LA plication is usually straight forward provided you dont make the >> mistake >> that I did once and lost the patient - do notextensively dissect any >> adhesions , open both pleurae if you need "mobility" as the atria are thin >> and adhesiolysis will make you regret it as tissues will bleed.if you need >> to adhesiolyse do not do finger disscetion but use sharp dissection of >> adhesions leaving the adventitial "film" (I hope you get what I mean) over >> the atrial tissue as denudation of that will make life horrible. >> You can go via the conventional left atrial incision but excise a good >> strip >> of the "left atrial bulge ". Plicate within the atria. >> I have emazed these patients and while they have a lower >> persistantconversion rate (around 60 %) those who convert have dramatic >> continued reduction in size on follow up and non converters at least have >> a >> good rate control. >> I would suture the left atrial appendage from inside (You can easily do a >> linear closure. Do not try to dissect the appendage externally - it may >> look >> tempting but can be particularly messy. I at times just dissect enough in >> that region to remove the "ankylosis" that tethers the mitral annulus >> preventing good exposure but usually this is not a problem as the atrium >> is >> so book you can virtually sit inside and operate. >> I would use bovine pericardial well technique only as a last option if you >> have a bleeding mess. >> These patients can easily hold a liter of blood inside and it is worth >> asking the prfusionist how much his level rises. Youcan bag a couple of >> units of blood and also hemofilter and have enough blood to spare after >> decreasing the size of the atrium !!! >> Direct benefits are - improved lung function (you will see the right lowr >> lobe especially open up.Be prepared to bronchsocope if there are retained >> plugs. Less bronchospasm and earlier ventilator wean comapred to patients >> who do not get a reduction and also lower embolic risk periop (the large >> LA >> can hold air pockets which can be difficult to deair. Use CO2 liberally >> once >> the main procedure is over to displace air out of the pulmonary veins. >> >> >>> Prasanna >>> >>> >>> >>> Thanks for the images and the tips. Do you have any images of your >>> patient >>> post-intervention? >>> >>> >>> >>> With regards to my patient, I agree with you about possibility of >>> improving >>> with conventional surgery. All patients post VAD will have a trial of >>> recovery and if he does recover we would take out VAD. It is though >>> extremely unlikely in this case I suspect. He would have an MVR, >>> tricuspid >>> repair and single vessel CABG at time of VAD implant. The other reason we >>> often do conventional surgery at time of VAD implant is that if the VAD >>> were >>> to be infected, explantation of VAD may sometimes be an option even if >>> cardiac function still suboptimal. What kind of left atrial incision >>> would >>> you make to approach the mitral valve here? ALso can you elaborate more >>> on >>> your method of LA plication - i think you have described it to us before. >>> Are there drawbacks to plication (esp hemorrhage - as you know VADs, >>> especially reoperative VADs, are bloody operations as they are, so >>> wouldnt >>> want to add more bleeding sources if I can avoid it)? Could one rather >>> than >>> plicate just reconstruct a new LA roof using bovine pericarium to divert >>> blood from the four veins to the valve? What to do with that giant LAA? >>> The >>> neck is about 7cm wide so I assume usual approaches cant fix this one, so >>> (and Tea may like this) evidence of fallacy of our categorical >>> discusssions >>> on techniques of LAA closure. Do you though find any direct postoperative >>> benefit you can relate to your LA reduction procedures? Finally what is >>> the >>> usefullness of doing a maze in such a patient - have you seen sustained >>> conversions in such a setting with restored functionality of the atria - >>> his >>> atrium must have been this big for decades now? Patients ventricular rate >>> is >>> 80s or 90s in atrial fibrillation. >>> >>> >>> >>> >>> >>> I think the transplant would be even more of a challenge than MVR and >>> VAD, >>> but at least at this operation I could get an idea as to how distorted >>> the >>> anatomy is. >>> >>> >>> >>> Thanks >>> >>> >>> >>> Ani >>> >>> From: prasannasimha@gmail.com >>>> Date: Mon, 1 Jun 2009 06:26:16 +0530 >>>> Subject: Re: [HSF] Image of the week: Giant Left Atrium >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> >>>> If this patient has MS MR why not stabilize and try MVR LA reduction >>>> >>> first. >>> >>>> His CVP is 12 so I would be loath to right him off to a transplant >>>> option >>>> (in my place we would have to call him "inoperable". >>>> Many of these patients with MS MR may have tachycardia induced myopathy >>>> >>> due >>> >>>> to Afib and do surprisingly well. You may use an LVAD if you want with >>>> an >>>> option of bridge to recovery. >>>> I would still do a electroc or cryo maze in this patient and plicate the >>>> atrium. This will give a smaller atrium for your VAD placement too if >>>> required. >>>> I am saying this because time and again we get such patients who >>>> >>> initially >>> >>>> look terribly sick, have low EF's etc etc in the decompensated phase and >>>> well they bounce back. >>>> What is his heart rate ? I am sure his ventricular rate is pretty high. >>>> (Remember the patient with the large LV - he followed up on Saturday. EF >>>> has improved to 50 % and he is doing well. We are still "upping " his >>>> Carvedilol and his LV size is progressively decreasing. >>>> If you want to see something largr - well here it is !! >>>> Keep glue and bovine pericardium ready in case you need it. >>>> Incidentally you (as you have mentioned) may have a terrible problem of >>>> pulmonary vein displacement which may even need tube graft replacement >>>> of >>>> the atrium using a bovine pericardial roll. >>>> Prasanna >>>> >>>> On Sun, May 31, 2009 at 11:26 PM, Ani Anyanwu >>> wrote: >>>> >>>> >>>>> A pathologic finding I know prasanna and others are more familiar with >>>>> >>>> but >>> >>>> one that is alien in my practice. >>>>> >>>>> >>>>> >>>>> 59 year old man status post mitral valve repair for rheumatic valve >>>>> >>>> disease >>> >>>> 20 years ago. Now presents in stage D heart failure and currently >>>>> >>>> admitted >>> >>>> in CCU in low-output state dependent on continuous milrinone infusion. >>>>> >>>> Echo >>> >>>> shows severe biventricular dysfunction, severe MR and moderate MS. >>>>> >>>> Etiology >>> >>>> of cardiomyopathy unclear but may be rheumatic and seems distinct from >>>>> valvular dysfunction. Hemodynamics include PCW 28, PA 70/30, RA 12. >>>>> Currently being evaluated for cardiac transplantation. Conventional >>>>> >>>> surgery >>> >>>> (MVR) is an option but unlikely to impact (and may worsen) the >>>>> >>>> biventricular >>> >>>> dysfunction. Will likely need left ventricular assist device as bridge >>>>> >>>> to >>> >>>> transplantation. >>>>> >>>>> >>>>> >>>>> Representative CT images showing giant atrium are shown. Poses >>>>> >>>> particular >>> >>>> problems for LVAD implantation because LV apex is rotated posteriorly >>>>> >>>> deep >>> >>>> into left chest so may not be ammenable to standard LVAD implant >>>>> >>>> techniques >>> >>>> that rely on anterior position of LV apex. Also high thromboembolic >>>>> potential with giant atrium. Will need a mitral valve replacement at >>>>> >>>> time of >>> >>>> LVAD. Transplantation equally challenging because of need to anastomose >>>>> >>>> a >>> >>>> giant atrium to a small donor atrium. Also the giant atrium has splayed >>>>> >>>> and >>> >>>> distorted position of great vessels. Because donor heart considerably >>>>> smaller high chance of kinking or stretching vascular connections. >>>>> >>>> Approach >>> >>>> might have to be total cardiac excision and total implantation >>>>> >>>> technique >>> >>>> with great vessels all anastomosed independently using conduits or >>>>> >>>> patches >>> >>>> to facilitate as required as opposed to standard approach which >>>>> >>>> involves >>> >>>> atrial anastomosis of left +/- right atrium. >>>>> >>>>> >>>>> >>>>> Ani >>>>> >>>>> _________________________________________________________________ >>>>> View your Twitter and Flickr updates from one place ? Learn more! >>>>> http://clk.atdmt.com/UKM/go/137984870/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 >>>> >>> >>> _________________________________________________________________ >>> Share your photos with Windows Live Photos ? Free. >>> >>> >>> http://clk.atdmt.com/UKM/go/134665338/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 >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 -------------- next part -------------- A non-text attachment was scrubbed... Name: kawazoelowerlobecollapse.jpg Type: image/jpeg Size: 26683 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090601/a1796bad/kawazoelowerlobecollapse-0001.jpg From rudi at kbd.hr Mon Jun 1 21:18:43 2009 From: rudi at kbd.hr (Igor Rudez) Date: Mon Jun 1 14:19:47 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: <003b01c9e2e5$65c1aef0$1d23a8c0@kbd.hr> Dear Prasanna, >From the bottom of my heart CONGRATULATION! You have certainly deserved it! Igor Rudez -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Monday, June 01, 2009 6:29 PM To: OpenHeart-L Subject: [HSF] News on promotion I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- Prasanna Simha M -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From gabuin at intramed.net Mon Jun 1 09:27:36 2009 From: gabuin at intramed.net (gustavo abuin) Date: Mon Jun 1 14:21:20 2009 Subject: [HSF] VALVE CHOICE IN THE FUTURE? References: <20DBAEF9-A000-43B9-A2D4-67B7D5E68609@gmail.com> Message-ID: <000001c9e2e5$affd21c0$13cde818@LIBERTAD> Ani. Hoping you and your patient are doing well. Many questions about the future, and the only way to know the future is to make it. The industry of valves is creating the future and we will be hostages of this created future. Does anybody know the real indications for a DES (Dollar Eluting Stent) vs the widespread use of it? The cardiologists have legions of patients with incomplete revascularizations, incomplete treatments because they or the patients don`t want any kind of scar or surgical treatment. The illusion of a new micropainless noninvasive therapy in the hands of any person who is not a surgeon is the philosophal stone of Cardiology. And the industry knows it. In the near future, the different ways of pressure-lobby-propaganda- or maybe clear and positive advances in medical treatment best for our patients will generate an explosion of the use of these type of devices and we have to be prepared for it. The illusion of a 10-20 years life-span period to the widespread use of the percutaneous valve replacement falls when we take the numbers into account. 300 million of citizens in the USA. South America 350 million Europe 725 million And other countries... The actual U$S 30.000 cost of a device will come down when the FDA approval becomes a reality. The concept of Valve in valve treatment will be the standard of care for a Cardiologist in high risk patients, redo`s and so on in the near future From rowlesjohn at aol.com Mon Jun 1 19:38:32 2009 From: rowlesjohn at aol.com (rowlesjohn@aol.com) Date: Mon Jun 1 14:39:51 2009 Subject: [HSF] News on promotion Message-ID: <1099961326-1243881503-cardhu_decombobulator_blackberry.rim.net-1278636511-@bxe1055.bisx.prod.on.blackberry> DQpDb25ncmF0dWxhdGlvbnMgUHJhc2FubmEgIQ0KWW91IGFyZSBkZXNlcnZpbmcgb2YgdGhlIGhv bm9yLg0KDQogV2hpbGUgeW91IHJlY29nbml6ZSB0aGUgaGVscCBvZiBNYXJrIGFuZCB0aGUgSFNG IEluIHRoaXMgYWNjb21wbGlzaG1lbnQuLi5JIHN1c3BlY3QgdGhhdCB5b3UgaGF2ZSBoYWQgYSBn cmVhdGVyIGltcGFjdCBvbiBjb3VudGxlc3MgbGl2ZXMgdGhyb3VnaCB5b3VyIHRob3VnaHRmdWwg cmVzcG9uc2VzIGFuZCB0cmVtZW5kb3VzIGluc2lnaHQgdG8gYSB2YXJpZXR5IG9mIGNsaW5pY2Fs IHByb2JsZW1zIGluIGNhcmRpYWMgc3VyZ2VyeS4gDQoNClBlb3BsZSBsaWtlIHlvdSBtYWtlIHRo aXMgZm9ydW0gc28gdmFsdWFibGUuIEFnYWluLCBjb25ncmF0dWxhdGlvbnMhDQoNCkpvaG4gUm93 bGVzDQotLS0tLS1PcmlnaW5hbCBNZXNzYWdlLS0tLS0tDQpGcm9tOiBQcmFzYW5uYSBTaW1oYSBN DQpTZW5kZXI6IG9wZW5oZWFydC1sLWJvdW5jZXNAbGlzdHMuaHNmb3J1bS5jb20NClRvOiBPcGVu SGVhcnQtTA0KUmVwbHlUbzogT3BlbkhlYXJ0LUxAbGlzdHMuaHNmb3J1bS5jb20NClN1YmplY3Q6 IFtIU0ZdIE5ld3Mgb24gcHJvbW90aW9uDQpTZW50OiBKdW4gMSwgMjAwOSA5OjI5IEFNDQoNCkkg d291bGQgbGlrZSB0byBzaGFyZSB3aXRoIHRoZSBIU0YgZnJhdGVybml0eSB0aGF0IEkgaGF2ZSB0 b2RheSBiZWVuDQpwcm9tb3RlZCBhcyBhIGZ1bGwgUHJvZmVzc29yIGluIENhcmRpb3Rob3JhY2lj IGFuZCBWYXNjdWxhciBTdXJnZXJ5IGluIG15DQpJbnN0aXR1dGUgYW5kIFJhaml2IEdhbmRoaSAg TWVkaWNhbCBVbml2ZXJzaXR5IChBbGwgbWVkaWNhbCAsIGRlbnRhbCBhbmQNCmFsbGllZCBoZWFs dGggc2NpZW5jZSBjb3Vyc2VzIGluIG15IHN0YXRlIGNvbWUgdW5kZXIgdGhpcyB1bml2ZXJzaXR5 KS4NCkhTRiBhbmQgTWFyayBMZXZpbnNvbiBpbiBwYXJ0aWN1bGFyIGhhdmUgaGVscGVkIG1lIGEg bG90IHRocm91Z2ggdGhpcw0KcHJvY2Vzcy4NClByYXNhbm5hDQotLSANClByYXNhbm5hIFNpbWhh IE0NCg0KDQoNCi0tIA0KUHJhc2FubmEgU2ltaGEgTQ0KX19fX19fX19fX19fX19fX19fX19fX19f X19fX19fX19fX19fX19fX19fX19fX18NCk9wZW5IZWFydC1MIG1haWxpbmcgbGlzdA0KDQpTZW5k IHBvc3RpbmdzIHRvOg0KIE9wZW5IZWFydC1MQGxpc3RzLmhzZm9ydW0uY29tDQoNClRvIFVOU1VC U0NSSUJFLCB0byBDSEFOR0UgZW1haWwgYWRkcmVzcywgb3IgdG8gdmlldyBhcmNoaXZlczoNCmh0 dHA6Ly9tbXAuY2pwLmNvbS9tYWlsbWFuL2xpc3RpbmZvL29wZW5oZWFydC1sDQoNCkFsbCBtZXNz YWdlcyB0cmFuc21pdHRlZCBieSB0aGUgT3BlbkhlYXJ0LUwgYXJlIHN1YmplY3QgdG8gdGhlIHBv bGljaWVzIGFuZCANCmRpc2NsYWltZXJzIHBvc3RlZCBhdDoNCmh0dHA6Ly93d3cuaHNmb3J1bS5j b20vbGlzdGRpc2NsYWltDQotLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0t LQ0KDQoNClNlbnQgZnJvbSBteSBWZXJpem9uIFdpcmVsZXNzIEJsYWNrQmVycnk= From gabuin at intramed.net Mon Jun 1 16:40:39 2009 From: gabuin at intramed.net (gustavo abuin) Date: Mon Jun 1 14:42:41 2009 Subject: [HSF] News on promotion References: Message-ID: <00f401c9e2e8$a9d1f890$13cde818@LIBERTAD> There is Justice in the world. Congratulations Professor!!! ----- Original Message ----- From: "Douville, Chuck" To: Sent: Monday, June 01, 2009 2:19 PM Subject: RE: [HSF] News on promotion Prasanna i have learned a lot from you over the past years and the thoughtful posts you always place. Congratulations to you, and also to the leaders of your institution, for recognizing this. chuckdouville ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Salerno, Tomas Sent: Mon 6/1/2009 9:40 AM To: 'OpenHeart-L@lists.hsforum.com' Subject: Re: [HSF] News on promotion Congratulations! Well deserved Tomas ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: OpenHeart-L Sent: Mon Jun 01 12:29:16 2009 Subject: [HSF] News on promotion I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- 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 > ----------------------------------------- -------------------------------------------------------------------------------- No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.339 / Virus Database: 270.12.46/2145 - Release Date: 05/31/09 05:53:00 From tacuff at swbell.net Mon Jun 1 13:07:43 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon Jun 1 15:08:16 2009 Subject: [HSF] VALVE CHOICE IN THE FUTURE? Message-ID: <658177.46562.qm@web81604.mail.mud.yahoo.com> I think you language is exactly correct even if we do not know the particulars, Gustavo. Note that Roberto has already confirmed the future has commenced. Tea Sent from my iPhone On Jun 1, 2009, at 6:27 AM, "gustavo abuin" wrote: Ani. Hoping you and your patient are doing well. Many questions about the future, and the only way to know the future is to make it. The industry of valves is creating the future and we will be hostages of this created future. Does anybody know the real indications for a DES (Dollar Eluting Stent) vs the widespread use of it? The cardiologists have legions of patients with incomplete revascularizations, incomplete treatments because they or the patients don`t want any kind of scar or surgical treatment. The illusion of a new micropainless noninvasive therapy in the hands of any person who is not a surgeon is the philosophal stone of Cardiology. And the industry knows it. In the near future, the different ways of pressure-lobby-propaganda- or maybe clear and positive advances in medical treatment best for our patients will generate an explosion of the use of these type of devices and we have to be prepared for it. The illusion of a 10-20 years life-span period to the widespread use of the percutaneous valve replacement falls when we take the numbers into account. 300 million of citizens in the USA. South America 350 million Europe 725 million And other countries... The actual U$S 30.000 cost of a device will come down when the FDA approval becomes a reality. The concept of Valve in valve treatment will be the standard of care for a Cardiologist in high risk patients, redo`s and so on in the near future _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 nfaabouseada at gmail.com Mon Jun 1 15:10:21 2009 From: nfaabouseada at gmail.com (Nasser F Abou'Seada) Date: Mon Jun 1 15:18:35 2009 Subject: [HSF] News on promotion In-Reply-To: References: <159524.6506.qm@web81601.mail.mud.yahoo.com> Message-ID: <1ECCE8A21DB2479CBD55C7EB72B94480@AbouSeadaN> Prasanna A "professorship candidate" is one who has an intellectual / technical "school" to be taught, to be followed by his "students". A professor is never made through "promotion", rather through self-indulgence in his "domain" and its supporting background "academia" evolving into a "school" and a "body" of knowledge / techniques / style that has followers and debaters. ..... Congratulations Dear Friend .... for your university faculty, for they have acknowledged what you have already had, for a long time .... They never promoted you to a full professor ..... they just merely acknowledged what you already have been. ..... the honours & the privileges are theirs ... ! Congratulations for us, HSFers ... having one of us acknowledged for his merits ... NFA -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Monday, June 01, 2009 12:26 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] News on promotion Wait a minute!!!! All of this time we were relying on the wisdom, advice, and vision of someone who are not a full professor???? That is great news Congrats and obviously well deserving. Are you still going to associate with us rugrats as you look down from your throne in the Irovy Tower? -michael On Mon, Jun 1, 2009 at 1:16 PM, Tea Acuff wrote: > > I don't suppose my double talk helped any as you fly way above it. > Congratulations, Professor. We respect you highly. > Tea > > > Sent from my iPhone > > On Jun 1, 2009, at 11:29 AM, Prasanna Simha M > wrote: > > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > Institute and Rajiv Gandhi Medical University (All medical , dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 > ----------------------------------------- > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 nfaabouseada at gmail.com Mon Jun 1 15:23:46 2009 From: nfaabouseada at gmail.com (Nasser F Abou'Seada) Date: Mon Jun 1 15:32:15 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906011046j7dcfbff5vde8ee92d54422b85@mail.gmail.com> References: <159524.6506.qm@web81601.mail.mud.yahoo.com> <89c4ed2d0906011046j7dcfbff5vde8ee92d54422b85@mail.gmail.com> Message-ID: <9BF90D9D377B44CA9C9AC4A68F36A835@AbouSeadaN> The ACTUAL issue now is NOT but what you are gonna invite US for !!! ..... I'm claiming that you should celebrate the "acknowledgement" verified by your university faculty, and invite us to a real Indian cuisine ...!!! ... Indian Kitchen is very rich ... even if VIRTUAL - in our case - ... but do not try to escape by claiming vegetarian .... many of us HSFers ... I -suppose- are very fond of a real steak !! .... The OBEROI Hotels are very well known for their courteous hospitality and rich generosity !! NFA -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Monday, June 01, 2009 12:46 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] News on promotion As far a sitting in the Ivory tower there is an ancient rite done by the Karate master when his student becomes a Sensei (getting his black belt and becoming the "little master"). The teacher brings out his old black belt awarded to him by his teacher - the black color being worn out and now speckled white to indicate that the teacher at last becomes a true student at that time.He changes and wears the worn out black - white belt while presenting the new black belt to his student. It drove me to tears during my Son's black belt awarding ceremony. Prasanna On Mon, Jun 1, 2009 at 10:56 PM, Michael Firstenberg wrote: > Wait a minute!!!! > All of this time we were relying on the wisdom, advice, and vision of > someone who are not a full professor???? > > > That is great news > Congrats and obviously well deserving. > Are you still going to associate with us rugrats as you look down from your > throne in the Irovy Tower? > > -michael > > > > > On Mon, Jun 1, 2009 at 1:16 PM, Tea Acuff wrote: > > > > > I don't suppose my double talk helped any as you fly way above it. > > Congratulations, Professor. We respect you highly. > > Tea > > > > > > Sent from my iPhone > > > > On Jun 1, 2009, at 11:29 AM, Prasanna Simha M > > wrote: > > > > I would like to share with the HSF fraternity that I have today been > > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > > Institute and Rajiv Gandhi Medical University (All medical , dental and > > allied health science courses in my state come under this university). > > HSF and Mark Levinson in particular have helped me a lot through this > > process. > > Prasanna > > -- > > 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 > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 chand.ramaiah at uky.edu Mon Jun 1 16:40:46 2009 From: chand.ramaiah at uky.edu (Ramaiah, Chandrashekar) Date: Mon Jun 1 15:41:16 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: <3ACC54310BF13645A0D12496D7CA94E501207B212A@EX7FM04.ad.uky.edu> Prasanna, Congratulations. I will be in Bangalore next week and will call you. Chand -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Monday, June 01, 2009 12:29 PM To: OpenHeart-L Subject: [HSF] News on promotion I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- 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 benjamin.bidstrup at bigpond.com Tue Jun 2 07:55:41 2009 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Mon Jun 1 16:56:08 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: Dearest Prasanna, My heartfelt congratulations on your promotion. It is well deserved for some who gives so much of himself to this specialty and the patients you treat. Kindest regards, Ben Bidstrup FRACS FRCSEd FEBCTS Cardiothoracic Surgeon On 02/06/2009, at 2:29 AM, Prasanna Simha M wrote: > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery > in my > Institute and Rajiv Gandhi Medical University (All medical , dental > and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 wftjrtyler at aol.com Mon Jun 1 18:03:05 2009 From: wftjrtyler at aol.com (wftjrtyler@aol.com) Date: Mon Jun 1 17:04:37 2009 Subject: [HSF] News on promotion Message-ID: congratulations,Prasanna......bill turner In a message dated 6/1/2009 11:37:33 A.M. Central Daylight Time, prasannasimha@gmail.com writes: I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna -- 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 ----------------------------------------- **************We found the real ?Hotel California? and the ?Seinfeld? diner. What will you find? Explore WhereItsAt.com. (http://www.whereitsat.com/#/music/all-spots/355/47.796964/-66.374711/2/Youve-Found-Where-Its-At?ncid=eml cntnew00000007) From ebender001 at me.com Mon Jun 1 17:16:54 2009 From: ebender001 at me.com (Edward Bender) Date: Mon Jun 1 17:17:28 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: Congratulations! I hope this means that you can be a visiting professor coming to the USA frequently. I bet Tea and one of his well known partners can tell you the best ways to do this. Ed Bender, MD On 6/1/09 11:29 AM, "prasannasimha" wrote: > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > Institute and Rajiv Gandhi Medical University (All medical , dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna From pfvil at intramed.net Mon Jun 1 20:02:08 2009 From: pfvil at intramed.net (Dr Patricio Villanueva) Date: Mon Jun 1 18:02:33 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: <29FF286276114149BEFF2E32A1B09E7B@villanuevaPC> Congratulations Dear Prasanna, I am happy for you Patricio Argentina ----- Original Message ----- From: "Prasanna Simha M" To: "OpenHeart-L" Sent: Monday, June 01, 2009 1:29 PM Subject: [HSF] News on promotion >I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > Institute and Rajiv Gandhi Medical University (All medical , dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 Mon Jun 1 16:07:56 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon Jun 1 18:09:25 2009 Subject: [HSF] News on promotion Message-ID: <167717.71358.qm@web81606.mail.mud.yahoo.com> I think the best way is to personally invite him... Tea Sent from my iPhone On Jun 1, 2009, at 4:16 PM, Edward Bender wrote: Congratulations! I hope this means that you can be a visiting professor coming to the USA frequently. I bet Tea and one of his well known partners can tell you the best ways to do this. Ed Bender, MD On 6/1/09 11:29 AM, "prasannasimha" wrote: I would like to share with the HSF fraternity that I have today been promoted as a full Professor in Cardiothoracic and Vascular Surgery in my Institute and Rajiv Gandhi Medical University (All medical , dental and allied health science courses in my state come under this university). HSF and Mark Levinson in particular have helped me a lot through this process. Prasanna _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Tue Jun 2 09:35:53 2009 From: donross at bigpond.com (Donald Ross) Date: Mon Jun 1 18:36:04 2009 Subject: [HSF] News on promotion In-Reply-To: <1594609306-1243874664-cardhu_decombobulator_blackberry.rim.net-82482947-@bxe1016.bisx.prod.on.blackberry> References: <1594609306-1243874664-cardhu_decombobulator_blackberry.rim.net-82482947-@bxe1016.bisx.prod.on.blackberry> Message-ID: <29F8EFDF-063D-4EC7-905A-B8B27FC495BD@bigpond.com> I think you should be promoted to full professor of the HSF as well. Don On 02/06/2009, at 2:44 AM, Hgrmd@aol.com wrote: > Prasanna, > Congrats, couldn't happened to a nicer or more deserving individual. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: "Salerno, Tomas" > > Date: Mon, 1 Jun 2009 12:40:20 > To: 'OpenHeart-L@lists.hsforum.com' > Subject: Re: [HSF] News on promotion > > > Congratulations! > Well deserved > > Tomas > > ----- Original Message ----- > From: openheart-l-bounces@lists.hsforum.com > > To: OpenHeart-L > Sent: Mon Jun 01 12:29:16 2009 > Subject: [HSF] News on promotion > > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery > in my > Institute and Rajiv Gandhi Medical University (All medical , dental > and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 > ----------------------------------------- From jpym at erols.com Mon Jun 1 19:57:55 2009 From: jpym at erols.com (John Pym) Date: Mon Jun 1 19:05:19 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: Congratulations Prasanna. Well deserved. John Pym On Mon, Jun 1, 2009 at 12:29 PM, Prasanna Simha M wrote: > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > Institute and Rajiv Gandhi Medical University (All medical , dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > Prasanna Simha M > From drmitch at cox.net Mon Jun 1 20:08:17 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Mon Jun 1 20:08:43 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: <6.2.1.2.2.20090601190719.01f20d30@pop.east.cox.net> Well done. Well deserved for a man of letters and quite diverse surgical knowledge and talent. MitchAt 11:29 AM 6/1/2009, you wrote: >I would like to share with the HSF fraternity that I have today been >promoted as a full Professor in Cardiothoracic and Vascular Surgery in my >Institute and Rajiv Gandhi Medical University (All medical , dental and >allied health science courses in my state come under this university). >HSF and Mark Levinson in particular have helped me a lot through this >process. >Prasanna >-- >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 robertobattellini at hotmail.com Tue Jun 2 08:54:43 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Tue Jun 2 01:55:33 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: Hurrah!! Roberto > From: prasannasimha@gmail.com > Date: Mon, 1 Jun 2009 21:59:16 +0530 > To: OpenHeart-L@lists.hsforum.com > CC: > Subject: [HSF] News on promotion > > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > Institute and Rajiv Gandhi Medical University (All medical , dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 grescigno at mac.com Tue Jun 2 11:28:11 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Tue Jun 2 04:35:00 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: <3841E6C9-F4A9-4A06-ABD3-59C5110E2099@mac.com> Nobody would be a better Professor than you! Congrats Giuseppe Il giorno 01/giu/09, alle ore 18:29, Prasanna Simha M ha scritto: > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery > in my > Institute and Rajiv Gandhi Medical University (All medical , > dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 jgold1 at bigpond.net.au Tue Jun 2 19:58:47 2009 From: jgold1 at bigpond.net.au (john goldblatt) Date: Tue Jun 2 04:59:17 2009 Subject: [HSF] News on promotion In-Reply-To: <003b01c9e2e5$65c1aef0$1d23a8c0@kbd.hr> References: <003b01c9e2e5$65c1aef0$1d23a8c0@kbd.hr> Message-ID: <063D12E6-0402-4748-8B49-70738A5C79A7@bigpond.net.au> Heartiest congrats Prasanna. Certainly most deserving - we have & continue to learn from you. john goldblatt Royal Melbourne Hospital Melbourne, Australia On 02/06/2009, at 4:18 AM, Igor Rudez wrote: > Dear Prasanna, >> From the bottom of my heart CONGRATULATION! > You have certainly deserved it! > > Igor Rudez > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna > Simha M > Sent: Monday, June 01, 2009 6:29 PM > To: OpenHeart-L > Subject: [HSF] News on promotion > > > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery > in my > Institute and Rajiv Gandhi Medical University (All medical , dental > and > allied health science courses in my state come under this > university). HSF > and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 > ----------------------------------------- From prasannasimha at gmail.com Tue Jun 2 17:59:26 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Jun 2 07:37:30 2009 Subject: [HSF] CABG +MV repair Message-ID: <89c4ed2d0906020429j5501e54al5a5dbba834facdb8@mail.gmail.com> POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: A randomized trial Khalil Fattouch, MD, PhD[image: Corresponding Author Information][image: email address] , Francesco Guccione, MD, Roberta Sampognaro, MD, Gaetano Panzarella, MD, Egle Corrado, MD, Emiliano Navarra, MD, Davide Calvaruso, MD, Giovanni Ruvolo, MD Received 2 May 2008; received in revised form 29 September 2008; accepted 7 November 2008. published online 01 June 2009. Corrected Proof Objective Surgical management of moderate chronic ischemic mitral valve regurgitation is still debated. The aim of this study was to evaluate the effect of adding mitral valve repair to coronary artery bypass grafting on clinical outcomes and left ventricular remodeling in patients who underwent coronary artery bypass grafting alone versus coronary artery bypass grafting plus mitral valve repair in a randomized trial. Methods Between February 2003 and May 2007, 102 patients were eligible for this study and were randomly assigned to one of 2 groups by means of card allocation: coronary artery bypass grafting plus mitral valve repair (CABG plus MVR group; 48 patients, 47%) or coronary artery bypass grafting alone (CABG group; 54 patients, 53%). The 2 groups were similar regarding demographics, perioperative clinical data, and outcomes. There were differences regarding cardiopulmonary bypass (*P* < .0001) and aortic crossclamp (*P* < .0001) times. Exercise tests were performed for all survivors to evaluate tolerance to exercise and variability on grade of mitral regurgitation and systolic pulmonary arterial pressure. The study was blinded for physicians and nurses involved in postoperative care and clinical follow-up. The mean follow-up was 32 ? 18 months. Results Overall in-hospital mortality was 3% (3 patients). One (1.8%) patient died in the CABG group, and 2 (4.1%) patients died in the CABG plus MVR group. Survival rates ? standard error at 5 years for patients in the CABG and CABG plus MVR groups were 88.8% ? 3.2% and 93.7% ? 