From prasannasimha at gmail.com Sun Mar 1 07:40:07 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Feb 28 21:10:34 2009 Subject: [HSF] Apicoaortic conduit a note Message-ID: <89c4ed2d0902281810i41b09db4nb435ac2704dd6be6@mail.gmail.com> 1: Ann Thorac Surg. 2009 Mar;87(3):927-928. A Previously Unreported Complication of Apicoaortic Conduit for Severe Aortic Stenosis. Parsa CJ, Milano CA, Proia AD, Mackensen GB, Hughes GC. Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina; Department of Pathology, Duke University Medical Center, Durham, North Carolina; Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina. Given the aging population, use of an apicoaortic conduit serves as an alternative method to treat severe aortic stenosis, especially in patients with a heavily calcified ascending aorta or prior cardiac surgery. Although an apicoaortic conduit fractionates systemic blood flow, it does so without significant deleterious effects. However, we report a novel complication with thrombosis of the aortic root and subsequent coronary insufficiency that likely resulted from a preponderance of cardiac output though the apicoaortic conduit with stagnation of native antegrade blood flow. Given increasing use of the apicoaortic conduit procedure, surgeons considering this approach should be familiar with this potential complication. PMID: 19231422 [PubMed - as supplied by publisher] -- Prasanna Simha M From anianyanwu at hotmail.com Sun Mar 1 02:16:52 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sat Feb 28 21:17:41 2009 Subject: [HSF] Apicoaortic conduit a note In-Reply-To: <89c4ed2d0902281810i41b09db4nb435ac2704dd6be6@mail.gmail.com> References: <89c4ed2d0902281810i41b09db4nb435ac2704dd6be6@mail.gmail.com> Message-ID: This complication is well recognized when ventricular assist device outflows are connected to the descending aorta. To avoid this some surgeons will try and offload the heart only partially such that the aortic valve opens intermittently. It serves though as a reminder that apicoaortic conduits are not a procedure of convenience and where possible antegrade blood flow is preferable. For a patient with a ventricular assist device to the descending aorta, the consequences of aortic root thrombosis are not so dire as the VAD carries the left circulation but for an apical conduit same can be fatal. Ani > Date: Sun, 1 Mar 2009 07:40:07 +0530 > From: prasannasimha@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > Subject: [HSF] Apicoaortic conduit a note > > 1: Ann Thorac Surg. 2009 Mar;87(3):927-928. > > A Previously Unreported Complication of Apicoaortic Conduit for Severe Aortic > Stenosis. > > Parsa CJ, Milano CA, Proia AD, Mackensen GB, Hughes GC. > > Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Duke > University Medical Center, Durham, North Carolina; Department of > Pathology, Duke > University Medical Center, Durham, North Carolina; Department of > Anesthesiology, > Duke University Medical Center, Durham, North Carolina. > > Given the aging population, use of an apicoaortic conduit serves as an > alternative method to treat severe aortic stenosis, especially in > patients with a > heavily calcified ascending aorta or prior cardiac surgery. Although an > apicoaortic conduit fractionates systemic blood flow, it does so without > significant deleterious effects. However, we report a novel complication with > thrombosis of the aortic root and subsequent coronary insufficiency that likely > resulted from a preponderance of cardiac output though the apicoaortic conduit > with stagnation of native antegrade blood flow. Given increasing use of the > apicoaortic conduit procedure, surgeons considering this approach should be > familiar with this potential complication. > > > PMID: 19231422 [PubMed - as supplied by publisher] > > > > -- > 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 > ----------------------------------------- _________________________________________________________________ Twice the fun?Share photos while you chat with Windows Live Messenger. Learn more. http://www.microsoft.com/uk/windows/windowslive/products/messenger.aspx From donross at bigpond.com Sun Mar 1 16:43:24 2009 From: donross at bigpond.com (Donald Ross) Date: Sun Mar 1 00:44:58 2009 Subject: [HSF] Re: STENT QUESTION-Otto Tanning case In-Reply-To: <583094.44490.qm@web24702.mail.ird.yahoo.com> References: <583094.44490.qm@web24702.mail.ird.yahoo.com> Message-ID: <9168C32E-E9CC-43A4-BEB6-F4DB76C098FC@bigpond.com> David, It is a brave/stupid thing to do although quite logical. It is also something which will never be scientifically tested. I thing the vein option which also has not been tested is the safest, just to protect against a misread angiogram. If you could be certain the lesion was <50% I believe it should be treated medically. Don On 01/03/2009, at 9:55 AM, David Harris wrote: > Not really, Don, especially if its not being studied scientifically > with long term results. > Dave > > > > --- On Tue, 24/2/09, Donald Ross wrote: > > From: Donald Ross > Subject: Re: [HSF] Re: STENT QUESTION-Otto Tanning case > To: OpenHeart-L@lists.hsforum.com > Date: Tuesday, 24 February, 2009, 6:38 AM > > Do you think it is cool David? > On 23/02/2009, at 10:16 AM, David Harris wrote: > >> I would definitely graft the LAD, most likely with vein as first >> option. It is already 40%, and we know the natural history of >> stents. If the IMA is good and has massive flow, I would use it (ie >> if its a 95 percentile IMA). I know another surgeon in Cape Town who >> ties an absorbable suture over a 1mm probe proximal to the IMA-LAD >> graft in cases with 50% stenosis, and claims good results. He's been >> doing it for years and the cardiologists think its quite cool. >> >> Dave Harris >> >> >> >> --- On Sun, 22/2/09, Roberto Battellini >> wrote: >> >> From: Roberto Battellini >> Subject: RE: [HSF] Re: STENT QUESTION-Otto Tanning case >> To: "lists HSF" >> Date: Sunday, 22 February, 2009, 11:46 PM >> >> excellent idea, also IVUS could be done. >> >> Roberto >> >>> From: benjamin.bidstrup@bigpond.com >>> To: OpenHeart-L@lists.hsforum.com >>> Subject: Re: [HSF] Re: STENT QUESTION-Otto Tanning case >>> Date: Mon, 23 Feb 2009 06:35:54 +1000 >>> CC: >>> >>> This is where CT angio comes into into its own. You can see the >>> circumferential narrowing, whereas in one plane or even 2, the >>> actual >>> measurement can be quite misleading. >>> >>> Ben Bidstrup FRACS FRCSEd FEBCTS >>> Cardiothoracic Surgeon >>> >>> >>> >>> On 23/02/2009, at 2:44 AM, Roberto Battellini wrote: >>> >>>> >>>> Otto, >>>> >>>> First of all, the % stenosis must be measured in the worse view. >>>> >>>> Then, I would also palpate the artery and IF there are many >>>> plaques, we would do a IMA, without EBM. >>>> >>>> May be the lesion is 50%, who can assure that? >>>> >>>> Are there more than one lesion? => that?s another point. >>>> >>>> Is the lesion irregular, and the stent new? May be after > competitive >>>> flow against LIMA, the stent closes. >>>> >>>> >>>> >>>> Roberto >>>> >>>> >>>> >>>> >>>> >>>>> From: grescigno@mac.com >>>>> Subject: Re: [HSF] Re: STENT QUESTION >>>>> Date: Sun, 22 Feb 2009 16:43:25 +0100 >>>>> To: OpenHeart-L@lists.hsforum.com >>>>> CC: >>>>> >>>>> Ani, >>>>> >>>>> You are probably right saying that a good flowmeter value does >> not >>>>> predict patency, but a bad value surely does. I measure flow > in >> every >>>>> graft I construct and I have found competion flow etc. When I >> wrote >>>>> my last message I was thinking to a 3-4 months ago case. It > was a >>>>> redo and I was unable to find the LAD. I had a LIMA graft free >> and I >>>>> decided to put it on a diagonal that had a 40% stenosis only. > I >>>>> measured the flow after CPB stop.... it was massive. It is not >> very >>>>> elegant to say but it was true. >>>>> >>>>> Giuseppe >>>>> >>>>> PS sorry for this late response >>>>> >>>>> >>>>> Il giorno 20/feb/09, alle ore 13:02, Ani Anyanwu ha scritto: >>>>> >>>>>> >>>>>>> I would do a Lima-Lad distally placed. If you will >> measure graft >>>>>>> flow afterward you will be surprised about the > result.... >>>>>>> >>>>>>> Giuseppe Rescigno M.D. >>>>>> >>>>>> >>>>>> >>>>>> >>>>>> >>>>>> So? I am still yet to find a paper that shows any > correlation >>>>>> between graft flow in the OR and long-term patency or > outcome >> of >>>>>> CABG. Surely the mammary cannot string in the OR so what >> value is >>>>>> this piece of data? The graft can be as patent as we wish > but >> if >>>>>> other future factors - such as competitive flow - > determine >> its >>>>>> outcome then the relevance of flow derived patency in the > OR >> is a >>>>>> moot point. I would more be interested in angiography at 3 >> and 12 >>>>>> months. >>>>>> >>>>>> >>>>>> >>>>>> Ani >>>>>> >>>>>> >>>>>> >>>>>> >>>>>> >>>>>>> Date: Fri, 20 Feb 2009 11:01:41 +0100 >>>>>>> From: grescigno@mac.com >>>>>>> To: OpenHeart-L@lists.hsforum.com >>>>>>> Subject: Re: [HSF] Re: STENT QUESTION >>>>>>> CC: >>>>>>> >>>>>>> I would do a Lima-Lad distally placed. If you will >> measure graft >>>>>>> flow afterward you will be surprised about the > result.... >>>>>>> >>>>>>> Giuseppe Rescigno M.D. >>>>>>> Cardiothoracic Surgeon >>>>>>> >>>>>>> Lancisi Hospital >>>>>>> Torrette - Ancona >>>>>>> Italy >>>>>>> >>>>>>> >>>>>>> >>>>>>> On Friday, February 20, 2009, at 08:15AM, "Otto >> Thaning" >>>>>>> wrote: >>>>>>>> Would appreciate comments on the following: >>>>>>>> >>>>>>>> 65 year old fit and active male with history of >> Myocardial >>>>>>>> infarct in 2004. >>>>>>>> LAD stented at that time and stent re-dilated in > 2006 >> for >>>>>>>> recurrence of >>>>>>>> angina. (original stent was bare metal). >>>>>>>> >>>>>>>> Has been followed for some years for Aortic > Stenosis >> and now >>>>>>>> presents with >>>>>>>> episode of self limiting AF and mild effort >> intolerance. Angio >>>>>>>> shows >>>>>>>> irregular stenosis of LAD stent (mild and less > than >> 40% >>>>>>>> narrowing) and a >>>>>>>> significant Cx lesion with a good distal vessel. > The >> AV is >>>>>>>> calcified and has >>>>>>>> stenosed wth a peek gradient + 100 and area < > 0.6. >>>>>>>> >>>>>>>> Question: What would be recommended with respect > to >> the LAD >>>>>>>> stent. ie graft >>>>>>>> or leave, and if graft recommended - IMA or > Saphenous >> vein? >>>>>>>> >>>>>>>> I plan AVR and Cx graft. >>>>>>>> >>>>>>>> OTTO THANING >>>>>>>> Cape Town >>>>>>>> >>>>>>>> _______________________________________________ >>>>>>>> OpenHeart-L mailing list >>>>>>>> >>>>>>>> Send postings to: >>>>>>>> OpenHeart-L@lists.hsforum.com >>>>>>>> >>>>>>>> To UNSUBSCRIBE, to CHANGE email address, or to > view >> archives: >>>>>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>>>>> >>>>>>>> All messages transmitted by the OpenHeart-L are >> subject to the >>>>>>>> policies and >>>>>>>> disclaimers posted at: >>>>>>>> http://www.hsforum.com/listdisclaim >>>>>>>> ----------------------------------------- >>>>>>>> >>>>>>>> >>>>>>> _______________________________________________ >>>>>>> OpenHeart-L mailing list >>>>>>> >>>>>>> Send postings to: >>>>>>> OpenHeart-L@lists.hsforum.com >>>>>>> >>>>>>> To UNSUBSCRIBE, to CHANGE email address, or to view >> archives: >>>>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>>>> >>>>>>> All messages transmitted by the OpenHeart-L are > subject >> to the >>>>>>> policies and >>>>>>> disclaimers posted at: >>>>>>> http://www.hsforum.com/listdisclaim >>>>>>> ----------------------------------------- >>>>>> >>>>>> >> _________________________________________________________________ >>>>>> >>>>>> Hotmail, Messenger, Photos and more - all with the new >> Windows >>>>>> Live. Get started! >>>>>> http://www.download.live.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 >>>>>> ----------------------------------------- >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> >>>>> All messages transmitted by the OpenHeart-L are subject to the >>>>> policies and >>>>> disclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the >>>> policies and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Sun Mar 1 10:26:59 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sun Mar 1 04:27:28 2009 Subject: [HSF] Post CABG dissection In-Reply-To: <8CB68384D06C073-E6C-9E4@FWM-M43.sysops.aol.com> References: <8CB64FD52B4961E-4C0-1766@MBLK-M03.sysops.aol.com><841600905-1235563959-cardhu_decombobulator_blackberry.rim.net-185544288-@bxe1271.bisx.prod.on.blackberry><89c4ed2d0902250446w1353328aofe2e5ad022968b83@mail.gmail.com><8CB663794C81135-E14-9A5@MBLK-M22.sysops.aol.com> <8CB68384D06C073-E6C-9E4@FWM-M43.sysops.aol.com> Message-ID: In a type "arch first"? Roberto > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Post CABG dissection > Date: Sat, 28 Feb 2009 22:52:39 -0500 > From: tdmartin2000@aol.com > CC: > > bifurcated graft to innom and carotid and occasionally to l subclavian taken off the prox ascending graft > > Tom > > > -----Original Message----- > From: Michael Firstenberg > To: OpenHeart-L@lists.hsforum.com > Sent: Thu, 26 Feb 2009 3:23 pm > Subject: Re: [HSF] Post CABG dissection > > > > can you describe your "prophylactic debranching?" > > -m > > On Thu, Feb 26, 2009 at 9:42 AM, wrote: > > > Prasanna > > Not sure if I have a real "strategy" as each one is a little different. We > > use felt strips inside and out on the aorta proximally and distally. We have > > gotten away from routinely using bioglue between the layers and just use?a > > thin layer of bioglue on the dacron needle holes. If you use too much glue > > it makes identifying the location of leaks difficult at times and I think > > may set you up for pseudoaneurysms in the future. We cool to 18 on all and > > replace at least up to the innominate. If they are young we might consider > > some type of debranching (grafts to innom and carotid) to set them up for > > possible stent grafting in the future if needed. If the hct is good we take > > 1 to3 units of blood off before going on pump to keep their plts etc and > > give this back after coming off. We also try to salvage as many valves as is > > safe to do. I use direct aortic cannulation if at all possible but don't > > hesitate to use the femorals. I am not an axillary fan but several o my > > partners are. > > > > Tom > > > > > > -----Original Message----- > > From: Prasanna Simha M > > To: OpenHeart-L@lists.hsforum.com > > Sent: Wed, 25 Feb 2009 7:46 am > > Subject: Re: [HSF] Post CABG dissection > > > > > > > > What is your dissection strategy and how do you manage bleeding /suture > > lines in these cases (Obviously the word is good technique 0but what do you > > do - tips and tricks > > Prasanna > > > > On Wed, Feb 25, 2009 at 5:42 PM, wrote: > > > > > Great job, Tom. That is why you are my "go to guy" when cases like this > > > arise. > > > > > > Hal > > > Sent from my Verizon Wireless BlackBerry > > > > > > -----Original Message----- > > > From: tdmartin2000@aol.com > > > > > > Date: Tue, 24 Feb 2009 20:12:55 > > > To: > > > Subject: Re: [HSF] Post CABG dissection > > > > > > > > > Follow up > > > I actually posted the case shortly after my resident called me and told > > me > > > abou > t the pt. On review of the CT it was quite different. What he had was > > > consolidation of his lung but he also had rupture of his aorta just above > > > the valve posteriorly with a pseudoaneurysm that compressed his RPA and > > part > > > of the MPA as it extended over to the left. He also had quite a > > compression > > > of his right atrium with fluid. I operated on him last night - he was > > > actually 6 wks out and as you might expect it was really stuck. He was > > quite > > > hypoxic (sats in 70's0 goin into the OR. Fem- fem (Hal would be proud) > > > opened chest, spent at least 1.5 - 2 hrs digging things out safely. > > Cooled, > > > replaced the ascending and prox arch, resuspended the valve, and > > reimplanted > > > 3 vein grafts. Moderate coagulopathy but is doing well today. > > > > > > Tom > > > > > > > > > -----Original Message----- > > > From: Hgrmd@aol.com > > > To: OpenHeart-L@lists.hsforum.com > > > Sent: Mon, 23 Feb 2009 5:59 am > > > Subject: Re: [HSF] Post CABG dissection > > > > > > > > > > > > Tom, > > > My guess is the dissection has been present for one month. I would > > favor > > > waiting until the pneumonia begins to clear up (at least until he is > > > afebrile, nonbacteremic, no leukocytosis). Obviously, TEE or CT's every > > > couple > > > of > > > days until you are sure the dimensions of the aorta are stable. If > > > uncontrolled CHF, will have to intervene sooner. Tough case. > > > > > > Hal > > > > > > > > > In a message dated 2/23/2009 5:42:56 A.M. Eastern Standard Time, > > > tdmartin200 > > 0@aol.com writes: > > > > > > 50 yo 1 mo s/p CABG at another institution. Presented with CHF symptoms, > > > vague chest pain, cough, SOB. TEE- type 1 dissection, 2-3+ AI. > > Transfered > > > to > > > UF. > > > Intubated for hypoxia shortly after admission. CXR and CT show > > > consolidated > > > LLL pneumonia. No pericardial effusion. > > > Treatment plan? When do you operate? > > > > > > Tom Martin > > > U of Florida > > > Gainesville > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.c > om > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > > > > **************Get a jump start on your taxes. Find a tax professional in > > > your > > > neighborhood today. > > > ( > > > > > http://yellowpages.aol.com/search?query=Tax+Return+Preparation+%26+Filing&ncid=emlcntusyelp00000004 > > > ) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists. > > hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/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 > ----------------------------------------- From ebender001 at me.com Sun Mar 1 09:28:47 2009 From: ebender001 at me.com (Edward Bender) Date: Sun Mar 1 12:33:40 2009 Subject: [HSF] St. Jude Valve Message-ID: <47261870939909203330570362579807116507-Webmail@me.com> Tom: I did not have access to the patient, and the cardiologist didn't bother to ask valve size (a valve is a valve, right?). I'm sure this is the first iteration of SJM aortic valve available for general use. I seem to remember helping on SJM valves as a resident in 1980/81 at the Denver VA, and being told that this was part of an initial clinical study. I did not know that there was a change in orifice dimension in the original valve models over time. The trans-septal puncture is a good idea, but I doubt any of our cardiologists will want to do it. How about a direct LV puncture as a more direct way to the chamber in question? The bottom line is that, lookingt at the echo, I am sure there is pannus hanging off the bottom of the valve. She should have surgery, but I have not yet been able to talk to the patient. Ed Bender, MD On Saturday, February 28, 2009, at 08:00PM, wrote: >Question- what size was placed. It was for sure a original standard St Jude and the smaller valves