3.1%, respectively. A significant difference was found between the 2 groups with regard to mean New York Heart Association class (*P* < .0001), left ventricular end-diastolic diameter (*P* < .01), left ventricular end-systolic diameter ( *P* < .01), pulmonary arterial pressure (*P* < .0001), and left atrial size (*P* < .01). At follow-up, coronary artery bypass grafting alone was able to reduce mitral regurgitation grade in 40% of patients, whereas in the remaining patients mitral regurgitation grade remained stable or worsened. In the CABG group, among the 17 patients with mild mitral regurgitation and 12 patients with moderate mitral regurgitation at rest, 7 (40%) and 9 (75%) patients, respectively, had worsening in mitral regurgitation grade and pulmonary artery pressure during exercise. Conclusions The efficacy of adding mitral valve repair to coronary artery bypass grafting is well demonstrated by the improvement of New York Heart Association functional class and percentage of left ventricular ejection fraction and by the decrease of mitral regurgitation grade, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, pulmonary artery pressure, and left atrial size. Moreover, coronary artery bypass grafting alone left more patients with heart failure symptoms at rest and during exercise. Combined coronary artery bypass grafting and mitral valve repair have no effect on survival at short-term follow-up, and the trends that are evident will likely become more significant with time. -- Prasanna Simha M From prasannasimha at gmail.com Tue Jun 2 18:27:41 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Jun 2 07:58:30 2009 Subject: [HSF] News on promotion In-Reply-To: References: Message-ID: <89c4ed2d0906020457l548135b2ib944bf16edb0284b@mail.gmail.com> Thanks Tom, I hope I do well in the post. Prasanna On Mon, Jun 1, 2009 at 10:10 PM, Salerno, Tomas wrote: > Congratulations! > Well deserved > > Tomas > > ----- Original Message ----- > From: openheart-l-bounces@lists.hsforum.com < > openheart-l-bounces@lists.hsforum.com> > To: OpenHeart-L > Sent: Mon Jun 01 12:29:16 2009 > Subject: [HSF] News on promotion > > I would like to share with the HSF fraternity that I have today been > promoted as a full Professor in Cardiothoracic and Vascular Surgery in my > Institute and Rajiv Gandhi Medical University (All medical , dental and > allied health science courses in my state come under this university). > HSF and Mark Levinson in particular have helped me a lot through this > process. > Prasanna > -- > 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 prasannasimha at gmail.com Tue Jun 2 20:31:43 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Jun 2 10:28:04 2009 Subject: [HSF] News on promotion In-Reply-To: <063D12E6-0402-4748-8B49-70738A5C79A7@bigpond.net.au> References: <003b01c9e2e5$65c1aef0$1d23a8c0@kbd.hr> <063D12E6-0402-4748-8B49-70738A5C79A7@bigpond.net.au> Message-ID: <89c4ed2d0906020701n2367c1edy40394e74bba051b@mail.gmail.com> Thanks John. Incidentally your bigpond address is being rejected when I reply to it offlist !! Prasanna On Tue, Jun 2, 2009 at 2:28 PM, john goldblatt wrote: > Heartiest congrats Prasanna. > Certainly most deserving - we have & continue to learn from you. > > john goldblatt > Royal Melbourne Hospital > Melbourne, Australia > > On 02/06/2009, at 4:18 AM, Igor Rudez wrote: > > Dear Prasanna, >> >>> From the bottom of my heart CONGRATULATION! >>> >> You have certainly deserved it! >> >> Igor Rudez >> >> -----Original Message----- >> From: openheart-l-bounces@lists.hsforum.com >> [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna >> Simha M >> Sent: Monday, June 01, 2009 6:29 PM >> To: OpenHeart-L >> Subject: [HSF] News on promotion >> >> >> I would like to share with the HSF fraternity that I have today been >> promoted as a full Professor in Cardiothoracic and Vascular Surgery in my >> Institute and Rajiv Gandhi Medical University (All medical , dental and >> allied health science courses in my state come under this university). HSF >> and Mark Levinson in particular have helped me a lot through this process. >> Prasanna >> -- >> 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 >> ----------------------------------------- >> > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, 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 drdharris at yahoo.co.uk Tue Jun 2 17:37:03 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Tue Jun 2 19:38:33 2009 Subject: [HSF] OPCAB in ST elevation-for Hal and Don Message-ID: <779259.79517.qm@web24711.mail.ird.yahoo.com> We hardly ever (or may I say never, Ani) operate on shocked patients (for isolated CABG). Thesedays they are PCI`d, given Plavix, Integrilin, IABP, etc, even mainstems.? Very often not only culprit vessels but other stenoses are ballooned. Then once the patient has recovered they get the real revascularisation. BTW, good article, Don. ? Dave --- On Sun, 31/5/09, Donald Ross wrote: From: Donald Ross Subject: Re: [HSF] OPCAB in ST elevation-for Hal and Don To: OpenHeart-L@lists.hsforum.com Date: Sunday, 31 May, 2009, 2:26 PM Hal, It is of course is hard to understand how a case can be done? off pump if there is insufficient cardiac output to perfuse the the body adequately. I would say impossible, as you suggest. My practice is the same as Roberto's. It is preferable to have? a balloon pump in place to maintain pulsatile flow and with normothermic CPB the grafts are done beating heart, naturally with a reusable stabiliser, starting with the culprit artery, using a graft which is ready to perfuse. It gives one, as well as the heart, a warm glow to see the return of contractility the instant a graft is opened. I have done plenty the old way and can't really tell which method is the best. I just like the former, same as some folk like organic vegetables. (BTW I don't give a damn organic food) Don On 30/05/2009, at 11:41 AM, Hgrmd@aol.com wrote: > Roberto, >? I recognize the difference, and I believe the beating heart ONCAB? makes > a lot of sense.? As you might guess, with my current case load, I now > rarely have to deal with these situations.? However, the next time I do, I? will > try it.? The down side to it is the need to open 2 sets of disposables > (pump and OPCAB stabilizer). > > Hal > > > In a message dated 5/29/2009 3:07:29 A.M. Eastern Daylight Time, > robertobattellini@hotmail.com writes: > > > Hal, > > > > But it is clear!!! > > They operated ST? elevation, not patients in shock!!! > > In our experience, Jan Gummert did? all this ST elevatiion cases off pump > with better results than others on-pump? with cardioplegia. > > On-pump does not signify only clamped aorta and? cardioplegia. > > > > But there is another way, so to say, ON-PUmp? beating heart which must be > separately? considered. > > > > Roberto > >> From: Hgrmd@aol.com >> Date: Thu, 28 May 2009 19:28:33 -0400 >> Subject: Re: [HSF] ECMO? survivors >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Don, >> Though this study is reportedly randomized, I can't? imagine randomizing >> someone to OPCAB who is in cardiogenic? shock. >> >> Hal >> >> >> In a message dated? 5/28/2009 8:49:42 A.M. Eastern Daylight Time, >> donross@bigpond.com? writes: >> >> Hal, >> I have one arrow in my quiver: >> Off-pump versus on-pump myocardial revascularization in patients >> with? ST-segment elevation myocardial infarction: A randomized trial >> Khalil? Fattouch, MD, PhD, Francesco Guccione, MD, Pietro Dioguardi, >> MD,? Roberta Sampognaro, MD, Egle Corrado, MD, >> Marco Caruso, MD, and? Giovanni Ruvolo, MD >> Objective: Conventional cardioplegic arrest? coronary artery bypass >> grafting after ST-segment elevation? myocardial >> infarction is associated with high mortality and morbidity.? The >> benefits of off-pump surgery have been suggested. >> This? study randomly evaluated the impact of the off-pump technique on >> clinical results. >> Methods: Between February 2002 and October 2007, 128? patients with ST- >> segment elevation myocardial infarction >> who? underwent myocardial revascularization within 48 hours from the >> onset? of symptoms were randomly >> assigned to 2 groups: on-pump group (66? patients/51.5%) and off-pump >> group (63 patients/48.5%). The? primary >> end point was the incidence of in-hospital death and outcomes? (low >> cardiac output syndrome, prolonged mechanical >> and? pharmacologic cardiac support, prolonged mechanical ventilation >> support, and postoperative length of >> stay in intensive care unit and? hospital). The secondary end point was >> the evaluation of myocardial? infarct size >> measured by the perioperative serum release of cardiac? troponin I and >> the improvement of contractile cardiac >> function evaluated by the wall motion score index. >> Results: Overall? in-hospital mortality was 4.6%. In-hospital mortality >> was 7.7% (5? patients) in the on-pump >> group and 1.6% (1 patient) in the off-pump? group (P 1/4 .04). >> Statistically significant differences were found? between >> the 2 groups concerning the incidence of low cardiac output? syndrome >> (P 1/4 .001), time of inotrope drugs >> support (P 1/4? .001), time of mechanical ventilation (P 1/4 .006), >> reoperation for? bleeding (P 1/4 .04), intensive care >> unit stay (P 1/4 .01), and? in-hospital stay (P 1/4 .02). Statistically >> significant differences? also were found between >> the 2 groups concerning the incidence of? in-hospital death in patients >> who were admitted to surgery in? cardiac >> shock (P 1/4 .0018) and patients who underwent surgery within? 6 hours >> from the onset of symptoms (P 1/4 .0026). The procedure in 1? patient >> (1.6%) in the off-pump group was converted to the on-pump? beating heart >> technique. The serum levels of cardiac troponin I were? high in the on- >> pump group during the first 48 hours after >> surgery. Myocardial function was better in the off-pump group. There >> were no cardiac-related late deaths, and >> patients had no recurrent? cardiac events. >> Conclusion: Off-pump surgery reduced early mortality? and morbidity in >> patients with ST-segment elevation >> myocardial infarction in respect to the conventional procedure. Off- >> pump surgery showed better results than >> on-pump surgery in patients? who underwent surgery within 6 hours from >> the onset of symptoms and? in patients >> with cardiogenic shock >> On 28/05/2009, at 6:40 PM,? Hgrmd@aol.com wrote: >> >>> Don, >>> Neither one of us? have data to back up our beliefs, but I just >>> don't see the logic? in keeping a severely ischemic heart beating >>> prior to? revascularization. Believe me, I'm becoming more and more >>> a? believer for OPCAB, but not in this rare situation. >>> >>> Hal >>> >>> Hal >>> Sent from my Verizon Wireless? BlackBerry >>> >>> -----Original Message----- >>> From: Donald Ross >>> >>> Date:? Thu, 28 May 2009 12:30:24 >>> To:? >>> Subject: Re: [HSF] ECMO? survivors >>> >>> >>> I agree,Prasanna, >>> If the heart has arrested from a LM stenosis and and is massaged? to >>> pump then the only hope is for some kind of? retrograde/antigrade >>> resuscitation. >>> The big question? is of course: How and with what? >>> For a shocked but not arrested? heart a balloon pump plus CPB is >>> necessary. There is evidence to? support both arrested and beating >>> heart protocols but I think? those, like me, who have had experience >>> with both would prefer? the non arrested option because it gets the >>> blood flowing to the? most ischaemic region quicker and anecdotally >>> seems to work very? well. >>> Remember in the bad old days before acute infarcts were? treated with >>> PCI, attempts at urgent surgical revascularisation? were dismal. >>> The success of urgent PCI perhaps lies in the fact? that the heart is >>> warm and beating? >>> Don >>> On 28/05/2009, at 11:53 AM, Prasanna Simha M wrote: >>> >>>> I wonder if on pump beating heart in a patient in cardiogenic shock >>>> is >>>> actually a good thing. I have at times? taken patients in cardiogenic >>>> shock or failure to wean and? arrested them with warm continuous >>>> anteretrograde? cardioplegia and monitored the coronary sinus >>>> resistance and? lactates. They actually have a very high coronary >>>> sinus >>>> resistance which lowers with progressive doses of? nitroglycerine >>>> and.adenosine and esmolol while maintaining? aerobic arrest. This >>>> allows the heart to have aerobic arrest,? repair itself, give a chance >>>> to decrease vasospasm and? improve myocardial perfusion. >>>> Placing a patient on pump can? do two things lower work load and >>>> energy >>>> requirements which is good but also lead to non pulsatile flow with >>>> reduced pressure head (unless flows are really high) and >>>> microvascular >>>> shut down which can be bad. Which will? be dominant would be >>>> difficult >>>> to say but? could be deduced by either signs of increasing ST's or >>>> raised? coronary resistance. >>>> Prasanna >>>> >>>> On Thu, May 28, 2009 at 12:48 AM, Roberto Battellini >>>> wrote: >>>>> >>>>> Hal, >>>>> >>>>> Taking my? experience in count, you are right. >>>>> >>>>> all my ECMO survivors were on cardiogenic shock but at least 50 >>>>> mmHg under high doses of adrenaline and IABP. >>>>> >>>>> >>>>> >>>>> The cases I did under > 30 minutes of reanimation and without BP >>>>> rehabilitation, died. >>>>> >>>>> Two last cases 2009 were: 1. a completely disected (no flow!) left >>>>> main, after 40 minutes reanimation, of course, stone heart in? cath >>>>> lab, >>>>> >>>>> 2. a? disected right coronary artery after cath, came in schock, I >>>>> performed an on pump beating heart bypass to RCA, IABP, she? could >>>>> be weaned under very high doses adrenalin, and died? 3rd day in >>>>> right heart failure, without ECMO, as she was? 82 (we do not >>>>> implant generally ECMO?s in > 80 years? old). >>>>> >>>>> >>>>> >>>>> Roberto >>>>> >>>>>> To:? OpenHeart-L@lists.hsforum.com >>>>>> Subject: Re: [HSF] ECMO? set-up >>>>>> From: hgrmd@aol.com >>>>>> Date: Sun, 24 May 2009 13:36:02 +0000 >>>>>> CC: >>>>>> >>>>>> Zhandong, >>>>>> I? take no one to the OR without a rhythm and BP. Otherwise, the >>>>>> salvage rate is zero. >>>>>> >>>>>> Hal >>>>>> Sent from my Verizon Wireless? BlackBerry >>>>>> >>>>>> -----Original? Message----- >>>>>> From: zzhoumd@pol.net >>>>>> >>>>>> Date: Sun, 24 May 2009? 13:28:36 >>>>>> To:? >>>>>> Subject: Re:? [HSF] ECMO set-up >>>>>> >>>>>> >>>>>> >>>>>> I only use ECMO for cath lab crash? if they did not call us in a >>>>>> timely fashion. We? recently had a patient arrested in ER. They >>>>>> even? could not finish the cath with chest compression over 40 >>>>>> minutes in a very young patient. >>>>>> >>>>>> None of my ECMO patients lived more? than three days. It does give >>>>>> us time to determine if? the patient is brain dead. It also gives >>>>>> the family? some time to accept the reality. >>>>>> >>>>>> Zhandong Zhou >>>>>> >>>>>> >>>>>> ------Original Message------ >>>>>> From: Hgrmd@aol.com >>>>>> Sender:? openheart-l-bounces@lists.hsforum.com >>>>>> To:? OpenHeart-L@lists.hsforum.com >>>>>> ReplyTo:? OpenHeart-L@lists.hsforum.com >>>>>> Sent: May 23, 2009? 12:39 PM >>>>>> Subject: Re: [HSF] ECMO set-up >>>>>> >>>>>> Zhandong, >>>>>> Was your patient alive 6 months later? >>>>>> >>>>>> Hal >>>>>> >>>>>> >>>>>> In a message dated 5/23/2009 7:57:14 A.M. Eastern Daylight? Time, >>>>>> zzhoumd@pol.net writes: >>>>>> >>>>>> >>>>>> I use ECMO? occasionally for "bridge to decision", i.e. in a >>>>>> cardiac arrest >>>>>> patient to see if he will wake? up. >>>>>> >>>>>> Most time the LV vent is? not needed if you have good venous >>>>>> drainage.? I >>>>>> had one patient with some AI and I had to place a? LV apical vent >>>>>> through a >>>>>> small left anterior thoracotomy. We did this after we consulted a >>>>>> Duke >>>>>> perfusionist. The vent was? directly connected the ECMO circuit >>>>>> with a? partial >>>>>> plastic clamp to control the flow. Echo was? used to see if any LV >>>>>> distention. >>>>>> We were concerned about the amount of suction from ECMO? circuit, >>>>>> but not a >>>>>> problem. >>>>>> >>>>>> Sorry for the later? reply, I was very busy in last couple of weeks. >>>>>> >>>>>> Zhandong Zhou >>>>>> >>>>>> >>>>>> >>>>>> Sent via BlackBerry by AT&T >>>>>> >>>>>> -----Original Message----- >>>>>> From: Giuseppe Rescigno >>>>>> >>>>>> Date: Fri, 22 May 2009? 20:37:39 >>>>>> To:? >>>>>> Subject: Re:? [HSF] ECMO set-up >>>>>> >>>>>> >>>>>> Hey Guys, >>>>>> >>>>>> nobody using ECMO out there? >>>>>> >>>>>> Giuseppe >>>>>> >>>>>> >>>>>> Il giorno 21/mag/09, alle ore 09:56, Giuseppe Rescigno ha? scritto: >>>>>> >>>>>>> Dear? Collegues, >>>>>>> >>>>>>> which is? your attitude in venting the LV in case of ECMO? And by >>>>>>> which route and cannula? >>>>>>> >>>>>>> >>>>>>> Thank you >>>>>>> >>>>>>> >>>>>>> Giuseppe >>>>>>> >>>>>>> >>>>>>> >>>>>>> Giuseppe Rescigno M.D. >>>>>>> Cardiothoracic? Surgeon >>>>>>> >>>>>>> Lancisi? Hospital >>>>>>> Torrette - Ancona >>>>>>> Italy >>>>>>> >>>>>>> _______________________________________________ >>>>>>> OpenHeart-L mailing list >>>>>>> >>>>>>> Send postings to: >>>>>>> OpenHeart-L@lists.hsforum.com >>>>>>> >>>>>>> To UNSUBSCRIBE, to CHANGE? email address, or to view archives: >>>>>>> http://mmp.cjp.com/mailman/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 >>>>>> ----------------------------------------- >>>>>> >>>>>> **************A strong credit score is 700 or above. See? Yours in >>>>>> Just 2 >>>>>> Easy? Steps! >>>>>> >> > (http://pr.atwola.com/promoclk/100126575x1222585033x1201462753/aol?redir=http://www.freecreditreport.com/pm/default.aspx >>>>>> ?sc=668072&hmpgID=115&b >>>>>> cd=Maystrongfooter52309NO115) >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@lists.hsforum.com >>>>>> >>>>>> To UNSUBSCRIBE, to CHANGE email address, or to view? archives: >>>>>> http://mmp.cjp.com/mailman/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 via BlackBerry by? AT&T >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send? postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or? to view archives: >>>>> http://mmp.cjp.com/mailman/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 >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing? list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email? address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages? transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> **************Cooking Dinner For Two? Sign Up & Get Immediate > Member-Only >> Savings. >> > (http://pr.atwola.com/promoclk/100126575x1222652750x1201460983/aol?redir=http:%2F%2Fad.doubleclick.net%2Fclk%3B215225797%3B37274671%3Bq%3Fhttp:%2 >> F%2Frecipes.cookingfor2.pillsbury.com%2F%3FESRC%3D934) >> _______________________________________________ >> OpenHeart-L mailing? list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email? address, or to view archives: >> http://mmp.cjp.com/mailman/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 the variety of Bisquick? mix. Get Recipes & Savings > Now. (http://pr.atwola.com/promocl > k/100126575x1222831871x1201491818/aol?redir=http:%2F%2Fad.doubleclick.net%2Fclk%3B215225813%3B37274670%3Be%3Fhttp:%2F%2 > Frecipes.bisquick.bettycrocker.com%3FESRC%3D971) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Tue Jun 2 21:08:19 2009 From: tacuff at swbell.net (Tea Acuff) Date: Tue Jun 2 23:08:50 2009 Subject: [HSF] airplane accidents and other "misfortunes" Message-ID: <748086.82923.qm@web81605.mail.mud.yahoo.com> The airbus disaster over the Atlantic brings up the issue for HSF as to what lessons might we learn on this occasion. That fact that we may not know the details, does not mean that there are no lessons to be gleaned. I mean no disrespect to those lost, and it is likely for a big audience such as HSF to have some that somehow know someone on that flight. What intrigues me about this airplane is that it was by design flown by electric or servo mechanisms. Further it seems that it was programed to be flown automatically by setting of goals or parameters and the software computer models "manned" the servomechanism. Whether this is the fact or not is not really necessary for this gedankenexperiment. (Einstein did not believe that there are elevators out in space.) What we have in this design is an elevation of protocol over experience or prethought "artificial intelligence" over organic intelligence. I am not interested in the specific details of the protocols, but the concept that the protocol is superior to the thinker...in all conditions. This issue occurs in every realm of thought: religious (word), political (law),?computers (software) or more clinical?medicine (best practice, protocol, etc.) Medicine is subject to other classes or levels?of protocol bureaucratic, political, economic etc that may further and undoubtedly does limit possible proscribed actions. The question is whether freedom of individual (nurse, doctor, institution, research, pilot, etc) action (in all its levels) is an important safe guard. If so, what does a protocol mean exactly? In medicine and on the forum some have argued that "blind' application of "best practice" yields?and will yield better medicine than less formalized practice patterns. The easy logic of such thought makes "best practice" a nearly universally acclaimed superlative. There are several problems with this line of thinking. From a logistic standpoint "best practice" does not have a specific meaning. It best seems to mirror the common practice of money mangers to be listed by the past (several) year(s) result as "best manger". We all know the economic consequence of following this logic. It is the equivalence of "buying into" a bull market. It works for the short term and is disastrous, buying high and selling low, in the long term. Another problem is that we are not likely to see a large obvious?and frightening "kill" in the medical analogy of this flight model. What is likely to happen is large numbers of remote and thus unrecognized protocol mismatch or "less than best practice" in the margins while that immediate in our view looks good if not always best. Lastly (there are more undoubtedly)?most of us are aware of the idiocy we see from labeling protocol adherence as superior medicine. It leads to large number of 100% perfect (and "gamed") hospitals and practioners with quite variable and disparate actual results. So, can we really design a plane or a medical system that flies itself? It seems that we can and are determined to, but do we want to fly in it? Let's see what happens to the airbus. Perhaps there is a story here. Expect some posturing along the way. Yes, I know it is "Off Topic." tea From donross at bigpond.com Wed Jun 3 16:08:30 2009 From: donross at bigpond.com (Donald Ross) Date: Wed Jun 3 01:09:03 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: <748086.82923.qm@web81605.mail.mud.yahoo.com> References: <748086.82923.qm@web81605.mail.mud.yahoo.com> Message-ID: <0179B986-1CB3-469B-B9C6-E0080847C29B@bigpond.com> When this aircraft was being demonstrated to the press by the chief test pilot, he over-road the fail safe computer to show off a bit and crashed the plane. I bit like doing cardiac surgery without the pump eh, Michael? Don On 03/06/2009, at 1:08 PM, Tea Acuff wrote: > The airbus disaster over the Atlantic brings up the issue for HSF as > to what lessons might we learn on this occasion. That fact that we > may not know the details, does not mean that there are no lessons to > be gleaned. I mean no disrespect to those lost, and it is likely for > a big audience such as HSF to have some that somehow know someone on > that flight. > > What intrigues me about this airplane is that it was by design flown > by electric or servo mechanisms. Further it seems that it was > programed to be flown automatically by setting of goals or > parameters and the software computer models "manned" the > servomechanism. > > Whether this is the fact or not is not really necessary for this > gedankenexperiment. (Einstein did not believe that there are > elevators out in space.) > > What we have in this design is an elevation of protocol over > experience or prethought "artificial intelligence" over organic > intelligence. I am not interested in the specific details of the > protocols, but the concept that the protocol is superior to the > thinker...in all conditions. This issue occurs in every realm of > thought: religious (word), political (law), computers (software) or > more clinical medicine (best practice, protocol, etc.) > > Medicine is subject to other classes or levels of protocol > bureaucratic, political, economic etc that may further and > undoubtedly does limit possible proscribed actions. The question is > whether freedom of individual (nurse, doctor, institution, research, > pilot, etc) action (in all its levels) is an important safe guard. > If so, what does a protocol mean exactly? > > In medicine and on the forum some have argued that "blind' > application of "best practice" yields and will yield better medicine > than less formalized practice patterns. The easy logic of such > thought makes "best practice" a nearly universally acclaimed > superlative. > > There are several problems with this line of thinking. From a > logistic standpoint "best practice" does not have a specific > meaning. It best seems to mirror the common practice of money > mangers to be listed by the past (several) year(s) result as "best > manger". We all know the economic consequence of following this > logic. It is the equivalence of "buying into" a bull market. It > works for the short term and is disastrous, buying high and selling > low, in the long term. > > Another problem is that we are not likely to see a large obvious and > frightening "kill" in the medical analogy of this flight model. What > is likely to happen is large numbers of remote and thus unrecognized > protocol mismatch or "less than best practice" in the margins while > that immediate in our view looks good if not always best. > > Lastly (there are more undoubtedly) most of us are aware of the > idiocy we see from labeling protocol adherence as superior medicine. > It leads to large number of 100% perfect (and "gamed") hospitals and > practioners with quite variable and disparate actual results. > > So, can we really design a plane or a medical system that flies > itself? It seems that we can and are determined to, but do we want > to fly in it? > > Let's see what happens to the airbus. Perhaps there is a story here. > Expect some posturing along the way. > > Yes, I know it is "Off Topic." > > 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 nkkejriwal at gmail.com Wed Jun 3 07:44:40 2009 From: nkkejriwal at gmail.com (nand kejriwal) Date: Wed Jun 3 02:50:51 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906020701n2367c1edy40394e74bba051b@mail.gmail.com> References: <003b01c9e2e5$65c1aef0$1d23a8c0@kbd.hr> <063D12E6-0402-4748-8B49-70738A5C79A7@bigpond.net.au> <89c4ed2d0906020701n2367c1edy40394e74bba051b@mail.gmail.com> Message-ID: Prasanna Your contribution to the forum has been invaluable. I have personally benefitted a lot from your postings. Congrats. Well-deserved. Hope to catch up with you one day. nand 2009/6/2 Prasanna Simha M > Thanks John. Incidentally your bigpond address is being rejected when I > reply to it offlist !! > Prasanna > > On Tue, Jun 2, 2009 at 2:28 PM, john goldblatt >wrote: > > > Heartiest congrats Prasanna. > > Certainly most deserving - we have & continue to learn from you. > > > > john goldblatt > > Royal Melbourne Hospital > > Melbourne, Australia > > > > On 02/06/2009, at 4:18 AM, Igor Rudez wrote: > > > > Dear Prasanna, > >> > >>> From the bottom of my heart CONGRATULATION! > >>> > >> You have certainly deserved it! > >> > >> Igor Rudez > >> > >> -----Original Message----- > >> From: openheart-l-bounces@lists.hsforum.com > >> [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna > >> Simha M > >> Sent: Monday, June 01, 2009 6:29 PM > >> To: OpenHeart-L > >> Subject: [HSF] News on promotion > >> > >> > >> I would like to share with the HSF fraternity that I have today been > >> promoted as a full Professor in Cardiothoracic and Vascular Surgery in > my > >> Institute and Rajiv Gandhi Medical University (All medical , dental and > >> allied health science courses in my state come under this university). > HSF > >> and Mark Levinson in particular have helped me a lot through this > process. > >> Prasanna > >> -- > >> 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 > >> ----------------------------------------- > >> > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, 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 axel.m.laczkovics at ruhr-uni-bochum.de Wed Jun 3 08:24:34 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Wed Jun 3 03:24:34 2009 Subject: [HSF] HTX in asia? In-Reply-To: <779259.79517.qm@web24711.mail.ird.yahoo.com> References: <779259.79517.qm@web24711.mail.ird.yahoo.com> Message-ID: <467f1a8b68514e4bb6e782bac353009a@ruhr-uni-bochum.de> dear friends, it was in 1985, whe i transplanted a something like 12yr old boy in vienna. he is now over 30 and fell in love with a girl (woman?) in thailand and wants to move to and with her. i have moved to germany 1992 and have no idea about tx in asia. has anybody knowledge about tx-centers round bangkok or somewhere else in asia? or at least bigger cardiologic centers for routine check-up?s? thx a lot, axel laczkovics bochum, germany From robertobattellini at hotmail.com Wed Jun 3 12:26:27 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Jun 3 05:27:17 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: <748086.82923.qm@web81605.mail.mud.yahoo.com> References: <748086.82923.qm@web81605.mail.mud.yahoo.com> Message-ID: Tea, you are incredible intelectual.I am still waying for you book on Tea?s thoughts. It is still stupid to think in Medicine that for example a robot could do the whole operation itself. A plane can fly in automatic pilot, but not thorough a storm. Roberto > Date: Tue, 2 Jun 2009 20:08:19 -0700 > From: tacuff@swbell.net > To: OpenHeart-L@lists.hsforum.com > CC: > Subject: [HSF] airplane accidents and other "misfortunes" > > The airbus disaster over the Atlantic brings up the issue for HSF as to what lessons might we learn on this occasion. That fact that we may not know the details, does not mean that there are no lessons to be gleaned. I mean no disrespect to those lost, and it is likely for a big audience such as HSF to have some that somehow know someone on that flight. > > What intrigues me about this airplane is that it was by design flown by electric or servo mechanisms. Further it seems that it was programed to be flown automatically by setting of goals or parameters and the software computer models "manned" the servomechanism. > > Whether this is the fact or not is not really necessary for this gedankenexperiment. (Einstein did not believe that there are elevators out in space.) > > What we have in this design is an elevation of protocol over experience or prethought "artificial intelligence" over organic intelligence. I am not interested in the specific details of the protocols, but the concept that the protocol is superior to the thinker...in all conditions. This issue occurs in every realm of thought: religious (word), political (law), computers (software) or more clinical medicine (best practice, protocol, etc.) > > Medicine is subject to other classes or levels of protocol bureaucratic, political, economic etc that may further and undoubtedly does limit possible proscribed actions. The question is whether freedom of individual (nurse, doctor, institution, research, pilot, etc) action (in all its levels) is an important safe guard. If so, what does a protocol mean exactly? > > In medicine and on the forum some have argued that "blind' application of "best practice" yields and will yield better medicine than less formalized practice patterns. The easy logic of such thought makes "best practice" a nearly universally acclaimed superlative. > > There are several problems with this line of thinking. From a logistic standpoint "best practice" does not have a specific meaning. It best seems to mirror the common practice of money mangers to be listed by the past (several) year(s) result as "best manger". We all know the economic consequence of following this logic. It is the equivalence of "buying into" a bull market. It works for the short term and is disastrous, buying high and selling low, in the long term. > > Another problem is that we are not likely to see a large obvious and frightening "kill" in the medical analogy of this flight model. What is likely to happen is large numbers of remote and thus unrecognized protocol mismatch or "less than best practice" in the margins while that immediate in our view looks good if not always best. > > Lastly (there are more undoubtedly) most of us are aware of the idiocy we see from labeling protocol adherence as superior medicine. It leads to large number of 100% perfect (and "gamed") hospitals and practioners with quite variable and disparate actual results. > > So, can we really design a plane or a medical system that flies itself? It seems that we can and are determined to, but do we want to fly in it? > > Let's see what happens to the airbus. Perhaps there is a story here. Expect some posturing along the way. > > Yes, I know it is "Off Topic." > > 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 robertobattellini at hotmail.com Wed Jun 3 12:31:58 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Jun 3 05:32:26 2009 Subject: [HSF] OPCAB in ST elevation-for Hal and Don In-Reply-To: <779259.79517.qm@web24711.mail.ird.yahoo.com> References: <779259.79517.qm@web24711.mail.ird.yahoo.com> Message-ID: Dave, give me a private email and i will send you next week some data from us about operating in cardiogenic schock. When the interventional cardiologists call you at night and they can do anything more for the patient, you must operate... I am flying now invited to a brasilian congress and cannot send it now.(now is winter there, no holidays, not on the beach) Roberto > Date: Tue, 2 Jun 2009 16:37:03 -0700 > From: drdharris@yahoo.co.uk > Subject: Re: [HSF] OPCAB in ST elevation-for Hal and Don > To: OpenHeart-L@lists.hsforum.com > CC: > > We hardly ever (or may I say never, Ani) operate on shocked patients (for isolated CABG). > Thesedays they are PCI`d, given Plavix, Integrilin, IABP, etc, even mainstems. Very often not only culprit vessels but other stenoses are ballooned. Then once the patient has recovered they get the real revascularisation. BTW, good article, Don. > > Dave > > > --- On Sun, 31/5/09, Donald Ross wrote: > > > From: Donald Ross > Subject: Re: [HSF] OPCAB in ST elevation-for Hal and Don > To: OpenHeart-L@lists.hsforum.com > Date: Sunday, 31 May, 2009, 2:26 PM > > > Hal, > It is of course is hard to understand how a case can be done off pump if there is insufficient cardiac output to perfuse the the body adequately. I would say impossible, as you suggest. > My practice is the same as Roberto's. It is preferable to have a balloon pump in place to maintain pulsatile flow and with normothermic CPB the grafts are done beating heart, naturally with a reusable stabiliser, starting with the culprit artery, using a graft which is ready to perfuse. > It gives one, as well as the heart, a warm glow to see the return of contractility the instant a graft is opened. > I have done plenty the old way and can't really tell which method is the best. > I just like the former, same as some folk like organic vegetables. (BTW I don't give a damn organic food) > Don > > On 30/05/2009, at 11:41 AM, Hgrmd@aol.com wrote: > > > Roberto, > > I recognize the difference, and I believe the beating heart ONCAB makes > > a lot of sense. As you might guess, with my current case load, I now > > rarely have to deal with these situations. However, the next time I do, I will > > try it. The down side to it is the need to open 2 sets of disposables > > (pump and OPCAB stabilizer). > > > > Hal > > > > > > In a message dated 5/29/2009 3:07:29 A.M. Eastern Daylight Time, > > robertobattellini@hotmail.com writes: > > > > > > Hal, > > > > > > > > But it is clear!!! > > > > They operated ST elevation, not patients in shock!!! > > > > In our experience, Jan Gummert did all this ST elevatiion cases off pump > > with better results than others on-pump with cardioplegia. > > > > On-pump does not signify only clamped aorta and cardioplegia. > > > > > > > > But there is another way, so to say, ON-PUmp beating heart which must be > > separately considered. > > > > > > > > Roberto > > > >> From: Hgrmd@aol.com > >> Date: Thu, 28 May 2009 19:28:33 -0400 > >> Subject: Re: [HSF] ECMO survivors > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> > >> Don, > >> Though this study is reportedly randomized, I can't imagine randomizing > >> someone to OPCAB who is in cardiogenic shock. > >> > >> Hal > >> > >> > >> In a message dated 5/28/2009 8:49:42 A.M. Eastern Daylight Time, > >> donross@bigpond.com writes: > >> > >> Hal, > >> I have one arrow in my quiver: > >> Off-pump versus on-pump myocardial revascularization in patients > >> with ST-segment elevation myocardial infarction: A randomized trial > >> Khalil Fattouch, MD, PhD, Francesco Guccione, MD, Pietro Dioguardi, > >> MD, Roberta Sampognaro, MD, Egle Corrado, MD, > >> Marco Caruso, MD, and Giovanni Ruvolo, MD > >> Objective: Conventional cardioplegic arrest coronary artery bypass > >> grafting after ST-segment elevation myocardial > >> infarction is associated with high mortality and morbidity. The > >> benefits of off-pump surgery have been suggested. > >> This study randomly evaluated the impact of the off-pump technique on > >> clinical results. > >> Methods: Between February 2002 and October 2007, 128 patients with ST- > >> segment elevation myocardial infarction > >> who underwent myocardial revascularization within 48 hours from the > >> onset of symptoms were randomly > >> assigned to 2 groups: on-pump group (66 patients/51.5%) and off-pump > >> group (63 patients/48.5%). The primary > >> end point was the incidence of in-hospital death and outcomes (low > >> cardiac output syndrome, prolonged mechanical > >> and pharmacologic cardiac support, prolonged mechanical ventilation > >> support, and postoperative length of > >> stay in intensive care unit and hospital). The secondary end point was > >> the evaluation of myocardial infarct size > >> measured by the perioperative serum release of cardiac troponin I and > >> the improvement of contractile cardiac > >> function evaluated by the wall motion score index. > >> Results: Overall in-hospital mortality was 4.6%. In-hospital mortality > >> was 7.7% (5 patients) in the on-pump > >> group and 1.6% (1 patient) in the off-pump group (P 1/4 .04). > >> Statistically significant differences were found between > >> the 2 groups concerning the incidence of low cardiac output syndrome > >> (P 1/4 .001), time of inotrope drugs > >> support (P 1/4 .001), time of mechanical ventilation (P 1/4 .006), > >> reoperation for bleeding (P 1/4 .04), intensive care > >> unit stay (P 1/4 .01), and in-hospital stay (P 1/4 .02). Statistically > >> significant differences also were found between > >> the 2 groups concerning the incidence of in-hospital death in patients > >> who were admitted to surgery in cardiac > >> shock (P 1/4 .0018) and patients who underwent surgery within 6 hours > >> from the onset of symptoms (P 1/4 .0026). The procedure in 1 patient > >> (1.6%) in the off-pump group was converted to the on-pump beating heart > >> technique. The serum levels of cardiac troponin I were high in the on- > >> pump group during the first 48 hours after > >> surgery. Myocardial function was better in the off-pump group. There > >> were no cardiac-related late deaths, and > >> patients had no recurrent cardiac events. > >> Conclusion: Off-pump surgery reduced early mortality and morbidity in > >> patients with ST-segment elevation > >> myocardial infarction in respect to the conventional procedure. Off- > >> pump surgery showed better results than > >> on-pump surgery in patients who underwent surgery within 6 hours from > >> the onset of symptoms and in patients > >> with cardiogenic shock > >> On 28/05/2009, at 6:40 PM, Hgrmd@aol.com wrote: > >> > >>> Don, > >>> Neither one of us have data to back up our beliefs, but I just > >>> don't see the logic in keeping a severely ischemic heart beating > >>> prior to revascularization. Believe me, I'm becoming more and more > >>> a believer for OPCAB, but not in this rare situation. > >>> > >>> Hal > >>> > >>> Hal > >>> Sent from my Verizon Wireless BlackBerry > >>> > >>> -----Original Message----- > >>> From: Donald Ross > >>> > >>> Date: Thu, 28 May 2009 12:30:24 > >>> To: > >>> Subject: Re: [HSF] ECMO survivors > >>> > >>> > >>> I agree,Prasanna, > >>> If the heart has arrested from a LM stenosis and and is massaged to > >>> pump then the only hope is for some kind of retrograde/antigrade > >>> resuscitation. > >>> The big question is of course: How and with what? > >>> For a shocked but not arrested heart a balloon pump plus CPB is > >>> necessary. There is evidence to support both arrested and beating > >>> heart protocols but I think those, like me, who have had experience > >>> with both would prefer the non arrested option because it gets the > >>> blood flowing to the most ischaemic region quicker and anecdotally > >>> seems to work very well. > >>> Remember in the bad old days before acute infarcts were treated with > >>> PCI, attempts at urgent surgical revascularisation were dismal. > >>> The success of urgent PCI perhaps lies in the fact that the heart is > >>> warm and beating? > >>> Don > >>> On 28/05/2009, at 11:53 AM, Prasanna Simha M wrote: > >>> > >>>> I wonder if on pump beating heart in a patient in cardiogenic shock > >>>> is > >>>> actually a good thing. I have at times taken patients in cardiogenic > >>>> shock or failure to wean and arrested them with warm continuous > >>>> anteretrograde cardioplegia and monitored the coronary sinus > >>>> resistance and lactates. They actually have a very high coronary > >>>> sinus > >>>> resistance which lowers with progressive doses of nitroglycerine > >>>> and.adenosine and esmolol while maintaining aerobic arrest. This > >>>> allows the heart to have aerobic arrest, repair itself, give a chance > >>>> to decrease vasospasm and improve myocardial perfusion. > >>>> Placing a patient on pump can do two things lower work load and > >>>> energy > >>>> requirements which is good but also lead to non pulsatile flow with > >>>> reduced pressure head (unless flows are really high) and > >>>> microvascular > >>>> shut down which can be bad. Which will be dominant would be > >>>> difficult > >>>> to say but could be deduced by either signs of increasing ST's or > >>>> raised coronary resistance. > >>>> Prasanna > >>>> > >>>> On Thu, May 28, 2009 at 12:48 AM, Roberto Battellini > >>>> wrote: > >>>>> > >>>>> Hal, > >>>>> > >>>>> Taking my experience in count, you are right. > >>>>> > >>>>> all my ECMO survivors were on cardiogenic shock but at least 50 > >>>>> mmHg under high doses of adrenaline and IABP. > >>>>> > >>>>> > >>>>> > >>>>> The cases I did under > 30 minutes of reanimation and without BP > >>>>> rehabilitation, died. > >>>>> > >>>>> Two last cases 2009 were: 1. a completely disected (no flow!) left > >>>>> main, after 40 minutes reanimation, of course, stone heart in cath > >>>>> lab, > >>>>> > >>>>> 2. a disected right coronary artery after cath, came in schock, I > >>>>> performed an on pump beating heart bypass to RCA, IABP, she could > >>>>> be weaned under very high doses adrenalin, and died 3rd day in > >>>>> right heart failure, without ECMO, as she was 82 (we do not > >>>>> implant generally ECMO?s in > 80 years old). > >>>>> > >>>>> > >>>>> > >>>>> Roberto > >>>>> > >>>>>> To: OpenHeart-L@lists.hsforum.com > >>>>>> Subject: Re: [HSF] ECMO set-up > >>>>>> From: hgrmd@aol.com > >>>>>> Date: Sun, 24 May 2009 13:36:02 +0000 > >>>>>> CC: > >>>>>> > >>>>>> Zhandong, > >>>>>> I take no one to the OR without a rhythm and BP. Otherwise, the > >>>>>> salvage rate is zero. > >>>>>> > >>>>>> Hal > >>>>>> Sent from my Verizon Wireless BlackBerry > >>>>>> > >>>>>> -----Original Message----- > >>>>>> From: zzhoumd@pol.net > >>>>>> > >>>>>> Date: Sun, 24 May 2009 13:28:36 > >>>>>> To: > >>>>>> Subject: Re: [HSF] ECMO set-up > >>>>>> > >>>>>> > >>>>>> > >>>>>> I only use ECMO for cath lab crash if they did not call us in a > >>>>>> timely fashion. We recently had a patient arrested in ER. They > >>>>>> even could not finish the cath with chest compression over 40 > >>>>>> minutes in a very young patient. > >>>>>> > >>>>>> None of my ECMO patients lived more than three days. It does give > >>>>>> us time to determine if the patient is brain dead. It also gives > >>>>>> the family some time to accept the reality. > >>>>>> > >>>>>> Zhandong Zhou > >>>>>> > >>>>>> > >>>>>> ------Original Message------ > >>>>>> From: Hgrmd@aol.com > >>>>>> Sender: openheart-l-bounces@lists.hsforum.com > >>>>>> To: OpenHeart-L@lists.hsforum.com > >>>>>> ReplyTo: OpenHeart-L@lists.hsforum.com > >>>>>> Sent: May 23, 2009 12:39 PM > >>>>>> Subject: Re: [HSF] ECMO set-up > >>>>>> > >>>>>> Zhandong, > >>>>>> Was your patient alive 6 months later? > >>>>>> > >>>>>> Hal > >>>>>> > >>>>>> > >>>>>> In a message dated 5/23/2009 7:57:14 A.M. Eastern Daylight Time, > >>>>>> zzhoumd@pol.net writes: > >>>>>> > >>>>>> > >>>>>> I use ECMO occasionally for "bridge to decision", i.e. in a > >>>>>> cardiac arrest > >>>>>> patient to see if he will wake up. > >>>>>> > >>>>>> Most time the LV vent is not needed if you have good venous > >>>>>> drainage. I > >>>>>> had one patient with some AI and I had to place a LV apical vent > >>>>>> through a > >>>>>> small left anterior thoracotomy. We did this after we consulted a > >>>>>> Duke > >>>>>> perfusionist. The vent was directly connected the ECMO circuit > >>>>>> with a partial > >>>>>> plastic clamp to control the flow. Echo was used to see if any LV > >>>>>> distention. > >>>>>> We were concerned about the amount of suction from ECMO circuit, > >>>>>> but not a > >>>>>> problem. > >>>>>> > >>>>>> Sorry for the later reply, I was very busy in last couple of weeks. > >>>>>> > >>>>>> Zhandong Zhou > >>>>>> > >>>>>> > >>>>>> > >>>>>> Sent via BlackBerry by AT&T > >>>>>> > >>>>>> -----Original Message----- > >>>>>> From: Giuseppe Rescigno > >>>>>> > >>>>>> Date: Fri, 22 May 2009 20:37:39 > >>>>>> To: > >>>>>> Subject: Re: [HSF] ECMO set-up > >>>>>> > >>>>>> > >>>>>> Hey Guys, > >>>>>> > >>>>>> nobody using ECMO out there? > >>>>>> > >>>>>> Giuseppe > >>>>>> > >>>>>> > >>>>>> Il giorno 21/mag/09, alle ore 09:56, Giuseppe Rescigno ha scritto: > >>>>>> > >>>>>>> Dear Collegues, > >>>>>>> > >>>>>>> which is your attitude in venting the LV in case of ECMO? And by > >>>>>>> which route and cannula? > >>>>>>> > >>>>>>> > >>>>>>> Thank you > >>>>>>> > >>>>>>> > >>>>>>> Giuseppe > >>>>>>> > >>>>>>> > >>>>>>> > >>>>>>> Giuseppe Rescigno M.D. > >>>>>>> Cardiothoracic Surgeon > >>>>>>> > >>>>>>> Lancisi Hospital > >>>>>>> Torrette - Ancona > >>>>>>> Italy > >>>>>>> > >>>>>>> _______________________________________________ > >>>>>>> OpenHeart-L mailing list > >>>>>>> > >>>>>>> Send postings to: > >>>>>>> OpenHeart-L@lists.hsforum.com > >>>>>>> > >>>>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>>>>>> http://mmp.cjp.com/mailman/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 > >>>>>> ----------------------------------------- > >>>>>> > >>>>>> **************A strong credit score is 700 or above. See Yours in > >>>>>> Just 2 > >>>>>> Easy Steps! > >>>>>> > >> > > (http://pr.atwola.com/promoclk/100126575x1222585033x1201462753/aol?redir=http://www.freecreditreport.com/pm/default.aspx > >>>>>> ?sc=668072&hmpgID=115&b > >>>>>> cd=Maystrongfooter52309NO115) > >>>>>> _______________________________________________ > >>>>>> OpenHeart-L mailing list > >>>>>> > >>>>>> Send postings to: > >>>>>> OpenHeart-L@lists.hsforum.com > >>>>>> > >>>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>>>>> http://mmp.cjp.com/mailman/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 via BlackBerry by AT&T > >>>>> _______________________________________________ > >>>>> OpenHeart-L mailing list > >>>>> > >>>>> Send postings to: > >>>>> OpenHeart-L@lists.hsforum.com > >>>>> > >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>>>> http://mmp.cjp.com/mailman/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 > >>> ----------------------------------------- > >> > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >> All messages transmitted by the OpenHeart-L are subject to the policies > >> and > >> disclaimers posted at: > >> http://www.hsforum.com/listdisclaim > >> ----------------------------------------- > >> > >> **************Cooking Dinner For Two? Sign Up & Get Immediate > > Member-Only > >> Savings. > >> > > (http://pr.atwola.com/promoclk/100126575x1222652750x1201460983/aol?redir=http:%2F%2Fad.doubleclick.net%2Fclk%3B215225797%3B37274671%3Bq%3Fhttp:%2 > >> F%2Frecipes.cookingfor2.pillsbury.com%2F%3FESRC%3D934) > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 the variety of Bisquick? mix. Get Recipes & Savings > > Now. (http://pr.atwola.com/promocl > > k/100126575x1222831871x1201491818/aol?redir=http:%2F%2Fad.doubleclick.net%2Fclk%3B215225813%3B37274670%3Be%3Fhttp:%2F%2 > > Frecipes.bisquick.bettycrocker.com%3FESRC%3D971) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 Jun 3 17:31:55 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Jun 3 07:02:43 2009 Subject: [HSF] HTX in asia? In-Reply-To: <467f1a8b68514e4bb6e782bac353009a@ruhr-uni-bochum.de> References: <779259.79517.qm@web24711.mail.ird.yahoo.com> <467f1a8b68514e4bb6e782bac353009a@ruhr-uni-bochum.de> Message-ID: <89c4ed2d0906030401n23288cd7r9ac1aaeb4fa29152@mail.gmail.com> There are centers in Thailand doing a lot of transplants but I am not sure of the follow up. Dr Pantpis Norrotham was doing a lot of Transplants. Prasanna On Wed, Jun 3, 2009 at 12:55 PM, prof. dr. axel laczkovics < axel.m.laczkovics@ruhr-uni-bochum.de> wrote: > dear friends, > > it was in 1985, whe i transplanted a something like 12yr old boy in > vienna. he is now over 30 and fell in love with a girl (woman?) in thailand > and wants to move to and with her. > > i have moved to germany 1992 and have no idea about tx in asia. > > has anybody knowledge about tx-centers round bangkok or somewhere else in > asia? or at least bigger cardiologic centers for routine check-up?s? > > thx a lot, axel laczkovics > bochum, germany > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 fesfagundes at terra.com.br Wed Jun 3 09:38:40 2009 From: fesfagundes at terra.com.br (Francisco Fagundes) Date: Wed Jun 3 07:39:16 2009 Subject: [PHISH]RE: [HSF] OPCAB in ST elevation-for Hal and Don In-Reply-To: References: <779259.79517.qm@web24711.mail.ird.yahoo.com> Message-ID: <4A2660C0.9030909@terra.com.br> Roberto, are you coming to XV SOLACI Congress in Rio de Janeiro? I live here and would like toomuch know you. Francisco Fagundes Cardiac Anesthesiologist Rio de Janeiro - Brasil fesfagundes@terra.com.br fesfagundes@gmail.com Roberto Battellini escreveu: > Dave, > > give me a private email and i will send you next week some data from us about operating in cardiogenic schock. > > When the interventional cardiologists call you at night and they can do anything more for the patient, you must operate... > > I am flying now invited to a brasilian congress and cannot send it now.(now is winter there, no holidays, not on the beach) > > Roberto > > From robertobattellini at hotmail.com Wed Jun 3 14:46:28 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Jun 3 07:46:57 2009 Subject: [PHISH]RE: [HSF] OPCAB in ST elevation-for Hal and Don In-Reply-To: <4A2660C0.9030909@terra.com.br> References: <779259.79517.qm@web24711.mail.ird.yahoo.com> <4A2660C0.9030909@terra.com.br> Message-ID: I am coming to Gramado, near porto Alegre. (Brazilian Schweiz). I fly now to sao Paulo. It is cold now in Brazil...unbeliebable. Roberto > Date: Wed, 3 Jun 2009 08:38:40 -0300 > From: fesfagundes@terra.com.br > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [PHISH]RE: [HSF] OPCAB in ST elevation-for Hal and Don > CC: > > Roberto, > are you coming to XV SOLACI Congress in Rio de Janeiro? > I live here and would like toomuch know you. > > Francisco Fagundes > Cardiac Anesthesiologist > Rio de Janeiro - Brasil > fesfagundes@terra.com.br > fesfagundes@gmail.com > > > > Roberto Battellini escreveu: > > Dave, > > > > give me a private email and i will send you next week some data from us about operating in cardiogenic schock. > > > > When the interventional cardiologists call you at night and they can do anything more for the patient, you must operate... > > > > I am flying now invited to a brasilian congress and cannot send it now.(now is winter there, no holidays, not on the beach) > > > > Roberto > > > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Jun 3 18:21:38 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Jun 3 07:52:15 2009 Subject: [PHISH]RE: [HSF] OPCAB in ST elevation-for Hal and Don In-Reply-To: References: <779259.79517.qm@web24711.mail.ird.yahoo.com> <4A2660C0.9030909@terra.com.br> Message-ID: <89c4ed2d0906030451l711bb80aq39f39fe2709d53be@mail.gmail.com> Cold for Roberto means freezing for me !! I thought Brazil was were the girl from Ipanema was frolicking around the beach !! Prasanna On Wed, Jun 3, 2009 at 5:16 PM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > I am coming to Gramado, near porto Alegre. (Brazilian Schweiz). > > I fly now to sao Paulo. > > It is cold now in Brazil...unbeliebable. > > Roberto > > > Date: Wed, 3 Jun 2009 08:38:40 -0300 > > From: fesfagundes@terra.com.br > > To: OpenHeart-L@lists.hsforum.com > > Subject: Re: [PHISH]RE: [HSF] OPCAB in ST elevation-for Hal and Don > > CC: > > > > Roberto, > > are you coming to XV SOLACI Congress in Rio de Janeiro? > > I live here and would like toomuch know you. > > > > Francisco Fagundes > > Cardiac Anesthesiologist > > Rio de Janeiro - Brasil > > fesfagundes@terra.com.br > > fesfagundes@gmail.com > > > > > > > > Roberto Battellini escreveu: > > > Dave, > > > > > > give me a private email and i will send you next week some data from us > about operating in cardiogenic schock. > > > > > > When the interventional cardiologists call you at night and they can do > anything more for the patient, you must operate... > > > > > > I am flying now invited to a brasilian congress and cannot send it > now.(now is winter there, no holidays, not on the beach) > > > > > > Roberto > > > > > > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 fesfagundes at terra.com.br Wed Jun 3 10:00:48 2009 From: fesfagundes at terra.com.br (Francisco Fagundes) Date: Wed Jun 3 08:02:26 2009 Subject: [PHISH]RE: [HSF] OPCAB in ST elevation-for Hal and Don In-Reply-To: References: <779259.79517.qm@web24711.mail.ird.yahoo.com> <4A2660C0.9030909@terra.com.br> Message-ID: <4A2665F0.5070806@terra.com.br> OK. Next time... Francisco Fagundes Roberto Battellini escreveu: > I am coming to Gramado, near porto Alegre. (Brazilian Schweiz). > > I fly now to sao Paulo. > > It is cold now in Brazil...unbeliebable. > > Roberto > > >> Date: Wed, 3 Jun 2009 08:38:40 -0300 >> From: fesfagundes@terra.com.br >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [PHISH]RE: [HSF] OPCAB in ST elevation-for Hal and Don >> CC: >> >> Roberto, >> are you coming to XV SOLACI Congress in Rio de Janeiro? >> I live here and would like toomuch know you. >> >> Francisco Fagundes >> Cardiac Anesthesiologist >> Rio de Janeiro - Brasil >> fesfagundes@terra.com.br >> fesfagundes@gmail.com >> >> >> >> Roberto Battellini escreveu: >> >>> Dave, >>> >>> give me a private email and i will send you next week some data from us about operating in cardiogenic schock. >>> >>> When the interventional cardiologists call you at night and they can do anything more for the patient, you must operate... >>> >>> I am flying now invited to a brasilian congress and cannot send it now.(now is winter there, no holidays, not on the beach) >>> >>> Roberto >>> >>> >>> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 > ----------------------------------------- > > Esta mensagem foi verificada pelo E-mail Protegido Terra. > Atualizado em 25/05/2009 > > > > -- Francisco Fagundes fesfagundes@terra.com.br fesfagundes@gmail.com From fesfagundes at terra.com.br Wed Jun 3 10:13:17 2009 From: fesfagundes at terra.com.br (Francisco Fagundes) Date: Wed Jun 3 08:13:54 2009 Subject: [PHISH]RE: [HSF] OPCAB in ST elevation-for Hal and Don In-Reply-To: <89c4ed2d0906030451l711bb80aq39f39fe2709d53be@mail.gmail.com> References: <779259.79517.qm@web24711.mail.ird.yahoo.com> <4A2660C0.9030909@terra.com.br> <89c4ed2d0906030451l711bb80aq39f39fe2709d53be@mail.gmail.com> Message-ID: <4A2668DD.6080904@terra.com.br> Prasanna, this is in Rio de Janeiro; Roberto is going to the coldest area in Brasil... Here, the girls from Ipanema are sunbathing now. Congratulations to you, Professor. Francisco Fagundes Rio de Janeiro - Brasil Prasanna Simha M escreveu: > Cold for Roberto means freezing for me !! I thought Brazil was were the girl > from Ipanema was frolicking around the beach !! > Prasanna From tacuff at swbell.net Wed Jun 3 06:51:53 2009 From: tacuff at swbell.net (Tea Acuff) Date: Wed Jun 3 08:53:24 2009 Subject: [HSF] HTX in asia? Message-ID: <955521.20553.qm@web81608.mail.mud.yahoo.com> Kit Arom lives in Thailand and could give you suggestions Tea Sent from my iPhone On Jun 3, 2009, at 2:25 AM, "prof. dr. axel laczkovics" wrote: dear friends, it was in 1985, whe i transplanted a something like 12yr old boy in vienna. he is now over 30 and fell in love with a girl (woman?) in thailand and wants to move to and with her. i have moved to germany 1992 and have no idea about tx in asia. has anybody knowledge about tx-centers round bangkok or somewhere else in asia? or at least bigger cardiologic centers for routine check-up?s? thx a lot, axel laczkovics bochum, germany _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 jgammie at gmail.com Wed Jun 3 09:29:03 2009 From: jgammie at gmail.com (James Gammie) Date: Wed Jun 3 08:59:05 2009 Subject: [HSF] News on promotion In-Reply-To: References: <003b01c9e2e5$65c1aef0$1d23a8c0@kbd.hr> <063D12E6-0402-4748-8B49-70738A5C79A7@bigpond.net.au> <89c4ed2d0906020701n2367c1edy40394e74bba051b@mail.gmail.com> Message-ID: Congrats Prasanna Well deserved JSG On Jun 3, 2009, at 2:44 AM, nand kejriwal wrote: > Prasanna > Your contribution to the forum has been invaluable. I have personally > benefitted a lot from your postings. Congrats. Well-deserved. Hope > to catch > up with you one day. > > nand > > 2009/6/2 Prasanna Simha M > >> Thanks John. Incidentally your bigpond address is being rejected >> when I >> reply to it offlist !! >> Prasanna >> >> On Tue, Jun 2, 2009 at 2:28 PM, john goldblatt >> wrote: >> >>> Heartiest congrats Prasanna. >>> Certainly most deserving - we have & continue to learn from you. >>> >>> john goldblatt >>> Royal Melbourne Hospital >>> Melbourne, Australia >>> >>> On 02/06/2009, at 4:18 AM, Igor Rudez wrote: >>> >>> Dear Prasanna, >>>> >>>>> From the bottom of my heart CONGRATULATION! >>>>> >>>> You have certainly deserved it! >>>> >>>> Igor Rudez >>>> >>>> -----Original Message----- >>>> From: openheart-l-bounces@lists.hsforum.com >>>> [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of >>>> Prasanna >>>> Simha M >>>> Sent: Monday, June 01, 2009 6:29 PM >>>> To: OpenHeart-L >>>> Subject: [HSF] News on promotion >>>> >>>> >>>> I would like to share with the HSF fraternity that I have today >>>> been >>>> promoted as a full Professor in Cardiothoracic and Vascular >>>> Surgery in >> my >>>> Institute and Rajiv Gandhi Medical University (All medical , >>>> dental and >>>> allied health science courses in my state come under this >>>> university). >> HSF >>>> and Mark Levinson in particular have helped me a lot through this >> process. >>>> Prasanna >>>> -- >>>> 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 >>>> ----------------------------------------- >>>> >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, 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 and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From msfirst at gmail.com Wed Jun 3 10:02:24 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Wed Jun 3 09:02:53 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: References: <748086.82923.qm@web81605.mail.mud.yahoo.com> Message-ID: True - however, there are many protocols out there, in medicine and in CT surgery - in which the outcomes (however defined) are better than in general what can be accomplished without the protocol - or when individuals chose to not adhere to the protocol. Much like overriding an auto-pilot and crashing a plane. In part, because what usually happens is that the people that override the protocol or auto-pilot think they know better or are smarter (regardless of the situation) than then people, process, data, whatever that led to the development of a protocol. If the protocols fail - and the outcomes and causes can be determined through a CQI then they get changed. Again, hence the checklists that we keep talking about. Ever try to go on pump (for those of you who still use it) without anticoagulation? -michael On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > Tea, > > you are incredible intelectual.I am still waying for you book on Tea?s > thoughts. > > > > It is still stupid to think in Medicine that for example a robot could do > the whole operation itself. A plane can fly in automatic pilot, but not > thorough a storm. > > Roberto > > > Date: Tue, 2 Jun 2009 20:08:19 -0700 > > From: tacuff@swbell.net > > To: OpenHeart-L@lists.hsforum.com > > CC: > > Subject: [HSF] airplane accidents and other "misfortunes" > > > > The airbus disaster over the Atlantic brings up the issue for HSF as to > what lessons might we learn on this occasion. That fact that we may not know > the details, does not mean that there are no lessons to be gleaned. I mean > no disrespect to those lost, and it is likely for a big audience such as HSF > to have some that somehow know someone on that flight. > > > > What intrigues me about this airplane is that it was by design flown by > electric or servo mechanisms. Further it seems that it was programed to be > flown automatically by setting of goals or parameters and the software > computer models "manned" the servomechanism. > > > > Whether this is the fact or not is not really necessary for this > gedankenexperiment. (Einstein did not believe that there are elevators out > in space.) > > > > What we have in this design is an elevation of protocol over experience > or prethought "artificial intelligence" over organic intelligence. I am not > interested in the specific details of the protocols, but the concept that > the protocol is superior to the thinker...in all conditions. This issue > occurs in every realm of thought: religious (word), political (law), > computers (software) or more clinical medicine (best practice, protocol, > etc.) > > > > Medicine is subject to other classes or levels of protocol bureaucratic, > political, economic etc that may further and undoubtedly does limit possible > proscribed actions. The question is whether freedom of individual (nurse, > doctor, institution, research, pilot, etc) action (in all its levels) is an > important safe guard. If so, what does a protocol mean exactly? > > > > In medicine and on the forum some have argued that "blind' application of > "best practice" yields and will yield better medicine than less formalized > practice patterns. The easy logic of such thought makes "best practice" a > nearly universally acclaimed superlative. > > > > There are several problems with this line of thinking. From a logistic > standpoint "best practice" does not have a specific meaning. It best seems > to mirror the common practice of money mangers to be listed by the past > (several) year(s) result as "best manger". We all know the economic > consequence of following this logic. It is the equivalence of "buying into" > a bull market. It works for the short term and is disastrous, buying high > and selling low, in the long term. > > > > Another problem is that we are not likely to see a large obvious and > frightening "kill" in the medical analogy of this flight model. What is > likely to happen is large numbers of remote and thus unrecognized protocol > mismatch or "less than best practice" in the margins while that immediate in > our view looks good if not always best. > > > > Lastly (there are more undoubtedly) most of us are aware of the idiocy we > see from labeling protocol adherence as superior medicine. It leads to large > number of 100% perfect (and "gamed") hospitals and practioners with quite > variable and disparate actual results. > > > > So, can we really design a plane or a medical system that flies itself? > It seems that we can and are determined to, but do we want to fly in it? > > > > Let's see what happens to the airbus. Perhaps there is a story here. > Expect some posturing along the way. > > > > Yes, I know it is "Off Topic." > > > > 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 robertobattellini at hotmail.com Wed Jun 3 17:00:29 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Jun 3 10:00:56 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: References: <748086.82923.qm@web81605.mail.mud.yahoo.com> Message-ID: You are right, in 10 years the pumps are going to be in a museum... Tea, write about this hypothesis. Roberto > Date: Wed, 3 Jun 2009 09:02:24 -0400 > Subject: Re: [HSF] airplane accidents and other "misfortunes" > From: msfirst@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > > True - however, there are many protocols out there, in medicine and in CT > surgery - in which the outcomes (however defined) are better than in general > what can be accomplished without the protocol - or when individuals chose to > not adhere to the protocol. Much like overriding an auto-pilot and crashing > a plane. In part, because what usually happens is that the people that > override the protocol or auto-pilot think they know better or are smarter > (regardless of the situation) than then people, process, data, whatever that > led to the development of a protocol. If the protocols fail - and the > outcomes and causes can be determined through a CQI then