didn't have great orifice areas. If it was placed in '81 then has been in for 28 yrs and quite possible has sig panus ingrowth narrowing the orifice area. I would ask the cardiologists to do a transspetal puncture with a direct pressure gradient measurement. I would bet it shows quite a sig gradient and then I would replace the valve, most likely w a bioprosthesis. > >Tom Martin >U of Florida >Gainesville > > >-----Original Message----- >From: Edward Bender >To: OpenHeart-L@lists.hsforum.com >Sent: Thu, 26 Feb 2009 3:41 pm >Subject: [HSF] St. Jude Valve > > > > Dear forum members and especially Bob Frater: > >I was asked a "curbside" question about an 81 year old female who had a St. Jude >aortic valve placed in 1981 whose echo velocity has increased from 3 cm/sec to >over 4 cm/sec. I told the cardiologist to take the patient to the cath lab and >flouro her valve. You can see 2 moving leaflets, but, my impression is that the >angles of excursion of the leaflets look less than I would expect. She now has >class 3 symptoms. There is no AI on echocardiogram. Does the SJM valve fail >like this? What other studies might I recommend to clarify the issue? > >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 >----------------------------------------- > > From drmitch at cox.net Sun Mar 1 16:09:52 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Sun Mar 1 17:11:19 2009 Subject: [HSF] Peripheral Vascular Case In-Reply-To: References: <8CB63BA683B7B7E-BE0-9B@webmail-dd03.sysops.aol.com> <785799.87360.qm@web81605.mail.mud.yahoo.com> Message-ID: <6.2.1.2.2.20090301154155.03ebc1c0@pop.east.cox.net> John I'm not sure there is a right answer. On the one hand, it's "smallish" but at 2.5cm, it can be resected. I've done five >4cm since Thanksgiving. I would guess that the orthopods, being on the low-risk side of the spectrum that they are, would want the thing fixed before they proceed. Concerns include the proximity of an aneurysmal vessel to where their hammers and drills are being used and the potential for injury. Also, does the relative immobility post-op lend itself to acute thrombosis? I'm pretty sure they Coumadinize the TKR's these days. Finally, is the small risk of infection a real concern? If so, then my guess is that a delay of one to the next of at least 6wks would be mandatory. If the answer to any of these is yes, I would use a segment of Grandpa's GSV, ligate the popliteal proximally and distally, and anastomose e-e to the proximal pop/ distal SFA and e-e to the distal pop thru a standard medial approach, passing the graft between the heads of the gastroc, without cutting the tendons of the semitendinosus and semimembranosus. Good luck. Mitch At 05:02 PM 2/27/2009, you wrote: >75 yo man with a 2.5 cm asymptomatic popliteal aneurysm needs a knee >replacement on that side. >What would you do and why???? > >John > >John Schor, MD >Thoracic and Cardiovascular Surgery >Verde Valley Medical Center >Cottonwood, AZ >Tel: 928-649-2584 > >On Feb 23, 2009, at 3:57 PM, Tea Acuff wrote: > >>Pneumonia is a interesting problem in cardiothoracic patients. In >>these stressed patients the pulmonologists/ internists almost always >>see pnemonia, while I rarely see pneumonia. I have no idea what this >>means for your patient and the many like them. If they are septic >>and have pus coming up, things are clearer as to what is happening. >> >>tea >> >> >> >> >>________________________________ >>From: "tdmartin2000@aol.com" >>To: openheart-l@lists.hsforum.com >>Sent: Monday, February 23, 2009 4:41:23 AM >>Subject: [HSF] Post CABG dissection >> >>50 yo 1 mo s/p CABG at another institution. Presented with CHF >>symptoms, vague chest pain, cough, SOB. TEE- type 1 dissection, 2-3+ >>AI. Transfered to UF. Intubated for hypoxia shortly after admission. >>CXR and CT show consolidated LLL pneumonia. No pericardial effusion. >>Treatment plan? When do you operate? >> >>Tom Martin >>U of Florida >>Gainesville >>_______________________________________________ >>OpenHeart-L mailing list >> >>Send postings to: >>OpenHeart-L@lists.hsforum.com >> >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>http://mmp.cjp.com/mailman/listinfo/openheart-l >> >>All messages transmitted by the OpenHeart-L are subject to the >>policies and >>disclaimers posted at: >>http://www.hsforum.com/listdisclaim >>----------------------------------------- >> >>_______________________________________________ >>OpenHeart-L mailing list >> >>Send postings to: >>OpenHeart-L@lists.hsforum.com >> >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>http://mmp.cjp.com/mailman/listinfo/openheart-l >> >>All messages transmitted by the OpenHeart-L are subject to the >>policies and >>disclaimers posted at: >>http://www.hsforum.com/listdisclaim >>----------------------------------------- > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/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 tdmartin2000 at aol.com Sun Mar 1 19:25:15 2009 From: tdmartin2000 at aol.com (tdmartin2000@aol.com) Date: Sun Mar 1 19:25:55 2009 Subject: [HSF] Post CABG dissection In-Reply-To: References: <8CB64FD52B4961E-4C0-1766@MBLK-M03.sysops.aol.com><841600905-1235563959-cardhu_decombobulator_blackberry.rim.net-185544288-@bxe1271.bisx.prod.on.blackberry><89c4ed2d0902250446w1353328aofe2e5ad022968b83@mail.gmail.com><8CB663794C81135-E14-9A5@MBLK-M22.sysops.aol.com> <8CB68384D06C073-E6C-9E4@FWM-M43.sysops.aol.com> Message-ID: <8CB68E47E11EBFA-C20-1D71@WEBMAIL-DF21.sysops.aol.com> yes -----Original Message----- From: Roberto Battellini To: lists HSF Sent: Sun, 1 Mar 2009 4:26 am Subject: RE: [HSF] Post CABG dissection In a type "arch first"? Roberto > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Post CABG dissection > Date: Sat, 28 Feb 2009 22:52:39 -0500 > From: tdmartin2000@aol.com > CC: > > bifurcated graft to innom and carotid and occasionally to l subclavian taken off the prox ascending graft > > Tom > > > -----Original Message----- > From: Michael Firstenberg > To: OpenHeart-L@lists.hsforum.com > Sent: Thu, 26 Feb 2009 3:23 pm > Subject: Re: [HSF] Post CABG dissection > > > > can you describe your "prophylactic debranching?" > > -m > > On Thu, Feb 26, 2009 at 9:42 AM, wrote: > > > Prasanna > > Not sure if I have a real "strategy" as each one is a little different. We > > use felt strips inside and out on the aorta proximally and distally. We have > > gotten away from routinely using bioglue between the layers and just use?a > > thin layer of bioglue on the dacron needle holes. If you use too much glue > > it makes identifying the location of leaks difficult at times and I think > > may set you up for pseudoaneurysms in the future. We cool to 18 on all and > > replace at least up to the innominate. If they are young we might consider > > some type of debranching (grafts to innom and carotid) to set them up for > > possible stent grafting in the future if needed. If the hct is good we take > > 1 to3 units of blood off before going on pump to keep their plts etc and > > give this back after coming off. We also try to salvage as many valves as is > > safe to do. I use direct aortic cannulation if at all possible but don't > > hesitate to use the femorals. I am not an axillary fan but several o my > > partners are. > > > > Tom > > > > > > -----Original Message----- > > From: Prasanna Simha M > > To: OpenHeart-L@lists.hsforum.com > > Sent: Wed, 25 Feb 2009 7:46 am > > Subject: Re: [HSF] Post CABG dissection > > > > > > > > What is your dissection strategy and how do you manage bleeding /suture > > lines in these cases (Obviously the word is good technique 0but what do you > > do - tips and tricks > > Prasanna > > > > On Wed, Feb 25, 2009 at 5:42 PM, wrote: > > > > > Great job, Tom. That is why you are my "go to guy" when cases like this > > > arise. > > > > > > Hal > > > Sent from my Verizon Wireless BlackBerry > > > > > > -----Original Message----- > > > From: tdmartin2000@aol.com > > > > > > Date: Tue, 24 Feb 2009 20:12:55 > > > To: > > > Subject: Re: [HSF] Post CABG dissection > > > > > > > > > Follow up > > > I actually posted the case shortly after my resident called me and told > > me > > > abou > t the pt. On review of the CT it was quite different. What he had was > > > consolidation of his lung but he also had rupture of his aorta just above > > > the valve posteriorly with a pseudoaneurysm that compressed his RPA and > > part > > > of the MPA as it extended over to the left. He also had quite a > > compression > > > of his right atrium with fluid. I operated on him last night - he was > > > actually 6 wks out and as you might expect it was really stuck. He was > > quite > > > hypoxic (sats in 70's0 goin into the OR. Fem- fem (Hal would be proud) > > > opened chest, spent at least 1.5 - 2 hrs digging things out safely. > > Cooled, > > > replaced the ascending and prox arch, resuspended the valve, and > > reimplanted > > > 3 vein grafts. Moderate coagulopathy but is doing well today. > > > > > > Tom > > > > > > > > > -----Original Message----- > > > From: Hgrmd@aol.com > > > To: OpenHeart-L@lists.hsforum.com > > > Sent: Mon, 23 Feb 2009 5:59 am > > > Subject: Re: [HSF] Post CABG dissection > > > > > > > > > > > > Tom, > > > My guess is the dissection has been present for one month. I would > > favor > > > waiting until the pneumonia begins to clear up (at least until he is > > > afebrile, nonbacteremic, no leukocytosis). Obviously, TEE or CT's every > > > couple > > > of > > > days until you are sure the dimensions of the aorta are stable. If > > > uncontrolled CHF, will have to inter vene sooner. Tough case. > > > > > > Hal > > > > > > > > > In a message dated 2/23/2009 5:42:56 A.M. Eastern Standard Time, > > > tdmartin200 > > 0@aol.com writes: > > > > > > 50 yo 1 mo s/p CABG at another institution. Presented with CHF symptoms, > > > vague chest pain, cough, SOB. TEE- type 1 dissection, 2-3+ AI. > > Transfered > > > to > > > UF. > > > Intubated for hypoxia shortly after admission. CXR and CT show > > > consolidated > > > LLL pneumonia. No pericardial effusion. > > > Treatment plan? When do you operate? > > > > > > Tom Martin > > > U of Florida > > > Gainesville > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.c > om > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > > > > **************Get a jump start on your taxes. Find a tax professional in > > > your > > > neighborhood today. > > > ( > > > > > http://yellowpages.aol.com/search?query=Tax+Return+Preparation+%26+Filing&ncid=emlcntusyelp00000004 > > > ) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to vie w archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists. > > hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/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 OpenHe art-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 tdmartin2000 at aol.com Sun Mar 1 19:35:44 2009 From: tdmartin2000 at aol.com (tdmartin2000@aol.com) Date: Sun Mar 1 19:36:18 2009 Subject: [HSF] St. Jude Valve In-Reply-To: <47261870939909203330570362579807116507-Webmail@me.com> References: <47261870939909203330570362579807116507-Webmail@me.com> Message-ID: <8CB68E5F4E51762-C20-1DE3@WEBMAIL-DF21.sysops.aol.com> Ed >From what you say I would agree that surgery?or hospice (should she choose) are the only options. Yes the St Jude valve orifice's have changed. As I recall the HP 's had the equivalent of one size up for each size (ie 19HP = 21 standard) and the Regent now is one size up on the HP (19 regent = 21 HP). If you look at valve geometric orifice areas the Regent and On-x give you the best areas of any of the mechanical valves available to us today. Tom -----Original Message----- From: Edward Bender To: OpenHeart-L@lists.hsforum.com Sent: Sun, 1 Mar 2009 12:28 pm Subject: Re: [HSF] St. Jude Valve Tom: I did not have access to the patient, and the cardiologist didn't bother to ask valve size (a valve is a valve, right?). I'm sure this is the first iteration of SJM aortic valve available for general use. I seem to remember helping on SJM valves as a resident in 1980/81 at the Denver VA, and being told that this was part of an initial clinical study. I did not know that there was a change in orifice dimension in the original valve models over time. The trans-septal puncture is a good idea, but I doubt any of our cardiologists will want to do it. How about a direct LV puncture as a more direct way to the chamber in question? The bottom line is that, lookingt at the echo, I am sure there is pannus hanging off the bottom of the valve. She should have surgery, but I have not yet been able to talk to the patient. Ed Bender, MD On Saturday, February 28, 2009, at 08:00PM, wrote: >Question- what size was placed. It was for sure a original standard St Jude and the smaller valves didn't have great orifice areas. If it was placed in '81 then has been in for 28 yrs and quite possible has sig panus ingrowth narrowing the orifice area. I would ask the cardiologists to do a transspetal puncture with a direct pressure gradient measurement. I would bet it shows quite a sig gradient and then I would replace the valve, most likely w a bioprosthesis. > >Tom Martin >U of Florida >Gainesville > > >-----Original Message----- >From: Edward Bender >To: OpenHeart-L@lists.hsforum.com >Sent: Thu, 26 Feb 2009 3:41 pm >Subject: [HSF] St. Jude Valve > > > > Dear forum members and especially Bob Frater: > >I was asked a "curbside" question about an 81 year old female who had a St. Jude >aortic valve placed in 1981 whose echo velocity has increased from 3 cm/sec to >over 4 cm/sec. I told the cardiologist to take the patient to the cath lab and >flouro her valve. You can see 2 moving leaflets, but, my impression is that the >angles of excursion of the leaflets look les s than I would expect. She now has >class 3 symptoms. There is no AI on echocardiogram. Does the SJM valve fail >like this? What other studies might I recommend to clarify the issue? > >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 ----------------------------------------- From robertobattellini at hotmail.com Mon Mar 2 10:38:51 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Mon Mar 2 04:39:19 2009 Subject: [HSF] Peripheral Vascular Case In-Reply-To: <6.2.1.2.2.20090301154155.03ebc1c0@pop.east.cox.net> References: <8CB63BA683B7B7E-BE0-9B@webmail-dd03.sysops.aol.com> <785799.87360.qm@web81605.mail.mud.yahoo.com> <6.2.1.2.2.20090301154155.03ebc1c0@pop.east.cox.net> Message-ID: We would do a Vein bypass or a VIAHBAHN, from Gore, like Dick Cheney has. Basically, the aneurysma left alone for the orthopedic surgery would embolize. Roberto > Date: Sun, 1 Mar 2009 16:09:52 -0600 > To: OpenHeart-L@lists.hsforum.com > From: drmitch@cox.net > Subject: Re: [HSF] Peripheral Vascular Case > CC: > > John > I'm not sure there is a right answer. On the one hand, it's "smallish" but > at 2.5cm, it can be resected. I've done five >4cm since Thanksgiving. I > would guess that the orthopods, being on the low-risk side of the spectrum > that they are, would want the thing fixed before they proceed. Concerns > include the proximity of an aneurysmal vessel to where their hammers and > drills are being used and the potential for injury. Also, does the relative > immobility post-op lend itself to acute thrombosis? I'm pretty sure they > Coumadinize the TKR's these days. Finally, is the small risk of infection a > real concern? If so, then my guess is that a delay of one to the next of at > least 6wks would be mandatory. > > If the answer to any of these is yes, I would use a segment of Grandpa's > GSV, ligate the popliteal proximally and distally, and anastomose e-e to > the proximal pop/ distal SFA and e-e to the distal pop thru a standard > medial approach, passing the graft between the heads of the > gastroc, without cutting the tendons of the semitendinosus and > semimembranosus. Good luck. > > Mitch > At 05:02 PM 2/27/2009, you wrote: > >75 yo man with a 2.5 cm asymptomatic popliteal aneurysm needs a knee > >replacement on that side. > >What would you do and why???? > > > >John > > > >John Schor, MD > >Thoracic and Cardiovascular Surgery > >Verde Valley Medical Center > >Cottonwood, AZ > >Tel: 928-649-2584 > > > >On Feb 23, 2009, at 3:57 PM, Tea Acuff wrote: > > > >>Pneumonia is a interesting problem in cardiothoracic patients. In > >>these stressed patients the pulmonologists/ internists almost always > >>see pnemonia, while I rarely see pneumonia. I have no idea what this > >>means for your patient and the many like them. If they are septic > >>and have pus coming up, things are clearer as to what is happening. > >> > >>tea > >> > >> > >> > >> > >>________________________________ > >>From: "tdmartin2000@aol.com" > >>To: openheart-l@lists.hsforum.com > >>Sent: Monday, February 23, 2009 4:41:23 AM > >>Subject: [HSF] Post CABG dissection > >> > >>50 yo 1 mo s/p CABG at another institution. Presented with CHF > >>symptoms, vague chest pain, cough, SOB. TEE- type 1 dissection, 2-3+ > >>AI. Transfered to UF. Intubated for hypoxia shortly after admission. > >>CXR and CT show consolidated LLL pneumonia. No pericardial effusion. > >>Treatment plan? When do you operate? > >> > >>Tom Martin > >>U of Florida > >>Gainesville > >>_______________________________________________ > >>OpenHeart-L mailing list > >> > >>Send postings to: > >>OpenHeart-L@lists.hsforum.com > >> > >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >>All messages transmitted by the OpenHeart-L are subject to the > >>policies and > >>disclaimers posted at: > >>http://www.hsforum.com/listdisclaim > >>----------------------------------------- > >> > >>_______________________________________________ > >>OpenHeart-L mailing list > >> > >>Send postings to: > >>OpenHeart-L@lists.hsforum.com > >> > >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >>All messages transmitted by the OpenHeart-L are subject to the > >>policies and > >>disclaimers posted at: > >>http://www.hsforum.com/listdisclaim > >>----------------------------------------- > > > >_______________________________________________ > >OpenHeart-L mailing list > > > >Send postings to: > >OpenHeart-L@lists.hsforum.com > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >All messages transmitted by the OpenHeart-L are subject to the policies > >and disclaimers posted at: > >http://www.hsforum.com/listdisclaim > >----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mon Mar 2 15:04:33 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Mon Mar 2 10:04:35 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: References: Message-ID: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> dear colleagues, I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs. what would be your advice in selecting the right animal? pigs? sheep? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details? thx for helping, axel laczkovics bochum From rwmfglycar at aol.com Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:29:32 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B80B6D28-BE0-CC6@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:38 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:29:40 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B1E5D564-BE0-CC0@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:29:43 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B87B7C3B-BE0-CD0@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:33 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:29:44 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962AE976E6D-BE0-CBE@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:29:45 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B7FD1EFA-BE0-CC5@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:29:50 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B8280984-BE0-CC9@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:29:51 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B844A5E0-BE0-CCB@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:29:54 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B86606F6-BE0-CCE@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:29:59 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B814F69C-BE0-CC7@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:30:00 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B84E2F54-BE0-CCC@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:30:01 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:30:07 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B887680C-BE0-CD1@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:48 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:30:09 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B7EED0CC-BE0-CC4@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:52 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:30:17 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B9E5E373-BE0-CD4@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:30:54 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B833F555-BE0-CCA@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mon Mar 2 10:28:49 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 10:30:59 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <8CB6962B85A1B25-BE0-CCD@webmail-de17.sysops.aol.com> Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/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 Mar 2 21:33:24 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Mar 2 11:30:42 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: <89c4ed2d0903020803s1e1de4b6q66f340d1a8841076@mail.gmail.com> Dogs are difficult to do and I had done quite a few but their aorta is friable. Pigs are easier and bigger and match humans more. Prasanna On Mon, Mar 2, 2009 at 8:35 PM, prof. dr. axel laczkovics wrote: > > > dear colleagues, > > I am planing ?to perform valve implantations in animals. ?my last > experiments training for cardiac transplantation ?dates back to the early > 80ies! at that ?time I switched ?from dogs ?to pigs and was finally > succesful after failing with dogs. > > what would be your advice in selecting the right ?animal? pigs? sheep? > > and for colleagues in germany or the netherlands: is anybody ?of you > accidentally doing operations with ?the help of ECC in animals to exchange > ideas or have the possibility to send somebody to look ?and discuss details? > > thx for helping, ?axel laczkovics > bochum > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mar 2 21:30:02 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Mar 2 14:11:37 2009 Subject: [HSF] Peripheral Vascular Case In-Reply-To: References: <8CB63BA683B7B7E-BE0-9B@webmail-dd03.sysops.aol.com> <785799.87360.qm@web81605.mail.mud.yahoo.com> Message-ID: <89c4ed2d0903020800j6ebe8bd5u9613e6dbd8849cf6@mail.gmail.com> Bypass it medially or laterally and ligate the aneurysm depending on the orthopedicians incision and approach. Prasanna On Sat, Feb 28, 2009 at 4:32 AM, John Schor wrote: > 75 yo man with a 2.5 cm asymptomatic popliteal aneurysm needs a knee > replacement on that side. > What would you do and why???? > > John > > John Schor, MD > Thoracic and Cardiovascular Surgery > Verde Valley Medical Center > Cottonwood, AZ > Tel: 928-649-2584 > > On Feb 23, 2009, at 3:57 PM, Tea Acuff wrote: > >> Pneumonia is a interesting problem in cardiothoracic patients. In these >> stressed patients the pulmonologists/ internists almost always see pnemonia, >> while I rarely see pneumonia. I have no idea what this means for your >> patient and the many like them. If they are septic and have pus coming up, >> things are clearer as to what is happening. >> >> tea >> >> >> >> >> ________________________________ >> From: "tdmartin2000@aol.com" >> To: openheart-l@lists.hsforum.com >> Sent: Monday, February 23, 2009 4:41:23 AM >> Subject: [HSF] Post CABG dissection >> >> 50 yo 1 mo s/p CABG at another institution. Presented with CHF symptoms, >> vague chest pain, cough, SOB. TEE- type 1 dissection, 2-3+ AI. Transfered to >> UF. Intubated for hypoxia shortly after admission. CXR and CT show >> consolidated LLL pneumonia. No pericardial effusion. >> Treatment plan? When do you operate? >> >> Tom Martin >> U of Florida >> Gainesville >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, 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 mwertheimer at mahealthcare.com Mon Mar 2 20:15:37 2009 From: mwertheimer at mahealthcare.com (mwertheimer@mahealthcare.com) Date: Mon Mar 2 15:16:09 2009 Subject: [HSF] Peripheral Vascular Case In-Reply-To: <89c4ed2d0903020800j6ebe8bd5u9613e6dbd8849cf6@mail.gmail.com> References: <8CB63BA683B7B7E-BE0-9B@webmail-dd03.sysops.aol.com><785799.87360.qm@web81605.mail.mud.yahoo.com><89c4ed2d0903020800j6ebe8bd5u9613e6dbd8849cf6@mail.gmail.com> Message-ID: 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YXJlIHN1YmplY3QgdG8gdGhlIHBvbGljaWVzIGFuZCANCmRpc2NsYWltZXJzIHBvc3RlZCBhdDoN Cmh0dHA6Ly93d3cuaHNmb3J1bS5jb20vbGlzdGRpc2NsYWltDQotLS0tLS0tLS0tLS0tLS0tLS0t LS0tLS0tLS0tLS0tLS0tLS0tLS0tLQ0K From ebender001 at me.com Mon Mar 2 14:53:34 2009 From: ebender001 at me.com (Edward Bender) Date: Mon Mar 2 15:54:11 2009 Subject: [HSF] Peripheral Vascular Case In-Reply-To: <89c4ed2d0903020800j6ebe8bd5u9613e6dbd8849cf6@mail.gmail.com> References: <8CB63BA683B7B7E-BE0-9B@webmail-dd03.sysops.aol.com> <785799.87360.qm@web81605.mail.mud.yahoo.com> <89c4ed2d0903020800j6ebe8bd5u9613e6dbd8849cf6@mail.gmail.com> Message-ID: I talked with one of my ortho friends and he absolutely would want this fixed prior to total knee. The most posterior cuts are blind, and risk of arterial injury is real. I repair these with medial above and below knee incisions, vein graft, and ligation. Ed Bender, MD Sent from my iPhone On Mar 2, 2009, at 10:00 AM, Prasanna Simha M wrote: > Bypass it medially or laterally and ligate the aneurysm depending on > the orthopedicians incision and approach. > Prasanna > > On Sat, Feb 28, 2009 at 4:32 AM, John Schor wrote: >> 75 yo man with a 2.5 cm asymptomatic popliteal aneurysm needs a knee >> replacement on that side. >> What would you do and why???? >> >> John >> >> John Schor, MD >> Thoracic and Cardiovascular Surgery >> Verde Valley Medical Center >> Cottonwood, AZ >> Tel: 928-649-2584 >> >> On Feb 23, 2009, at 3:57 PM, Tea Acuff wrote: >> >>> Pneumonia is a interesting problem in cardiothoracic patients. In >>> these >>> stressed patients the pulmonologists/ internists almost always see >>> pnemonia, >>> while I rarely see pneumonia. I have no idea what this means for >>> your >>> patient and the many like them. If they are septic and have pus >>> coming up, >>> things are clearer as to what is happening. >>> >>> tea >>> >>> >>> >>> >>> ________________________________ >>> From: "tdmartin2000@aol.com" >>> To: openheart-l@lists.hsforum.com >>> Sent: Monday, February 23, 2009 4:41:23 AM >>> Subject: [HSF] Post CABG dissection >>> >>> 50 yo 1 mo s/p CABG at another institution. Presented with CHF >>> symptoms, >>> vague chest pain, cough, SOB. TEE- type 1 dissection, 2-3+ AI. >>> Transfered to >>> UF. Intubated for hypoxia shortly after admission. CXR and CT show >>> consolidated LLL pneumonia. No pericardial effusion. >>> Treatment plan? When do you operate? >>> >>> Tom Martin >>> U of Florida >>> Gainesville >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, 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 rwmfglycar at aol.com Mon Mar 2 17:39:06 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Mar 2 17:43:46 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter In-Reply-To: <8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> <8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com> Message-ID: <8CB699ED424D918-172C-1654@webmail-dx18.sysops.aol.com> Humble apologies for the clutter . I swear I only hit the button once Bob -----Original Message----- From: rwmfglycar@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:28 pm Subject: Re: [HSF] experimental heart valve operations? Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/listinfo/openheart-l? ? All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at:? http://www.hsforum.com/listdisclaim? -----------------------------------------? _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Mar 2 22:46:58 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Mon Mar 2 17:47:19 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter In-Reply-To: <8CB699ED424D918-172C-1654@webmail-dx18.sysops.aol.com> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de><8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com><8CB699ED424D918-172C-1654@webmail-dx18.sysops.aol.com> Message-ID: <97081219-1236034032-cardhu_decombobulator_blackberry.rim.net-686611355-@bxe1271.bisx.prod.on.blackberry> RG9uJ3Qgd29ycnksIEJvYiwgeW91J3JlIHdvcnRoIGl0Lg0KDQpIYWwNClNlbnQgZnJvbSBteSBW ZXJpem9uIFdpcmVsZXNzIEJsYWNrQmVycnkNCg0KLS0tLS1PcmlnaW5hbCBNZXNzYWdlLS0tLS0N CkZyb206IHJ3bWZnbHljYXJAYW9sLmNvbQ0KDQpEYXRlOiBNb24sIDAyIE1hciAyMDA5IDE3OjM5 OjA2IA0KVG86IDxPcGVuSGVhcnQtTEBsaXN0cy5oc2ZvcnVtLmNvbT4NClN1YmplY3Q6IFJlOiBb SFNGXSBleHBlcmltZW50YWwgaGVhcnQgdmFsdmUgb3BlcmF0aW9ucz8gYXBvbG9naWVzIGZvciBj bHV0dGVyDQoNCg0KSHVtYmxlIGFwb2xvZ2llcyBmb3IgdGhlIGNsdXR0ZXIgLiBJIHN3ZWFyIEkg b25seSBoaXQgdGhlIGJ1dHRvbiBvbmNlDQpCb2INCg0KDQotLS0tLU9yaWdpbmFsIE1lc3NhZ2Ut LS0tLQ0KRnJvbTogcndtZmdseWNhckBhb2wuY29tDQpUbzogT3BlbkhlYXJ0LUxAbGlzdHMuaHNm b3J1bS5jb20NClNlbnQ6IE1vbiwgMiBNYXIgMjAwOSA1OjI4IHBtDQpTdWJqZWN0OiBSZTogW0hT 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bmdzIHRvOg0KIE9wZW5IZWFydC1MQGxpc3RzLmhzZm9ydW0uY29tDQoNClRvIFVOU1VCU0NSSUJF LCB0byBDSEFOR0UgZW1haWwgYWRkcmVzcywgb3IgdG8gdmlldyBhcmNoaXZlczoNCmh0dHA6Ly9t bXAuY2pwLmNvbS9tYWlsbWFuL2xpc3RpbmZvL29wZW5oZWFydC1sDQoNCkFsbCBtZXNzYWdlcyB0 cmFuc21pdHRlZCBieSB0aGUgT3BlbkhlYXJ0LUwgYXJlIHN1YmplY3QgdG8gdGhlIHBvbGljaWVz IGFuZCANCmRpc2NsYWltZXJzIHBvc3RlZCBhdDoNCmh0dHA6Ly93d3cuaHNmb3J1bS5jb20vbGlz dGRpc2NsYWltDQotLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLQ0KDQpf X19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fXw0KT3BlbkhlYXJ0 LUwgbWFpbGluZyBsaXN0DQoNClNlbmQgcG9zdGluZ3MgdG86DQogT3BlbkhlYXJ0LUxAbGlzdHMu aHNmb3J1bS5jb20NCg0KVG8gVU5TVUJTQ1JJQkUsIHRvIENIQU5HRSBlbWFpbCBhZGRyZXNzLCBv ciB0byB2aWV3IGFyY2hpdmVzOg0KaHR0cDovL21tcC5janAuY29tL21haWxtYW4vbGlzdGluZm8v b3BlbmhlYXJ0LWwNCg0KQWxsIG1lc3NhZ2VzIHRyYW5zbWl0dGVkIGJ5IHRoZSBPcGVuSGVhcnQt TCBhcmUgc3ViamVjdCB0byB0aGUgcG9saWNpZXMgYW5kIA0KZGlzY2xhaW1lcnMgcG9zdGVkIGF0 Og0KaHR0cDovL3d3dy5oc2ZvcnVtLmNvbS9saXN0ZGlzY2xhaW0NCi0tLS0tLS0tLS0tLS0tLS0t LS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tDQo= From johnschor at mac.com Mon Mar 2 16:32:10 2009 From: johnschor at mac.com (John Schor) Date: Mon Mar 2 18:36:41 2009 Subject: [HSF] Peripheral Vascular Case In-Reply-To: References: <8CB63BA683B7B7E-BE0-9B@webmail-dd03.sysops.aol.com> <785799.87360.qm@web81605.mail.mud.yahoo.com> <89c4ed2d0903020800j6ebe8bd5u9613e6dbd8849cf6@mail.gmail.com> Message-ID: <303FFA39-B622-4F86-AF83-6C2DA64ACEA3@mac.com> Thanks to all who answered... I guess it's unanimous. I will operate. Thank you. John John Schor, MD Thoracic and Cardiovascular Surgery Heart and Vascular Center of Northern Arizona Flagstaff, Sedona, and Cottonwood, AZ Tel: 928-649-2584 On Mar 2, 2009, at 1:53 PM, Edward Bender wrote: > I talked with one of my ortho friends and he absolutely would want > this fixed prior to total knee. The most posterior cuts are blind, > and risk of arterial injury is real. I repair these with medial > above and below knee incisions, vein graft, and ligation. > > Ed Bender, MD > > Sent from my iPhone > > On Mar 2, 2009, at 10:00 AM, Prasanna Simha M > wrote: > >> Bypass it medially or laterally and ligate the aneurysm depending on >> the orthopedicians incision and approach. >> Prasanna >> >> On Sat, Feb 28, 2009 at 4:32 AM, John Schor >> wrote: >>> 75 yo man with a 2.5 cm asymptomatic popliteal aneurysm needs a knee >>> replacement on that side. >>> What would you do and why???? >>> >>> John >>> >>> John Schor, MD >>> Thoracic and Cardiovascular Surgery >>> Verde Valley Medical Center >>> Cottonwood, AZ >>> Tel: 928-649-2584 >>> >>> On Feb 23, 2009, at 3:57 PM, Tea Acuff wrote: >>> >>>> Pneumonia is a interesting problem in cardiothoracic patients. In >>>> these >>>> stressed patients the pulmonologists/ internists almost always >>>> see pnemonia, >>>> while I rarely see pneumonia. I have no idea what this means for >>>> your >>>> patient and the many like them. If they are septic and have pus >>>> coming up, >>>> things are clearer as to what is happening. >>>> >>>> tea >>>> >>>> >>>> >>>> >>>> ________________________________ >>>> From: "tdmartin2000@aol.com" >>>> To: openheart-l@lists.hsforum.com >>>> Sent: Monday, February 23, 2009 4:41:23 AM >>>> Subject: [HSF] Post CABG dissection >>>> >>>> 50 yo 1 mo s/p CABG at another institution. Presented with CHF >>>> symptoms, >>>> vague chest pain, cough, SOB. TEE- type 1 dissection, 2-3+ AI. >>>> Transfered to >>>> UF. Intubated for hypoxia shortly after admission. CXR and CT show >>>> consolidated LLL pneumonia. No pericardial effusion. >>>> Treatment plan? When do you operate? >>>> >>>> Tom Martin >>>> U of Florida >>>> Gainesville >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the >>>> policies >>>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the >>>> policies >>>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From tacuff at swbell.net Mon Mar 2 16:39:11 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon Mar 2 19:39:39 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> <8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com> <8CB699ED424D918-172C-1654@webmail-dx18.sysops.aol.com> Message-ID: <365343.86496.qm@web81604.mail.mud.yahoo.com> that's what all parkinson patients say... ;) tea ________________________________ From: "rwmfglycar@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Monday, March 2, 2009 4:39:06 PM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Humble apologies for the clutter . I swear I only hit the button once Bob -----Original Message----- From: rwmfglycar@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:28 pm Subject: Re: [HSF] experimental heart valve operations? Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after failing with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/listinfo/openheart-l? ? All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at:? http://www.hsforum.com/listdisclaim? -----------------------------------------? _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Mar 3 06:49:49 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Mar 2 21:18:36 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter In-Reply-To: <365343.86496.qm@web81604.mail.mud.yahoo.com> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> <8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com> <8CB699ED424D918-172C-1654@webmail-dx18.sysops.aol.com> <365343.86496.qm@web81604.mail.mud.yahoo.com> Message-ID: <89c4ed2d0903021719t6d7b6ae4p6a844fbf6cba1c6c@mail.gmail.com> Tea I'll give you a rap on the head. Prasanna On Tue, Mar 3, 2009 at 6:09 AM, Tea Acuff wrote: > that's what all parkinson patients say... > ;) > tea > > > > > ________________________________ > From: "rwmfglycar@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Monday, March 2, 2009 4:39:06 PM > Subject: Re: [HSF] experimental heart valve operations? apologies for clutter > > Humble apologies for the clutter . I swear I only hit the button once > Bob > > > -----Original Message----- > From: rwmfglycar@aol.com > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:28 pm > Subject: Re: [HSF] experimental heart valve operations? > > > > Mitral or aortic position? Mechanical or Bioprosthetic? > Bob > > -----Original Message----- > From: prof. dr. axel laczkovics > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:05 pm > Subject: [HSF] experimental heart valve operations? > > > ? > dear colleagues,? > ? > I am planing to perform valve implantations in animals. my last experiments > training for cardiac transplantation dates back to the early 80ies! at that time > I switched from dogs to pigs and was finally succesful after failing with dogs.? > ? > what would be your advice in selecting the right animal? pigs? sheep?? > ? > and for colleagues in germany or the netherlands: is anybody of you accidentally > doing operations with the help of ECC in animals to exchange ideas or have the > possibility to send somebody to look and discuss details?? > ? > thx for helping, axel laczkovics? > bochum? > ? > _______________________________________________? > OpenHeart-L mailing list? > ? > Send postings to:? > OpenHeart-L@lists.hsforum.com? > ? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? > ? > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mon Mar 2 18:50:38 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon Mar 2 21:52:07 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> <8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com> <8CB699ED424D918-172C-1654@webmail-dx18.sysops.aol.com> <365343.86496.qm@web81604.mail.mud.yahoo.com> <89c4ed2d0903021719t6d7b6ae4p6a844fbf6cba1c6c@mail.gmail.com> Message-ID: <687433.67732.qm@web81607.mail.mud.yahoo.com> Undoubtedly I will deserve it. I just hope that you, too, are not smit with the Parkinson tremor. Although i may also deserve that. tea ________________________________ From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Monday, March 2, 2009 7:19:49 PM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Tea I'll give you a rap on the head. Prasanna On Tue, Mar 3, 2009 at 6:09 AM, Tea Acuff wrote: > that's what all parkinson patients say... > ;) > tea > > > > > ________________________________ > From: "rwmfglycar@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Monday, March 2, 2009 4:39:06 PM > Subject: Re: [HSF] experimental heart valve operations? apologies for clutter > > Humble apologies for the clutter . I swear I only hit the button once > Bob > > > -----Original Message----- > From: rwmfglycar@aol.com > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:28 pm > Subject: Re: [HSF] experimental heart valve operations? > > > > Mitral or aortic position? Mechanical or Bioprosthetic? > Bob > > -----Original Message----- > From: prof. dr. axel laczkovics > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:05 pm > Subject: [HSF] experimental heart valve operations? > > > ? > dear colleagues,? > ? > I am planing to perform valve implantations in animals. my last experiments > training for cardiac transplantation dates back to the early 80ies! at that time > I switched from dogs to pigs and was finally succesful after failing with dogs.? > ? > what would be your advice in selecting the right animal? pigs? sheep?? > ? > and for colleagues in germany or the netherlands: is anybody of you accidentally > doing operations with the help of ECC in animals to exchange ideas or have the > possibility to send somebody to look and discuss details?? > ? > thx for helping, axel laczkovics? > bochum? > ? > _______________________________________________? > OpenHeart-L mailing list? > ? > Send postings to:? > OpenHeart-L@lists.hsforum.com? > ? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? > ? > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Tue Mar 3 03:01:24 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Tue Mar 3 03:01:59 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT In-Reply-To: <687433.67732.qm@web81607.mail.mud.yahoo.com> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de><8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com><8CB699ED424D918-172C-1654@webmail-dx18.sysops.aol.com><365343.86496.qm@web81604.mail.mud.yahoo.com><89c4ed2d0903021719t6d7b6ae4p6a844fbf6cba1c6c@mail.gmail.com> <687433.67732.qm@web81607.mail.mud.yahoo.com> Message-ID: <8CB69ED61822F1E-C5C-1712@WEBMAIL-MY08.sysops.aol.com> I did not take offense. No, although it is a fascinating exercise to track the changes in our bodies. Yesterday I had messages on my cellphone making sure that I knew Stewart had died. When I got to Einstein in in 1964 he was the first perfusionist I trained. He was terrific in every way. 15 years after we started together?he told me he had been diagnosed with Parkinson's. Not ?one of us had in any way spotted it. We made a pact. His medical records would be totally available to me. He would undergo cognitive testing and motor skills testing once a year. I would tell my colleagues confidentially. He would tell his two perfusion mates. He would be watched by all of us but we would expect him to tell us that he could not achieve his and our standards of performance. One of my colleagues thought I was irresponsibly mad but went along with the plan. We never even thought of telling the administration. He stopped perfusing voluntarily?after about?8 years. By then a keen observer would have picked up slower movements and? slower speech. He had retained all of his former quick wit and keen mind. He had read Dwight Mcgoon's book and followed his example. He went into a randomised trial (turned out he was in the placebo arm), took up pet watching to keep himself occupied. He progressed steadily but in his last year deteriorated rapidly with severe cognitive loss. His good wife Judy took care of his wishes to have his brain sent to Columbia University and his body cremated. Later this year we will gather from various parts to swap Stewart stories and raise a glass?in his memory. Bob -----Original Message----- From: Tea Acuff To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 4:50 am Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Undoubtedly I will deserve it. I just hope that you, too, are not smit with the Parkinson tremor. Although i may also deserve that. tea ________________________________ From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Monday, March 2, 2009 7:19:49 PM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Tea I'll give you a rap on the head. Prasanna On Tue, Mar 3, 2009 at 6:09 AM, Tea Acuff wrote: > that's what all parkinson patients say... > ;) > tea > > > > > ________________________________ > From: "rwmfglycar@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Monday, March 2, 2009 4:39:06 PM > Subject: Re: [HSF] experimental heart valve operations? apologies for clutter > > Humble apologies for the clutter . I swear I only hit the button once > Bob > > > -----Original Message----- > From: rwmfglycar@aol.com > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:28 pm > Subject: Re: [HSF] experimental heart valve operations? > > > > Mitral or aortic position? Mechanical or Bioprosthetic? > Bob > > -----Original Message----- > From: prof. dr. axel laczkovics > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:05 pm > Subject: [HSF] experimental heart valve operations? > > > ? > dear colleagues,? > ? > I am planing to perform valve implantations in animals. my last experiments > training for cardiac transplantation dates back to the early 80ies! at that time > I switched from dogs to pigs and was finally succesful after failing with dogs.? > ? > what would be your advice in selecting the right animal? pigs? sheep?? > ? > and for colleagues in germany or the netherlands: is anybody of you accidentally > doing operations with the help of ECC in animals to exchange ideas or have the > possibility to send somebody to look and discuss details?? > ? > thx for helping, axel laczkovics? > bochum? > ? > _______________________________________________ ? > OpenHeart-L mailing list? > ? > Send postings to:? > OpenHeart-L@lists.hsforum.com? > ? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? > ? > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 disc laimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Tue Mar 3 11:09:24 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Tue Mar 3 06:09:28 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <8CB6962B80B6D28-BE0-CC6@webmail-de17.sysops.aol.com> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> <8CB6962B80B6D28-BE0-CC6@webmail-de17.sysops.aol.com> Message-ID: <8aacc5327adea2cb81752147baf44fae@ruhr-uni-bochum.de> thx for your multiple(!) replies! the aim of the study is digital phonocardiography by measurement of the opening and closing sounds of the protheses and other features like resonance frequency et al. therefore it need to be a mechanical vlave, but the position is irrelevant. the animal must survive only for some days. and for prasanna; y, i would never use dogs again. better walking with them on a sunday morning! thx, axel > Mitral or aortic position? Mechanical or Bioprosthetic? > Bob > > -----Original Message----- > From: prof. dr. axel laczkovics > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:05 pm > Subject: [HSF] experimental heart valve operations? > > > ? > dear colleagues,? > ? > I am planing to perform valve implantations in animals. my last > experiments training for cardiac transplantation dates back to the > early 80ies! at that time I switched from dogs to pigs and was finally > succesful after failing with dogs.? > ? > what would be your advice in selecting the right animal? pigs? sheep?? > ? > and for colleagues in germany or the netherlands: is anybody of you > accidentally doing operations with the help of ECC in animals to > exchange ideas or have the possibility to send somebody to look and > discuss details?? > ? > thx for helping, axel laczkovics? > bochum? > ? > _______________________________________________? > OpenHeart-L mailing list? > ? > Send postings to:? > OpenHeart-L@lists.hsforum.com? > ? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? > ? > All messages transmitted by the OpenHeart-L are subject to the > policies and disclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mar 3 19:35:06 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Mar 3 09:05:36 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <8aacc5327adea2cb81752147baf44fae@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> <8CB6962B80B6D28-BE0-CC6@webmail-de17.sysops.aol.com> <8aacc5327adea2cb81752147baf44fae@ruhr-uni-bochum.de> Message-ID: <89c4ed2d0903030605j24d39c06he40aa0d448c7d494@mail.gmail.com> Axel there is a commercial device available which was demonstrated to me with which a daily check can be done by the patient by keeping it over his chest. Any change in frequency mandates a clinical visit and echo to check for prosthetic valve dysfunction. Prasanna On Tue, Mar 3, 2009 at 4:40 PM, prof. dr. axel laczkovics wrote: > thx for your multiple(!) replies! > > the aim of the study is digital ?phonocardiography by measurement of the > opening and closing sounds of the protheses and other ?features like > resonance frequency et al. > > therefore it need to be a mechanical vlave, ?but the position is irrelevant. > ?the animal must survive only ?for some days. > > and for prasanna; ?y, i would never use dogs again. better walking with them > on a sunday morning! > > thx, axel > >> Mitral or aortic position? Mechanical or Bioprosthetic? >> Bob >> >> -----Original Message----- >> From: prof. dr. axel laczkovics >> To: OpenHeart-L@lists.hsforum.com >> Sent: Mon, 2 Mar 2009 5:05 pm >> Subject: [HSF] experimental heart valve operations? >> >> >> ? >> dear colleagues,? >> ? >> I am planing to perform valve implantations in animals. my last >> experiments training for cardiac transplantation dates back to the early >> 80ies! at that time I switched from dogs to pigs and was finally succesful >> after failing with dogs.? >> ? >> what would be your advice in selecting the right animal? pigs? sheep?? >> ? >> and for colleagues in germany or the netherlands: is anybody of you >> accidentally doing operations with the help of ECC in animals to exchange >> ideas or have the possibility to send somebody to look and discuss details?? >> ? >> thx for helping, axel laczkovics? >> bochum? >> ? >> _______________________________________________? >> OpenHeart-L mailing list? >> ? >> Send postings to:? >> OpenHeart-L@lists.hsforum.com? >> ? >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:? >> http://mmp.cjp.com/mailman/listinfo/openheart-l? >> ? >> All messages transmitted by the OpenHeart-L are subject to the policies >> and disclaimers posted at:? >> http://www.hsforum.com/listdisclaim? >> -----------------------------------------? >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 axel.m.laczkovics at ruhr-uni-bochum.de Tue Mar 3 14:42:25 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Tue Mar 3 09:42:26 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <89c4ed2d0903030605j24d39c06he40aa0d448c7d494@mail.gmail.com> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> <8CB6962B80B6D28-BE0-CC6@webmail-de17.sysops.aol.com> <8aacc5327adea2cb81752147baf44fae@ruhr-uni-bochum.de> <89c4ed2d0903030605j24d39c06he40aa0d448c7d494@mail.gmail.com> Message-ID: <9f31286aeaa23752366478f50a04b1ae@ruhr-uni-bochum.de> exactly. it is called THROMBOCHECK and produced by a german company called CARDIOSIGNAL. we do use it in pts especially with low anticoagulation routinely. but the aim ist not to test the gadget, but some valves and the possibility of recognizing failures early. the changing parameter will be the valves and modifications of them. thx again, axel > Axel there is a commercial device available which was demonstrated to > me with which a daily check can be done by the patient by keeping it > over his chest. Any change in frequency mandates a clinical visit and > echo to check for prosthetic valve dysfunction. > Prasanna > > On Tue, Mar 3, 2009 at 4:40 PM, prof. dr. axel laczkovics > wrote: >> thx for your multiple(!) replies! >> >> the aim of the study is digital ?phonocardiography by measurement of >> the >> opening and closing sounds of the protheses and other ?features like >> resonance frequency et al. >> >> therefore it need to be a mechanical vlave, ?but the position is >> irrelevant. >> ?the animal must survive only ?for some days. >> >> and for prasanna; ?y, i would never use dogs again. better walking >> with them >> on a sunday morning! >> >> thx, axel >> >>> Mitral or aortic position? Mechanical or Bioprosthetic? >>> Bob >>> >>> -----Original Message----- >>> From: prof. dr. axel laczkovics >>> >>> To: OpenHeart-L@lists.hsforum.com >>> Sent: Mon, 2 Mar 2009 5:05 pm >>> Subject: [HSF] experimental heart valve operations? >>> >>> >>> ? >>> dear colleagues,? >>> ? >>> I am planing to perform valve implantations in animals. my last >>> experiments training for cardiac transplantation dates back to the >>> early >>> 80ies! at that time I switched from dogs to pigs and was finally >>> succesful >>> after failing with dogs.? >>> ? >>> what would be your advice in selecting the right animal? pigs? >>> sheep?? >>> ? >>> and for colleagues in germany or the netherlands: is anybody of you >>> accidentally doing operations with the help of ECC in animals to >>> exchange >>> ideas or have the possibility to send somebody to look and discuss >>> details?? >>> ? >>> thx for helping, axel laczkovics? >>> bochum? >>> ? >>> _______________________________________________? >>> OpenHeart-L mailing list? >>> ? >>> Send postings to:? >>> OpenHeart-L@lists.hsforum.com? >>> ? >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:? >>> http://mmp.cjp.com/mailman/listinfo/openheart-l? >>> ? >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and disclaimers posted at:? >>> http://www.hsforum.com/listdisclaim? >>> -----------------------------------------? >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 grescigno at mac.com Tue Mar 3 16:30:30 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Tue Mar 3 10:35:09 2009 Subject: [HSF] Recurrent pericardial effusion Message-ID: <14211287630034541604787844435911961481-Webmail@me.com> Dear Members, I need your advice concenrning a patient, operated on for CABG in another center, that we admitted for postoperative (1 mo) pericardial effusion. He underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial windows by left and right minithoracotomies. All cancer markers are negative as well as CT scans. Nervertheless he still produces 200 mL of effusion each day. We have tried all the possible drugs. Is there anyone who has experience with glue injection or some other voodoos? Thanks in advance Giuseppe Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy From jgammie at gmail.com Tue Mar 3 10:32:05 2009 From: jgammie at gmail.com (James Gammie) Date: Tue Mar 3 10:40:40 2009 Subject: [HSF] Apicoaortic conduit a note In-Reply-To: References: <89c4ed2d0902281810i41b09db4nb435ac2704dd6be6@mail.gmail.com> Message-ID: Ani We have found that aortic valve bypass (AVB, apicoaortic conduit) surgery affords the surgeon the opportunity to treat AS without cpb, without xclamping the ascending aorta, and without cardioplegic cardiac arrest. It is ideally suited for the patient with a porcelain ascending aorta who would be at high risk for brain injury with conventional avr, as well as the pt with a prior sternotomy and patent grafts. The patient reported by Parsa and colleagues had a very low EF and was in cardiogenic shock on arrival to the OR. Cpb was used and an lvad was placed for failure to wean. In our combined experience of > 100 AVBs, John Brown and I have never observed thrombosis of the aorta. Pts receive asa only. All pts have routine ptedismissal echo and either MRI or ct. Flow split is quite consistent with 70 % via conduit and 30% native valve (circulation 2008 118:1460). We have noted that the native as does not progress over time. We now routinely perform avb without cpb through a small left chest incision. John has several patients out > 25 years doing well. So while AVB surgery is of great value for high-risk AS patients we would avoid it for a pt with abysmal ventricular function and cardiogenic shock who likely would be better served with initial mechanical circulatory support or nonoperative management. JSG On Feb 28, 2009, at 9:16 PM, Ani Anyanwu wrote: > > This complication is well recognized when ventricular assist device > outflows are connected to the descending aorta. To avoid this some > surgeons will try and offload the heart only partially such that > the aortic valve opens intermittently. > > > > It serves though as a reminder that apicoaortic conduits are not a > procedure of convenience and where possible antegrade blood flow is > preferable. For a patient with a ventricular assist device to the > descending aorta, the consequences of aortic root thrombosis are not > so dire as the VAD carries the left circulation but for an apical > conduit same can be fatal. > > > > Ani > > > > > >> Date: Sun, 1 Mar 2009 07:40:07 +0530 >> From: prasannasimha@gmail.com >> To: OpenHeart-L@lists.hsforum.com >> CC: >> Subject: [HSF] Apicoaortic conduit a note >> >> 1: Ann Thorac Surg. 2009 Mar;87(3):927-928. >> >> A Previously Unreported Complication of Apicoaortic Conduit for >> Severe Aortic >> Stenosis. >> >> Parsa CJ, Milano CA, Proia AD, Mackensen GB, Hughes GC. >> >> Department of Surgery, Division of Thoracic and Cardiovascular >> Surgery, Duke >> University Medical Center, Durham, North Carolina; Department of >> Pathology, Duke >> University Medical Center, Durham, North Carolina; Department of >> Anesthesiology, >> Duke University Medical Center, Durham, North Carolina. >> >> Given the aging population, use of an apicoaortic conduit serves as >> an >> alternative method to treat severe aortic stenosis, especially in >> patients with a >> heavily calcified ascending aorta or prior cardiac surgery. >> Although an >> apicoaortic conduit fractionates systemic blood flow, it does so >> without >> significant deleterious effects. However, we report a novel >> complication with >> thrombosis of the aortic root and subsequent coronary insufficiency >> that likely >> resulted from a preponderance of cardiac output though the >> apicoaortic conduit >> with stagnation of native antegrade blood flow. Given increasing >> use of the >> apicoaortic conduit procedure, surgeons considering this approach >> should be >> familiar with this potential complication. >> >> >> PMID: 19231422 [PubMed - as supplied by publisher] >> >> >> >> -- >> 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 >> ----------------------------------------- > > _________________________________________________________________ > Twice the fun?Share photos while you chat with Windows Live Messenge > r. Learn more. > http://www.microsoft.com/uk/windows/windowslive/products/messenger.aspx_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mar 3 07:41:09 2009 From: tacuff at swbell.net (Tea Acuff) Date: Tue Mar 3 10:41:38 2009 Subject: [HSF] Recurrent pericardial effusion References: <14211287630034541604787844435911961481-Webmail@me.com> Message-ID: <177063.16716.qm@web81607.mail.mud.yahoo.com> This is unusual and I do not understand it. Why does not the 200cc per day disappear into or become a pleural effusion? tea ________________________________ From: Giuseppe Rescigno To: "OpenHeart-L@lists.hsforum.com" Sent: Tuesday, March 3, 2009 9:30:30 AM Subject: [HSF] Recurrent pericardial effusion Dear Members, I need your advice concenrning a patient, operated on for CABG in another center, that we admitted for postoperative (1 mo) pericardial effusion. He underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial windows by left and right minithoracotomies. All cancer markers are negative as well as CT scans. Nervertheless he still produces 200 mL of effusion each day. We have tried all the possible drugs. Is there anyone who has experience with glue injection or some other voodoos? Thanks in advance 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 ----------------------------------------- From prasannasimha at gmail.com Tue Mar 3 21:10:18 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Mar 3 10:48:10 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <14211287630034541604787844435911961481-Webmail@me.com> References: <14211287630034541604787844435911961481-Webmail@me.com> Message-ID: <89c4ed2d0903030740x7517fec0l545e36bfacfe4918@mail.gmail.com> Has chylopericardium been ruled out. Some patients with CCF drain for days and benefit by drying them out.In some cases leaving a chest tube for a week or so causes d adhesions and stopsthe effusion. i would not add sclerosants for fear of constricition and scarring and encasing of grafts. Prasanna On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno wrote: > > Dear Members, > > I need your advice concenrning a patient, operated on for CABG in another center, that we admitted for postoperative (1 mo) pericardial effusion. He underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial windows by left and right minithoracotomies. All cancer markers are negative as well as CT scans. Nervertheless he still produces 200 mL of effusion each day. We have tried all the possible drugs. Is there anyone who has experience with glue injection or some other voodoos? > > Thanks in advance > > 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 > ----------------------------------------- > -- Prasanna Simha M From grescigno at mac.com Tue Mar 3 17:02:28 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Tue Mar 3 11:07:00 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <009101c7615a$d3bc1c60$b3160a06@HZLPC0679> References: <001201c75d90$0c189580$b3160a06@HZLPC0679> <8C92E6BBF13CD53-6F8-112B@webmail-mf17.sysops.aol.com> <8C92E75F01F1761-6F8-13D6@webmail-mf17.sysops.aol.com> <45EEC794.5030500@gmail.com> <007301c760f9$0bda0830$b3160a06@HZLPC0679> <45EF641E.3090608@gmail.com> <009101c7615a$d3bc1c60$b3160a06@HZLPC0679> Message-ID: <155667659108027853901098758090316571256-Webmail@me.com> Prasanna, Thank you as usual. No it is not chylopericardium. We are really worried because this patient is in our Dept since January! Moreover a postop bleeding of one thoracotomy near failed to kill him! He has still a pigtail into the pericardial cavity and each day 200 mL of serous fluid comes out. Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Tuesday, March 03, 2009, at 04:40PM, "Prasanna Simha M" wrote: >Has chylopericardium been ruled out. Some patients with CCF drain for >days and benefit by drying them out.In some cases leaving a chest tube >for a week or so causes d >adhesions and stopsthe effusion. i would not add sclerosants for fear >of constricition and scarring and encasing of grafts. >Prasanna >On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno wrote: >> >> Dear Members, >> >> I need your advice concenrning a patient, operated on for CABG in another center, that we admitted for postoperative (1 mo) pericardial effusion. He underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial windows by left and right minithoracotomies. All cancer markers are negative as well as CT scans. Nervertheless he still produces 200 mL of effusion each day. We have tried all the possible drugs. Is there anyone who has experience with glue injection or some other voodoos? >> >> Thanks in advance >> >> 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 >> ----------------------------------------- >> > > > >-- >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 Mar 3 17:03:51 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Tue Mar 3 11:08:09 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <177063.16716.qm@web81607.mail.mud.yahoo.com> References: <14211287630034541604787844435911961481-Webmail@me.com> <177063.16716.qm@web81607.mail.mud.yahoo.com> Message-ID: <148302319049870696803130798830159874623-Webmail@me.com> Tea, he still has a pigtail, inserted by our cardiologist into the pericardial cavity. Our windows do not work anymore. Giuseppe Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Tuesday, March 03, 2009, at 04:41PM, "Tea Acuff" wrote: >This is unusual and I do not understand it. Why does not the 200cc per day disappear into or become a pleural effusion? > >tea > > > > >________________________________ >From: Giuseppe Rescigno >To: "OpenHeart-L@lists.hsforum.com" >Sent: Tuesday, March 3, 2009 9:30:30 AM >Subject: [HSF] Recurrent pericardial effusion > > >Dear Members, > >I need your advice concenrning a patient, operated on for CABG in another center, that we admitted for postoperative (1 mo) pericardial effusion. He underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial windows by left and right minithoracotomies. All cancer markers are negative as well as CT scans. Nervertheless he still produces 200 mL of effusion each day. We have tried all the possible drugs. Is there anyone who has experience with glue injection or some other voodoos? > >Thanks in advance > >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 >----------------------------------------- > > From tacuff at swbell.net Tue Mar 3 08:07:22 2009 From: tacuff at swbell.net (Tea Acuff) Date: Tue Mar 3 11:08:51 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de><8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com><8CB699ED424D918-172C-1654@webmail-dx18.sysops.aol.com><365343.86496.qm@web81604.mail.mud.yahoo.com><89c4ed2d0903021719t6d7b6ae4p6a844fbf6cba1c6c@mail.gmail.com> <687433.67732.qm@web81607.mail.mud.yahoo.com> <8CB69ED61822F1E-C5C-1712@WEBMAIL-MY08.sysops.aol.com> Message-ID: <268298.71463.qm@web81608.mail.mud.yahoo.com> Why does a boy continue to poke with a stick well beyond his first admonishment and childhood years? He may have learned that the occasional new insights are worth the occasional beatings. A?toast to your Stewart and all his namesakes who have provided us with long careers of stick poking... A?toast to?Stewart's teacher as well, but may I have that honor in person. tea ? ________________________________ From: "rwmfglycar@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Tuesday, March 3, 2009 2:01:24 AM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT I did not take offense. No, although it is a fascinating exercise to track the changes in our bodies. Yesterday I had messages on my cellphone making sure that I knew Stewart had died. When I got to Einstein in in 1964 he was the first perfusionist I trained. He was terrific in every way. 15 years after we started together?he told me he had been diagnosed with Parkinson's. Not ?one of us had in any way spotted it. We made a pact. His medical records would be totally available to me. He would undergo cognitive testing and motor skills testing once a year. I would tell my colleagues confidentially. He would tell his two perfusion mates. He would be watched by all of us but we would expect him to tell us that he could not achieve his and our standards of performance. One of my colleagues thought I was irresponsibly mad but went along with the plan. We never even thought of telling the administration. He stopped perfusing voluntarily?after about?8 years. By then a keen observer would have picked up slower movements and? slower speech. He had retained all of his former quick wit and keen mind. He had read Dwight Mcgoon's book and followed his example. He went into a randomised trial (turned out he was in the placebo arm), took up pet watching to keep himself occupied. He progressed steadily but in his last year deteriorated rapidly with severe cognitive loss. His good wife Judy took care of his wishes to have his brain sent to Columbia University and his body cremated. Later this year we will gather from various parts to swap Stewart stories and raise a glass?in his memory. Bob -----Original Message----- From: Tea Acuff To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 4:50 am Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Undoubtedly I will deserve it. I just hope that you, too, are not smit with the Parkinson tremor. Although i may also deserve that. tea ________________________________ From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Monday, March 2, 2009 7:19:49 PM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Tea I'll give you a rap on the head. Prasanna On Tue, Mar 3, 2009 at 6:09 AM, Tea Acuff wrote: > that's what all parkinson patients say... > ;) > tea > > > > > ________________________________ > From: "rwmfglycar@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Monday, March 2, 2009 4:39:06 PM > Subject: Re: [HSF] experimental heart valve operations? apologies for clutter > > Humble apologies for the clutter . I swear I only hit the button once > Bob > > > -----Original Message----- > From: rwmfglycar@aol.com > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:28 pm > Subject: Re: [HSF] experimental heart valve operations? > > > > Mitral or aortic position? Mechanical or Bioprosthetic? > Bob > > -----Original Message----- > From: prof. dr. axel laczkovics > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:05 pm > Subject: [HSF] experimental heart valve operations? > > > ? > dear colleagues,? > ? > I am planing to perform valve implantations in animals. my last experiments > training for cardiac transplantation dates back to the early 80ies! at that time > I switched from dogs to pigs and was finally succesful after failing with dogs.? > ? > what would be your advice in selecting the right animal? pigs? sheep?? > ? > and for colleagues in germany or the netherlands: is anybody of you accidentally > doing operations with the help of ECC in animals to exchange ideas or have the > possibility to send somebody to look and discuss details?? > ? > thx for helping, axel laczkovics? > bochum? > ? > _______________________________________________ ? > OpenHeart-L mailing list? > ? > Send postings to:? > OpenHeart-L@lists.hsforum.com? > ? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? > ? > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 disc laimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Mar 3 08:13:53 2009 From: tacuff at swbell.net (Tea Acuff) Date: Tue Mar 3 11:14:21 2009 Subject: [HSF] Recurrent pericardial effusion References: <001201c75d90$0c189580$b3160a06@HZLPC0679> <8C92E6BBF13CD53-6F8-112B@webmail-mf17.sysops.aol.com> <8C92E75F01F1761-6F8-13D6@webmail-mf17.sysops.aol.com> <45EEC794.5030500@gmail.com> <007301c760f9$0bda0830$b3160a06@HZLPC0679> <45EF641E.3090608@gmail.com> <009101c7615a$d3bc1c60$b3160a06@HZLPC0679> <155667659108027853901098758090316571256-Webmail@me.com> Message-ID: <677830.13543.qm@web81603.mail.mud.yahoo.com> If he has two windows, why not pull?the pigtail?out? The solution in this disease is not to close but to open. You may be reluctant but at some point more excised pericardium perhaps with strips to pervent herniation if no adhsions are present will have to prevent accumulation of "pericardial" fluid. tea ________________________________ From: Giuseppe Rescigno To: OpenHeart-L@lists.hsforum.com Sent: Tuesday, March 3, 2009 10:02:28 AM Subject: Re: [HSF] Recurrent pericardial effusion Prasanna, Thank you as usual. No it is not chylopericardium. We are really worried because this patient is in our Dept since January! Moreover a postop bleeding of one thoracotomy near failed to kill him! He has still a pigtail into the pericardial cavity and each day 200 mL of serous fluid comes out. Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Tuesday, March 03, 2009, at 04:40PM, "Prasanna Simha M" wrote: >Has chylopericardium been ruled out. Some patients with CCF drain for >days and benefit by drying them out.In some cases leaving a chest tube >for a week or so causes d >adhesions and stopsthe effusion. i would not add sclerosants for fear >of constricition and? scarring and encasing of grafts. >Prasanna >On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno wrote: >> >> Dear Members, >> >> I need your advice concenrning a patient, operated on for CABG in another center, that we admitted for postoperative (1 mo) pericardial effusion. He underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial windows by left and right minithoracotomies. All cancer markers are negative as well as CT scans. Nervertheless he still produces 200 mL of effusion each day. We have tried all the possible drugs. Is there anyone who has experience with glue injection or some other voodoos? >> >> Thanks in advance >> >> 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 >> ----------------------------------------- >> > > > >-- >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 Mar 3 21:46:22 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Mar 3 11:16:49 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <148302319049870696803130798830159874623-Webmail@me.com> References: <14211287630034541604787844435911961481-Webmail@me.com> <177063.16716.qm@web81607.mail.mud.yahoo.com> <148302319049870696803130798830159874623-Webmail@me.com> Message-ID: <89c4ed2d0903030816n782c2cb6g15b527299557563a@mail.gmail.com> I would make a pericardio peritoneal fistula into the bare area of the liver. This has extensive lymphatics and will drain.Has tuberculosis and sarcoid been ruled out ? I had one patient who drained and had an autoimmune disease and it stopped after we started steroids. Prasanna Prasanna On Tue, Mar 3, 2009 at 9:33 PM, Giuseppe Rescigno wrote: > Tea, > > he still has a pigtail, inserted by our cardiologist into the pericardial cavity. Our windows do not work anymore. > > Giuseppe > > Giuseppe Rescigno M.D. > Cardiothoracic Surgeon > > Lancisi Hospital > Torrette - Ancona > Italy > > > > On Tuesday, March 03, 2009, at 04:41PM, "Tea Acuff" wrote: >>This is unusual and I do not understand it. Why does not the 200cc per day disappear into or become a pleural effusion? >> >>tea >> >> >> >> >>________________________________ >>From: Giuseppe Rescigno >>To: "OpenHeart-L@lists.hsforum.com" >>Sent: Tuesday, March 3, 2009 9:30:30 AM >>Subject: [HSF] Recurrent pericardial effusion >> >> >>Dear Members, >> >>I need your advice concenrning a patient, operated on for CABG in another center, that we admitted for postoperative (1 mo) pericardial effusion. He underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial windows by left and right minithoracotomies. All cancer markers are negative as well as CT scans. Nervertheless he still produces 200 mL of effusion each day. We have tried all the possible drugs. Is there anyone who has experience with glue injection or some other voodoos? >> >>Thanks in advance >> >>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 > ----------------------------------------- > -- Prasanna Simha M From msfirst at gmail.com Tue Mar 3 12:32:26 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Tue Mar 3 12:39:14 2009 Subject: [HSF] Ntric vs FloLan Message-ID: For a variety of reasons, there is much interest in switching from nitric oxide (which we use a lot of - we always have at least 2 patients on it at all times) to inhaled floLan. I have no experience with inhaled floLab, but swear by iNO - any comments/thoughts/experiences? thanks -michael From anianyanwu at hotmail.com Tue Mar 3 18:08:39 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Tue Mar 3 13:09:27 2009 Subject: [HSF] Ntric vs FloLan In-Reply-To: References: Message-ID: We shifted from inhaled nitric oxide to nebulized Epoprostenol about two years ago, I am sure for the same reason why your hospital is having such interest (i.e. cost). We use epoprostenol in I would say 95% of cases in preference to NO to modulate pulmonary vascular resistance. NO we use when we need to set it up in a hurry (logistically easier), where there is non-response to epoprostenol (but usually wont respond to nitric either) or for other 'indication' (such as ARDs or physician preference). In the OR I prefer to start with Nitric because it is logistically easier to set up and delivery more guaranteed. If patients come out of the OR on NO, they are usually converted to epoprostenol shortly after arrival to ICU. I had one patient die following pulmonary hypertensive crisis during such conversion but do not know if that was causative or incidental. Overall I do not perceive a difference in outcomes now we use epoprostenol routinely compared to previously when we used NO routinely. Of course it is not certain either affects patient outcomes but that is a an issue for debate. I think though you should curtail your use of NO as find it hard to imagine why you would have 2 patients or more on NO at any given time when several alternative management modalities should be suitable in most patients. If you do not control your use, you may find one day you will no longer have access to it as was the case in a big VAD center where NO was withdrawn from hospital formulary because of rampant use by surgeons. Of course when those surgeons where asked to provide data of its benefit there were none so hospital said they could not justify such cost for a therapy where there was no evidence of benefit. This is partly why we moved to epoprostenol so in that way we regulated our use of NO, and by minimizing rampant use we are not under radar of hospital cost police but can continue to use it selectively when we desire. Ani > Date: Tue, 3 Mar 2009 12:32:26 -0500 > From: msfirst@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > Subject: [HSF] Ntric vs FloLan > > For a variety of reasons, there is much interest in switching from nitric > oxide (which we use a lot of - we always have at least 2 patients on it at > all times) to inhaled floLan. I have no experience with inhaled floLab, but > swear by iNO - any comments/thoughts/experiences? > > thanks > > > -michael > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ All your Twitter and other social updates in one place http://clk.atdmt.com/UKM/go/137984870/direct/01/ From anianyanwu at hotmail.com Tue Mar 3 18:26:27 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Tue Mar 3 13:27:16 2009 Subject: [HSF] Apicoaortic conduit a note In-Reply-To: References: <89c4ed2d0902281810i41b09db4nb435ac2704dd6be6@mail.gmail.com> Message-ID: Thanks a lot for the clarification Dr Gammie. Always good to hear from the experts. I must say I now remember coming accross a patient in London who had one of these in the late 1960s and was doing well 30 years out. I had not appreciated that there remains considerable flow through the native valve which would be the major difference compared to the LVAD scenario I referred to. How bad must the descending aorta be for you do decide that too is unclampable? One of my colleagues has talked about bypassing to the subclavian artery, rather than descending aorta, when there is descending disease - is this something you have experience in or advocate? Ani > From: jgammie@gmail.