they get changed. > Again, hence the checklists that we keep talking about. > > Ever try to go on pump (for those of you who still use it) without > anticoagulation? > > -michael > > > > > On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > > > > > Tea, > > > > you are incredible intelectual.I am still waying for you book on Tea?s > > thoughts. > > > > > > > > It is still stupid to think in Medicine that for example a robot could do > > the whole operation itself. A plane can fly in automatic pilot, but not > > thorough a storm. > > > > Roberto > > > > > Date: Tue, 2 Jun 2009 20:08:19 -0700 > > > From: tacuff@swbell.net > > > To: OpenHeart-L@lists.hsforum.com > > > CC: > > > Subject: [HSF] airplane accidents and other "misfortunes" > > > > > > The airbus disaster over the Atlantic brings up the issue for HSF as to > > what lessons might we learn on this occasion. That fact that we may not know > > the details, does not mean that there are no lessons to be gleaned. I mean > > no disrespect to those lost, and it is likely for a big audience such as HSF > > to have some that somehow know someone on that flight. > > > > > > What intrigues me about this airplane is that it was by design flown by > > electric or servo mechanisms. Further it seems that it was programed to be > > flown automatically by setting of goals or parameters and the software > > computer models "manned" the servomechanism. > > > > > > Whether this is the fact or not is not really necessary for this > > gedankenexperiment. (Einstein did not believe that there are elevators out > > in space.) > > > > > > What we have in this design is an elevation of protocol over experience > > or prethought "artificial intelligence" over organic intelligence. I am not > > interested in the specific details of the protocols, but the concept that > > the protocol is superior to the thinker...in all conditions. This issue > > occurs in every realm of thought: religious (word), political (law), > > computers (software) or more clinical medicine (best practice, protocol, > > etc.) > > > > > > Medicine is subject to other classes or levels of protocol bureaucratic, > > political, economic etc that may further and undoubtedly does limit possible > > proscribed actions. The question is whether freedom of individual (nurse, > > doctor, institution, research, pilot, etc) action (in all its levels) is an > > important safe guard. If so, what does a protocol mean exactly? > > > > > > In medicine and on the forum some have argued that "blind' application of > > "best practice" yields and will yield better medicine than less formalized > > practice patterns. The easy logic of such thought makes "best practice" a > > nearly universally acclaimed superlative. > > > > > > There are several problems with this line of thinking. From a logistic > > standpoint "best practice" does not have a specific meaning. It best seems > > to mirror the common practice of money mangers to be listed by the past > > (several) year(s) result as "best manger". We all know the economic > > consequence of following this logic. It is the equivalence of "buying into" > > a bull market. It works for the short term and is disastrous, buying high > > and selling low, in the long term. > > > > > > Another problem is that we are not likely to see a large obvious and > > frightening "kill" in the medical analogy of this flight model. What is > > likely to happen is large numbers of remote and thus unrecognized protocol > > mismatch or "less than best practice" in the margins while that immediate in > > our view looks good if not always best. > > > > > > Lastly (there are more undoubtedly) most of us are aware of the idiocy we > > see from labeling protocol adherence as superior medicine. It leads to large > > number of 100% perfect (and "gamed") hospitals and practioners with quite > > variable and disparate actual results. > > > > > > So, can we really design a plane or a medical system that flies itself? > > It seems that we can and are determined to, but do we want to fly in it? > > > > > > Let's see what happens to the airbus. Perhaps there is a story here. > > Expect some posturing along the way. > > > > > > Yes, I know it is "Off Topic." > > > > > > 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 Wed Jun 3 08:22:51 2009 From: tacuff at swbell.net (Tea Acuff) Date: Wed Jun 3 10:24:21 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: References: <748086.82923.qm@web81605.mail.mud.yahoo.com> Message-ID: <306982.89689.qm@web81603.mail.mud.yahoo.com> Thanks for the challenge. It is hard to imagine politics without laws, but the question is at what level is the control asserted, how ubiquitious should the law be,?and where are the enforcements for failure? Does anticoagulation mean heparin, hirudin, or in alternative "CP support" little of no anticoagulation? Is it better to leave the control and enforcement of such decisions to local control and enforcement or "manufacture" it in from the top after a thousand meetings. Or as we are heading in the US with little of no consensus from one or two meetings at the top? Should the "highest protocols" be of the form "do this , this, and this", or say the form of the?Ten Commandments, "don't do this, don't do that" and have a thousand different demonimations play out the details of the protocol? As I asked define protocol exactly. We can not agree often on the details of a specific protocol eg on or off pump. Should we agree on the higher question, the form?of protocol? tea ________________________________ From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Wednesday, June 3, 2009 8:02:24 AM Subject: Re: [HSF] airplane accidents and other "misfortunes" True - however, there are many protocols out there, in medicine and in CT surgery - in which the outcomes (however defined) are better than in general what can be accomplished without the protocol - or when individuals chose to not adhere to the protocol.? Much like overriding an auto-pilot and crashing a plane.? In part, because what usually happens is that the people that override the protocol or auto-pilot think they know better or are smarter (regardless of the situation) than then people, process, data, whatever that led to the development of a protocol.? If the protocols fail - and the outcomes and causes can be determined through a CQI then they get changed. Again, hence the checklists that we keep talking about. Ever try to go on pump (for those of you who still use it) without anticoagulation? -michael On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > Tea, > > you are incredible intelectual.I am still waying for you book on Tea?s > thoughts. > > > > It is still stupid to think in Medicine that for example a robot could do > the whole operation itself. A plane can fly in automatic pilot, but not > thorough a storm. > > Roberto > > > Date: Tue, 2 Jun 2009 20:08:19 -0700 > > From: tacuff@swbell.net > > To: OpenHeart-L@lists.hsforum.com > > CC: > > Subject: [HSF] airplane accidents and other "misfortunes" >? > > > The airbus disaster over the Atlantic brings up the issue for HSF as to > what lessons might we learn on this occasion. That fact that we may not know > the details, does not mean that there are no lessons to be gleaned. I mean > no disrespect to those lost, and it is likely for a big audience such as HSF > to have some that somehow know someone on that flight. > > > > What intrigues me about this airplane is that it was by design flown by > electric or servo mechanisms. Further it seems that it was programed to be > flown automatically by setting of goals or parameters and the software > computer models "manned" the servomechanism. > > > > Whether this is the fact or not is not really necessary for this > gedankenexperiment. (Einstein did not believe that there are elevators out > in space.) > > > > What we have in this design is an elevation of protocol over experience > or prethought "artificial intelligence" over organic intelligence. I am not > interested in the specific details of the protocols, but the concept that > the protocol is superior to the thinker...in all conditions. This issue > occurs in every realm of thought: religious (word), political (law), > computers (software) or more clinical medicine (best practice, protocol, > etc.) > > > > Medicine is subject to other classes or levels of protocol bureaucratic, > political, economic etc that may further and undoubtedly does limit possible > proscribed actions. The question is whether freedom of individual (nurse, > doctor, institution, research, pilot, etc) action (in all its levels) is an > important safe guard. If so, what does a protocol mean exactly? > > > > In medicine and on the forum some have argued that "blind' application of > "best practice" yields and will yield better medicine than less formalized > practice patterns. The easy logic of such thought makes "best practice" a > nearly universally acclaimed superlative. > > > > There are several problems with this line of thinking. From a logistic > standpoint "best practice" does not have a specific meaning. It best seems > to mirror the common practice of money mangers to be listed by the past > (several) year(s) result as "best manger". We all know the economic > consequence of following this logic. It is the equivalence of "buying into" > a bull market. It works for the short term and is disastrous, buying high > and selling low, in the long term. > > > > Another problem is that we are not likely to see a large obvious and > frightening "kill" in the medical analogy of this flight model. What is > likely to happen is large numbers of remote and thus unrecognized protocol > mismatch or "less than best practice" in the margins while that immediate in > our view looks good if not always best. > > > > Lastly (there are more undoubtedly) most of us are aware of the idiocy we > see from labeling protocol adherence as superior medicine. It leads to large > number of 100% perfect (and "gamed") hospitals and practioners with quite > variable and disparate actual results. > > > > So, can we really design a plane or a medical system that flies itself? > It seems that we can and are determined to, but do we want to fly in it? > > > > Let's see what happens to the airbus. Perhaps there is a story here. > Expect some posturing along the way. > > > > Yes, I know it is "Off Topic." > > > > 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 prasannasimha at gmail.com Wed Jun 3 21:18:09 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Jun 3 10:48:59 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: <306982.89689.qm@web81603.mail.mud.yahoo.com> References: <748086.82923.qm@web81605.mail.mud.yahoo.com> <306982.89689.qm@web81603.mail.mud.yahoo.com> Message-ID: <89c4ed2d0906030748r679c461bkac9c3d10902ccdd0@mail.gmail.com> Protocols should be defined as that which makes a thing "Idiot proof" Protocol demands Heparin administration to be announced loudly , an ACT done and announced. Protocol also demands that a surgeon says to start the wean with the loud proclomation "Ventilator on" which should be done and acknowledged by the anesthesiologist. The anesthesiologist should not look at it as micromanaging but as a "check and balance" and "idiot proofing". A senior would always put the Ventilator on but its nott really for him where it has become second nature but for the neophyte or more dangerously the midrung (not too "junior" to be micromanaged but not too senior to be an "expert" who would be able to set a protocol him/herself. Prasanna On Wed, Jun 3, 2009 at 7:52 PM, Tea Acuff wrote: > Thanks for the challenge. > > It is hard to imagine politics without laws, but the question is at what > level is the control asserted, how ubiquitious should the law be, and where > are the enforcements for failure? > > Does anticoagulation mean heparin, hirudin, or in alternative "CP support" > little of no anticoagulation? > > Is it better to leave the control and enforcement of such decisions to > local control and enforcement or "manufacture" it in from the top after a > thousand meetings. Or as we are heading in the US with little of no > consensus from one or two meetings at the top? > > Should the "highest protocols" be of the form "do this , this, and this", > or say the form of the Ten Commandments, "don't do this, don't do that" and > have a thousand different demonimations play out the details of the > protocol? > > As I asked define protocol exactly. We can not agree often on the details > of a specific protocol eg on or off pump. Should we agree on the higher > question, the form of protocol? > > tea > > > > ________________________________ > From: Michael Firstenberg > To: OpenHeart-L@lists.hsforum.com > Sent: Wednesday, June 3, 2009 8:02:24 AM > Subject: Re: [HSF] airplane accidents and other "misfortunes" > > True - however, there are many protocols out there, in medicine and in CT > surgery - in which the outcomes (however defined) are better than in > general > what can be accomplished without the protocol - or when individuals chose > to > not adhere to the protocol. Much like overriding an auto-pilot and > crashing > a plane. In part, because what usually happens is that the people that > override the protocol or auto-pilot think they know better or are smarter > (regardless of the situation) than then people, process, data, whatever > that > led to the development of a protocol. If the protocols fail - and the > outcomes and causes can be determined through a CQI then they get changed. > Again, hence the checklists that we keep talking about. > > Ever try to go on pump (for those of you who still use it) without > anticoagulation? > > -michael > > > > > On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > > > > > Tea, > > > > you are incredible intelectual.I am still waying for you book on Tea?s > > thoughts. > > > > > > > > It is still stupid to think in Medicine that for example a robot could do > > the whole operation itself. A plane can fly in automatic pilot, but not > > thorough a storm. > > > > Roberto > > > > > Date: Tue, 2 Jun 2009 20:08:19 -0700 > > > From: tacuff@swbell.net > > > To: OpenHeart-L@lists.hsforum.com > > > CC: > > > Subject: [HSF] airplane accidents and other "misfortunes" > > > > > > The airbus disaster over the Atlantic brings up the issue for HSF as to > > what lessons might we learn on this occasion. That fact that we may not > know > > the details, does not mean that there are no lessons to be gleaned. I > mean > > no disrespect to those lost, and it is likely for a big audience such as > HSF > > to have some that somehow know someone on that flight. > > > > > > What intrigues me about this airplane is that it was by design flown by > > electric or servo mechanisms. Further it seems that it was programed to > be > > flown automatically by setting of goals or parameters and the software > > computer models "manned" the servomechanism. > > > > > > Whether this is the fact or not is not really necessary for this > > gedankenexperiment. (Einstein did not believe that there are elevators > out > > in space.) > > > > > > What we have in this design is an elevation of protocol over experience > > or prethought "artificial intelligence" over organic intelligence. I am > not > > interested in the specific details of the protocols, but the concept that > > the protocol is superior to the thinker...in all conditions. This issue > > occurs in every realm of thought: religious (word), political (law), > > computers (software) or more clinical medicine (best practice, protocol, > > etc.) > > > > > > Medicine is subject to other classes or levels of protocol > bureaucratic, > > political, economic etc that may further and undoubtedly does limit > possible > > proscribed actions. The question is whether freedom of individual (nurse, > > doctor, institution, research, pilot, etc) action (in all its levels) is > an > > important safe guard. If so, what does a protocol mean exactly? > > > > > > In medicine and on the forum some have argued that "blind' application > of > > "best practice" yields and will yield better medicine than less > formalized > > practice patterns. The easy logic of such thought makes "best practice" a > > nearly universally acclaimed superlative. > > > > > > There are several problems with this line of thinking. From a logistic > > standpoint "best practice" does not have a specific meaning. It best > seems > > to mirror the common practice of money mangers to be listed by the past > > (several) year(s) result as "best manger". We all know the economic > > consequence of following this logic. It is the equivalence of "buying > into" > > a bull market. It works for the short term and is disastrous, buying high > > and selling low, in the long term. > > > > > > Another problem is that we are not likely to see a large obvious and > > frightening "kill" in the medical analogy of this flight model. What is > > likely to happen is large numbers of remote and thus unrecognized > protocol > > mismatch or "less than best practice" in the margins while that immediate > in > > our view looks good if not always best. > > > > > > Lastly (there are more undoubtedly) most of us are aware of the idiocy > we > > see from labeling protocol adherence as superior medicine. It leads to > large > > number of 100% perfect (and "gamed") hospitals and practioners with quite > > variable and disparate actual results. > > > > > > So, can we really design a plane or a medical system that flies itself? > > It seems that we can and are determined to, but do we want to fly in it? > > > > > > Let's see what happens to the airbus. Perhaps there is a story here. > > Expect some posturing along the way. > > > > > > Yes, I know it is "Off Topic." > > > > > > 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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Wed Jun 3 21:23:25 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Jun 3 10:54:15 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: <89c4ed2d0906030748r679c461bkac9c3d10902ccdd0@mail.gmail.com> References: <748086.82923.qm@web81605.mail.mud.yahoo.com> <306982.89689.qm@web81603.mail.mud.yahoo.com> <89c4ed2d0906030748r679c461bkac9c3d10902ccdd0@mail.gmail.com> Message-ID: <89c4ed2d0906030753h2a15b91asfb1e7f6e7970a211@mail.gmail.com> "The most dangerous time for a baby is not when it is in its womb or after it has a healthy cry but during transit. Same can be said for the process of training." I am always worried about the New lecturer who has recently passed out and over years consistently had a call from a perfusionist/anesthesiologist running up to me and calling me to come over stat as the New lecturer has made a hole in the posterior wall of the IVC while looping and hasn't placed at least a purse string let alone an aortic cannula before taping the SVC and IVC - a thing that I tell them to do specifically when I am not around !! After getting burnt they become a little more careful. Prasanna On Wed, Jun 3, 2009 at 8:18 PM, Prasanna Simha M wrote: > Protocols should be defined as that which makes a thing "Idiot proof" > Protocol demands Heparin administration to be announced loudly , an ACT > done and announced. > Protocol also demands that a surgeon says to start the wean with the loud > proclomation "Ventilator on" which should be done and acknowledged by the > anesthesiologist. The anesthesiologist should not look at it as > micromanaging but as a "check and balance" and "idiot proofing". A senior > would always put the Ventilator on but its nott really for him where it has > become second nature but for the neophyte or more dangerously the midrung > (not too "junior" to be micromanaged but not too senior to be an "expert" > who would be able to set a protocol him/herself. > Prasanna > > On Wed, Jun 3, 2009 at 7:52 PM, Tea Acuff wrote: > >> Thanks for the challenge. >> >> It is hard to imagine politics without laws, but the question is at what >> level is the control asserted, how ubiquitious should the law be, and where >> are the enforcements for failure? >> >> Does anticoagulation mean heparin, hirudin, or in alternative "CP support" >> little of no anticoagulation? >> >> Is it better to leave the control and enforcement of such decisions to >> local control and enforcement or "manufacture" it in from the top after a >> thousand meetings. Or as we are heading in the US with little of no >> consensus from one or two meetings at the top? >> >> Should the "highest protocols" be of the form "do this , this, and this", >> or say the form of the Ten Commandments, "don't do this, don't do that" and >> have a thousand different demonimations play out the details of the >> protocol? >> >> As I asked define protocol exactly. We can not agree often on the details >> of a specific protocol eg on or off pump. Should we agree on the higher >> question, the form of protocol? >> >> tea >> >> >> >> ________________________________ >> From: Michael Firstenberg >> To: OpenHeart-L@lists.hsforum.com >> Sent: Wednesday, June 3, 2009 8:02:24 AM >> Subject: Re: [HSF] airplane accidents and other "misfortunes" >> >> True - however, there are many protocols out there, in medicine and in CT >> surgery - in which the outcomes (however defined) are better than in >> general >> what can be accomplished without the protocol - or when individuals chose >> to >> not adhere to the protocol. Much like overriding an auto-pilot and >> crashing >> a plane. In part, because what usually happens is that the people that >> override the protocol or auto-pilot think they know better or are smarter >> (regardless of the situation) than then people, process, data, whatever >> that >> led to the development of a protocol. If the protocols fail - and the >> outcomes and causes can be determined through a CQI then they get changed. >> Again, hence the checklists that we keep talking about. >> >> Ever try to go on pump (for those of you who still use it) without >> anticoagulation? >> >> -michael >> >> >> >> >> On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < >> robertobattellini@hotmail.com> wrote: >> >> > >> > Tea, >> > >> > you are incredible intelectual.I am still waying for you book on Tea?s >> > thoughts. >> > >> > >> > >> > It is still stupid to think in Medicine that for example a robot could >> do >> > the whole operation itself. A plane can fly in automatic pilot, but not >> > thorough a storm. >> > >> > Roberto >> > >> > > Date: Tue, 2 Jun 2009 20:08:19 -0700 >> > > From: tacuff@swbell.net >> > > To: OpenHeart-L@lists.hsforum.com >> > > CC: >> > > Subject: [HSF] airplane accidents and other "misfortunes" >> > > >> > > The airbus disaster over the Atlantic brings up the issue for HSF as >> to >> > what lessons might we learn on this occasion. That fact that we may not >> know >> > the details, does not mean that there are no lessons to be gleaned. I >> mean >> > no disrespect to those lost, and it is likely for a big audience such as >> HSF >> > to have some that somehow know someone on that flight. >> > > >> > > What intrigues me about this airplane is that it was by design flown >> by >> > electric or servo mechanisms. Further it seems that it was programed to >> be >> > flown automatically by setting of goals or parameters and the software >> > computer models "manned" the servomechanism. >> > > >> > > Whether this is the fact or not is not really necessary for this >> > gedankenexperiment. (Einstein did not believe that there are elevators >> out >> > in space.) >> > > >> > > What we have in this design is an elevation of protocol over >> experience >> > or prethought "artificial intelligence" over organic intelligence. I am >> not >> > interested in the specific details of the protocols, but the concept >> that >> > the protocol is superior to the thinker...in all conditions. This issue >> > occurs in every realm of thought: religious (word), political (law), >> > computers (software) or more clinical medicine (best practice, protocol, >> > etc.) >> > > >> > > Medicine is subject to other classes or levels of protocol >> bureaucratic, >> > political, economic etc that may further and undoubtedly does limit >> possible >> > proscribed actions. The question is whether freedom of individual >> (nurse, >> > doctor, institution, research, pilot, etc) action (in all its levels) is >> an >> > important safe guard. If so, what does a protocol mean exactly? >> > > >> > > In medicine and on the forum some have argued that "blind' application >> of >> > "best practice" yields and will yield better medicine than less >> formalized >> > practice patterns. The easy logic of such thought makes "best practice" >> a >> > nearly universally acclaimed superlative. >> > > >> > > There are several problems with this line of thinking. From a logistic >> > standpoint "best practice" does not have a specific meaning. It best >> seems >> > to mirror the common practice of money mangers to be listed by the past >> > (several) year(s) result as "best manger". We all know the economic >> > consequence of following this logic. It is the equivalence of "buying >> into" >> > a bull market. It works for the short term and is disastrous, buying >> high >> > and selling low, in the long term. >> > > >> > > Another problem is that we are not likely to see a large obvious and >> > frightening "kill" in the medical analogy of this flight model. What is >> > likely to happen is large numbers of remote and thus unrecognized >> protocol >> > mismatch or "less than best practice" in the margins while that >> immediate in >> > our view looks good if not always best. >> > > >> > > Lastly (there are more undoubtedly) most of us are aware of the idiocy >> we >> > see from labeling protocol adherence as superior medicine. It leads to >> large >> > number of 100% perfect (and "gamed") hospitals and practioners with >> quite >> > variable and disparate actual results. >> > > >> > > So, can we really design a plane or a medical system that flies >> itself? >> > It seems that we can and are determined to, but do we want to fly in it? >> > > >> > > Let's see what happens to the airbus. Perhaps there is a story here. >> > Expect some posturing along the way. >> > > >> > > Yes, I know it is "Off Topic." >> > > >> > > 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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From msfirst at gmail.com Wed Jun 3 12:06:49 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Wed Jun 3 11:34:09 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: <89c4ed2d0906030753h2a15b91asfb1e7f6e7970a211@mail.gmail.com> References: <748086.82923.qm@web81605.mail.mud.yahoo.com> <306982.89689.qm@web81603.mail.mud.yahoo.com> <89c4ed2d0906030748r679c461bkac9c3d10902ccdd0@mail.gmail.com> <89c4ed2d0906030753h2a15b91asfb1e7f6e7970a211@mail.gmail.com> Message-ID: yes, patients often need protection from us. How many of you have heparin nomograms for anticoagulation in your hospitals? -m On Wed, Jun 3, 2009 at 10:53 AM, Prasanna Simha M wrote: > "The most dangerous time for a baby is not when it is in its womb or after > it has a healthy cry but during transit. > Same can be said for the process of training." > > I am always worried about the New lecturer who has recently passed out and > over years consistently had a call from a perfusionist/anesthesiologist > running up to me and calling me to come over stat as the New lecturer has > made a hole in the posterior wall of the IVC while looping and hasn't > placed > at least a purse string let alone an aortic cannula before taping the SVC > and IVC - a thing that I tell them to do specifically when I am not around > !! > After getting burnt they become a little more careful. > Prasanna > > On Wed, Jun 3, 2009 at 8:18 PM, Prasanna Simha M >wrote: > > > Protocols should be defined as that which makes a thing "Idiot proof" > > Protocol demands Heparin administration to be announced loudly , an ACT > > done and announced. > > Protocol also demands that a surgeon says to start the wean with the > loud > > proclomation "Ventilator on" which should be done and acknowledged by the > > anesthesiologist. The anesthesiologist should not look at it as > > micromanaging but as a "check and balance" and "idiot proofing". A > senior > > would always put the Ventilator on but its nott really for him where it > has > > become second nature but for the neophyte or more dangerously the midrung > > (not too "junior" to be micromanaged but not too senior to be an "expert" > > who would be able to set a protocol him/herself. > > Prasanna > > > > On Wed, Jun 3, 2009 at 7:52 PM, Tea Acuff wrote: > > > >> Thanks for the challenge. > >> > >> It is hard to imagine politics without laws, but the question is at what > >> level is the control asserted, how ubiquitious should the law be, and > where > >> are the enforcements for failure? > >> > >> Does anticoagulation mean heparin, hirudin, or in alternative "CP > support" > >> little of no anticoagulation? > >> > >> Is it better to leave the control and enforcement of such decisions to > >> local control and enforcement or "manufacture" it in from the top after > a > >> thousand meetings. Or as we are heading in the US with little of no > >> consensus from one or two meetings at the top? > >> > >> Should the "highest protocols" be of the form "do this , this, and > this", > >> or say the form of the Ten Commandments, "don't do this, don't do that" > and > >> have a thousand different demonimations play out the details of the > >> protocol? > >> > >> As I asked define protocol exactly. We can not agree often on the > details > >> of a specific protocol eg on or off pump. Should we agree on the higher > >> question, the form of protocol? > >> > >> tea > >> > >> > >> > >> ________________________________ > >> From: Michael Firstenberg > >> To: OpenHeart-L@lists.hsforum.com > >> Sent: Wednesday, June 3, 2009 8:02:24 AM > >> Subject: Re: [HSF] airplane accidents and other "misfortunes" > >> > >> True - however, there are many protocols out there, in medicine and in > CT > >> surgery - in which the outcomes (however defined) are better than in > >> general > >> what can be accomplished without the protocol - or when individuals > chose > >> to > >> not adhere to the protocol. Much like overriding an auto-pilot and > >> crashing > >> a plane. In part, because what usually happens is that the people that > >> override the protocol or auto-pilot think they know better or are > smarter > >> (regardless of the situation) than then people, process, data, whatever > >> that > >> led to the development of a protocol. If the protocols fail - and the > >> outcomes and causes can be determined through a CQI then they get > changed. > >> Again, hence the checklists that we keep talking about. > >> > >> Ever try to go on pump (for those of you who still use it) without > >> anticoagulation? > >> > >> -michael > >> > >> > >> > >> > >> On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < > >> robertobattellini@hotmail.com> wrote: > >> > >> > > >> > Tea, > >> > > >> > you are incredible intelectual.I am still waying for you book on Tea?s > >> > thoughts. > >> > > >> > > >> > > >> > It is still stupid to think in Medicine that for example a robot could > >> do > >> > the whole operation itself. A plane can fly in automatic pilot, but > not > >> > thorough a storm. > >> > > >> > Roberto > >> > > >> > > Date: Tue, 2 Jun 2009 20:08:19 -0700 > >> > > From: tacuff@swbell.net > >> > > To: OpenHeart-L@lists.hsforum.com > >> > > CC: > >> > > Subject: [HSF] airplane accidents and other "misfortunes" > >> > > > >> > > The airbus disaster over the Atlantic brings up the issue for HSF as > >> to > >> > what lessons might we learn on this occasion. That fact that we may > not > >> know > >> > the details, does not mean that there are no lessons to be gleaned. I > >> mean > >> > no disrespect to those lost, and it is likely for a big audience such > as > >> HSF > >> > to have some that somehow know someone on that flight. > >> > > > >> > > What intrigues me about this airplane is that it was by design flown > >> by > >> > electric or servo mechanisms. Further it seems that it was programed > to > >> be > >> > flown automatically by setting of goals or parameters and the software > >> > computer models "manned" the servomechanism. > >> > > > >> > > Whether this is the fact or not is not really necessary for this > >> > gedankenexperiment. (Einstein did not believe that there are elevators > >> out > >> > in space.) > >> > > > >> > > What we have in this design is an elevation of protocol over > >> experience > >> > or prethought "artificial intelligence" over organic intelligence. I > am > >> not > >> > interested in the specific details of the protocols, but the concept > >> that > >> > the protocol is superior to the thinker...in all conditions. This > issue > >> > occurs in every realm of thought: religious (word), political (law), > >> > computers (software) or more clinical medicine (best practice, > protocol, > >> > etc.) > >> > > > >> > > Medicine is subject to other classes or levels of protocol > >> bureaucratic, > >> > political, economic