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Apicoaortic conduit a note > Date: Tue, 3 Mar 2009 10:32:05 -0500 > CC: > > Ani > We have found that aortic valve bypass (AVB, apicoaortic conduit) > surgery affords the surgeon the opportunity to treat AS without cpb, > without xclamping the ascending aorta, and without cardioplegic > cardiac arrest. It is ideally suited for the patient with a porcelain > ascending aorta who would be at high risk for brain injury with > conventional avr, as well as the pt with a prior sternotomy and patent > grafts. The patient reported by Parsa and colleagues had a very low EF > and was in cardiogenic shock on arrival to the OR. Cpb was used and > an lvad was placed for failure to wean. In our combined experience of > > 100 AVBs, John Brown and I have never observed thrombosis of the > aorta. Pts receive asa only. All pts have routine ptedismissal echo > and either MRI or ct. Flow split is quite consistent with 70 % via > conduit and 30% native valve (circulation 2008 118:1460). We have > noted that the native as does not progress over time. We now > routinely perform avb without cpb through a small left chest > incision. John has several patients out > 25 years doing well. So > while AVB surgery is of great value for high-risk AS patients we would > avoid it for a pt with abysmal ventricular function and cardiogenic > shock who likely would be better served with initial mechanical > circulatory support or nonoperative management. > JSG > > > > > > On Feb 28, 2009, at 9:16 PM, Ani Anyanwu wrote: > > > > > This complication is well recognized when ventricular assist device > > outflows are connected to the descending aorta. To avoid this some > > surgeons will try and offload the heart only partially such that > > the aortic valve opens intermittently. > > > > > > > > It serves though as a reminder that apicoaortic conduits are not a > > procedure of convenience and where possible antegrade blood flow is > > preferable. For a patient with a ventricular assist device to the > > descending aorta, the consequences of aortic root thrombosis are not > > so dire as the VAD carries the left circulation but for an apical > > conduit same can be fatal. > > > > > > > > Ani > > > > > > > > > > > >> Date: Sun, 1 Mar 2009 07:40:07 +0530 > >> From: prasannasimha@gmail.com > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> Subject: [HSF] Apicoaortic conduit a note > >> > >> 1: Ann Thorac Surg. 2009 Mar;87(3):927-928. > >> > >> A Previously Unreported Complication of Apicoaortic Conduit for > >> Severe Aortic > >> Stenosis. > >> > >> Parsa CJ, Milano CA, Proia AD, Mackensen GB, Hughes GC. > >> > >> Department of Surgery, Division of Thoracic and Cardiovascular > >> Surgery, Duke > >> University Medical Center, Durham, North Carolina; Department of > >> Pathology, Duke > >> University Medical Center, Durham, North Carolina; Department of > >> Anesthesiology, > >> Duke University Medical Center, Durham, North Carolina. > >> > >> Given the aging population, use of an apicoaortic conduit serves as > >> an > >> alternative method to treat severe aortic stenosis, especially in > >> patients with a > >> heavily calcified ascending aorta or prior cardiac surgery. > >> Although an > >> apicoaortic conduit fractionates systemic blood flow, it does so > >> without > >> significant deleterious effects. However, we report a novel > >> complication with > >> thrombosis of the aortic root and subsequent coronary insufficiency > >> that likely > >> resulted from a preponderance of cardiac output though the > >> apicoaortic conduit > >> with stagnation of native antegrade blood flow. Given increasing > >> use of the > >> apicoaortic conduit procedure, surgeons considering this approach > >> should be > >> familiar with this potential complication. > >> > >> > >> PMID: 19231422 [PubMed - as supplied by publisher] > >> > >> > >> > >> -- > >> 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 > >> ----------------------------------------- > > > > _________________________________________________________________ > > Twice the fun?Share photos while you chat with Windows Live Messenge > > r. Learn more. > > http://www.microsoft.com/uk/windows/windowslive/products/messenger.aspx_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ 25GB of FREE Online Storage ? Find out more http://clk.atdmt.com/UKM/go/134665320/direct/01/ From rwmfglycar at aol.com Tue Mar 3 13:49:34 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Tue Mar 3 13:52:41 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT In-Reply-To: <268298.71463.qm@web81608.mail.mud.yahoo.com> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de><8CB6962B86F906A-BE0-CCF@webmail-de17.sysops.aol.com><8CB699ED424D918-172C-1654@webmail-dx18.sysops.aol.com><365343.86496.qm@web81604.mail.mud.yahoo.com><89c4ed2d0903021719t6d7b6ae4p6a844fbf6cba1c6c@mail.gmail.com><687433.67732.qm@web81607.mail.mud.yahoo.com><8CB69ED61822F1E-C5C-1712@WEBMAIL-MY08.sysops.aol.com> <268298.71463.qm@web81608.mail.mud.yahoo.com> Message-ID: <8CB6A47ED177392-E44-74A@FWM-D45.sysops.aol.com> Thank you Tea. It turns ?out that he died at 3am in Washington DC and his brain reached Columbia?in NY City?at 10 am. All his friends agreed that he would have roared with approval at such efficiency and organisation. Bob -----Original Message----- From: Tea Acuff To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 6:07 pm Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT Why does a boy continue to poke with a stick well beyond his first admonishment and childhood years? He may have learned that the occasional new insights are worth the occasional beatings. A?toast to your Stewart and all his namesakes who have provided us with long careers of stick poking... A?toast to?Stewart's teacher as well, but may I have that honor in person. tea ? ________________________________ From: "rwmfglycar@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Tuesday, March 3, 2009 2:01:24 AM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT I did not take offense. No, although it is a fascinating exercise to track the changes in our bodies. Yesterday I had messages on my cellphone making sure that I knew Stewart had died. When I got to Einstein in in 1964 he was the first perfusionist I trained. He was terrific in every way. 15 years after we started together?he told me he had been diagnosed with Parkinson's. Not ?one of us had in any way spotted it. We made a pact. His medical records would be totally available to me. He would undergo cognitive testing and motor skills testing once a year. I would tell my colleagues confidentially. He would tell his two perfusion mates. He would be watched by all of us but we would expect him to tell us that he could not achieve his and our standards of performance. One of my colleagues thought I was irresponsibly mad but went along with the plan. We never even thought of telling the administration. He stopped perfusing voluntarily?after about?8 years. By then a keen observer would have picked up slower movements and? slower speech. He had retained all of his former quick wit and keen mind. He had read Dwight Mcgoon's book and followed his example. He went into a randomised trial (turned out he was in the placebo arm), took up pet watching to keep himself occupied. He progressed steadily but in his last year deteriorated rapidly with severe cognitive loss. His goo d wife Judy took care of his wishes to have his brain sent to Columbia University and his body cremated. Later this year we will gather from various parts to swap Stewart stories and raise a glass?in his memory. Bob -----Original Message----- From: Tea Acuff To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 4:50 am Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Undoubtedly I will deserve it. I just hope that you, too, are not smit with the Parkinson tremor. Although i may also deserve that. tea ________________________________ From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Monday, March 2, 2009 7:19:49 PM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Tea I'll give you a rap on the head. Prasanna On Tue, Mar 3, 2009 at 6:09 AM, Tea Acuff wrote: > that's what all parkinson patients say... > ;) > tea > > > > > ________________________________ > From: "rwmfglycar@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Monday, March 2, 2009 4:39:06 PM > Subject: Re: [HSF] experimental heart valve operations? apologies for clutter > > Humble apologies for the clutter . I swear I only hit the button once > Bob > > > -----Original Message----- > From: rwmfglycar@aol.com > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:28 pm > Subject: Re: [HSF] experimental heart valve operations? > > > > Mitral or aortic position? Mechanical or Bioprosthetic? > Bob > > -----Original Message----- > From: prof. dr. axel laczkovics > To: OpenHeart-L@lists.hsforum.com > Sent: Mon, 2 Mar 2009 5:05 pm > Subject: [HSF] experimental heart valve operations? > > > ? > dear colleagues,? > ? > I am planing to perform valve implantations in animals. my last experiments > training for cardiac transplantation dates back to the early 80ies! at that time > I switched from dogs to pigs and was finally succesful after fa iling with dogs.? > ? > what would be your advice in selecting the right animal? pigs? sheep?? > ? > and for colleagues in germany or the netherlands: is anybody of you accidentally > doing operations with the help of ECC in animals to exchange ideas or have the > possibility to send somebody to look and discuss details?? > ? > thx for helping, axel laczkovics? > bochum? > ? > _______________________________________________ ? > OpenHeart-L mailing list? > ? > Send postings to:? > OpenHeart-L@lists.hsforum.com? > ? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? > ? > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp..com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers po sted 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 disc laimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Mar 3 11:00:25 2009 From: tacuff at swbell.net (Tea Acuff) Date: Tue Mar 3 14:01:56 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT Message-ID: <675695.40792.qm@web81601.mail.mud.yahoo.com> Well at least I can understand that he did not want to waste his brain in D.C.! Tea Sent from my iPhone On Mar 3, 2009, at 12:49 PM, rwmfglycar@aol.com wrote: Thank you Tea. It turns ?out that he died at 3am in Washington DC and his brain reached Columbia?in NY City?at 10 am. All his friends agreed that he would have roared with approval at such efficiency and organisation. Bob -----Original Message----- From: Tea Acuff To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 6:07 pm Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT Why does a boy continue to poke with a stick well beyond his first admonishment and childhood years? He may have learned that the occasional new insights are worth the occasional beatings. A?toast to your Stewart and all his namesakes who have provided us with long careers of stick poking... A?toast to?Stewart's teacher as well, but may I have that honor in person. tea ? ________________________________ From: "rwmfglycar@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Tuesday, March 3, 2009 2:01:24 AM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT I did not take offense. No, although it is a fascinating exercise to track the changes in our bodies. Yesterday I had messages on my cellphone making sure that I knew Stewart had died. When I got to Einstein in in 1964 he was the first perfusionist I trained. He was terrific in every way. 15 years after we started together?he told me he had been diagnosed with Parkinson's. Not ?one of us had in any way spotted it. We made a pact. His medical records would be totally available to me. He would undergo cognitive testing and motor skills testing once a year. I would tell my colleagues confidentially. He would tell his two perfusion mates. He would be watched by all of us but we would expect him to tell us that he could not achieve his and our standards of performance. One of my colleagues thought I was irresponsibly mad but went along with the plan. We never even thought of telling the administration. He stopped perfusing voluntarily?after about?8 years. By then a keen observer would have picked up slower movements and? slower speech. He had retained all of his former quick wit and keen mind. He had read Dwight Mcgoon's book and followed his example. He went into a randomised trial (turned out he was in the placebo arm), took up pet watching to keep himself occupied. He progressed steadily but in his last year deteriorated rapidly with severe cognitive loss. His goo d wife Judy took care of his wishes to have his brain sent to Columbia University and his body cremated. Later this year we will gather from various parts to swap Stewart stories and raise a glass?in his memory. Bob -----Original Message----- From: Tea Acuff To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 4:50 am Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Undoubtedly I will deserve it. I just hope that you, too, are not smit with the Parkinson tremor. Although i may also deserve that. tea ________________________________ From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Monday, March 2, 2009 7:19:49 PM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Tea I'll give you a rap on the head. Prasanna On Tue, Mar 3, 2009 at 6:09 AM, Tea Acuff wrote: that's what all parkinson patients say... ;) tea ________________________________ From: "rwmfglycar@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Monday, March 2, 2009 4:39:06 PM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Humble apologies for the clutter . I swear I only hit the button once Bob -----Original Message----- From: rwmfglycar@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:28 pm Subject: Re: [HSF] experimental heart valve operations? Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after fa iling with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________ ? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/listinfo/openheart-l? ? All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at:? http://www.hsforum.com/listdisclaim? -----------------------------------------? _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp..com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: ?OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers po sted 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 disc laimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Tue Mar 3 14:14:03 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Tue Mar 3 14:15:25 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <9f31286aeaa23752366478f50a04b1ae@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de><8CB6962B80B6D28-BE0-CC6@webmail-de17.sysops.aol.com><8aacc5327adea2cb81752147baf44fae@ruhr-uni-bochum.de><89c4ed2d0903030605j24d39c06he40aa0d448c7d494@mail.gmail.com> <9f31286aeaa23752366478f50a04b1ae@ruhr-uni-bochum.de> Message-ID: <8CB6A4B56FE92A0-888-6C@FWM-D45.sysops.aol.com> For that purpose, Sheep. Do not need to be juveniles.? Mitral position. Leave native valve in place. Left thoracotomy. One dose of cardioplegia or beating heart provided you keep the valve incompetent throughout and aspirate the top of the ventricle between circumflex and marginal and the ascending aorta before removing the transvalvular vent from the nearly closed atrial appendage. Most important is that vets declare the animal fit. No pneumonia, no anemia. ?Anesthesia should allow early spontaneous breathing and waking. Extubate as soon as breathes spontaneously. Chest tube can usually be removed within an hour. Should be standing in two hours. Keep the flock in a sunny airy room with straw on the floor. As soon as the?sheep stands send it back to the flock. They will gather round and provide comfort and recovery that you won't see if you try?to duplicate an ICU. Ignacio Gallo and I wrote this up in the 80's. I can't find the reference although I know I have a reprint somewhere. Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 4:42 pm Subject: Re: [HSF] experimental heart valve operations? exactly.? ? it is called THROMBOCHECK and produced by a german company called CARDIOSIGNAL. we do use it in pts especially with low anticoagulation routinely.? ? but the aim ist not to test the gadget, but some valves and the possibility of recognizing failures early. the changing parameter will be the valves and modifications of them.? ? thx again, axel? ? > Axel there is a commercial device available which was demonstrated to? > me with which a daily check can be done by the patient by keeping it? > over his chest. Any change in frequency mandates a clinical visit and? > echo to check for prosthetic valve dysfunction.? > Prasanna? >? > On Tue, Mar 3, 2009 at 4:40 PM, prof. dr. axel laczkovics? > wrote:? >> thx for your multiple(!) replies!? >>? >> the aim of the study is digital ?phonocardiography by measurement of >> the? >> opening and closing sounds of the protheses and other ?features like? >> resonance frequency et al.? >>? >> therefore it need to be a mechanical vlave, ?but the position is >> irrelevant.? >> ?the animal must survive only ?for some days.? >>? >> and for prasanna; ?y, i would never use dogs again. better walking >> with them? >> on a sunday morning!? >>? >> thx, axel? >>? >>> Mitral or aortic position? Mechanical or Bioprosthetic?? >>> Bob? >>>? >>> -----Original Message-----? >>> From: prof. dr. axel laczkovics >>> ? >>> To: OpenHeart-L@lists.hsforum.com? >>> Sent: Mon, 2 Mar 2009 5:05 pm? >>> Subject: [HSF] experimental heart valve operations?? >>>? >>>? >>> ?? >>> dear colleagues,?? >>> ?? >>> I am planing to perform valve implantations in animals. my last? >>> experiments training for cardiac transplantation dates back to the >>> early? >>> 80ies! at that time I switched from dogs to pigs and was finally >>> succesful? >>> after failing with dogs.?? >>> ?? >>> what would be your advice in selecting the right animal? pigs? >>> sheep??? >>> ?? >>> and for colleagues in germany or the netherlands: is anybody of you? >>> accidentally doing operations with the help of ECC in animals to >>> exchange? >>> ideas or have the possibility to send somebody to look and discuss >>> details??? >>> ?? >>> thx for helping, axel laczkovics?? >>> bochum?? >>> ?? >>> _______________________________________________?? >>> OpenHeart-L mailing list?? >>> ?? >>> Send postings to:?? >>> OpenHeart-L@lists.hsforum.com?? >>> ?? >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:?? >>> http://mmp.cjp.com/mailman/listinfo/openheart-l?? >>> ?? >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies? >>> and disclaimers posted at:?? >>> http://www.hsforum.com/listdisclaim?? >>> -----------------------------------------?? >>>? >>> _______________________________________________? >>> OpenHeart-L mailing list? >>>? >>> Send postings to:? >>> ?OpenHeart-L@lists.hsforum.com? >>>? >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:? >>> http://mmp.cjp.com/mailman/listinfo/openheart-l? >>>? >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies? >>> and? >>> disclaimers posted at:? >>> http://www.hsforum.com/listdisclaim? >>> -----------------------------------------? >>>? >>? >> _______________________________________________? >> OpenHeart-L mailing list? >>? >> Send postings to:? >> OpenHeart-L@lists.hsforum.com? >>? >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:? >> http://mmp.cjp.com/mailman/listinfo/openheart-l? >>? >> All messages transmitted by the OpenHeart-L are subject to the >> policies and? >> disclaimers posted at:? >> http://www.hsforum.com/listdisclaim? >> -----------------------------------------? >>? >? >? >? > -- > Prasanna Simha M? > _______________________________________________? > OpenHeart-L mailing list? >? > Send postings to:? > OpenHeart-L@lists.hsforum.com? >? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? >? > All messages transmitted by the OpenHeart-L are subject to the > policies and? > disclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? >? ? _______________________________________________? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/listinfo/openheart-l? ? All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at:? http://www.hsforum.com/listdisclaim? -----------------------------------------? From jgammie at gmail.com Tue Mar 3 15:06:57 2009 From: jgammie at gmail.com (James Gammie) Date: Tue Mar 3 15:39:47 2009 Subject: [HSF] Apicoaortic conduit a note In-Reply-To: References: <89c4ed2d0902281810i41b09db4nb435ac2704dd6be6@mail.gmail.com> Message-ID: <428D2B00-B224-439C-A688-04749DB2ED92@gmail.com> Ani: Thanks for sharing your experience w long-surviving AVB pt. On CT most of these pts have some calcium in wall of descending aorta - often it feels eggshell like on palpation - we have just gone ahead and put partial clamp on and sewed and it works out fine. Would NOT operate if calcium is dense and circumferential - this is quite uncommon JSG On Mar 3, 2009, at 1:26 PM, Ani Anyanwu wrote: > > Thanks a lot for the clarification Dr Gammie. Always good to hear > from the experts. I must say I now remember coming accross a patient > in London who had one of these in the late 1960s and was doing well > 30 years out. I had not appreciated that there remains considerable > flow through the native valve which would be the major difference > compared to the LVAD scenario I referred to. How bad must the > descending aorta be for you do decide that too is unclampable? One > of my colleagues has talked about bypassing to the subclavian > artery, rather than descending aorta, when there is descending > disease - is this something you have experience in or advocate? > > > > Ani > > > > > >> From: jgammie@gmail.com >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Apicoaortic conduit a note >> Date: Tue, 3 Mar 2009 10:32:05 -0500 >> CC: >> >> Ani >> We have found that aortic valve bypass (AVB, apicoaortic conduit) >> surgery affords the surgeon the opportunity to treat AS without cpb, >> without xclamping the ascending aorta, and without cardioplegic >> cardiac arrest. It is ideally suited for the patient with a porcelain >> ascending aorta who would be at high risk for brain injury with >> conventional avr, as well as the pt with a prior sternotomy and >> patent >> grafts. The patient reported by Parsa and colleagues had a very low >> EF >> and was in cardiogenic shock on arrival to the OR. Cpb was used and >> an lvad was placed for failure to wean. In our combined experience of >>> 100 AVBs, John Brown and I have never observed thrombosis of the >> aorta. Pts receive asa only. All pts have routine ptedismissal echo >> and either MRI or ct. Flow split is quite consistent with 70 % via >> conduit and 30% native valve (circulation 2008 118:1460). We have >> noted that the native as does not progress over time. We now >> routinely perform avb without cpb through a small left chest >> incision. John has several patients out > 25 years doing well. So >> while AVB surgery is of great value for high-risk AS patients we >> would >> avoid it for a pt with abysmal ventricular function and cardiogenic >> shock who likely would be better served with initial mechanical >> circulatory support or nonoperative management. >> JSG >> >> >> >> >> >> On Feb 28, 2009, at 9:16 PM, Ani Anyanwu >> wrote: >> >>> >>> This complication is well recognized when ventricular assist device >>> outflows are connected to the descending aorta. To avoid this some >>> surgeons will try and offload the heart only partially such that >>> the aortic valve opens intermittently. >>> >>> >>> >>> It serves though as a reminder that apicoaortic conduits are not a >>> procedure of convenience and where possible antegrade blood flow is >>> preferable. For a patient with a ventricular assist device to the >>> descending aorta, the consequences of aortic root thrombosis are not >>> so dire as the VAD carries the left circulation but for an apical >>> conduit same can be fatal. >>> >>> >>> >>> Ani >>> >>> >>> >>> >>> >>>> Date: Sun, 1 Mar 2009 07:40:07 +0530 >>>> From: prasannasimha@gmail.com >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> Subject: [HSF] Apicoaortic conduit a note >>>> >>>> 1: Ann Thorac Surg. 2009 Mar;87(3):927-928. >>>> >>>> A Previously Unreported Complication of Apicoaortic Conduit for >>>> Severe Aortic >>>> Stenosis. >>>> >>>> Parsa CJ, Milano CA, Proia AD, Mackensen GB, Hughes GC. >>>> >>>> Department of Surgery, Division of Thoracic and Cardiovascular >>>> Surgery, Duke >>>> University Medical Center, Durham, North Carolina; Department of >>>> Pathology, Duke >>>> University Medical Center, Durham, North Carolina; Department of >>>> Anesthesiology, >>>> Duke University Medical Center, Durham, North Carolina. >>>> >>>> Given the aging population, use of an apicoaortic conduit serves as >>>> an >>>> alternative method to treat severe aortic stenosis, especially in >>>> patients with a >>>> heavily calcified ascending aorta or prior cardiac surgery. >>>> Although an >>>> apicoaortic conduit fractionates systemic blood flow, it does so >>>> without >>>> significant deleterious effects. However, we report a novel >>>> complication with >>>> thrombosis of the aortic root and subsequent coronary insufficiency >>>> that likely >>>> resulted from a preponderance of cardiac output though the >>>> apicoaortic conduit >>>> with stagnation of native antegrade blood flow. Given increasing >>>> use of the >>>> apicoaortic conduit procedure, surgeons considering this approach >>>> should be >>>> familiar with this potential complication. >>>> >>>> >>>> PMID: 19231422 [PubMed - as supplied by publisher] >>>> >>>> >>>> >>>> -- >>>> 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 >>>> ----------------------------------------- >>> >>> _________________________________________________________________ >>> Twice the fun?Share photos while you chat with Windows Live Mess >>> enge >>> r. Learn more. >>> http://www.microsoft.com/uk/windows/windowslive/products/messenger.aspx_______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > 25GB of FREE Online Storage ? Find out more > http://clk.atdmt.com/UKM/go/134665320/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From rwmfglycar at aol.com Tue Mar 3 16:00:10 2009 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Tue Mar 3 16:01:04 2009 Subject: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT In-Reply-To: <675695.40792.qm@web81601.mail.mud.yahoo.com> References: <675695.40792.qm@web81601.mail.mud.yahoo.com> Message-ID: <8CB6A5A2CA641D1-1048-EE3@WEBMAIL-DF07.sysops.aol.com> He would have laughed and laughed at that comment. -----Original Message----- From: Tea Acuff To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 9:00 pm Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT Well at least I can understand that he did not want to waste his brain in D.C.! Tea Sent from my iPhone On Mar 3, 2009, at 12:49 PM, rwmfglycar@aol.com wrote: Thank you Tea. It turns ?out that he died at 3am in Washington DC and his brain reached Columbia?in NY City?at 10 am. All his friends agreed that he would have roared with approval at such efficiency and organisation. Bob -----Original Message----- From: Tea Acuff To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 6:07 pm Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT Why does a boy continue to poke with a stick well beyond his first admonishment and childhood years? He may have learned that the occasional new insights are worth the occasional beatings. A?toast to your Stewart and all his namesakes who have provided us with long careers of stick poking... A?toast to?Stewart's teacher as well, but may I have that honor in person. tea ? ________________________________ From: "rwmfglycar@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Tuesday, March 3, 2009 2:01:24 AM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Parkinson's andperfusion OT I did not take offense. No, although it is a fascinating exercise to track the changes in our bodies. Yesterday I had messages on my cellphone making sure that I knew Stewart had died. When I got to Einstein in in 1964 he was the first perfusionist I trained. He was terrific in every way. 15 years after we started together?he told me he had been diagnosed with Parkinson's. Not ?one of us had in any way spotted it. We made a pact. His medical records would be totally available to me. He would undergo cognitive testing and motor skills testing once a year. I would tell my colleagues confidentially. He would tell his two perfusion mates. He would be watched by all of us but we would expect him to tell us that he could not achieve his and our standards of per formance. One of my colleagues thought I was irresponsibly mad but went along with the plan. We never even thought of telling the administration. He stopped perfusing voluntarily?after about?8 years. By then a keen observer would have picked up slower movements and? slower speech. He had retained all of his former quick wit and keen mind. He had read Dwight Mcgoon's book and followed his example. He went into a randomised trial (turned out he was in the placebo arm), took up pet watching to keep himself occupied. He progressed steadily but in his last year deteriorated rapidly with severe cognitive loss. His goo d wife Judy took care of his wishes to have his brain sent to Columbia University and his body cremated. Later this year we will gather from various parts to swap Stewart stories and raise a glass?in his memory. Bob -----Original Message----- From: Tea Acuff To: OpenHeart-L@lists.hsforum.com Sent: Tue, 3 Mar 2009 4:50 am Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Undoubtedly I will deserve it. I just hope that you, too, are not smit with the Parkinson tremor. Although i may also deserve that. tea ________________________________ From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Monday, March 2, 2009 7:19:49 PM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Tea I'll give you a rap on the head. Prasanna On Tue, Mar 3, 2009 at 6:09 AM, Tea Acuff wrote: that's what all parkinson patients say... ;) tea ________________________________ From: "rwmfglycar@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Monday, March 2, 2009 4:39:06 PM Subject: Re: [HSF] experimental heart valve operations? apologies for clutter Humble apologies for the clutter . I swear I only hit the button once Bob -----Original Message----- From: rwmfglycar@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:28 pm Subject: Re: [HSF] experimental heart valve operations? Mitral or aortic position? Mechanical or Bioprosthetic? Bob -----Original Message----- From: prof. dr. axel laczkovics To: OpenHeart-L@lists.hsforum.com Sent: Mon, 2 Mar 2009 5:05 pm Subject: [HSF] experimental heart valve operations? ? dear colleagues,? ? I am planing to perform valve implantations in animals. my last experiments training for cardiac transplantation dates back to the early 80ies! at that time I switched from dogs to pigs and was finally succesful after fa iling with dogs.? ? what would be your advice in selecting the right animal? pigs? sheep?? ? and for colleagues in germany or the netherlands: is anybody of you accidentally doing operations with the help of ECC in animals to exchange ideas or have the possibility to send somebody to look and discuss details?? ? thx for helping, axel laczkovics? bochum? ? _______________________________________________ ? OpenHeart-L mailing list? ? Send postings to:? OpenHeart-L@lists.hsforum.com? ? To UNSUBSCRIBE, to CHANGE email address, or to view archives:? http://mmp.cjp.com/mailman/listinfo/openheart-l? ? All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at:? http://www.hsforum.com/listdisclaim? -----------------------------------------? _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp..com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subje ct to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: ?OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers po sted 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 disc laimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Jbflegejr at aol.com Tue Mar 3 17:48:34 2009 From: Jbflegejr at aol.com (Jbflegejr@aol.com) Date: Tue Mar 3 17:51:26 2009 Subject: [HSF] Recurrent pericardial effusion Message-ID: If you have used steroids without relief, I would suggest pericardiectomy. John Flege **************A Good Credit Score is 700 or Above. See yours in just 2 easy steps! (http://pr.atwola.com/promoclk/100126575x1219957551x1201325337/aol?redir=http:%2F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%3D668072%26hmpgID %3D62%26bcd%3DfebemailfooterNO62) From grescigno at mac.com Tue Mar 3 23:50:29 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Tue Mar 3 17:57:50 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <89c4ed2d0903030816n782c2cb6g15b527299557563a@mail.gmail.com> References: <14211287630034541604787844435911961481-Webmail@me.com> <177063.16716.qm@web81607.mail.mud.yahoo.com> <148302319049870696803130798830159874623-Webmail@me.com> <89c4ed2d0903030816n782c2cb6g15b527299557563a@mail.gmail.com> Message-ID: Prasanna, we have already used steroids without effect. Could you please explain how to create this fistula? Thanks Giuseppe Il giorno 03/mar/09, alle ore 17:16, Prasanna Simha M ha scritto: > I would make a pericardio peritoneal fistula into the bare area of the > liver. This has extensive lymphatics and will drain.Has tuberculosis > and sarcoid been ruled out ? I had one patient who drained and had an > autoimmune disease and it stopped after we started steroids. > Prasanna > > Prasanna > > On Tue, Mar 3, 2009 at 9:33 PM, Giuseppe Rescigno > wrote: >> Tea, >> >> he still has a pigtail, inserted by our cardiologist into the >> pericardial cavity. Our windows do not work anymore. >> >> Giuseppe >> >> Giuseppe Rescigno M.D. >> Cardiothoracic Surgeon >> >> Lancisi Hospital >> Torrette - Ancona >> Italy >> >> >> >> On Tuesday, March 03, 2009, at 04:41PM, "Tea Acuff" >> wrote: >>> This is unusual and I do not understand it. Why does not the >>> 200cc per day disappear into or become a pleural effusion? >>> >>> tea >>> >>> >>> >>> >>> ________________________________ >>> From: Giuseppe Rescigno >>> To: "OpenHeart-L@lists.hsforum.com" >>> Sent: Tuesday, March 3, 2009 9:30:30 AM >>> Subject: [HSF] Recurrent pericardial effusion >>> >>> >>> Dear Members, >>> >>> I need your advice concenrning a patient, operated on for CABG in >>> another center, that we admitted for postoperative (1 mo) >>> pericardial effusion. He underwent 2 percutaneous drainages and >>> subsequently 2 pleuro-pericardial windows by left and right >>> minithoracotomies. All cancer markers are negative as well as CT >>> scans. Nervertheless he still produces 200 mL of effusion each >>> day. We have tried all the possible drugs. Is there anyone who >>> has experience with glue injection or some other voodoos? >>> >>> Thanks in advance >>> >>> 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 >> ----------------------------------------- >> > > > > -- > 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 Mar 4 06:50:08 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Mar 3 20:20:34 2009 Subject: [HSF] Ntric vs FloLan In-Reply-To: References: Message-ID: <89c4ed2d0903031720n760f38u1866318b539e17df@mail.gmail.com> I will give a still cheaper alternative to NO. You can use Inhaled sodium nitroprusside. It works as well as NO !! Especially if you give Sildenafil. We have NO but use it rarely (and all the more after we had problems with the delivery system). I have found (Inhaled SNP) works very well. Prasanna On Tue, Mar 3, 2009 at 11:38 PM, Ani Anyanwu wrote: > > We shifted from inhaled nitric oxide to nebulized Epoprostenol about two years ago, I am sure for the same reason why your hospital is having such interest (i.e. cost). > > > > We use epoprostenol in I would say 95% of cases in preference to NO to modulate pulmonary vascular resistance. NO we use when we need to set it up in a hurry (logistically easier), where there is non-response to epoprostenol (but usually wont respond to nitric either) or for other 'indication' (such as ARDs or physician preference). In the OR I prefer to start with Nitric because it is logistically easier to set up and delivery more guaranteed. If patients come out of the OR on NO, they are usually converted to epoprostenol shortly after arrival to ICU. I had one patient die following pulmonary hypertensive crisis during such conversion but do not know if that was causative or incidental. > > > > Overall I do not perceive a difference in outcomes now we use epoprostenol routinely compared to previously when we used NO routinely. Of course it is not certain either affects patient outcomes but that is a an issue for debate. > > > > I think though you should curtail your use of NO as find it hard to imagine why you would have 2 patients or more on NO at any given time when several alternative management modalities should be suitable in most patients. If