etc that may further and undoubtedly does limit > >> possible > >> > proscribed actions. The question is whether freedom of individual > >> (nurse, > >> > doctor, institution, research, pilot, etc) action (in all its levels) > is > >> an > >> > important safe guard. If so, what does a protocol mean exactly? > >> > > > >> > > In medicine and on the forum some have argued that "blind' > application > >> of > >> > "best practice" yields and will yield better medicine than less > >> formalized > >> > practice patterns. The easy logic of such thought makes "best > practice" > >> a > >> > nearly universally acclaimed superlative. > >> > > > >> > > There are several problems with this line of thinking. From a > logistic > >> > standpoint "best practice" does not have a specific meaning. It best > >> seems > >> > to mirror the common practice of money mangers to be listed by the > past > >> > (several) year(s) result as "best manger". We all know the economic > >> > consequence of following this logic. It is the equivalence of "buying > >> into" > >> > a bull market. It works for the short term and is disastrous, buying > >> high > >> > and selling low, in the long term. > >> > > > >> > > Another problem is that we are not likely to see a large obvious and > >> > frightening "kill" in the medical analogy of this flight model. What > is > >> > likely to happen is large numbers of remote and thus unrecognized > >> protocol > >> > mismatch or "less than best practice" in the margins while that > >> immediate in > >> > our view looks good if not always best. > >> > > > >> > > Lastly (there are more undoubtedly) most of us are aware of the > idiocy > >> we > >> > see from labeling protocol adherence as superior medicine. It leads to > >> large > >> > number of 100% perfect (and "gamed") hospitals and practioners with > >> quite > >> > variable and disparate actual results. > >> > > > >> > > So, can we really design a plane or a medical system that flies > >> itself? > >> > It seems that we can and are determined to, but do we want to fly in > it? > >> > > > >> > > Let's see what happens to the airbus. Perhaps there is a story here. > >> > Expect some posturing along the way. > >> > > > >> > > Yes, I know it is "Off Topic." > >> > > > >> > > 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 > >> ----------------------------------------- > >> > > > > > > > > -- > > 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 prasannasimha at gmail.com Wed Jun 3 22:09:01 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Jun 3 11:39:42 2009 Subject: [HSF] The fine art of suing.How does this impact you ? Message-ID: <89c4ed2d0906030839l74e2e0c7u884272974cdb3718@mail.gmail.com> From Medscape Business of Medicine> Your Malpractice Advisor Watch Out for This Growing Malpractice Trend Brian S Kern, Esq. Published: 05/27/2009 Introduction Physicians who have created legal entities, such as LLCs (limited liability companies) and professional associations, to limit their liability may mistakenly believe that they are well protected against medical negligence lawsuits. Although this legal structure does protect physicians in areas ranging from contractual obligations to "slip-and-fall" type claims, new litigation trends suggest that this can now *increase* liability in medical negligence cases. Here's why: In many *nonphysician* business settings, creating legal entities transfers liability and insulates individual actions. Plaintiffs will typically sue corporations rather than individuals, and corporations can buy insurance to protect all of their owners and employees. Medicine is different. Plaintiffs generally sue the individual physician rather than the entity, as by law in many states doctors cannot avoid exposure by working through a corporate entity. Therefore, physicians generally buy medical malpractice policies in their own name, rather than in the name of the practice. However, because medical malpractice premiums have become more expensive, physicians began buying policies with lower limits of insurance. Previously, individual doctors carried as much as $12 million of insurance per claim; now the majority of physicians carry no more than $1 million per claim. In response, plaintiff lawyers began to seek larger awards by dragging medical entities into lawsuits. Now more than previously, lawyers sue the individual physician *and* the corporation. That's true even for solo practitioners. In the past, plaintiff attorneys may have named entities for a variety of reasons, but mainly to ensure that there was underlying coverage. Once coverage was established, entities were commonly dropped from a lawsuit. Now when lawyers sue an entity, they are less likely to let it out of a case, not only because it may provide potential leverage in settlement negotiations, but also because a number of legal theories can render them an effective source of independent recovery. Be Aware of Everyone Involved Lawyers often use a vicarious liability theory known as *respondeat superior *, which translates literally to "let the master answer," to hold entities liable. Under *respondeat superior*, the master is the corporation or other legal entity that a physician's group may practice under. "Agency" principles are used to establish all the parties for which the master is responsible. Agency refers to an individual acting or appearing to act on behalf of another, and thus can make a medical practice liable for the acts of its entire professional and nonprofessional staff. This causes trouble when the individual doctor responsible for an act of negligence does not have enough insurance to cover a claim. The corporation can become jointly and severally liable for paying the remainder of the judgment. Even if physicians have insurance coverage for themselves and their entities, they must still be aware of the "vicarious" liability that can emerge from using independent contractors, sharing office space, or even using "covering doctors." Still another negative is that when a practice is sued, it may need to hire its own lawyers to represent it. Legal fees associated with defending an entity can quickly mount, giving plaintiffs' attorneys yet additional leverage to facilitate a settlement. This "double jeopardy" -- suing both the physician and the entity -- can have a devastating effect on medical practices. How Can Physicians Lessen This Risk? Buying additional insurance for the entity can reduce the risk for personal liability. However, the cost may be prohibitive. Worse, high insurance limits often result in higher settlements. The more money available, the more money plaintiffs' attorneys may demand. To lower both cost and exposure, physicians should develop an overall coverage strategy. Four options follow. *First, use 1 policy limit* to cover multiple entities, if applicable. *Second, have physicians "share" their respective limits* with the corporate limits to avoid bringing additional insurance policies into a lawsuit and largely eliminate a plaintiff's leverage. Be careful when constructing this, because it can create significant exposure if coverage is not coordinated for every agent of the corporation. Shared coverage will only respond on behalf of the corporation if the claim is related to a physician that is a "named insured" on the underlying policy. *Third, look into creative solutions for insurance.* Although state laws and credentialing requirements often govern insurance policy limits for physicians, there is often no similar framework for healthcare entities. As a result, insurers can offer unique solutions, such as high deductibles, aggregate limits, or even policies that only cover legal expenses, but do not insure against losses (settlements or awards). *Fourth, check with your broker* before renewing your insurance coverage. Also consider consulting with experts in accounting, healthcare, and insurance law to coordinate your insurance needs with a comprehensive asset protection plan. -- Prasanna Simha M From prasannasimha at gmail.com Wed Jun 3 22:09:56 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Jun 3 11:40:52 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: References: <748086.82923.qm@web81605.mail.mud.yahoo.com> <306982.89689.qm@web81603.mail.mud.yahoo.com> <89c4ed2d0906030748r679c461bkac9c3d10902ccdd0@mail.gmail.com> <89c4ed2d0906030753h2a15b91asfb1e7f6e7970a211@mail.gmail.com> Message-ID: <89c4ed2d0906030839m7d268151h5b98d5e84c1fe72e@mail.gmail.com> Nomograms when you are measuring ACt's or APTT ? prasanna On Wed, Jun 3, 2009 at 8:36 PM, Michael Firstenberg wrote: > yes, patients often need protection from us. > > How many of you have heparin nomograms for anticoagulation in your > hospitals? > > -m > > On Wed, Jun 3, 2009 at 10:53 AM, Prasanna Simha M > wrote: > > > "The most dangerous time for a baby is not when it is in its womb or > after > > it has a healthy cry but during transit. > > Same can be said for the process of training." > > > > I am always worried about the New lecturer who has recently passed out > and > > over years consistently had a call from a perfusionist/anesthesiologist > > running up to me and calling me to come over stat as the New lecturer has > > made a hole in the posterior wall of the IVC while looping and hasn't > > placed > > at least a purse string let alone an aortic cannula before taping the SVC > > and IVC - a thing that I tell them to do specifically when I am not > around > > !! > > After getting burnt they become a little more careful. > > Prasanna > > > > On Wed, Jun 3, 2009 at 8:18 PM, Prasanna Simha M < > prasannasimha@gmail.com > > >wrote: > > > > > Protocols should be defined as that which makes a thing "Idiot proof" > > > Protocol demands Heparin administration to be announced loudly , an > ACT > > > done and announced. > > > Protocol also demands that a surgeon says to start the wean with the > > loud > > > proclomation "Ventilator on" which should be done and acknowledged by > the > > > anesthesiologist. The anesthesiologist should not look at it as > > > micromanaging but as a "check and balance" and "idiot proofing". A > > senior > > > would always put the Ventilator on but its nott really for him where it > > has > > > become second nature but for the neophyte or more dangerously the > midrung > > > (not too "junior" to be micromanaged but not too senior to be an > "expert" > > > who would be able to set a protocol him/herself. > > > Prasanna > > > > > > On Wed, Jun 3, 2009 at 7:52 PM, Tea Acuff wrote: > > > > > >> Thanks for the challenge. > > >> > > >> It is hard to imagine politics without laws, but the question is at > what > > >> level is the control asserted, how ubiquitious should the law be, and > > where > > >> are the enforcements for failure? > > >> > > >> Does anticoagulation mean heparin, hirudin, or in alternative "CP > > support" > > >> little of no anticoagulation? > > >> > > >> Is it better to leave the control and enforcement of such decisions to > > >> local control and enforcement or "manufacture" it in from the top > after > > a > > >> thousand meetings. Or as we are heading in the US with little of no > > >> consensus from one or two meetings at the top? > > >> > > >> Should the "highest protocols" be of the form "do this , this, and > > this", > > >> or say the form of the Ten Commandments, "don't do this, don't do > that" > > and > > >> have a thousand different demonimations play out the details of the > > >> protocol? > > >> > > >> As I asked define protocol exactly. We can not agree often on the > > details > > >> of a specific protocol eg on or off pump. Should we agree on the > higher > > >> question, the form of protocol? > > >> > > >> tea > > >> > > >> > > >> > > >> ________________________________ > > >> From: Michael Firstenberg > > >> To: OpenHeart-L@lists.hsforum.com > > >> Sent: Wednesday, June 3, 2009 8:02:24 AM > > >> Subject: Re: [HSF] airplane accidents and other "misfortunes" > > >> > > >> True - however, there are many protocols out there, in medicine and in > > CT > > >> surgery - in which the outcomes (however defined) are better than in > > >> general > > >> what can be accomplished without the protocol - or when individuals > > chose > > >> to > > >> not adhere to the protocol. Much like overriding an auto-pilot and > > >> crashing > > >> a plane. In part, because what usually happens is that the people > that > > >> override the protocol or auto-pilot think they know better or are > > smarter > > >> (regardless of the situation) than then people, process, data, > whatever > > >> that > > >> led to the development of a protocol. If the protocols fail - and the > > >> outcomes and causes can be determined through a CQI then they get > > changed. > > >> Again, hence the checklists that we keep talking about. > > >> > > >> Ever try to go on pump (for those of you who still use it) without > > >> anticoagulation? > > >> > > >> -michael > > >> > > >> > > >> > > >> > > >> On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < > > >> robertobattellini@hotmail.com> wrote: > > >> > > >> > > > >> > Tea, > > >> > > > >> > you are incredible intelectual.I am still waying for you book on > Tea?s > > >> > thoughts. > > >> > > > >> > > > >> > > > >> > It is still stupid to think in Medicine that for example a robot > could > > >> do > > >> > the whole operation itself. A plane can fly in automatic pilot, but > > not > > >> > thorough a storm. > > >> > > > >> > Roberto > > >> > > > >> > > Date: Tue, 2 Jun 2009 20:08:19 -0700 > > >> > > From: tacuff@swbell.net > > >> > > To: OpenHeart-L@lists.hsforum.com > > >> > > CC: > > >> > > Subject: [HSF] airplane accidents and other "misfortunes" > > >> > > > > >> > > The airbus disaster over the Atlantic brings up the issue for HSF > as > > >> to > > >> > what lessons might we learn on this occasion. That fact that we may > > not > > >> know > > >> > the details, does not mean that there are no lessons to be gleaned. > I > > >> mean > > >> > no disrespect to those lost, and it is likely for a big audience > such > > as > > >> HSF > > >> > to have some that somehow know someone on that flight. > > >> > > > > >> > > What intrigues me about this airplane is that it was by design > flown > > >> by > > >> > electric or servo mechanisms. Further it seems that it was programed > > to > > >> be > > >> > flown automatically by setting of goals or parameters and the > software > > >> > computer models "manned" the servomechanism. > > >> > > > > >> > > Whether this is the fact or not is not really necessary for this > > >> > gedankenexperiment. (Einstein did not believe that there are > elevators > > >> out > > >> > in space.) > > >> > > > > >> > > What we have in this design is an elevation of protocol over > > >> experience > > >> > or prethought "artificial intelligence" over organic intelligence. I > > am > > >> not > > >> > interested in the specific details of the protocols, but the concept > > >> that > > >> > the protocol is superior to the thinker...in all conditions. This > > issue > > >> > occurs in every realm of thought: religious (word), political (law), > > >> > computers (software) or more clinical medicine (best practice, > > protocol, > > >> > etc.) > > >> > > > > >> > > Medicine is subject to other classes or levels of protocol > > >> bureaucratic, > > >> > political, economic etc that may further and undoubtedly does limit > > >> possible > > >> > proscribed actions. The question is whether freedom of individual > > >> (nurse, > > >> > doctor, institution, research, pilot, etc) action (in all its > levels) > > is > > >> an > > >> > important safe guard. If so, what does a protocol mean exactly? > > >> > > > > >> > > In medicine and on the forum some have argued that "blind' > > application > > >> of > > >> > "best practice" yields and will yield better medicine than less > > >> formalized > > >> > practice patterns. The easy logic of such thought makes "best > > practice" > > >> a > > >> > nearly universally acclaimed superlative. > > >> > > > > >> > > There are several problems with this line of thinking. From a > > logistic > > >> > standpoint "best practice" does not have a specific meaning. It best > > >> seems > > >> > to mirror the common practice of money mangers to be listed by the > > past > > >> > (several) year(s) result as "best manger". We all know the economic > > >> > consequence of following this logic. It is the equivalence of > "buying > > >> into" > > >> > a bull market. It works for the short term and is disastrous, buying > > >> high > > >> > and selling low, in the long term. > > >> > > > > >> > > Another problem is that we are not likely to see a large obvious > and > > >> > frightening "kill" in the medical analogy of this flight model. What > > is > > >> > likely to happen is large numbers of remote and thus unrecognized > > >> protocol > > >> > mismatch or "less than best practice" in the margins while that > > >> immediate in > > >> > our view looks good if not always best. > > >> > > > > >> > > Lastly (there are more undoubtedly) most of us are aware of the > > idiocy > > >> we > > >> > see from labeling protocol adherence as superior medicine. It leads > to > > >> large > > >> > number of 100% perfect (and "gamed") hospitals and practioners with > > >> quite > > >> > variable and disparate actual results. > > >> > > > > >> > > So, can we really design a plane or a medical system that flies > > >> itself? > > >> > It seems that we can and are determined to, but do we want to fly in > > it? > > >> > > > > >> > > Let's see what happens to the airbus. Perhaps there is a story > here. > > >> > Expect some posturing along the way. > > >> > > > > >> > > Yes, I know it is "Off Topic." > > >> > > > > >> > > 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 > > >> ----------------------------------------- > > >> > > > > > > > > > > > > -- > > > 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 v_tall_e at hotmail.com Wed Jun 3 17:47:35 2009 From: v_tall_e at hotmail.com (Vitaly Demyanchuk) Date: Wed Jun 3 12:48:32 2009 Subject: [HSF] News on promotion In-Reply-To: <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> References: <89c4ed2d0906010926n2c988d20o3a270d697589d0b5@mail.gmail.com> <89c4ed2d0906010929ne8ce2buc6e5caa232d53bc1@mail.gmail.com> Message-ID: Dear Prof. Prasanna, My warmest congratulations to you!!! And I wish you every success! Best regards, Vitaly Ukraine _________________________________________________________________ Lauren found her dream laptop. Find the PC that?s right for you. http://www.microsoft.com/windows/choosepc/?ocid=ftp_val_wl_290 From prasannasimha at gmail.com Wed Jun 3 18:49:08 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Jun 3 13:10:24 2009 Subject: [PHISH]RE: [HSF] OPCAB in ST elevation-for Hal and Don In-Reply-To: <4A2668DD.6080904@terra.com.br> References: <779259.79517.qm@web24711.mail.ird.yahoo.com> <4A2660C0.9030909@terra.com.br> <89c4ed2d0906030451l711bb80aq39f39fe2709d53be@mail.gmail.com> <4A2668DD.6080904@terra.com.br> Message-ID: <89c4ed2d0906030519q6499f27co856cde59be32585@mail.gmail.com> Thanks - you have now warmed the cockles of my heart and have also reaffirmed my faith in the Sunny warm Brazil that I know (and admire in the discovery channel) and hope to visit some time !! I have a small cube of the laser etching of Christ the redeemer in my house. Prasanna On Wed, Jun 3, 2009 at 5:43 PM, Francisco Fagundes wrote: > Prasanna, > this is in Rio de Janeiro; Roberto is going to the coldest area in > Brasil... > Here, the girls from Ipanema are sunbathing now. > Congratulations to you, Professor. > > Francisco Fagundes > Rio de Janeiro - Brasil > > > Prasanna Simha M escreveu: > >> Cold for Roberto means freezing for me !! I thought Brazil was were the >> girl >> from Ipanema was frolicking around the beach !! >> Prasanna >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 damle at cableone.net Wed Jun 3 16:24:35 2009 From: damle at cableone.net (Ajit Damle) Date: Wed Jun 3 16:31:23 2009 Subject: [HSF] Renal failure and prognosis In-Reply-To: <89c4ed2d0906030839l74e2e0c7u884272974cdb3718@mail.gmail.com> References: <89c4ed2d0906030839l74e2e0c7u884272974cdb3718@mail.gmail.com> Message-ID: <000001c9e489$50688790$f13996b0$@net> I have been asked to see two patients, both 87. Both normal EF, severe triple vessel disease, good distal targets, severe MR. The first patient looks OK, but the second patient is on peritoneal dialysis and is having daily chest pain on max med therapy. What is the impact of renal failure on corrective cardiac surgery in terms of longevity? Thanks! Ajit Damle From tacuff at swbell.net Wed Jun 3 20:56:04 2009 From: tacuff at swbell.net (Tea Acuff) Date: Wed Jun 3 22:57:34 2009 Subject: [HSF] Renal failure and prognosis In-Reply-To: <000001c9e489$50688790$f13996b0$@net> References: <89c4ed2d0906030839l74e2e0c7u884272974cdb3718@mail.gmail.com> <000001c9e489$50688790$f13996b0$@net> Message-ID: <739006.62864.qm@web81604.mail.mud.yahoo.com> In age 65 and older (Downloading may take up to 30 seconds. If the slide opens in your browser, select File -> Save As to save it.) Click on image to view larger version. Notice that the rate of death lessens with time, however. The cause of?ESRD changes the prognosis. Imagine that! tea ________________________________ From: Ajit Damle To: OpenHeart-L@lists.hsforum.com Sent: Wednesday, June 3, 2009 3:24:35 PM Subject: [HSF] Renal failure and prognosis I have been asked to see two patients, both 87. Both normal EF, severe triple vessel disease, good distal targets, severe MR. The first patient looks OK, but the second patient is on peritoneal dialysis and is having daily chest pain on max med therapy. What is the impact of renal failure on corrective cardiac surgery in terms of longevity? Thanks! 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 axel.m.laczkovics at ruhr-uni-bochum.de Thu Jun 4 06:14:41 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Thu Jun 4 01:14:43 2009 Subject: [HSF] HTX in asia? In-Reply-To: <89c4ed2d0906030401n23288cd7r9ac1aaeb4fa29152@mail.gmail.com> References: <779259.79517.qm@web24711.mail.ird.yahoo.com> <467f1a8b68514e4bb6e782bac353009a@ruhr-uni-bochum.de> <89c4ed2d0906030401n23288cd7r9ac1aaeb4fa29152@mail.gmail.com> Message-ID: many thx, but how can i contact dr norrotham ? any emailadresses? thx, axel laczkovics > There are centers in Thailand doing a lot of transplants but I am not > sure > of the follow up. Dr Pantpis Norrotham was doing a lot of Transplants. > Prasanna > > On Wed, Jun 3, 2009 at 12:55 PM, prof. dr. axel laczkovics < > axel.m.laczkovics@ruhr-uni-bochum.de> wrote: > >> dear friends, >> >> it was in 1985, whe i transplanted a something like 12yr old boy in >> vienna. he is now over 30 and fell in love with a girl (woman?) in >> thailand >> and wants to move to and with her. >> >> i have moved to germany 1992 and have no idea about tx in asia. >> >> has anybody knowledge about tx-centers round bangkok or somewhere >> else in >> asia? or at least bigger cardiologic centers for routine check-up?s? >> >> thx a lot, axel laczkovics >> bochum, germany >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 Rwmfglycar at aol.com Thu Jun 4 04:17:41 2009 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Thu Jun 4 03:16:41 2009 Subject: [HSF] News on promotion Message-ID: Congratulations Prasanna. Well deserved. Don't let it go to your head! Bob In a message dated 6/3/2009 8:52:32 A.M. South Africa Standard Time, nkkejriwal@gmail.com writes: Prasanna Your contribution to the forum has been invaluable. I have personally benefitted a lot from your postings. Congrats. Well-deserved. Hope to catch up with you one day. nand 2009/6/2 Prasanna Simha M > Thanks John. Incidentally your bigpond address is being rejected when I > reply to it offlist !! > Prasanna > > On Tue, Jun 2, 2009 at 2:28 PM, john goldblatt >wrote: > > > Heartiest congrats Prasanna. > > Certainly most deserving - we have & continue to learn from you. > > > > john goldblatt > > Royal Melbourne Hospital > > Melbourne, Australia > > > > On 02/06/2009, at 4:18 AM, Igor Rudez wrote: > > > > Dear Prasanna, > >> > >>> From the bottom of my heart CONGRATULATION! > >>> > >> You have certainly deserved it! > >> > >> Igor Rudez > >> > >> -----Original Message----- > >> From: openheart-l-bounces@lists.hsforum.com > >> [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna > >> Simha M > >> Sent: Monday, June 01, 2009 6:29 PM > >> To: OpenHeart-L > >> Subject: [HSF] News on promotion > >> > >> > >> I would like to share with the HSF fraternity that I have today been > >> promoted as a full Professor in Cardiothoracic and Vascular Surgery in > my > >> Institute and Rajiv Gandhi Medical University (All medical , dental and > >> allied health science courses in my state come under this university). > HSF > >> and Mark Levinson in particular have helped me a lot through this > process. > >> Prasanna > >> -- > >> 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 > >> ----------------------------------------- > >> > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, 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 and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************Limited Time Offers: Save big on popular laptops at Dell (http://pr.atwola.com/promoclk/100126575x1221354145x1201369495/aol?redir=http:%2F %2Fad.doubleclick.net%2Fclk%3B215221161%3B37268813%3By) From axel.m.laczkovics at ruhr-uni-bochum.de Thu Jun 4 11:13:20 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Thu Jun 4 06:13:22 2009 Subject: [HSF] HTX in asia? In-Reply-To: <955521.20553.qm@web81608.mail.mud.yahoo.com> References: <955521.20553.qm@web81608.mail.mud.yahoo.com> Message-ID: tea, thx for the advice; do you have any info how to contact kit arom? axel > > Kit Arom lives in Thailand and could give you suggestions > Tea > > Sent from my iPhone > > On Jun 3, 2009, at 2:25 AM, "prof. dr. axel laczkovics" > wrote: > > dear friends, > > it was in 1985, whe i transplanted a something like 12yr old boy in > vienna. he is now over 30 and fell in love with a girl (woman?) in > thailand and wants to move to and with her. > > i have moved to germany 1992 and have no idea about tx in asia. > > has anybody knowledge about tx-centers round bangkok or somewhere else > in asia? or at least bigger cardiologic centers for routine > check-up?s? > > thx a lot, axel laczkovics > bochum, germany > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 matthroth at aol.com Thu Jun 4 07:20:48 2009 From: matthroth at aol.com (matthroth@aol.com) Date: Thu Jun 4 06:23:04 2009 Subject: [HSF] HTX in asia? In-Reply-To: References: <955521.20553.qm@web81608.mail.mud.yahoo.com> Message-ID: <8CBB31543632B58-16DC-2170@WEBMAIL-MA20.sysops.aol.com> Kit V. Arom, M.D., Ph.D. 2 Soi Soonvijai 7 New Phetburi Road Bangkok 10310 Thailand 1 662 310-3323 1 662 310-3088 (Fax) Karom@bangkokheart.com -----Urspr?ngliche Mitteilung----- Von: prof. dr. axel laczkovics An: OpenHeart-L@lists.hsforum.com Verschickt: Do., 4. Jun. 2009, 12:11 Thema: Re: [HSF] HTX in asia? tea,? ? thx for the advice; do you have any info how to contact kit arom?? ? axel? ? >? > Kit Arom lives in Thailand and could give you suggestions? > Tea? >? > Sent from my iPhone? >? > On Jun 3, 2009, at 2:25 AM, "prof. dr. axel laczkovics" > wrote:? >? > dear friends,? >? > it was in 1985, whe i transplanted a something like 12yr old boy in > vienna. he is now over 30 and fell in love with a girl (woman?) in > thailand and wants to move to and with her.? >? > i have moved to germany 1992 and have no idea about tx in asia.? >? > has anybody knowledge about tx-centers round bangkok or somewhere else > in asia? or at least bigger cardiologic centers for routine > check-up?s?? >? > thx a lot, axel laczkovics? > bochum, germany? > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@lists.hsforum.com? >? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/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? -----------------------------------------? ________________________________________________________________________ AOL eMail auf Ihrem Handy! Ab sofort k?nnen Sie auch unterwegs Ihre AOL email abrufen. Registrieren Sie sich jetzt kostenlos. From tacuff at swbell.net Thu Jun 4 06:32:55 2009 From: tacuff at swbell.net (Tea Acuff) Date: Thu Jun 4 08:33:24 2009 Subject: [HSF] HTX in asia? Message-ID: <719932.39279.qm@web81605.mail.mud.yahoo.com> He probably is in CTS net with the STS. If you do not have acces I can try to find it Tea Sent from my iPhone On Jun 4, 2009, at 5:11 AM, "prof. dr. axel laczkovics" wrote: tea, thx for the advice; do you have any info how to contact kit arom? axel Kit Arom lives in Thailand and could give you suggestions Tea Sent from my iPhone On Jun 3, 2009, at 2:25 AM, "prof. dr. axel laczkovics" wrote: dear friends, it was in 1985, whe i transplanted a something like 12yr old boy in vienna. he is now over 30 and fell in love with a girl (woman?) in thailand and wants to move to and with her. i have moved to germany 1992 and have no idea about tx in asia. has anybody knowledge about tx-centers round bangkok or somewhere else in asia? or at least bigger cardiologic centers for routine check-up?s? thx a lot, axel laczkovics bochum, germany _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Jun 4 13:40:39 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Thu Jun 4 08:40:51 2009 Subject: [HSF] HTX in asia? In-Reply-To: <8CBB31543632B58-16DC-2170@WEBMAIL-MA20.sysops.aol.com> References: <955521.20553.qm@web81608.mail.mud.yahoo.com><8CBB31543632B58-16DC-2170@WEBMAIL-MA20.sysops.aol.com> Message-ID: <1430058169-1244119224-cardhu_decombobulator_blackberry.rim.net-2067066012-@bxe1236.bisx.prod.on.blackberry> It may be a delay before Kit responds. Yesterday, I saw him at ISMICS here in San Francisco. However, I did tell him Axel needed his advice. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: matthroth@aol.com Date: Thu, 04 Jun 2009 06:20:48 To: Subject: Re: [HSF] HTX in asia? Kit V. Arom, M.D., Ph.D. 2 Soi Soonvijai 7 New Phetburi Road Bangkok 10310 Thailand 1 662 310-3323 1 662 310-3088 (Fax) Karom@bangkokheart.com -----Urspr?ngliche Mitteilung----- Von: prof. dr. axel laczkovics An: OpenHeart-L@lists.hsforum.com Verschickt: Do., 4. Jun. 2009, 12:11 Thema: Re: [HSF] HTX in asia? tea,? ? thx for the advice; do you have any info how to contact kit arom?? ? axel? ? >? > Kit Arom lives in Thailand and could give you suggestions? > Tea? >? > Sent from my iPhone? >? > On Jun 3, 2009, at 2:25 AM, "prof. dr. axel laczkovics" > wrote:? >? > dear friends,? >? > it was in 1985, whe i transplanted a something like 12yr old boy in > vienna. he is now over 30 and fell in love with a girl (woman?) in > thailand and wants to move to and with her.? >? > i have moved to germany 1992 and have no idea about tx in asia.? >? > has anybody knowledge about tx-centers round bangkok or somewhere else > in asia? or at least bigger cardiologic centers for routine > check-up?s?? >? > thx a lot, axel laczkovics? > bochum, germany? >_______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@lists.hsforum.com? >? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/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? -----------------------------------------? ________________________________________________________________________ AOL eMail auf Ihrem Handy! Ab sofort k?nnen Sie auch unterwegs Ihre AOL email abrufen. Registrieren Sie sich jetzt kostenlos. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Thu Jun 4 10:20:11 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Thu Jun 4 09:21:03 2009 Subject: [HSF] News on promotion In-Reply-To: References: Message-ID: <57B93F74-4DED-4774-B837-0F4F54DFF637@gmail.com> Probably too late for that. -michael. On Jun 4, 2009, at 3:17 AM, Rwmfglycar@aol.com wrote: > Congratulations Prasanna. Well deserved. Don't let it go to your > head! > Bob > > > In a message dated 6/3/2009 8:52:32 A.M. South Africa Standard Time, > nkkejriwal@gmail.com writes: > > Prasanna > Your contribution to the forum has been invaluable. I have personally > benefitted a lot from your postings. Congrats. Well-deserved. Hope > to > catch > up with you one day. > > nand > > 2009/6/2 Prasanna Simha M > >> Thanks John. Incidentally your bigpond address is being rejected >> when I >> reply to it offlist !! >> Prasanna >> >> On Tue, Jun 2, 2009 at 2:28 PM, john goldblatt >> >> wrote: >> >>> Heartiest congrats Prasanna. >>> Certainly most deserving - we have & continue to learn from you. >>> >>> john goldblatt >>> Royal Melbourne Hospital >>> Melbourne, Australia >>> >>> On 02/06/2009, at 4:18 AM, Igor Rudez wrote: >>> >>> Dear Prasanna, >>>> >>>>> From the bottom of my heart CONGRATULATION! >>>>> >>>> You have certainly deserved it! >>>> >>>> Igor Rudez >>>> >>>> -----Original Message----- >>>> From: openheart-l-bounces@lists.hsforum.com >>>> [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of >>>> Prasanna >>>> Simha M >>>> Sent: Monday, June 01, 2009 6:29 PM >>>> To: OpenHeart-L >>>> Subject: [HSF] News on promotion >>>> >>>> >>>> I would like to share with the HSF fraternity that I have today >>>> been >>>> promoted as a full Professor in Cardiothoracic and Vascular >>>> Surgery in >> my >>>> Institute and Rajiv Gandhi Medical University (All medical , >>>> dental > and >>>> allied health science courses in my state come under this >>>> university). >> HSF >>>> and Mark Levinson in particular have helped me a lot through this >> process. >>>> Prasanna >>>> -- >>>> 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 >>>> ----------------------------------------- >>>> >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, 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 > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > **************Limited Time Offers: Save big on popular laptops at Dell > (http://pr.atwola.com/promoclk/100126575x1221354145x1201369495/aol?redir=http:%2F > %2Fad.doubleclick.net%2Fclk%3B215221161%3B37268813%3By) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 meguren at intramed.net.ar Thu Jun 4 11:41:35 2009 From: meguren at intramed.net.ar (Angela Eguren Maxwell) Date: Thu Jun 4 09:42:59 2009 Subject: [HSF] promotion References: <748086.82923.qm@web81605.mail.mud.yahoo.com> <306982.89689.qm@web81603.mail.mud.yahoo.com> <89c4ed2d0906030748r679c461bkac9c3d10902ccdd0@mail.gmail.com> Message-ID: Many congratulations Professor Prasanna. You are an honour to the Forum. Sincere regards, Angela Eguren Maxwell From axel.m.laczkovics at ruhr-uni-bochum.de Thu Jun 4 15:44:39 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Thu Jun 4 10:44:41 2009 Subject: [HSF] HTX in asia? In-Reply-To: <1430058169-1244119224-cardhu_decombobulator_blackberry.rim.net-2067066012-@bxe1236.bisx.prod.on.blackberry> References: <955521.20553.qm@web81608.mail.mud.yahoo.com><8CBB31543632B58-16DC-2170@WEBMAIL-MA20.sysops.aol.com> <1430058169-1244119224-cardhu_decombobulator_blackberry.rim.net-2067066012-@bxe1236.bisx.prod.on.blackberry> Message-ID: <2bf49055c6f8ba09dd10b2ebcf423c31@ruhr-uni-bochum.de> hal and tea, many thanks to both of you. meanwhile i got his email-adress from matthias roth from bad nauheim. HSF is a wonderful thing. axel > It may be a delay before Kit responds. Yesterday, I saw him at ISMICS > here in San Francisco. However, I did tell him Axel needed his > advice. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: matthroth@aol.com > > Date: Thu, 04 Jun 2009 06:20:48 > To: > Subject: Re: [HSF] HTX in asia? > > > > > Kit V. Arom, M.D., Ph.D. > > 2 Soi Soonvijai 7 > New Phetburi Road > Bangkok 10310 > Thailand > > 1 662 310-3323 > 1 662 310-3088 (Fax) > > Karom@bangkokheart.com > > > -----Urspr?ngliche Mitteilung----- > Von: prof. dr. axel laczkovics > An: OpenHeart-L@lists.hsforum.com > Verschickt: Do., 4. Jun. 2009, 12:11 > Thema: Re: [HSF] HTX in asia? > > > tea,? > ? > thx for the advice; do you have any info how to contact kit arom?? > ? > axel? > ? >> ? >> Kit Arom lives in Thailand and could give you suggestions? >> Tea? >> ? >> Sent from my iPhone? >> ? >> On Jun 3, 2009, at 2:25 AM, "prof. dr. axel laczkovics" > >> wrote:? >> ? >> dear friends,? >> ? >> it was in 1985, whe i transplanted a something like 12yr old boy in > >> vienna. he is now over 30 and fell in love with a girl (woman?) in > >> thailand and wants to move to and with her.? >> ? >> i have moved to germany 1992 and have no idea about tx in asia.? >> ? >> has anybody knowledge about tx-centers round bangkok or somewhere >> else > in asia? or at least bigger cardiologic centers for routine > >> check-up?s?? >> ? >> thx a lot, axel laczkovics? >> bochum, germany? >> _______________________________________________? >> OpenHeart-L mailing list? >> ? >> Send postings to:? >> OpenHeart-L@lists.hsforum.com? >> ? >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:? >> http://mmp.cjp.com/mailman/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? > -----------------------------------------? > > > _______________________________________________________________________ > _ > AOL eMail auf Ihrem Handy! Ab sofort k?nnen Sie auch unterwegs Ihre > AOL email abrufen. Registrieren Sie sich jetzt kostenlos. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Thu Jun 4 09:32:44 2009 From: tacuff at swbell.net (Tea Acuff) Date: Thu Jun 4 11:33:14 2009 Subject: [HSF] HTX in asia? In-Reply-To: <2bf49055c6f8ba09dd10b2ebcf423c31@ruhr-uni-bochum.de> References: <955521.20553.qm@web81608.mail.mud.yahoo.com><8CBB31543632B58-16DC-2170@WEBMAIL-MA20.sysops.aol.com> <1430058169-1244119224-cardhu_decombobulator_blackberry.rim.net-2067066012-@bxe1236.bisx.prod.on.blackberry> <2bf49055c6f8ba09dd10b2ebcf423c31@ruhr-uni-bochum.de> Message-ID: <74594.8653.qm@web81606.mail.mud.yahoo.com> What is Bad Nauheim? A rock group? You may remember me saying that I asked my dad, a surgeon,?long ago as I was a medical student how could one keep up with all the information. He said,"You don't memorize you just have to know where to find it." As a result I memorized very little, but spent a lot of time thinking about what to do with the information and what was primary. Part of that is the associtive tags by which we store things in our head. (see above :)) Good luck. tea ________________________________ From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Thursday, June 4, 2009 9:40:48 AM Subject: Re: [HSF] HTX in asia? hal and tea, many thanks to both of you. meanwhile i got his? email-adress? from matthias roth from? bad nauheim. HSF is a wonderful thing. axel > It may be a delay before Kit responds.? Yesterday, I saw him at ISMICS here in San Francisco.? However, I did tell him Axel needed his advice. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: matthroth@aol.com > > Date: Thu, 04 Jun 2009 06:20:48 > To: > Subject: Re: [HSF] HTX in asia? > > > > > Kit V. Arom, M.D., Ph.D. > > 2 Soi Soonvijai 7 > New Phetburi Road > Bangkok 10310 > Thailand > > 1 662 310-3323 > 1 662 310-3088 (Fax) > > Karom@bangkokheart.com > > > -----Urspr?ngliche Mitteilung----- > Von: prof. dr. axel laczkovics > An: OpenHeart-L@lists.hsforum.com > Verschickt: Do., 4. Jun. 2009, 12:11 > Thema: Re: [HSF] HTX in asia? > > > tea,? > ? > thx for the advice; do you have any info how to contact kit arom?? > ? > axel? > ? >> ? >> Kit Arom lives in Thailand and could give you suggestions? >> Tea? >> ? >> Sent from my iPhone? >> ? >> On Jun 3, 2009, at 2:25 AM, "prof. dr. axel laczkovics" > wrote:? >> ? >> dear friends,? >> ? >> it was in 1985, whe i transplanted a something like 12yr old boy in > vienna. he is now over 30 and fell in love with a girl (woman?) in > thailand and wants to move to and with her.? >> ? >> i have moved to germany 1992 and have no idea about tx in asia.? >> ? >> has anybody knowledge about tx-centers round bangkok or somewhere else > in asia? or at least bigger cardiologic centers for routine > check-up?s?? >> ? >> thx a lot, axel laczkovics? >> bochum, germany? >> _______________________________________________? >> OpenHeart-L mailing list? >> ? >> Send postings to:? >> OpenHeart-L@lists.hsforum.com? >> ? >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:? >> http://mmp.cjp.com/mailman/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? > -----------------------------------------? > > > ________________________________________________________________________ > AOL eMail auf Ihrem Handy! Ab sofort k?nnen Sie auch unterwegs Ihre AOL email abrufen. Registrieren Sie sich jetzt kostenlos. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: >? OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Thu Jun 4 22:06:50 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Jun 4 11:37:44 2009 Subject: [HSF] HTX in asia? In-Reply-To: <74594.8653.qm@web81606.mail.mud.yahoo.com> References: <955521.20553.qm@web81608.mail.mud.yahoo.com> <8CBB31543632B58-16DC-2170@WEBMAIL-MA20.sysops.aol.com> <1430058169-1244119224-cardhu_decombobulator_blackberry.rim.net-2067066012-@bxe1236.bisx.prod.on.blackberry> <2bf49055c6f8ba09dd10b2ebcf423c31@ruhr-uni-bochum.de> <74594.8653.qm@web81606.mail.mud.yahoo.com> Message-ID: <89c4ed2d0906040836m1303beafiff5703ca15141e04@mail.gmail.com> http://en.wikipedia.org/wiki/Bad_Nauheim Elvis is associated with it. Prasanna On Thu, Jun 4, 2009 at 9:02 PM, Tea Acuff wrote: > What is Bad Nauheim? A rock group? > > You may remember me saying that I asked my dad, a surgeon, long ago as I > was a medical student how could one keep up with all the information. He > said,"You don't memorize you just have to know where to find it." As a > result I memorized very little, but spent a lot of time thinking about what > to do with the information and what was primary. Part of that is the > associtive tags by which we store things in our head. (see above :)) > > Good luck. > tea > > > > > ________________________________ > From: prof. dr. axel laczkovics > To: OpenHeart-L@lists.hsforum.com > Sent: Thursday, June 4, 2009 9:40:48 AM > Subject: Re: [HSF] HTX in asia? > > hal and tea, > > many thanks to both of you. meanwhile i got his email-adress from > matthias roth from bad nauheim. > HSF is a wonderful thing. > > axel > > > > > It may be a delay before Kit responds. Yesterday, I saw him at ISMICS > here in San Francisco. However, I did tell him Axel needed his advice. > > > > Hal > > Sent from my Verizon Wireless BlackBerry > > > > -----Original Message----- > > From: matthroth@aol.com > > > > Date: Thu, 04 Jun 2009 06:20:48 > > To: > > Subject: Re: [HSF] HTX in asia? > > > > > > > > > > Kit V. Arom, M.D., Ph.D. > > > > 2 Soi Soonvijai 7 > > New Phetburi Road > > Bangkok 10310 > > Thailand > > > > 1 662 310-3323 > > 1 662 310-3088 (Fax) > > > > Karom@bangkokheart.com > > > > > > -----Urspr?ngliche Mitteilung----- > > Von: prof. dr. axel laczkovics > > An: OpenHeart-L@lists.hsforum.com > > Verschickt: Do., 4. Jun. 2009, 12:11 > > Thema: Re: [HSF] HTX in asia? > > > > > > tea, > > > > thx for the advice; do you have any info how to contact kit arom? > > > > axel > > > >> > >> Kit Arom lives in Thailand and could give you suggestions > >> Tea > >> > >> Sent from my iPhone > >> > >> On Jun 3, 2009, at 2:25 AM, "prof. dr. axel laczkovics" > < > axel.m.laczkovics@ruhr-uni-bochum.de> wrote: > >> > >> dear friends, > >> > >> it was in 1985, whe i transplanted a something like 12yr old boy in > > vienna. he is now over 30 and fell in love with a girl (woman?) in > > thailand and wants to move to and with her. > >> > >> i have moved to germany 1992 and have no idea about tx in asia. > >> > >> has anybody knowledge about tx-centers round bangkok or somewhere else > > in asia? or at least bigger cardiologic centers for routine > check-up?s? > >> > >> thx a lot, axel laczkovics > >> bochum, germany > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 > > ----------------------------------------- > > > > > > ________________________________________________________________________ > > AOL eMail auf Ihrem Handy! Ab sofort k?nnen Sie auch unterwegs Ihre AOL > email abrufen. Registrieren Sie sich jetzt kostenlos. > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 Rwmfglycar at aol.com Thu Jun 4 12:42:23 2009 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Thu Jun 4 11:44:00 2009 Subject: [HSF] AATS 2009-ligation of LAA and CX closure Message-ID: Dwight Harken called this closure the "resident proof" closure. In my version the second continuous over and running layer was superficial to the continuos mattress.. It served me well over many years. Bob In a message dated 6/1/2009 8:28:04 A.M. South Africa Standard Time, ebender001@me.com writes: I usually close an aortotomy for AVR's with a running 4-0 RB1 running horizontal followed by over and over. I frequently place a pledget at the "angle of death" to start the suture line. One question I always ask myself while doing this closure is should the second row depth be more shallow, deeper, or the same level as the first suture line. Ed Bender, MD On 5/31/09 7:09 AM, "Donald Ross" wrote: > Do any members use a horizontal mattress followed by an over and over? > I use this for the aorta and RA. > Seems foolproof, which is essential for me. > Don > On 31/05/2009, at 8:06 AM, Tea Acuff wrote: > >> >> Smaller suture is better for a tissue problem and looking to the >> atrial trabecular for better tissue. >> As a matter of "dogma" locking mucosal stiches but not vascular >> "to prevent leaks" seemed illogical, but I don't use exactlly for >> vascular. >> Tea >> >> Sent from my iPhone >> >> On May 30, 2009, at 12:09 PM, Prasanna Simha M >> wrote: >> >> Both ? There were three points ;) >> Prasanna >> >> On Sat, May 30, 2009 at 10:20 PM, Tea Acuff wrote: >> >> >> >> Agree with both >> Tea >> Sent from my iPhone >> >> On May 30, 2009, at 9:46 AM, Prasanna Simha M >> >> wrote: >> >> One small point that Roberto mentioned some years back was the fact >> that >> bleeding in these suture lines is often due to minor loss of tension >> 9He >> had >> mentioned it in relation to the Manouguian patch) so I generally >> "lock" the >> suture at at least the ends while picking the second run. Probably >> that is >> extended in principle by the running lock suture.After I started >> locking or >> even using an additional sutre to fix the "ends" sutre line >> hemostasis has >> become less of a problem too. especially useful when doing aortic >> and more >> so pulmonary anstomoses (like in a Ross) and in RVOT patches in >> Tetralogy. >> I have become firmly convinced with the "finer suture + smaller fine >> bites >> for greater bleeding " after seeing time and again senior colleagues >> worsening the bleeding using larger and larger and thicker and thicker >> sutures. If there is a "coaptation" probblem may be it is time for a >> patch >> rather than bigger sutures if fine sutures dont work as the inter >> tissue >> tension is just too high leading to cutting through. >> One more small point that has been highlighted by Nasser in an old >> post >> (which I was using subconciously but not systematically) is to >> systematically take the atrial bites through the trabeculae carnea >> and not >> through the wafery wispy atrial tissue especially in those friable >> and fat >> laden right atria. >> Prasanna >> >> On Sat, May 30, 2009 at 8:04 PM, wrote: >> >> Prasanna, >> I've been using 3-0 Prolene for my open cases and 4-0 Goretex for the >> robotic ones. I will definitely try finer suture an bd see if that >> helps. >> One >> thing I've recently learned after watching Giles Dreyfus at >> Carpentier's >> Paris meeting is to close the RA with a running locking stitch. That >> helps >> immensely. >> >> Hal >> >> >> In a message dated 5/30/2009 10:30:41 A.M. Eastern Daylight Time, >> prasannasimha@gmail.com writes: >> >> Hal I used to get pesky suture line bleeding from the RA etc but >> it has >> virtually become history after I shifted to using 5/0 or even 6/0 >> prolene >> for the suture lines. (The thinner the finer the suture).Seems to >> work >> well. >> Prasanna >> >> On Sat, May 30, 2009 at 7:43 PM, wrote: >> >> Gustavo, >> That's a great idea! Have you ever seen it published anywhere? >> Along >> the same lines, lately I've used the pericardial patch to seal >> persistent >> bleeding from frail RA suture lines or pursestrings. It's easy. >> Just >> add >> a >> little Bioglue between the RA and the patch before completing the >> suture >> line. >> >> Hal >> >> >> In a message dated 5/30/2009 10:07:37 A.M. Eastern Daylight Time, >> gabuin@intramed.net writes: >> >> Have any of the members do a patch closure instead of a ligation? >> Tiny small bits of atrial tissue with pericardial patch closing the >> ostium >> of the LAA. Smooth surface, no trombogenic, no possibility of >> dehiscence >> of >> any device or ligature, no risk of bleeding, no matter with the >> atrial >> natriuretic factor... >> >> gustavo. >> >> ----- Original Message ----- >> From: >> To: >> Sent: Saturday, May 30, 2009 10:33 AM >> Subject: Re: [HSF] AATS 2009-ligation of LAA and CX closure >> >> >> Prasanna, >> What you say may be true, but I've closed the LAA several hundred >> times >> from the inside and have yet to recognize a case with CX >> injury. For >> that >> matter, I can't recall ever injuring the CX with LAA closure or any >> mitral >> procedure I've done. I'm not naive enough to know that I possibly >> just >> didn't recognize the injury, since CX injury often produces only >> subtle >> EKG >> findings. >> Also, what do you base your statement? The incidence of CX >> injury is >> so >> low no matter how the LAA is closed that I doubt what you said is >> known >> for sure. >> >> Hal >> >> >> In a message dated 5/30/2009 9:26:55 A.M. Eastern Daylight Time, >> prasannasimha@gmail.com writes: >> >> The highest chance of damaging the circ is actually with internal >> closure(compared to ligation). >> Prasanna >> >> On Sat, May 30, 2009 at 12:30 PM, Roberto Battellini < >> robertobattellini@hotmail.com> wrote: >> >> >> Mark, >> >> >> >> Intelligent hypothesis about the high pressure in the appendage. >> >> >> >> But, again, I know people in USA reporting privately having >> ligated >> the >> CX. >> >> Some day I?m going to the Anatomie Institut and make some >> dissections. >> >> In my valve-coronary combi cases I have sutured allways from >> inside, >> a >> couple >> >> of times resected, now abandoned to preserve the endocrine >> function. >> >> Roberto >> >> From: Hgrmd@aol.com >> Date: Fri, 29 May 2009 21:19:50 -0400 >> Subject: Re: [HSF] AATS 2009-ligation of LAA and CX closure >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Mark, >> I appreciate your patient explanations to my questions. Actually, >> now >> that you've explained it, I agree with what you've said. My >> incidence >> of >> important postop pericardial effusions has also nearly >> disappeared >> since >> I >> stopped anticoagulating my mitral repairs over 3 years ago (thanks >> to >> HSF). >> This double ligation technique seems reasonable for CABG's. I >> wonder >> if >> and when Atricure will finally release its LAA clip. From the >> lectures >> I've >> seen, it seems to be an effective device. However, it's been at >> least >> 4 >> years since I first saw it. >> >> Hal >> >> >> In a message dated 5/28/2009 11:46:40 P.M. Eastern Daylight Time, >> mmlevinson@hsforum.com writes: >> >> >> On May 23, 2009, at 12:14 PM, Hgrmd@aol.com wrote: >> >> Mark, >> You attribute lower incidence of AF and pericardial effusions >> with >> routine closure of the LAA. Since most of my cases are mitral >> valves, I also >> close a large number of LAA's. I still have a routine incidence >> of >> AF and >> pericardial effusions. What are you doing different? What >> is/are >> the >> mechanisms that LAA ligation decreases AF and pericardial >> effusions? >> >> >> Hal: >> >> I enjoyed your comments and questions. >> >> I have seen just a few postop echos (because they are not >> indicated >> just for follow up of the appendage) and >> of the ones I have seen, I cannot see an appendage stump. I do >> not >> have followup on the whole cohort, and >> doubt if a study like that will ever get funded. >> >> My report of a reduced incidence of a-fib is based on empiric >> observations. We have an incidence of about 12% now >> compared with about 25% several years ago, and it was an >> interesting >> side note that we saw the drop >> after starting to ligate the appendage regularly. We did not >> introduce any new anti-arrythmics to the regime. >> >> You and I might be talking about two different groups because your >> practice is primarily valves and mine >> is primarily non-valve (CABG). The conclusions I have reached are >> in >> post-op CABG, not post-op mitrals. >> >> The reduced incidence of pericardial effusions I believe is from >> the >> absence of Coumadin. We have not >> treated post-afib with Coumadin since routinely ligating the >> appendage, and anecdotally we have stopped >> seeing (and re-admitting patients for) early postop pericardial >> effusions. Cause and effect?? Maybe.... >> >> I am assuming that the reduced incidence (and severity) of postop >> afib >> after ligation of the appendage means >> that some of the PACs that trigger the a-fib were coming from >> elevated >> left atrial pressure and its affect on >> myocytes in the appendage who may have shortened refractory >> periods >> and prone to spontaneous depolarizations. >> If the appendage is ligated, its cavity pressure is zero. We know >> that distension is associated with PACs and afib so >> maybe ligation relaxes these myocytes and reduces their >> spontaneous >> depolarizations. >> >> Do I have proof? No. I am just making the observations and since >> the benefit seems positive and the risk >> nil, I am still ligating the appendage. >> >> BTW, we mobilize the appendage from the surrounding epicardial >> fat. >> Sometimes there is considerable distance >> between the visible base and the true anatomical base of the >> appendage. In our hands, the anatomical base is ligated. When we >> view the result from inside the left atrium during a mitral case, >> there is a puckering appearance but rarely any expose trabeculae. >> I >> would >> submit this is no different anatomically from the external running >> suture line which will leave a "ridge" internally. >> >> I used to oversew the orifice of the LA appendage from inside the >> LA >> using a double running 3-0 prolene in all my mitral valves. >> Occasionally the tension on the suture line from gathering all >> this >> tissue would be associated with a "split" in the endocardium. >> I saw a patient operated by another surgeon with morbid bleeding >> from >> this very cause. And, this internal oversew technique >> is not practical in the majority of CABG patients. You refer to >> internal suturing as the preferred technique, but your practice >> is nearly all valves. For us mortal CABG surgeons, an external >> approach that eliminates the cul-de-sac safely is the best >> way. Thus, my offering to ligate the anatomic base with two >> encircling sutures. Silk. Polyester, Endo-loop makes no >> difference >> What makes a difference is getting the surrounding tissue cleared >> away >> and getting the ligature to the true base. If you do >> not do this step, even the external double suture line leaves a >> residual appendiceal stump. >> >> I would like to have more echo followup. Now that we have routine >> intraop TEE, I will ask for images after ligation and see >> what we get.. >> >> Thanks. >> >> Mark >> >> Mark Levinson, MD. >> Founder, Editor-in-Chief >> The Heart Surgery Forum? >> Multimedia Cardiothoracic Journal >> URL: http://www.hsforum.com >> URL: http://newoptionsinheartsurgery.com >> Emali: mmlevinson@hsforum.com >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 the variety of Bisquick? mix. Get Recipes >> & >> Savings >> Now. >> ( >> >> >> >> >> >> http://pr.atwola.com/promoclk/100126575x1222831871x1201491818/aol?redir=http >> :%2F%2Fad.doubleclick.net%2Fclk%3B215225813%3B37274670%3Be%3Fhttp:%2F >> %2 >> Frecipes.bisquick.bettycrocker.com%3FESRC%3D971) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 >> ----------------------------------------- >> >> **************A Good Credit Score is 700 or Above. See yours in >> just 2 >> easy >> steps! >> ( >> >> http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=htt >> p://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd= >> >> MaystepsfooterNO62< >> >> http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=%0AMa >> ystepsfooterNO62 >> >> ) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 - www.avg.com >> Version: 8.5.339 / Virus Database: 270.12.46/2143 - Release Date: >> 05/30/09 >> >> 05:53:00 >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> **************A Good Credit Score is 700 or Above. See yours in >> just 2 >> easy >> steps! >> ( >> >> >> >> http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http: >> //www.freecreditreport.com/pm/default.aspx >> ?sc=668072&hmpgID=62&bcd= >> >> MaystepsfooterNO62< >> >> http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http: >> //www.freecreditreport.com/pm/default.aspx >> ?sc=668072& >> hmpgID=62&bcd=%0AMaystepsfooterNO62< >> http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http: >> //www.freecreditreport.com/pm/default.aspx >> ?sc=668072&%0AhmpgID=62&bcd=%0AMaystepsfooterNO62 >> >> >> ) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 >> ----------------------------------------- >> >> **************A Good Credit Score is 700 or Above. See yours in just >> 2 easy >> steps! >> ( >> >> http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http: >> //www.freecreditreport.com/pm/default.aspx >> ?sc=668072&hmpgID=62&bcd= >> MaystepsfooterNO62< >> http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http: >> //www.freecreditreport.com/pm/default.aspx >> ?sc=668072&hmpgID=62&bcd=%0AMaystepsfooterNO62 >> >> ) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 >> ----------------------------------------- >> aimers 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 >> ----------------------------------------- >> ed 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 > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************Limited Time Offers: Save big on popular laptops at Dell (http://pr.atwola.com/promoclk/100126575x1221354145x1201369495/aol?redir=http:%2F %2Fad.doubleclick.net%2Fclk%3B215221161%3B37268813%3By) From prasannasimha at gmail.com Thu Jun 4 22:18:11 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Jun 4 11:49:00 2009 Subject: [HSF] AATS 2009-ligation of LAA and CX closure In-Reply-To: References: Message-ID: <89c4ed2d0906040848v1fd2d983j66dc2d45778699b6@mail.gmail.com> Hah Tea I have eminence based medicine to my aid !! So you have to agree with me now !! Prasanna On Thu, Jun 4, 2009 at 9:12 PM, wrote: > Dwight Harken called this closure the "resident proof" closure. In my > version the second continuous over and running layer was superficial to > the > continuos mattress.. It served me well over many years. > Bob > > > In a message dated 6/1/2009 8:28:04 A.M. South Africa Standard Time, > ebender001@me.com writes: > > I usually close an aortotomy for AVR's with a running 4-0 RB1 running > horizontal followed by over and over. I frequently place a pledget at the > "angle of death" to start the suture line. > One question I always ask myself while doing this closure is should the > second row depth be more shallow, deeper, or the same level as the first > suture line. > Ed Bender, MD > > > On 5/31/09 7:09 AM, "Donald Ross" wrote: > > > Do any members use a horizontal mattress followed by an over and over? > > I use this for the aorta and RA. > > Seems foolproof, which is essential for me. > > Don > > On 31/05/2009, at 8:06 AM, Tea Acuff wrote: > > > >> > >> Smaller suture is better for a tissue problem and looking to the > >> atrial trabecular for better tissue. > >> As a matter of "dogma" locking mucosal stiches but not vascular > >> "to prevent leaks" seemed illogical, but I don't use exactlly for > >> vascular. > >> Tea > >> > >> Sent from my iPhone > >> > >> On May 30, 2009, at 12:09 PM, Prasanna Simha M < > prasannasimha@gmail.com > >>> wrote: > >> > >> Both ? There were three points ;) > >> Prasanna > >> > >> On Sat, May 30, 2009 at 10:20 PM, Tea Acuff wrote: > >> > >> > >> > >> Agree with both > >> Tea > >> Sent from my iPhone > >> > >> On May 30, 2009, at 9:46 AM, Prasanna Simha M > >> > >> wrote: > >> > >> One small point that Roberto mentioned some years back was the fact > >> that > >> bleeding in these suture lines is often due to minor loss of tension > >> 9He > >> had > >> mentioned it in relation to the Manouguian patch) so I generally > >> "lock" the > >> suture at at least the ends while picking the second run. Probably > >> that is > >> extended in principle by the running lock suture.After I started > >> locking or > >> even using an additional sutre to fix the "ends" sutre line > >> hemostasis has > >> become less of a problem too. especially useful when doing aortic > >> and more > >> so pulmonary anstomoses (like in a Ross) and in RVOT patches in > >> Tetralogy. > >> I have become firmly convinced with the "finer suture + smaller fine > >> bites > >> for greater bleeding " after seeing time and again senior colleagues > >> worsening the bleeding using larger and larger and thicker and thicker > >> sutures. If there is a "coaptation" probblem may be it is time for a > >> patch > >> rather than bigger sutures if fine sutures dont work as the inter > >> tissue > >> tension is just too high leading to cutting through. > >> One more small point that has been highlighted by Nasser in an old > >> post > >> (which I was using subconciously but not systematically) is to > >> systematically take the atrial bites through the trabeculae carnea > >> and not > >> through the wafery wispy atrial tissue especially in those friable > >> and fat > >> laden right atria. > >> Prasanna > >> > >> On Sat, May 30, 2009 at 8:04 PM, wrote: > >> > >> Prasanna, > >> I've been using 3-0 Prolene for my open cases and 4-0 Goretex for the > >> robotic ones. I will definitely try finer suture an bd see if that > >> helps. > >> One > >> thing I've recently learned after watching Giles Dreyfus at > >> Carpentier's > >> Paris meeting is to close the RA with a running locking stitch. That > >> helps > >> immensely. > >> > >> Hal > >> > >> > >> In a message dated 5/30/2009 10:30:41 A.M. Eastern Daylight Time, > >> prasannasimha@gmail.com writes: > >> > >> Hal I used to get pesky suture line bleeding from the RA etc but > >> it has > >> virtually become history after I shifted to using 5/0 or even 6/0 > >> prolene > >> for the suture lines. (The thinner the finer the suture).Seems to > >> work > >> well. > >> Prasanna > >> > >> On Sat, May 30, 2009 at 7:43 PM, wrote: > >> > >> Gustavo, > >> That's a great idea! Have you ever seen it published anywhere? > >> Along > >> the same lines, lately I've used the pericardial patch to seal > >> persistent > >> bleeding from frail RA suture lines or pursestrings. It's easy. > >> Just > >> add > >> a > >> little Bioglue between the RA and the patch before completing the > >> suture > >> line. > >> > >> Hal > >> > >> > >> In a message dated 5/30/2009 10:07:37 A.M. Eastern Daylight Time, > >> gabuin@intramed.net writes: > >> > >> Have any of the members do a patch closure instead of a ligation? > >> Tiny small bits of atrial tissue with pericardial patch closing the > >> ostium > >> of the LAA. Smooth surface, no trombogenic, no possibility of > >> dehiscence > >> of > >> any device or ligature, no risk of bleeding, no matter with the > >> atrial > >> natriuretic factor... > >> > >> gustavo. > >> > >> ----- Original Message ----- > >> From: > >> To: > >> Sent: Saturday, May 30, 2009 10:33 AM > >> Subject: Re: [HSF] AATS 2009-ligation of LAA and CX closure > >> > >> > >> Prasanna, > >> What you say may be true, but I've closed the LAA several hundred > >> times > >> from the inside and have yet to recognize a case with CX > >> injury. For > >> that > >> matter, I can't recall ever injuring the CX with LAA closure or any > >> mitral > >> procedure I've done. I'm not naive enough to know that I possibly > >> just > >> didn't recognize the injury, since CX injury often produces only > >> subtle > >> EKG > >> findings. > >> Also, what do you base your statement? The incidence of CX > >> injury is > >> so > >> low no matter how the LAA is closed that I doubt what you said is > >> known > >> for sure. > >> > >> Hal > >> > >> > >> In a message dated 5/30/2009 9:26:55 A.M. Eastern Daylight Time, > >> prasannasimha@gmail.com writes: > >> > >> The highest chance of damaging the circ is actually with internal > >> closure(compared to ligation). > >> Prasanna > >> > >> On Sat, May 30, 2009 at 12:30 PM, Roberto Battellini < > >> robertobattellini@hotmail.com> wrote: > >> > >> > >> Mark, > >> > >> > >> > >> Intelligent hypothesis about the high pressure in the appendage. > >> > >> > >> > >> But, again, I know people in USA reporting privately having > >> ligated > >> the > >> CX. > >> > >> Some day I?m going to the Anatomie Institut and make some > >> dissections. > >> > >> In my valve-coronary combi cases I have sutured allways from > >> inside, > >> a > >> couple > >> > >> of times resected, now abandoned to preserve the endocrine > >> function. > >> > >> Roberto > >> > >> From: Hgrmd@aol.com > >> Date: Fri, 29 May 2009 21:19:50 -0400 > >> Subject: Re: [HSF] AATS 2009-ligation of LAA and CX closure > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> > >> Mark, > >> I appreciate your patient explanations to my questions. Actually, > >> now > >> that you've explained it, I agree with what you've said. My > >> incidence > >> of > >> important postop pericardial effusions has also nearly > >> disappeared > >> since > >> I > >> stopped anticoagulating my mitral repairs over 3 years ago (thanks > >> to > >> HSF). > >> This double ligation technique seems reasonable for CABG's. I > >> wonder > >> if > >> and when Atricure will finally release its LAA clip. From the > >> lectures > >> I've > >> seen, it seems to be an effective device. However, it's been at > >> least > >> 4 > >> years since I first saw it. > >> > >> Hal > >> > >> > >> In a message dated 5/28/2009 11:46:40 P.M. Eastern Daylight Time, > >> mmlevinson@hsforum.com writes: > >> > >> > >> On May 23, 2009, at 12:14 PM, Hgrmd@aol.com wrote: > >> > >> Mark, > >> You attribute lower incidence of AF and pericardial effusions > >> with > >> routine closure of the LAA. Since most of my cases are mitral > >> valves, I also > >> close a large number of LAA's. I still have a routine incidence > >> of > >> AF and > >> pericardial effusions. What are you doing different? What > >> is/are > >> the > >> mechanisms that LAA ligation decreases AF and pericardial > >> effusions? > >> > >> > >> Hal: > >> > >> I enjoyed your comments and questions. > >> > >> I have seen just a few postop echos (because they are not > >> indicated > >> just for follow up of the appendage) and > >> of the ones I have seen, I cannot see an appendage stump. I do > >> not > >> have followup on the whole cohort, and > >> doubt if a study like that will ever get funded. > >> > >> My report of a reduced incidence of a-fib is based on empiric > >> observations. We have an incidence of about 12% now > >> compared with about 25% several years ago, and it was an > >> interesting > >> side note that we saw the drop > >> after starting to ligate the appendage regularly. We did not > >> introduce any new anti-arrythmics to the regime. > >> > >> You and I might be talking about two different groups because your > >> practice is primarily valves and mine > >> is primarily non-valve (CABG). The conclusions I have reached are > >> in > >> post-op CABG, not post-op mitrals. > >> > >> The reduced incidence of pericardial effusions I believe is from > >> the > >> absence of Coumadin. We have not > >> treated post-afib with Coumadin since routinely ligating the > >> appendage, and anecdotally we have stopped > >> seeing (and re-admitting patients for) early postop pericardial > >> effusions. Cause and effect?? Maybe.... > >> > >> I am assuming that the reduced incidence (and severity) of postop > >> afib > >> after ligation of the appendage means > >> that some of the PACs that trigger the a-fib were coming from > >> elevated > >> left atrial pressure and its affect on > >> myocytes in the appendage who may have shortened refractory > >> periods > >> and prone to spontaneous depolarizations. > >> If the appendage is ligated, its cavity pressure is zero. We know > >> that distension is associated with PACs and afib so > >> maybe ligation relaxes these myocytes and reduces their > >> spontaneous > >> depolarizations. > >> > >> Do I have proof? No. I am just making the observations and since > >> the benefit seems positive and the risk > >> nil, I am still ligating the appendage. > >> > >> BTW, we mobilize the appendage from the surrounding epicardial > >> fat. > >> Sometimes there is considerable distance > >> between the visible base and the true anatomical base of the > >> appendage. In our hands, the anatomical base is ligated. When we > >> view the result from inside the left atrium during a mitral case, > >> there is a puckering appearance but rarely any expose trabeculae. > >> I > >> would > >> submit this is no different anatomically from the external running > >> suture line which will leave a "ridge" internally. > >> > >> I used to oversew the orifice of the LA appendage from inside the > >> LA > >> using a double running 3-0 prolene in all my mitral valves. > >> Occasionally the tension on the suture line from gathering all > >> this > >> tissue would be associated with a "split" in the endocardium. > >> I saw a patient operated by another surgeon with morbid bleeding > >> from > >> this very cause. And, this internal oversew technique > >> is not practical in the majority of CABG patients. You refer to > >> internal suturing as the preferred technique, but your practice > >> is nearly all valves. For us mortal CABG surgeons, an external > >> approach that eliminates the cul-de-sac safely is the best > >> way. Thus, my offering to ligate the anatomic base with two > >> encircling sutures. Silk. Polyester, Endo-loop makes no > >> difference > >> What makes a difference is getting the surrounding tissue cleared > >> away > >> and getting the ligature to the true base. If you do > >> not do this step, even the external double suture line leaves a > >> residual appendiceal stump. > >> > >> I would like to have more echo followup. Now that we have routine > >> intraop TEE, I will ask for images after ligation and see > >> what we get.. > >> > >> Thanks. > >> > >> Mark > >> > >> Mark Levinson, MD. > >> Founder, Editor-in-Chief > >> The Heart Surgery Forum? > >> Multimedia Cardiothoracic Journal > >> URL: http://www.hsforum.com > >> URL: http://newoptionsinheartsurgery.com > >> Emali: mmlevinson@hsforum.com > >> > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 the variety of Bisquick? mix. Get Recipes > >> & > >> Savings > >> Now. > >> ( > >> > >> > >> > >> > >> > >> > > http://pr.atwola.com/promoclk/100126575x1222831871x1201491818/aol?redir=http > >> :%2F%2Fad.doubleclick.net%2Fclk%3B215225813%3B37274670%3Be%3Fhttp:%2F > >> %2 > >> Frecipes.bisquick.bettycrocker.com%3FESRC%3D971) > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 > >> ----------------------------------------- > >> > >> **************A Good Credit Score is 700 or Above. See yours in > >> just 2 > >> easy > >> steps! > >> ( > >> > >> > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=htt > >> p://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd= > >> > >> MaystepsfooterNO62< > >> > >> > > http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=%0AMa > >> ystepsfooterNO62 > >> > >> ) > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 - www.avg.com > >> Version: 8.5.339 / Virus Database: 270.12.46/2143 - Release Date: > >> 05/30/09 > >> > >> 05:53:00 > >> > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >> All messages transmitted by the OpenHeart-L are subject to the > >> policies > >> and > >> disclaimers posted at: > >> http://www.hsforum.com/listdisclaim > >> ----------------------------------------- > >> > >> **************A Good Credit Score is 700 or Above. See yours in > >> just 2 > >> easy > >> steps! > >> ( > >> > >> > >> > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >> //www.freecreditreport.com/pm/default.aspx > >> ?sc=668072&hmpgID=62&bcd= > >> > >> MaystepsfooterNO62< > >> > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >> //www.freecreditreport.com/pm/default.aspx > >> ?sc=668072& > >> hmpgID=62&bcd=%0AMaystepsfooterNO62< > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >> //www.freecreditreport.com/pm/default.aspx > >> ?sc=668072&%0AhmpgID=62&bcd=%0AMaystepsfooterNO62 > >> > >> > >> ) > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 > >> ----------------------------------------- > >> > >> **************A Good Credit Score is 700 or Above. See yours in just > >> 2 easy > >> steps! > >> ( > >> > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >> //www.freecreditreport.com/pm/default.aspx > >> ?sc=668072&hmpgID=62&bcd= > >> MaystepsfooterNO62< > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >> //www.freecreditreport.com/pm/default.aspx > >> ?sc=668072&hmpgID=62&bcd=%0AMaystepsfooterNO62 > >> > >> ) > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 > >> ----------------------------------------- > >> aimers 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 > >> ----------------------------------------- > >> ed 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 > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > **************Limited Time Offers: Save big on popular laptops at Dell > ( > http://pr.atwola.com/promoclk/100126575x1221354145x1201369495/aol?redir=http:%2F > %2Fad.doubleclick.net%2Fclk%3B215221161%3B37268813%3By) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Jun 4 10:21:27 2009 From: tacuff at swbell.net (Tea Acuff) Date: Thu Jun 4 12:21:56 2009 Subject: [HSF] AATS 2009-ligation of LAA and CX closure In-Reply-To: <89c4ed2d0906040848v1fd2d983j66dc2d45778699b6@mail.gmail.com> References: <89c4ed2d0906040848v1fd2d983j66dc2d45778699b6@mail.gmail.com> Message-ID: <579861.30872.qm@web81601.mail.mud.yahoo.com> Well, I reserve the right to disparage the eminent also as a matter of theory (principle) unless Bob has begun spelling?his title,?Eminence. As a practical matter I was trained and performed such resident proof closure for years. Then I put away childish myopic preoccupation and went to a simple closure in most cases for all cardiotomies. However in your giant atrium maybe three layers would be considered. It would make?the atrium?smaller in the process. tea ________________________________ From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Thursday, June 4, 2009 10:48:11 AM Subject: Re: [HSF] AATS 2009-ligation of LAA and CX closure Hah Tea? I have eminence based medicine to my aid !! So you have to agree with me now !! Prasanna On Thu, Jun 4, 2009 at 9:12 PM, wrote: > Dwight Harken called this closure the "resident proof" closure. In my > version the second continuous over and running? layer was? superficial to > the > continuos mattress..? It served me well over many? years. > Bob > > > In a message dated 6/1/2009 8:28:04 A.M. South Africa Standard Time, > ebender001@me.com writes: > > I? usually close an aortotomy for AVR's with a running 4-0 RB1? running > horizontal followed by over and over.? I frequently place a? pledget at the > "angle of death" to start the suture line. > One question I? always ask myself while doing this closure is should the > second row depth? be more shallow, deeper, or the same level as the first > suture line. > Ed? Bender, MD > > > On 5/31/09 7:09 AM, "Donald Ross"? wrote: > > > Do any members use a horizontal? mattress? followed by an over and over? > > I use this for the aorta? and RA. > > Seems foolproof,? which is essential for me. > >? Don > > On 31/05/2009, at 8:06 AM, Tea Acuff wrote: > > > >> > >> Smaller suture is better for a tissue problem and looking? to? the > >> atrial trabecular for better tissue. > >> As a? matter of "dogma" locking mucosal? stiches? but not? vascular > >> "to prevent leaks" seemed illogical, but I don't use? exactlly for > >> vascular. > >> Tea > >> > >>? Sent from my iPhone > >> > >> On May 30, 2009, at 12:09 PM,? Prasanna Simha M < > prasannasimha@gmail.com > >>>? wrote: > >> > >> Both ? There were three points? ;) > >> Prasanna > >> > >> On Sat, May 30, 2009 at 10:20? PM, Tea Acuff wrote: > >> > >> > >> > >> Agree with both > >> Tea > >> Sent? from my iPhone > >> > >> On May 30, 2009, at 9:46 AM, Prasanna? Simha M > >> > >>? wrote: > >> > >> One small point that Roberto mentioned some? years back was the fact > >> that > >> bleeding in these suture? lines is often due to minor loss of tension > >> 9He > >>? had > >> mentioned it in relation to the Manouguian patch) so I? generally > >> "lock" the > >> suture at at least the ends while? picking the second run. Probably > >> that is > >> extended in? principle by the running lock suture.After I started > >> locking? or > >> even using an additional sutre to fix the "ends" sutre? line > >> hemostasis has > >> become less of a problem too.? especially useful when doing aortic > >> and more > >> so? pulmonary anstomoses (like in a Ross) and in RVOT patches in > >>? Tetralogy. > >> I have become firmly convinced with the "finer suture +? smaller fine > >> bites > >> for greater bleeding " after seeing? time and again? senior colleagues > >> worsening the bleeding? using larger and larger and thicker and thicker > >> sutures. If there? is a "coaptation" probblem may be it is time for a > >>? patch > >> rather than bigger sutures if fine sutures dont work as the? inter > >> tissue > >> tension is just too high leading to? cutting through. > >> One more small point that has been highlighted by? Nasser in an old > >> post > >> (which I was using subconciously? but not systematically) is to > >> systematically take the atrial bites? through the trabeculae carnea > >> and not > >> through the? wafery wispy atrial tissue especially in those friable > >> and? fat > >> laden right atria. > >> Prasanna > >> > >> On Sat, May 30, 2009 at 8:04 PM, ? wrote: > >> > >> Prasanna, > >> I've been using 3-0? Prolene for my open cases and 4-0 Goretex for? the > >> robotic? ones.? I will definitely try finer suture an bd see if that > >>? helps. > >> One > >> thing I've recently learned after watching? Giles Dreyfus at > >> Carpentier's > >> Paris meeting is to? close the RA with a running locking? stitch.? That > >>? helps > >> immensely. > >> > >> Hal > >> > >> > >> In a message dated 5/30/2009 10:30:41 A.M. Eastern? Daylight Time, > >> prasannasimha@gmail.com writes: > >> > >> Hal? I? used to get pesky suture line bleeding from the? RA etc but > >> it? has > >> virtually become history after? I shifted to using 5/0 or even 6/0 > >> prolene > >> for the? suture lines. (The thinner the finer the suture).Seems to > >>? work > >> well. > >> Prasanna > >> > >> On Sat,? May 30, 2009 at 7:43 PM,? wrote: > >> > >> Gustavo, > >> That's a great? idea!? Have you? ever seen it published? anywhere? > >> Along > >> the same? lines, lately I've used the pericardial patch to? seal > >>? persistent > >> bleeding from frail RA suture lines or? pursestrings.? It's? easy. > >> Just > >>? add > >> a > >> little? Bioglue between the RA and the? patch before? completing the > >> suture > >>? line. > >> > >> Hal > >> > >> > >> In a? message? dated 5/30/2009 10:07:37 A.M. Eastern Daylight Time, > >>? gabuin@intramed.net writes: > >> > >> Have any? of the? members do a? patch closure instead of a ligation? > >> Tiny small? bits of? atrial? tissue with pericardial patch closing? the > >> ostium > >> of the LAA.? Smooth? surface, no? trombogenic, no possibility of > >> dehiscence > >>? of > >> any device or? ligature, no risk of bleeding, no matter? with? the > >> atrial > >> natriuretic? factor... > >> > >> gustavo. > >> > >> -----? Original Message ----- > >> From:? ? > >> To:? > >> Sent:? Saturday, May? 30,? 2009 10:33 AM > >> Subject: Re: [HSF] AATS 2009-ligation? of? LAA and? CX closure > >> > >> > >>? Prasanna, > >> What you say may be? true,? but I've closed? the LAA several? hundred > >> times > >> from? the? inside and? have yet to recognize a case with CX > >>? injury.? For > >> that > >> matter, I? can't? recall ever injuring the CX? with LAA? closure or any > >>? mitral > >> procedure I've? done.? I'm not naive enough to? know? that I? possibly > >> just > >> didn't recognize? the injury, since CX injury often? produces? only > >>? subtle > >> EKG > >> findings. > >> Also, what do? you base? your statement?? The incidence of CX > >> injury? is > >> so > >> low no matter? how the LAA is closed that I? doubt what you? said is > >> known > >> for? sure. > >> > >> Hal > >> > >> > >> In a? message dated 5/30/2009 9:26:55 A.M.? Eastern? Daylight? Time, > >> prasannasimha@gmail.com? writes: > >> > >> The? highest? chance of damaging the circ is? actually with? internal > >> closure(compared to? ligation). > >> Prasanna > >> > >> On Sat, May? 30,? 2009? at 12:30 PM, Roberto Battellini? < > >>? robertobattellini@hotmail.com>? wrote: > >> > >> > >> Mark, > >> > >> > >> > >>? Intelligent? hypothesis about the? high pressure in the? ? appendage. > >> > >> > >> > >> But,? ? again, I know people in USA? reporting privately having > >>? ligated > >> the > >> CX. > >> > >> Some day? I?m? going? to the Anatomie Institut? and make some > >>? dissections. > >> > >> In my? valve-coronary combi? cases I have sutured? allways from > >> inside, > >>? a > >> couple > >> > >> of times resected, now abandoned? to preserve the? endocrine > >> function. > >> > >> Roberto > >> > >> From:? ? Hgrmd@aol.com > >> Date: Fri, 29 May 2009? 21:19:50? -0400 > >> Subject: Re: [HSF] AATS? 2009-ligation of LAA and CX? closure > >> To:? OpenHeart-L@lists.hsforum.com > >>? CC: > >> > >> Mark, > >> I appreciate your? patient? explanations to my questions.? Actually, > >>? now > >> that you've? explained it, I agree with what you've? said. My > >> incidence > >> of > >> important postop? pericardial? effusions has? also nearly > >>? disappeared > >> since > >> I > >> stopped? anticoagulating? my? mitral repairs over? 3 years ago? (thanks > >> to > >> HSF). > >> This? double? ligation technique seems reasonable for CABG's. I > >>? wonder > >> if > >> and when Atricure will finally release its? LAA? clip.? From the > >> lectures > >>? I've > >> seen, it seems to be an? effective device.? However, it's been at > >> least > >> 4 > >> years? since? I first saw it. > >> > >> Hal > >> > >> > >> In a message? dated 5/28/2009 11:46:40? P.M.? Eastern? Daylight Time, > >>? mmlevinson@hsforum.com? writes: > >> > >> > >>? On? May? 23, 2009, at 12:14 PM,? Hgrmd@aol.com? wrote: > >> > >> Mark, > >> You? attribute lower? incidence of AF and pericardial? effusions > >> with > >>? routine closure of the LAA. Since most of? my? cases are? mitral > >> valves, I also > >> close? a? large number? of LAA's. I still have a? routine incidence > >> of > >> AF? and > >> pericardial effusions. What are you? doing? different?? What > >> is/are > >> the > >>? mechanisms? that LAA? ligation decreases AF and? pericardial > >> effusions? > >> > >> > >>? Hal: > >> > >> I enjoyed your comments? and? questions. > >> > >> I have seen? just a few postop? echos? (because they are? not > >> indicated > >> just? for follow up of the? appendage)? and > >> of the ones I have? seen, I cannot see an appendage? stump. I? do > >>? not > >> have followup on the whole cohort,? and > >> doubt? if a study like that will ever get? funded. > >> > >> My? report of a reduced incidence of? a-fib is based on? empiric > >> observations. We have? an? incidence of about? 12% now > >> compared? with? about 25% several? years? ago, and it was an > >> interesting > >> side? note that we? saw? the drop > >> after starting to? ligate the? appendage? regularly.? We did not > >> introduce any new? anti-arrythmics to the? regime. > >> > >> You and I? might be talking about two? ? different groups because? your > >> practice is primarily? valves? and? mine > >> is primarily non-valve (CABG).? The conclusions I? have? reached are > >> in > >> post-op? CABG, not? post-op? mitrals. > >> > >> The? reduced incidence of? pericardial? effusions I believe is? from > >>? the > >> absence of Coumadin. We? have not > >>? treated? post-afib with Coumadin since routinely? ligating? the > >> appendage,? and anecdotally we have? ? stopped > >> seeing (and re-admitting patients? for) early? postop? pericardial > >> effusions. Cause and effect??? ? Maybe.... > >> > >> I am assuming that the? reduced? incidence? (and? severity) of postop > >> afib > >>? after ligation of the appendage? means > >> that some of the? PACs that trigger the a-fib were? coming? from > >>? elevated > >> left atrial pressure and its? affect? on > >> myocytes in the appendage who may have? shortened? refractory > >> periods > >> and prone to? spontaneous? depolarizations. > >> If the appendage? is? ligated, its cavity? pressure is zero. We know > >> that? distension? is associated? with PACs and afib so > >> maybe? ligation relaxes these? myocytes? and reduces their > >>? spontaneous > >> depolarizations. > >> > >> Do I have? proof? No. I am just making the? observations? and? since > >> the benefit seems? positive and the risk > >>? nil, I? am still ligating? the appendage. > >> > >>? BTW, we? mobilize? the appendage from the surrounding? epicardial > >> fat. > >> Sometimes? there is considerable? distance > >> between the visible base and the? true anatomical? base of? the > >> appendage. In our hands, the? anatomical? base? is ligated. When? we > >> view the result from? inside? the left atrium during a? mitral case, > >>? there is a? puckering? appearance but rarely any? expose? trabeculae. > >> I > >> would > >> submit this is? no? different? anatomically from the external running > >>? suture? line which will leave a "ridge" internally. > >> > >> I? used to oversew the orifice of the LA appendage? from? inside the > >> LA > >> using a double running 3-0? prolene in? all my mitral? valves. > >> Occasionally? the tension? on the suture line from? gathering? all > >> this > >> tissue would be associated with a? "split"? in? the? endocardium. > >> I saw a patient? operated by another? surgeon with? morbid bleeding > >>? from > >> this very cause.? And,? this internal oversew? technique > >> is not? practical in the? majority of CABG? patients. You? refer to > >> internal suturing? as the? preferred technique, but your? practice > >> is nearly? all? valves. For us mortal CABG? surgeons, an? external > >> approach? that eliminates? the cul-de-sac? safely is the? best > >> way.? Thus, my? offering to? ligate the anatomic base with? two > >> encircling sutures. Silk.? Polyester, Endo-loop makes no > >> difference > >> What makes a? difference is getting the? surrounding? tissue? cleared > >> away > >> and getting? the ligature to? the true base. If? you do > >> not do? this step, even? the? external double suture line? leaves a > >> residual? appendiceal? stump. > >> > >> I? would like to have? more echo? followup. Now that we have? routine > >> intraop? TEE, I will ask? for images after? ligation and see > >> what? we? get.. > >> > >> Thanks. > >> > >>? Mark > >> > >> Mark Levinson,? MD. > >>? Founder,? Editor-in-Chief > >> The Heart Surgery? Forum? > >> Multimedia? Cardiothoracic Journal > >>? URL:? http://www.hsforum.com > >> URL:? ? http://newoptionsinheartsurgery.com > >> Emali:? ? mmlevinson@hsforum.com > >> > >>? _______________________________________________ > >>? OpenHeart-L? mailing list > >> > >> Send? postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To? UNSUBSCRIBE,? to? CHANGE email address, or to? view archives: > >>? http://mmp.cjp.com/mailman/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 the variety of Bisquick? mix. Get? Recipes > >> & > >> Savings > >> Now. > >>? ( > >> > >> > >> > >> > >> > >> > > http://pr.atwola.com/promoclk/100126575x1222831871x1201491818/aol?redir=http > >>? :%2F%2Fad.doubleclick.net%2Fclk%3B215225813%3B37274670%3Be%3Fhttp:%2F > >>? %2 > >> Frecipes.bisquick.bettycrocker.com%3FESRC%3D971) > >>? _______________________________________________ > >>? OpenHeart-L? mailing list > >> > >> Send postings? to: > >> OpenHeart-L@lists.hsforum.com > >> > >>? To? UNSUBSCRIBE,? to? CHANGE email address, or to view? archives: > >>? http://mmp.cjp.com/mailman/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 > >>? ----------------------------------------- > >> > >>? **************A? Good Credit Score is 700 or Above. See yours? in > >> just? 2 > >> easy > >> steps! > >>? ( > >> > >> > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=htt > >>? p://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd= > >> > >> MaystepsfooterNO62< > >> > >> > > http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=%0AMa > >>? ystepsfooterNO62 > >> > >> ) > >>? _______________________________________________ > >> OpenHeart-L? mailing list > >> > >> Send postings? to: > >>? OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to? CHANGE? email? address, or to view? archives: > >>? http://mmp.cjp.com/mailman/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 -? www.avg.com > >>? Version: 8.5.339 / Virus Database: 270.12.46/2143 -? Release? Date: > >> 05/30/09 > >> > >> 05:53:00 > >> > >> _______________________________________________ > >>? OpenHeart-L? mailing list > >> > >> Send? postings? to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE? email? address, or to? view? archives: > >>? http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >>? All? messages transmitted by the OpenHeart-L are subject to? the > >> policies > >> and > >> disclaimers posted? at: > >> http://www.hsforum.com/listdisclaim > >>? ----------------------------------------- > >> > >>? **************A Good? Credit Score is 700 or Above. See yours? in > >> just 2 > >> easy > >> steps! > >>? ( > >> > >> > >> > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >>? //www.freecreditreport.com/pm/default.aspx > >>? ?sc=668072&hmpgID=62&bcd= > >> > >>? MaystepsfooterNO62< > >> > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >>? //www.freecreditreport.com/pm/default.aspx > >>? ?sc=668072& > >>? hmpgID=62&bcd=%0AMaystepsfooterNO62< > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >>? //www.freecreditreport.com/pm/default.aspx > >>? ?sc=668072&%0AhmpgID=62&bcd=%0AMaystepsfooterNO62 > >> > >> > >> ) > >>? _______________________________________________ > >> OpenHeart-L? mailing list > >> > >> Send postings to: > >>? OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to? CHANGE email? address, or to view archives: > >>? http://mmp.cjp.com/mailman/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 > >>? ----------------------------------------- > >> > >>? **************A Good Credit Score is 700 or Above. See yours in? just > >> 2 easy > >> steps! > >> ( > >> > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >>? //www.freecreditreport.com/pm/default.aspx > >>? ?sc=668072&hmpgID=62&bcd= > >>? MaystepsfooterNO62< > >> > > http://pr.atwola.com/promoclk/100126575x1221322950x1201367186/aol?redir=http > : > >>? //www.freecreditreport.com/pm/default.aspx > >>? ?sc=668072&hmpgID=62&bcd=%0AMaystepsfooterNO62 > >> > >> ) > >>? _______________________________________________ > >> OpenHeart-L? mailing list > >> > >> Send postings to: > >>? OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to? CHANGE email address, or to view archives: > >>? http://mmp.cjp.com/mailman/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 > >>? ----------------------------------------- > >> aimers 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 > >>? ----------------------------------------- > >> ed 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 > >? ----------------------------------------- > > > _______________________________________________ > OpenHeart-L? mailing list > > Send postings? to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email? address, or to view? archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All? messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted? at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > **************Limited Time Offers: Save big on popular laptops at Dell > ( > http://pr.atwola.com/promoclk/100126575x1221354145x1201369495/aol?redir=http:%2F > %2Fad.doubleclick.net%2Fclk%3B215221161%3B37268813%3By) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: >? OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Thu Jun 4 10:36:24 2009 From: tacuff at swbell.net (Tea Acuff) Date: Thu Jun 4 12:36:44 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: References: <748086.82923.qm@web81605.mail.mud.yahoo.com> <306982.89689.qm@web81603.mail.mud.yahoo.com> <89c4ed2d0906030748r679c461bkac9c3d10902ccdd0@mail.gmail.com> <89c4ed2d0906030753h2a15b91asfb1e7f6e7970a211@mail.gmail.com> Message-ID: <463195.61765.qm@web81601.mail.mud.yahoo.com> I ran across another problem with elevation of protocol to the primary focus of safety. As in most of life things play out backwards as we try to "save" "fools" from error. I did a recent talc pleurodiesis. The nurse called and said we could not take the patient back untiL I marked the side. I said that my PA was nearby and she could do it. I was told that was "not allowed" (protocol). Do all of you with residents mark your own patients? If not then you are committing a "moral" (I can explain later) error. So I later come to the OR and go through the usual listed time out protocol. I ask to see the films even though everyone already "knows" what side the effusion is on. Of course the PACS film are not up yet since this is only "my" rule, not protocol. As a final laugh from the gods as I get ready make the small incision, I see the "X" mark?on the inferior posterior lateral wall placed by the now rountine echo exam for entry point for the needle to tap the effusion. I ignore that now useless mark as I get ready to drain his effusion directly. Protocols tend to make us fools in order to save us. Did that happen to the airbus? If we think as fools we shall surely get there. tea ? ________________________________ From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Wednesday, June 3, 2009 10:06:49 AM Subject: Re: [HSF] airplane accidents and other "misfortunes" yes, patients often need protection from us. How many of you have heparin nomograms for anticoagulation in your hospitals? -m On Wed, Jun 3, 2009 at 10:53 AM, Prasanna Simha M wrote: > "The most dangerous time for a baby is not when it is in its womb or after > it has a healthy cry but during transit. > Same can be said for the process of training." > > I am always worried about the New lecturer who has recently passed out and > over years consistently? had a call from a perfusionist/anesthesiologist > running up to me and calling me to come over stat as the New lecturer has > made a hole in the posterior wall of the IVC while looping and hasn't > placed > at least a purse string let alone an aortic cannula before taping the SVC > and IVC - a thing that I tell them to do specifically when I am not around > !! > After getting burnt they become a little more careful. > Prasanna > > On Wed, Jun 3, 2009 at 8:18 PM, Prasanna Simha M >wrote: > > > Protocols should be defined as that which makes a thing "Idiot proof" > > Protocol demands Heparin? administration to be announced loudly , an ACT > > done and announced. > > Protocol? also demands that a surgeon says to start the wean with the > loud > > proclomation "Ventilator on" which should be done and acknowledged by the > > anesthesiologist. The anesthesiologist should not look at it as > > micromanaging but as a "check and balance" and? "idiot proofing". A > senior > > would always put the Ventilator on but its nott really for him where it > has > > become second nature but for the neophyte or more dangerously the midrung > > (not too "junior" to be micromanaged but not too senior to be an "expert" > > who would be able to set a protocol him/herself. > > Prasanna > > > > On Wed, Jun 3, 2009 at 7:52 PM, Tea Acuff wrote: > > > >> Thanks for the challenge. > >> > >> It is hard to imagine politics without laws, but the question is at what > >> level is the control asserted, how ubiquitious should the law be, and > where > >> are the enforcements for failure? > >> > >> Does anticoagulation mean heparin, hirudin, or in alternative "CP > support" > >> little of no anticoagulation? > >> > >> Is it better to leave the control and enforcement of such decisions to > >> local control and enforcement or "manufacture" it in from the top after > a > >> thousand meetings. Or as we are heading in the US with little of no > >> consensus from one or two meetings at the top? > >> > >> Should the "highest protocols" be of the form "do this , this, and > this", > >> or say the form of the Ten Commandments, "don't do this, don't do that" > and > >> have a thousand different demonimations play out the details of the > >> protocol? > >> > >> As I asked define protocol exactly. We can not agree often on the > details > >> of a specific protocol eg on or off pump. Should we agree on the higher > >> question, the form of protocol? > >> > >> tea > >> > >> > >> > >> ________________________________ > >> From: Michael Firstenberg > >> To: OpenHeart-L@lists.hsforum.com > >> Sent: Wednesday, June 3, 2009 8:02:24 AM > >> Subject: Re: [HSF] airplane accidents and other "misfortunes" > >> > >> True - however, there are many protocols out there, in medicine and in > CT > >> surgery - in which the outcomes (however defined) are better than in > >> general > >> what can be accomplished without the protocol - or when individuals > chose > >> to > >> not adhere to the protocol.? Much like overriding an auto-pilot and > >> crashing > >> a plane.? In part, because what usually happens is that the people that > >> override the protocol or auto-pilot think they know better or are > smarter > >> (regardless of the situation) than then people, process, data, whatever > >> that > >> led to the development of a protocol.? If the protocols fail - and the > >> outcomes and causes can be determined through a CQI then they get > changed. > >> Again, hence the checklists that we keep talking about. > >> > >> Ever try to go on pump (for those of you who still use it) without > >> anticoagulation? > >> > >> -michael > >> > >> > >> > >> > >> On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < > >> robertobattellini@hotmail.com> wrote: > >> > >> > > >> > Tea, > >> > > >> > you are incredible intelectual.I am still waying for you book on Tea?s > >> > thoughts. > >> > > >> > > >> > > >> > It is still stupid to think in Medicine that for example a robot could > >> do > >> > the whole operation itself. A plane can fly in automatic pilot, but > not > >> > thorough a storm. > >> > > >> > Roberto > >> > > >> > > Date: Tue, 2 Jun 2009 20:08:19 -0700 > >> > > From: tacuff@swbell.net > >> > > To: OpenHeart-L@lists.hsforum.com > >> > > CC: > >> > > Subject: [HSF] airplane accidents and other "misfortunes" > >> >? > > >> > > The airbus disaster over the Atlantic brings up the issue for HSF as > >> to > >> > what lessons might we learn on this occasion. That fact that we may > not > >> know > >> > the details, does not mean that there are no lessons to be gleaned. I > >> mean > >> > no disrespect to those lost, and it is likely for a big audience such > as > >> HSF > >> > to have some that somehow know someone on that flight. > >> > > > >> > > What intrigues me about this airplane is that it was by design flown > >> by > >> > electric or servo mechanisms. Further it seems that it was programed > to > >> be > >> > flown automatically by setting of goals or parameters and the software > >> > computer models "manned" the servomechanism. > >> > > > >> > > Whether this is the fact or not is not really necessary for this > >> > gedankenexperiment. (Einstein did not believe that there are elevators > >> out > >> > in space.) > >> > > > >> > > What we have in this design is an elevation of protocol over > >> experience > >> > or prethought "artificial intelligence" over organic intelligence. I > am > >> not > >> > interested in the specific details of the protocols, but the concept > >> that > >> > the protocol is superior to the thinker...in all conditions. This > issue > >> > occurs in every realm of thought: religious (word), political (law), > >> > computers (software) or more clinical medicine (best practice, > protocol, > >> > etc.) > >> > > > >> > > Medicine is subject to other classes or levels of protocol > >> bureaucratic, > >> > political, economic etc that may further and undoubtedly does limit > >> possible > >> > proscribed actions. The question is whether freedom of individual > >> (nurse, > >> > doctor, institution, research, pilot, etc) action (in all its levels) > is > >> an > >> > important safe guard. If so, what does a protocol mean exactly? > >> > > > >> > > In medicine and on the forum some have argued that "blind' > application > >> of > >> > "best practice" yields and will yield better medicine than less > >> formalized > >> > practice patterns. The easy logic of such thought makes "best > practice" > >> a > >> > nearly universally acclaimed superlative. > >> > > > >> > > There are several problems with this line of thinking. From a > logistic > >> > standpoint "best practice" does not have a specific meaning. It best > >> seems > >> > to mirror the common practice of money mangers to be listed by the > past > >> > (several) year(s) result as "best manger". We all know the economic > >> > consequence of following this logic. It is the equivalence of "buying > >> into" > >> > a bull market. It works for the short term and is disastrous, buying > >> high > >> > and selling low, in the long term. > >> > > > >> > > Another problem is that we are not likely to see a large obvious and > >> > frightening "kill" in the medical analogy of this flight model. What > is > >> > likely to happen is large numbers of remote and thus unrecognized > >> protocol > >> > mismatch or "less than best practice" in the margins while that > >> immediate in > >> > our view looks good if not always best. > >> > > > >> > > Lastly (there are more undoubtedly) most of us are aware of the > idiocy > >> we > >> > see from labeling protocol adherence as superior medicine. It leads to > >> large > >> > number of 100% perfect (and "gamed") hospitals and practioners with > >> quite > >> > variable and disparate actual results. > >> > > > >> > > So, can we really design a plane or a medical system that flies > >> itself? > >> > It seems that we can and are determined to, but do we want to fly in > it? > >> > > > >> > > Let's see what happens to the airbus. Perhaps there is a story here. > >> > Expect some posturing along the way. > >> > > > >> > > Yes, I know it is "Off Topic." > >> > > > >> > > 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 > >> ----------------------------------------- > >> > > > > > > > > -- > > 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 ----------------------------------------- From tacuff at swbell.net Thu Jun 4 10:37:57 2009 From: tacuff at swbell.net (Tea Acuff) Date: Thu Jun 4 12:38:28 2009 Subject: [HSF] HTX in asia? In-Reply-To: <89c4ed2d0906040836m1303beafiff5703ca15141e04@mail.gmail.com> References: <955521.20553.qm@web81608.mail.mud.yahoo.com> <8CBB31543632B58-16DC-2170@WEBMAIL-MA20.sysops.aol.com> <1430058169-1244119224-cardhu_decombobulator_blackberry.rim.net-2067066012-@bxe1236.bisx.prod.on.blackberry> <2bf49055c6f8ba09dd10b2ebcf423c31@ruhr-uni-bochum.de> <74594.8653.qm@web81606.mail.mud.yahoo.com> <89c4ed2d0906040836m1303beafiff5703ca15141e04@mail.gmail.com> Message-ID: <262831.26451.qm@web81605.mail.mud.yahoo.com> so it is a rock group, sort of. tea ________________________________ From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Thursday, June 4, 2009 10:36:50 AM Subject: Re: [HSF] HTX in asia? http://en.wikipedia.org/wiki/Bad_Nauheim Elvis is associated with it. Prasanna On Thu, Jun 4, 2009 at 9:02 PM, Tea Acuff wrote: > What is Bad Nauheim? A rock group? > > You may remember me saying that I asked my dad, a surgeon, long ago as I > was a medical student how could one keep up with all the information. He > said,"You don't memorize you just have to know where to find it." As a > result I memorized very little, but spent a lot of time thinking about what > to do with the information and what was primary. Part of that is the > associtive tags by which we store things in our head. (see above :)) > > Good luck. > tea > > > > > ________________________________ > From: prof. dr. axel laczkovics > To: OpenHeart-L@lists.hsforum.com > Sent: Thursday, June 4, 2009 9:40:48 AM > Subject: Re: [HSF] HTX in asia? > > hal and tea, > > many thanks to both of you. meanwhile i got his? email-adress? from > matthias roth from? bad nauheim. > HSF is a wonderful thing. > > axel > > > > > It may be a delay before Kit responds.? Yesterday, I saw him at ISMICS > here in San Francisco.? However, I did tell him Axel needed his advice. > > > > Hal > > Sent from my Verizon Wireless BlackBerry > > > > -----Original Message----- > > From: matthroth@aol.com > > > > Date: Thu, 04 Jun 2009 06:20:48 > > To: > > Subject: Re: [HSF] HTX in asia? > > > > > > > > > > Kit V. Arom, M.D., Ph.D. > > > > 2 Soi Soonvijai 7 > > New Phetburi Road > > Bangkok 10310 > > Thailand > > > > 1 662 310-3323 > > 1 662 310-3088 (Fax) > > > > Karom@bangkokheart.com > > > > > > -----Urspr?ngliche Mitteilung----- > > Von: prof. dr. axel laczkovics > > An: OpenHeart-L@lists.hsforum.com > > Verschickt: Do., 4. Jun. 2009, 12:11 > > Thema: Re: [HSF] HTX in asia? > > > > > > tea, > > > > thx for the advice; do you have any info how to contact kit arom? > > > > axel > > > >> > >> Kit Arom lives in Thailand and could give you suggestions > >> Tea > >> > >> Sent from my iPhone > >> > >> On Jun 3, 2009, at 2:25 AM, "prof. dr. axel laczkovics" > < > axel.m.laczkovics@ruhr-uni-bochum.de> wrote: > >> > >> dear friends, > >> > >> it was in 1985, whe i transplanted a something like 12yr old boy in > > vienna. he is now over 30 and fell in love with a girl (woman?) in > > thailand and wants to move to and with her. > >> > >> i have moved to germany 1992 and have no idea about tx in asia. > >> > >> has anybody knowledge about tx-centers round bangkok or somewhere else > > in asia? or at least bigger cardiologic centers for routine > check-up?s? > >> > >> thx a lot, axel laczkovics > >> bochum, germany > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 > > ----------------------------------------- > > > > > > ________________________________________________________________________ > > AOL eMail auf Ihrem Handy! Ab sofort k?nnen Sie auch unterwegs Ihre AOL > email abrufen. Registrieren Sie sich jetzt kostenlos. > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > >? OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Jun 5 02:50:19 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Thu Jun 4 19:51:10 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: <463195.61765.qm@web81601.mail.mud.yahoo.com> References: <748086.82923.qm@web81605.mail.mud.yahoo.com> <306982.89689.qm@web81603.mail.mud.yahoo.com> <89c4ed2d0906030748r679c461bkac9c3d10902ccdd0@mail.gmail.com> <89c4ed2d0906030753h2a15b91asfb1e7f6e7970a211@mail.gmail.com> <463195.61765.qm@web81601.mail.mud.yahoo.com> Message-ID: Tea, in Tchernobyl they were making some experiment, went wrong, there was a protocol, they followed it and it was mistake... let me re read that as I am back to Leipzig, I am in Brazil, for a cardiology meeting, crossed the atlantic with TAM airlines same Airbus as Air France, had turbulences in the same place, my wife was terryfied.We Landed in Sao Paulo. Sunday fly back. Roberto > Date: Thu, 4 Jun 2009 09:36:24 -0700 > From: tacuff@swbell.net > Subject: Re: [HSF] airplane accidents and other "misfortunes" > To: OpenHeart-L@lists.hsforum.com > CC: > > I ran across another problem with elevation of protocol to the primary focus of safety. As in most of life things play out backwards as we try to "save" "fools" from error. > > I did a recent talc pleurodiesis. The nurse called and said we could not take the patient back untiL I marked the side. I said that my PA was nearby and she could do it. I was told that was "not allowed" (protocol). Do all of you with residents mark your own patients? If not then you are committing a "moral" (I can explain later) error. > > So I later come to the OR and go through the usual listed time out protocol. I ask to see the films even though everyone already "knows" what side the effusion is on. Of course the PACS film are not up yet since this is only "my" rule, not protocol. As a final laugh from the gods as I get ready make the small incision, I see the "X" mark on the inferior posterior lateral wall placed by the now rountine echo exam for entry point for the needle to tap the effusion. I ignore that now useless mark as I get ready to drain his effusion directly. > > Protocols tend to make us fools in order to save us. Did that happen to the airbus? If we think as fools we shall surely get there. > > tea > > > > > > > ________________________________ > From: Michael Firstenberg > To: OpenHeart-L@lists.hsforum.com > Sent: Wednesday, June 3, 2009 10:06:49 AM > Subject: Re: [HSF] airplane accidents and other "misfortunes" > > yes, patients often need protection from us. > > How many of you have heparin nomograms for anticoagulation in your > hospitals? > > -m > > On Wed, Jun 3, 2009 at 10:53 AM, Prasanna Simha M > wrote: > > > "The most dangerous time for a baby is not when it is in its womb or after > > it has a healthy cry but during transit. > > Same can be said for the process of training." > > > > I am always worried about the New lecturer who has recently passed out and > > over years consistently had a call from a perfusionist/anesthesiologist > > running up to me and calling me to come over stat as the New lecturer has > > made a hole in the posterior wall of the IVC while looping and hasn't > > placed > > at least a purse string let alone an aortic cannula before taping the SVC > > and IVC - a thing that I tell them to do specifically when I am not around > > !! > > After getting burnt they become a little more careful. > > Prasanna > > > > On Wed, Jun 3, 2009 at 8:18 PM, Prasanna Simha M > >wrote: > > > > > Protocols should be defined as that which makes a thing "Idiot proof" > > > Protocol demands Heparin administration to be announced loudly , an ACT > > > done and announced. > > > Protocol also demands that a surgeon says to start the wean with the > > loud > > > proclomation "Ventilator on" which should be done and acknowledged by the > > > anesthesiologist. The anesthesiologist should not look at it as > > > micromanaging but as a "check and balance" and "idiot proofing". A > > senior > > > would always put the Ventilator on but its nott really for him where it > > has > > > become second nature but for the neophyte or more dangerously the midrung > > > (not too "junior" to be micromanaged but not too senior to be an "expert" > > > who would be able to set a protocol him/herself. > > > Prasanna > > > > > > On Wed, Jun 3, 2009 at 7:52 PM, Tea Acuff wrote: > > > > > >> Thanks for the challenge. > > >> > > >> It is hard to imagine politics without laws, but the question is at what > > >> level is the control asserted, how ubiquitious should the law be, and > > where > > >> are the enforcements for failure? > > >> > > >> Does anticoagulation mean heparin, hirudin, or in alternative "CP > > support" > > >> little of no anticoagulation? > > >> > > >> Is it better to leave the control and enforcement of such decisions to > > >> local control and enforcement or "manufacture" it in from the top after > > a > > >> thousand meetings. Or as we are heading in the US with little of no > > >> consensus from one or two meetings at the top? > > >> > > >> Should the "highest protocols" be of the form "do this , this, and > > this", > > >> or say the form of the Ten Commandments, "don't do this, don't do that" > > and > > >> have a thousand different demonimations play out the details of the > > >> protocol? > > >> > > >> As I asked define protocol exactly. We can not agree often on the > > details > > >> of a specific protocol eg on or off pump. Should we agree on the higher > > >> question, the form of protocol? > > >> > > >> tea > > >> > > >> > > >> > > >> ________________________________ > > >> From: Michael Firstenberg > > >> To: OpenHeart-L@lists.hsforum.com > > >> Sent: Wednesday, June 3, 2009 8:02:24 AM > > >> Subject: Re: [HSF] airplane accidents and other "misfortunes" > > >> > > >> True - however, there are many protocols out there, in medicine and in > > CT > > >> surgery - in which the outcomes (however defined) are better than in > > >> general > > >> what can be accomplished without the protocol - or when individuals > > chose > > >> to > > >> not adhere to the protocol. Much like overriding an auto-pilot and > > >> crashing > > >> a plane. In part, because what usually happens is that the people that > > >> override the protocol or auto-pilot think they know better or are > > smarter > > >> (regardless of the situation) than then people, process, data, whatever > > >> that > > >> led to the development of a protocol. If the protocols fail - and the > > >> outcomes and causes can be determined through a CQI then they get > > changed. > > >> Again, hence the checklists that we keep talking about. > > >> > > >> Ever try to go on pump (for those of you who still use it) without > > >> anticoagulation? > > >> > > >> -michael > > >> > > >> > > >> > > >> > > >> On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < > > >> robertobattellini@hotmail.com> wrote: > > >> > > >> > > > >> > Tea, > > >> > > > >> > you are incredible intelectual.I am still waying for you book on Tea?s > > >> > thoughts. > > >> > > > >> > > > >> > > > >> > It is still stupid to think in Medicine that for example a robot could > > >> do > > >> > the whole operation itself. A plane can fly in automatic pilot, but > > not > > >> > thorough a storm. > > >> > > > >> > Roberto > > >> > > > >> > > Date: Tue, 2 Jun 2009 20:08:19 -0700 > > >> > > From: tacuff@swbell.net > > >> > > To: OpenHeart-L@lists.hsforum.com > > >> > > CC: > > >> > > Subject: [HSF] airplane accidents and other "misfortunes" > > >> > > > > >> > > The airbus disaster over the Atlantic brings up the issue for HSF as > > >> to > > >> > what lessons might we learn on this occasion. That fact that we may > > not > > >> know > > >> > the details, does not mean that there are no lessons to be gleaned. I > > >> mean > > >> > no disrespect to those lost, and it is likely for a big audience such > > as > > >> HSF > > >> > to have some that somehow know someone on that flight. > > >> > > > > >> > > What intrigues me about this airplane is that it was by design flown > > >> by > > >> > electric or servo mechanisms. Further it seems that it was programed > > to > > >> be > > >> > flown automatically by setting of goals or parameters and the software > > >> > computer models "manned" the servomechanism. > > >> > > > > >> > > Whether this is the fact or not is not really necessary for this > > >> > gedankenexperiment. (Einstein did not believe that there are elevators > > >> out > > >> > in space.) > > >> > > > > >> > > What we have in this design is an elevation of protocol over > > >> experience > > >> > or prethought "artificial intelligence" over organic intelligence. I > > am > > >> not > > >> > interested in the specific details of the protocols, but the concept > > >> that > > >> > the protocol is superior to the thinker...in all conditions. This > > issue > > >> > occurs in every realm of thought: religious (word), political (law), > > >> > computers (software) or more clinical medicine (best practice, > > protocol, > > >> > etc.) > > >> > > > > >> > > Medicine is subject to other classes or levels of protocol > > >> bureaucratic, > > >> > political, economic etc that may further and undoubtedly does limit > > >> possible > > >> > proscribed actions. The question is whether freedom of individual > > >> (nurse, > > >> > doctor, institution, research, pilot, etc) action (in all its levels) > > is > > >> an > > >> > important safe guard. If so, what does a protocol mean exactly? > > >> > > > > >> > > In medicine and on the forum some have argued that "blind' > > application > > >> of > > >> > "best practice" yields and will yield better medicine than less > > >> formalized > > >> > practice patterns. The easy logic of such thought makes "best > > practice" > > >> a > > >> > nearly universally acclaimed superlative. > > >> > > > > >> > > There are several problems with this line of thinking. From a > > logistic > > >> > standpoint "best practice" does not have a specific meaning. It best > > >> seems > > >> > to mirror the common practice of money mangers to be listed by the > > past > > >> > (several) year(s) result as "best manger". We all know the economic > > >> > consequence of following this logic. It is the equivalence of "buying > > >> into" > > >> > a bull market. It works for the short term and is disastrous, buying > > >> high > > >> > and selling low, in the long term. > > >> > > > > >> > > Another problem is that we are not likely to see a large obvious and > > >> > frightening "kill" in the medical analogy of this flight model. What > > is > > >> > likely to happen is large numbers of remote and thus unrecognized > > >> protocol > > >> > mismatch or "less than best practice" in the margins while that > > >> immediate in > > >> > our view looks good if not always best. > > >> > > > > >> > > Lastly (there are more undoubtedly) most of us are aware of the > > idiocy > > >> we > > >> > see from labeling protocol adherence as superior medicine. It leads to > > >> large > > >> > number of 100% perfect (and "gamed") hospitals and practioners with > > >> quite > > >> > variable and disparate actual results. > > >> > > > > >> > > So, can we really design a plane or a medical system that flies > > >> itself? > > >> > It seems that we can and are determined to, but do we want to fly in > > it? > > >> > > > > >> > > Let's see what happens to the airbus. Perhaps there is a story here. > > >> > Expect some posturing along the way. > > >> > > > > >> > > Yes, I know it is "Off Topic." > > >> > > > > >> > > 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 > > >> ----------------------------------------- > > >> > > > > > > > > > > > > -- > > > 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 > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Jun 5 07:54:17 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Jun 4 21:25:06 2009 Subject: [HSF] airplane accidents and other "misfortunes" In-Reply-To: References: <748086.82923.qm@web81605.mail.mud.yahoo.com> <306982.89689.qm@web81603.mail.mud.yahoo.com> <89c4ed2d0906030748r679c461bkac9c3d10902ccdd0@mail.gmail.com> <89c4ed2d0906030753h2a15b91asfb1e7f6e7970a211@mail.gmail.com> <463195.61765.qm@web81601.mail.mud.yahoo.com> Message-ID: <89c4ed2d0906041824p6d50b7e4y4b267799422fdaea@mail.gmail.com> Actually ib Chernobyl they did not follow protocol. In fact an experiment was being done at that time. Disabling of the safety systems The reactor had many safety measures built-in, but they could easily be shut off or circumvented. The Chernobyl scientists had too much faith in the reactor and wanted to proceed with their experiment at all costs, so they disabled many security features, believing that a major incident would not occur. Among the systems that were disabled were: ECCS (Emergency Core Cooling System), LAR (Local Automatic control system), and AZ (emergency power reduction system).[21] >From the start, the experiment's parameters went beyond the normal safe conditions of the reactor. This was further compounded when the chiefs on duty while the experiment was being carried out ordered that the safety systems be further circumvented.[ Prasanna On Fri, Jun 5, 2009 at 5:20 AM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > Tea, > > in Tchernobyl they were making some experiment, went wrong, there was a > protocol, they followed it and it was mistake... > > let me re read that as I am back to Leipzig, I am in Brazil, for a > cardiology meeting, crossed the atlantic with TAM airlines same Airbus as > Air France, had turbulences in the same place, my wife was terryfied.We > Landed in Sao Paulo. > > Sunday fly back. > > Roberto > > > Date: Thu, 4 Jun 2009 09:36:24 -0700 > > From: tacuff@swbell.net > > Subject: Re: [HSF] airplane accidents and other "misfortunes" > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > I ran across another problem with elevation of protocol to the primary > focus of safety. As in most of life things play out backwards as we try to > "save" "fools" from error. > > > > I did a recent talc pleurodiesis. The nurse called and said we could not > take the patient back untiL I marked the side. I said that my PA was nearby > and she could do it. I was told that was "not allowed" (protocol). Do all of > you with residents mark your own patients? If not then you are committing a > "moral" (I can explain later) error. > > > > So I later come to the OR and go through the usual listed time out > protocol. I ask to see the films even though everyone already "knows" what > side the effusion is on. Of course the PACS film are not up yet since this > is only "my" rule, not protocol. As a final laugh from the gods as I get > ready make the small incision, I see the "X" mark on the inferior posterior > lateral wall placed by the now rountine echo exam for entry point for the > needle to tap the effusion. I ignore that now useless mark as I get ready to > drain his effusion directly. > > > > Protocols tend to make us fools in order to save us. Did that happen to > the airbus? If we think as fools we shall surely get there. > > > > tea > > > > > > > > > > > > > > ________________________________ > > From: Michael Firstenberg > > To: OpenHeart-L@lists.hsforum.com > > Sent: Wednesday, June 3, 2009 10:06:49 AM > > Subject: Re: [HSF] airplane accidents and other "misfortunes" > > > > yes, patients often need protection from us. > > > > How many of you have heparin nomograms for anticoagulation in your > > hospitals? > > > > -m > > > > On Wed, Jun 3, 2009 at 10:53 AM, Prasanna Simha M > > wrote: > > > > > "The most dangerous time for a baby is not when it is in its womb or > after > > > it has a healthy cry but during transit. > > > Same can be said for the process of training." > > > > > > I am always worried about the New lecturer who has recently passed out > and > > > over years consistently had a call from a > perfusionist/anesthesiologist > > > running up to me and calling me to come over stat as the New lecturer > has > > > made a hole in the posterior wall of the IVC while looping and hasn't > > > placed > > > at least a purse string let alone an aortic cannula before taping the > SVC > > > and IVC - a thing that I tell them to do specifically when I am not > around > > > !! > > > After getting burnt they become a little more careful. > > > Prasanna > > > > > > On Wed, Jun 3, 2009 at 8:18 PM, Prasanna Simha M < > prasannasimha@gmail.com > > > >wrote: > > > > > > > Protocols should be defined as that which makes a thing "Idiot proof" > > > > Protocol demands Heparin administration to be announced loudly , an > ACT > > > > done and announced. > > > > Protocol also demands that a surgeon says to start the wean with the > > > loud > > > > proclomation "Ventilator on" which should be done and acknowledged by > the > > > > anesthesiologist. The anesthesiologist should not look at it as > > > > micromanaging but as a "check and balance" and "idiot proofing". A > > > senior > > > > would always put the Ventilator on but its nott really for him where > it > > > has > > > > become second nature but for the neophyte or more dangerously the > midrung > > > > (not too "junior" to be micromanaged but not too senior to be an > "expert" > > > > who would be able to set a protocol him/herself. > > > > Prasanna > > > > > > > > On Wed, Jun 3, 2009 at 7:52 PM, Tea Acuff wrote: > > > > > > > >> Thanks for the challenge. > > > >> > > > >> It is hard to imagine politics without laws, but the question is at > what > > > >> level is the control asserted, how ubiquitious should the law be, > and > > > where > > > >> are the enforcements for failure? > > > >> > > > >> Does anticoagulation mean heparin, hirudin, or in alternative "CP > > > support" > > > >> little of no anticoagulation? > > > >> > > > >> Is it better to leave the control and enforcement of such decisions > to > > > >> local control and enforcement or "manufacture" it in from the top > after > > > a > > > >> thousand meetings. Or as we are heading in the US with little of no > > > >> consensus from one or two meetings at the top? > > > >> > > > >> Should the "highest protocols" be of the form "do this , this, and > > > this", > > > >> or say the form of the Ten Commandments, "don't do this, don't do > that" > > > and > > > >> have a thousand different demonimations play out the details of the > > > >> protocol? > > > >> > > > >> As I asked define protocol exactly. We can not agree often on the > > > details > > > >> of a specific protocol eg on or off pump. Should we agree on the > higher > > > >> question, the form of protocol? > > > >> > > > >> tea > > > >> > > > >> > > > >> > > > >> ________________________________ > > > >> From: Michael Firstenberg > > > >> To: OpenHeart-L@lists.hsforum.com > > > >> Sent: Wednesday, June 3, 2009 8:02:24 AM > > > >> Subject: Re: [HSF] airplane accidents and other "misfortunes" > > > >> > > > >> True - however, there are many protocols out there, in medicine and > in > > > CT > > > >> surgery - in which the outcomes (however defined) are better than in > > > >> general > > > >> what can be accomplished without the protocol - or when individuals > > > chose > > > >> to > > > >> not adhere to the protocol. Much like overriding an auto-pilot and > > > >> crashing > > > >> a plane. In part, because what usually happens is that the people > that > > > >> override the protocol or auto-pilot think they know better or are > > > smarter > > > >> (regardless of the situation) than then people, process, data, > whatever > > > >> that > > > >> led to the development of a protocol. If the protocols fail - and > the > > > >> outcomes and causes can be determined through a CQI then they get > > > changed. > > > >> Again, hence the checklists that we keep talking about. > > > >> > > > >> Ever try to go on pump (for those of you who still use it) without > > > >> anticoagulation? > > > >> > > > >> -michael > > > >> > > > >> > > > >> > > > >> > > > >> On Wed, Jun 3, 2009 at 5:26 AM, Roberto Battellini < > > > >> robertobattellini@hotmail.com> wrote: > > > >> > > > >> > > > > >> > Tea, > > > >> > > > > >> > you are incredible intelectual.I am still waying for you book on > Tea?s > > > >> > thoughts. > > > >> > > > > >> > > > > >> > > > > >> > It is still stupid to think in Medicine that for example a robot > could > > > >> do > > > >> > the whole operation itself. A plane can fly in automatic pilot, > but > > > not > > > >> > thorough a storm. > > > >> > > > > >> > Roberto > > > >> > > > > >> > > Date: Tue, 2 Jun 2009 20:08:19 -0700 > > > >> > > From: tacuff@swbell.net > > > >> > > To: OpenHeart-L@lists.hsforum.com > > > >> > > CC: > > > >> > > Subject: [HSF] airplane accidents and other "misfortunes" > > > >> > > > > > >> > > The airbus disaster over the Atlantic brings up the issue for > HSF as > > > >> to > > > >> > what lessons might we learn on this occasion. That fact that we > may > > > not > > > >> know > > > >> > the details, does not mean that there are no lessons to be > gleaned. I > > > >> mean > > > >> > no disrespect to those lost, and it is likely for a big audience > such > > > as > > > >> HSF > > > >> > to have some that somehow know someone on that flight. > > > >> > > > > > >> > > What intrigues me about this airplane is that it was by design > flown > > > >> by > > > >> > electric or servo mechanisms. Further it seems that it was > programed > > > to > > > >> be > > > >> > flown automatically by setting of goals or parameters and the > software > > > >> > computer models "manned" the servomechanism. > > > >> > > > > > >> > > Whether this is the fact or not is not really necessary for this > > > >> > gedankenexperiment. (Einstein did not believe that there are > elevators > > > >> out > > > >> > in space.) > > > >> > > > > > >> > > What we have in this design is an elevation of protocol over > > > >> experience > > > >> > or prethought "artificial intelligence" over organic intelligence. > I > > > am > > > >> not > > > >> > interested in the specific details of the protocols, but the > concept > > > >> that > > > >> > the protocol is superior to the thinker...in all conditions. This > > > issue > > > >> > occurs in every realm of thought: religious (word), political > (law), > > > >> > computers (software) or more clinical medicine (best practice, > > > protocol, > > > >> > etc.) > > > >> > > > > > >> > > Medicine is subject to other classes or levels of protocol > > > >> bureaucratic, > > > >> > political, economic etc that may further and undoubtedly does > limit > > > >> possible > > > >> > proscribed actions. The question is whether freedom of individual > > > >> (nurse, > > > >> > doctor, institution, research, pilot, etc) action (in all its > levels) > > > is > > > >> an > > > >> > important safe guard. If so, what does a protocol mean exactly? > > > >> > > > > > >> > > In medicine and on the forum some have argued that "blind' > > > application > > > >> of > > > >> > "best practice" yields and will yield better medicine than less > > > >> formalized > > > >> > practice patterns. The easy logic of such thought makes "best > > > practice" > > > >> a > > > >> > nearly universally acclaimed superlative. > > > >> > > > > > >> > > There are several problems with this line of thinking. From a > > > logistic > > > >> > standpoint "best practice" does not have a specific meaning. It > best > > > >> seems > > > >> > to mirror the common practice of money mangers to be listed by the > > > past > > > >> > (several) year(s) result as "best manger". We all know the > economic > > > >> > consequence of following this logic. It is the equivalence of > "buying > > > >> into" > > > >> > a bull market. It works for the short term and is disastrous, > buying > > > >> high > > > >> > and selling low, in the long term. > > > >> > > > > > >> > > Another problem is that we are not likely to see a large obvious > and > > > >> > frightening "kill" in the medical analogy of this flight model. > What > > > is > > > >> > likely to happen is large numbers of remote and thus unrecognized > > > >> protocol > > > >> > mismatch or "less than best practice" in the margins while that > > > >> immediate in > > > >> > our view looks good if not always best. > > > >> > > > > > >> > > Lastly (there are more undoubtedly) most of us are aware of the > > > idiocy > > > >> we > > > >> > see from labeling protocol adherence as superior medicine. It > leads to > > > >> large > > > >> > number of 100% perfect (and "gamed") hospitals and practioners > with > > > >> quite > > > >> > variable and disparate actual results. > > > >> > > > > > >> > > So, can we really design a plane or a medical system that flies > > > >> itself? > > > >> > It seems that we can and are determined to, but do we want to fly > in > > > it? > > > >> > > > > > >> > > Let's see what happens to the airbus. Perhaps there is a story > here. > > > >> > Expect some posturing along the way. > > > >> > > > > > >> > > Yes, I know it is "Off Topic." > > > >> > > > > > >> > > 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 > > > >> ----------------------------------------- > > > >> > > > > > > > > > > > > > > > > -- > > > > 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 > > ---------------