you do not control your use, you may find one day you will no longer have access to it as was the case in a big VAD center where NO was withdrawn from hospital formulary because of rampant use by surgeons. Of course when those surgeons where asked to provide data of its benefit there were none so hospital said they could not justify such cost for a therapy where there was no evidence of benefit. This is partly why we moved to epoprostenol so in that way we regulated our use of NO, and by minimizing rampant use we are not under radar of hospital cost police but can continue to use it selectively when we desire. > > > > Ani > > > > > > > > > >> Date: Tue, 3 Mar 2009 12:32:26 -0500 >> From: msfirst@gmail.com >> To: OpenHeart-L@lists.hsforum.com >> CC: >> Subject: [HSF] Ntric vs FloLan >> >> For a variety of reasons, there is much interest in switching from nitric >> oxide (which we use a lot of - we always have at least 2 patients on it at >> all times) to inhaled floLan. I have no experience with inhaled floLab, but >> swear by iNO - any comments/thoughts/experiences? >> >> thanks >> >> >> -michael >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > All your Twitter and other social updates in one place > 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 From ecdouville at orclinic.com Tue Mar 3 17:29:29 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Tue Mar 3 20:31:43 2009 Subject: [HSF] Ntric vs FloLan In-Reply-To: <89c4ed2d0903031720n760f38u1866318b539e17df@mail.gmail.com> References: <89c4ed2d0903031720n760f38u1866318b539e17df@mail.gmail.com> Message-ID: <0818212D-F89A-427C-B609-161A660D60BD@orclinic.com> How do you deliver it Prasanna? Sent from my iPhone On Mar 3, 2009, at 5:21 PM, "Prasanna Simha M" wrote: > I will give a still cheaper alternative to NO. You can use Inhaled > sodium nitroprusside. It works as well as NO !! Especially if you give > Sildenafil. We have NO but use it rarely (and all the more after we > had problems with the delivery system). I have found (Inhaled SNP) > works very well. > Prasanna > > On Tue, Mar 3, 2009 at 11:38 PM, Ani Anyanwu > wrote: >> >> We shifted from inhaled nitric oxide to nebulized Epoprostenol >> about two years ago, I am sure for the same reason why your >> hospital is having such interest (i.e. cost). >> >> >> >> We use epoprostenol in I would say 95% of cases in preference to NO >> to modulate pulmonary vascular resistance. NO we use when we need >> to set it up in a hurry (logistically easier), where there is non- >> response to epoprostenol (but usually wont respond to nitric >> either) or for other 'indication' (such as ARDs or physician >> preference). In the OR I prefer to start with Nitric because it is >> logistically easier to set up and delivery more guaranteed. If >> patients come out of the OR on NO, they are usually converted to >> epoprostenol shortly after arrival to ICU. I had one patient die >> following pulmonary hypertensive crisis during such conversion but >> do not know if that was causative or incidental. >> >> >> >> Overall I do not perceive a difference in outcomes now we use >> epoprostenol routinely compared to previously when we used NO >> routinely. Of course it is not certain either affects patient >> outcomes but that is a an issue for debate. >> >> >> >> I think though you should curtail your use of NO as find it hard to >> imagine why you would have 2 patients or more on NO at any given >> time when several alternative management modalities should be >> suitable in most patients. If you do not control your use, you may >> find one day you will no longer have access to it as was the case >> in a big VAD center where NO was withdrawn from hospital formulary >> because of rampant use by surgeons. Of course when those surgeons >> where asked to provide data of its benefit there were none so >> hospital said they could not justify such cost for a therapy where >> there was no evidence of benefit. This is partly why we moved to >> epoprostenol so in that way we regulated our use of NO, and by >> minimizing rampant use we are not under radar of hospital cost >> police but can continue to use it selectively when we desire. >> >> >> >> Ani >> >> >> >> >> >> >> >> >> >>> Date: Tue, 3 Mar 2009 12:32:26 -0500 >>> From: msfirst@gmail.com >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> Subject: [HSF] Ntric vs FloLan >>> >>> For a variety of reasons, there is much interest in switching from >>> nitric >>> oxide (which we use a lot of - we always have at least 2 patients >>> on it at >>> all times) to inhaled floLan. I have no experience with inhaled >>> floLab, but >>> swear by iNO - any comments/thoughts/experiences? >>> >>> thanks >>> >>> >>> -michael >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _________________________________________________________________ >> All your Twitter and other social updates in one place >> 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 > ----------------------------------------- From prasannasimha at gmail.com Wed Mar 4 07:07:59 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Mar 3 20:38:18 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: References: <14211287630034541604787844435911961481-Webmail@me.com> <177063.16716.qm@web81607.mail.mud.yahoo.com> <148302319049870696803130798830159874623-Webmail@me.com> <89c4ed2d0903030816n782c2cb6g15b527299557563a@mail.gmail.com> Message-ID: <89c4ed2d0903031737o1b8ce4c9n14acb0b3a18c2ba7@mail.gmail.com> Basically it is a generous excision of a V wedge of the diaphragm in the inferior part of the partial hemisternotomy to expose the bare area of the liver. Prasanna On Wed, Mar 4, 2009 at 4:20 AM, Giuseppe Rescigno wrote: > Prasanna, > we have already used steroids without effect. Could you please explain how > to create this fistula? > Thanks > > Giuseppe > > > Il giorno 03/mar/09, alle ore 17:16, Prasanna Simha M ha scritto: > >> I would make a pericardio peritoneal fistula into the bare area of the >> liver. This has extensive lymphatics and will drain.Has tuberculosis >> and sarcoid been ruled out ? I had one patient who drained and had an >> autoimmune disease and it stopped after we started steroids. >> Prasanna >> >> Prasanna >> >> On Tue, Mar 3, 2009 at 9:33 PM, Giuseppe Rescigno >> wrote: >>> >>> Tea, >>> >>> he still has a pigtail, inserted by our cardiologist into the pericardial >>> cavity. Our windows do not work anymore. >>> >>> Giuseppe >>> >>> Giuseppe Rescigno M.D. >>> Cardiothoracic Surgeon >>> >>> Lancisi Hospital >>> Torrette - Ancona >>> Italy >>> >>> >>> >>> On Tuesday, March 03, 2009, at 04:41PM, "Tea Acuff" >>> wrote: >>>> >>>> This is unusual and I do not understand it. Why does not the 200cc per >>>> day disappear into or become a pleural effusion? >>>> >>>> tea >>>> >>>> >>>> >>>> >>>> ________________________________ >>>> From: Giuseppe Rescigno >>>> To: "OpenHeart-L@lists.hsforum.com" >>>> Sent: Tuesday, March 3, 2009 9:30:30 AM >>>> Subject: [HSF] Recurrent pericardial effusion >>>> >>>> >>>> Dear Members, >>>> >>>> I need your advice concenrning a patient, operated on for CABG in >>>> another center, that we admitted for postoperative (1 mo) pericardial >>>> effusion. He underwent 2 percutaneous drainages and subsequently 2 >>>> pleuro-pericardial windows by left and right minithoracotomies. All cancer >>>> markers are negative as well as CT scans. Nervertheless he still produces >>>> 200 mL of effusion each day. We have tried all the possible drugs. Is there >>>> anyone who has experience with glue injection or some other voodoos? >>>> >>>> Thanks in advance >>>> >>>> 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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Wed Mar 4 07:12:24 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue Mar 3 21:10:49 2009 Subject: [HSF] Ntric vs FloLan In-Reply-To: <0818212D-F89A-427C-B609-161A660D60BD@orclinic.com> References: <89c4ed2d0903031720n760f38u1866318b539e17df@mail.gmail.com> <0818212D-F89A-427C-B609-161A660D60BD@orclinic.com> Message-ID: <89c4ed2d0903031742t1b28cb02hcf42bd7f3c97c722@mail.gmail.com> Hook a nebulizer into the circuit and use the either two methods - A syringe pump with nitroprusside that feeds the SNP into the nebulizer via a port or by sticking a needle into it in a disposable nebulizer at the rate that you want or feed the hourly or half hourly amount manually. After extubation it can be given via a face mask and nebulizer.Remember to keep all HME filters near the machine end so that the nebulized drug reaches the patient. Prasanna On Wed, Mar 4, 2009 at 6:59 AM, Douville, Chuck wrote: > How do you deliver it Prasanna? > > Sent from my iPhone > > On Mar 3, 2009, at 5:21 PM, "Prasanna Simha M" > wrote: > >> I will give a still cheaper alternative to NO. You can use Inhaled >> sodium nitroprusside. It works as well as NO !! Especially if you give >> Sildenafil. We have NO but use it rarely (and all the more after we >> had problems with the delivery system). I have found (Inhaled SNP) >> works very well. >> Prasanna >> >> On Tue, Mar 3, 2009 at 11:38 PM, Ani Anyanwu >> wrote: >>> >>> We shifted from inhaled nitric oxide to nebulized Epoprostenol about two >>> years ago, I am sure for the same reason why your hospital is having such >>> interest (i.e. cost). >>> >>> >>> >>> We use epoprostenol in I would say 95% of cases in preference to NO to >>> modulate pulmonary vascular resistance. NO we use when we need to set it up >>> in a hurry (logistically easier), where there is non-response to >>> epoprostenol (but usually wont respond to nitric either) or for other >>> 'indication' (such as ARDs or physician preference). In the OR I prefer to >>> start with Nitric because it is logistically easier to set up and delivery >>> more guaranteed. If patients come out of the OR on NO, they are usually >>> converted to epoprostenol shortly after arrival to ICU. I had one patient >>> die following pulmonary hypertensive crisis during such conversion but do >>> not know if that was causative or incidental. >>> >>> >>> >>> Overall I do not perceive a difference in outcomes now we use >>> epoprostenol routinely compared to previously when we used NO routinely. Of >>> course it is not certain either affects patient outcomes but that is a an >>> issue for debate. >>> >>> >>> >>> I think though you should curtail your use of NO as find it hard to >>> imagine why you would have 2 patients or more on NO at any given time when >>> several alternative management modalities should be suitable in most >>> patients. If you do not control your use, you may find one day you will no >>> longer have access to it as was the case in a big VAD center where NO was >>> withdrawn from hospital formulary because of rampant use by surgeons. Of >>> course when those surgeons where asked to provide data of its benefit there >>> were none so hospital said they could not justify such cost for a therapy >>> where there was no evidence of benefit. This is partly why we moved to >>> epoprostenol so in that way we regulated our use of NO, and by minimizing >>> rampant use we are not under radar of hospital cost police but can continue >>> to use it selectively when we desire. >>> >>> >>> >>> Ani >>> >>> >>> >>> >>> >>> >>> >>> >>> >>>> Date: Tue, 3 Mar 2009 12:32:26 -0500 >>>> From: msfirst@gmail.com >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> Subject: [HSF] Ntric vs FloLan >>>> >>>> For a variety of reasons, there is much interest in switching from >>>> nitric >>>> oxide (which we use a lot of - we always have at least 2 patients on it >>>> at >>>> all times) to inhaled floLan. I have no experience with inhaled floLab, >>>> but >>>> swear by iNO - any comments/thoughts/experiences? >>>> >>>> thanks >>>> >>>> >>>> -michael >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> >>> _________________________________________________________________ >>> All your Twitter and other social updates in one place >>> >>> 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 >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, 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 tdmartin2000 at aol.com Tue Mar 3 21:26:48 2009 From: tdmartin2000 at aol.com (tdmartin2000@aol.com) Date: Tue Mar 3 21:27:45 2009 Subject: [HSF] Ntric vs FloLan In-Reply-To: References: Message-ID: <8CB6A87CDB1CCDA-308-16DA@WEBMAIL-MY27.sysops.aol.com> Michael- same here. Flolan works. I am not sure it is as good as iNO but it does work. It is also way less expensive and that is the reason, at least here, for the push. Tom Martin U of Florida Gainesville -----Original Message----- From: Michael Firstenberg To: openheart-l Sent: Tue, 3 Mar 2009 12:32 pm Subject: [HSF] Ntric vs FloLan For a variety of reasons, there is much interest in switching from nitric oxide (which we use a lot of - we always have at least 2 patients on it at all times) to inhaled floLan. I have no experience with inhaled floLab, but swear by iNO - any comments/thoughts/experiences? thanks -michael _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From drmitch at cox.net Tue Mar 3 22:06:49 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Tue Mar 3 23:08:59 2009 Subject: [HSF] Choice of conduit Message-ID: <6.2.1.2.2.20090303213534.0403b818@pop.east.cox.net> Greetings I really don't want to beat this subject to death, but varied opinions are sought: A 50yo AA male, non-diabetic, has had multiple PTCA's over the years. He returns with unstable pain. LHC shows a big, normal LAD save for the very apical bifurcation vessels. There is an 80% ISR in a good D2, and the OM. The "ongoing Cx" trifucates after the OM with a proximal 90% lesion in the "feeder" vessel. The RCA is a series of high-grade ISR with patent AM, PDA, and PLA. All good vessels. LV is normal. I'm kinda hesitant to take down the LIMA for a diag or a distal circ. A skeletonized RIMA won't reach all the way out. I think I do that op pretty well and I just don't think it'll go. So here's what I think: sequential svg to D and OM. RA from the hood of the svg to the distal Cx. An svg to the AM (graft?/ no graft?) and perhaps a GEA to the distal Rt system. Any takers? Thanks in advance. Mitch From donross at bigpond.com Wed Mar 4 15:41:05 2009 From: donross at bigpond.com (Donald Ross) Date: Tue Mar 3 23:41:37 2009 Subject: [HSF] Choice of conduit In-Reply-To: <6.2.1.2.2.20090303213534.0403b818@pop.east.cox.net> References: <6.2.1.2.2.20090303213534.0403b818@pop.east.cox.net> Message-ID: Hold your breath ,Mitch, Lima to Dl, Composite Rima-Radial through sinus to Cx & pda etc. ( This graft will reach to the acute marginal) Treat potential lad stenosis with statins. Don On 04/03/2009, at 3:06 PM, Mitch Lirtzman wrote: > Greetings > > I really don't want to beat this subject to death, but varied > opinions are sought: > > A 50yo AA male, non-diabetic, has had multiple PTCA's over the > years. He returns with unstable pain. LHC shows a big, normal LAD > save for the very apical bifurcation vessels. There is an 80% ISR in > a good D2, and the OM. The "ongoing Cx" trifucates after the OM with > a proximal 90% lesion in the "feeder" vessel. The RCA is a series of > high-grade ISR with patent AM, PDA, and PLA. All good vessels. LV is > normal. > > I'm kinda hesitant to take down the LIMA for a diag or a distal > circ. A skeletonized RIMA won't reach all the way out. I think I do > that op pretty well and I just don't think it'll go. > > So here's what I think: sequential svg to D and OM. RA from the hood > of the svg to the distal Cx. An svg to the AM (graft?/ no graft?) > and perhaps a GEA to the distal Rt system. Any takers? > Thanks in advance. > > Mitch > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mar 4 08:05:10 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Mar 4 02:06:00 2009 Subject: [HSF] experimental heart valve operations? In-Reply-To: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> References: <62b257abcea79a008ddd3348846e26ab@ruhr-uni-bochum.de> Message-ID: Axel, contact Thomas Walther in Leipzig, walt@medizin.uni-leipzig.de He is working and worked in val?ves. Roberto > Date: Mon, 2 Mar 2009 16:05:50 +0100 > From: axel.m.laczkovics@ruhr-uni-bochum.de > To: OpenHeart-L@lists.hsforum.com > CC: > Subject: [HSF] experimental heart valve operations? > > > > dear colleagues, > > I am planing to perform valve implantations in animals. my last > experiments training for cardiac transplantation dates back to the > early 80ies! at that time I switched from dogs to pigs and was > finally succesful after failing with dogs. > > what would be your advice in selecting the right animal? pigs? sheep? > > and for colleagues in germany or the netherlands: is anybody of you > accidentally doing operations with the help of ECC in animals to > exchange ideas or have the possibility to send somebody to look and > discuss details? > > thx for helping, axel laczkovics > bochum > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 drdharris at yahoo.co.uk Wed Mar 4 01:30:37 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Wed Mar 4 04:32:24 2009 Subject: [HSF] Choice of conduit In-Reply-To: Message-ID: <560069.62662.qm@web24709.mail.ird.yahoo.com> I`m not too sure a radial on the hood of a vein is a good thing. I had a case where they both went down at the ostium, so have never done it again. If the aorta is thin, and the radial a good caliber (should only use if good caliber) then put it on aorta. ? In this case I would do bilat skeletonised IMA, with OPCAB: LIMA to D1, and RIMA off LIMA with sequentials to Cx system. Radial to distal right branches. ? I did a similar case a few months ago, you can reach all the L sided vessels nicely with the IMA s. ? The only instrumentation of the aorta is a single side clamp to the aorta for the radial. Dave Harris ? --- On Wed, 4/3/09, Donald Ross wrote: From: Donald Ross Subject: Re: [HSF] Choice of conduit To: OpenHeart-L@lists.hsforum.com Date: Wednesday, 4 March, 2009, 6:41 AM Hold your breath ,Mitch, Lima to Dl, Composite Rima-Radial through sinus to Cx & pda etc. ( This graft will reach to the acute marginal) Treat potential lad stenosis with statins. Don On 04/03/2009, at 3:06 PM, Mitch Lirtzman wrote: > Greetings > > I really don't want to beat this subject to death, but varied opinions are sought: > > A 50yo AA male, non-diabetic, has had multiple PTCA's over the years. He returns with unstable pain. LHC shows a big, normal LAD save for the very apical bifurcation vessels. There is an 80% ISR in a good D2, and the OM. The "ongoing Cx" trifucates after the OM with a proximal 90% lesion in the "feeder" vessel. The RCA is a series of high-grade ISR with patent AM, PDA, and PLA. All good vessels. LV is normal. > > I'm kinda hesitant to take down the LIMA for a diag or a distal circ. A skeletonized RIMA won't reach all the way out. I think I do that op pretty well and I just don't think it'll go. > > So here's what I think: sequential svg to D and OM. RA from the hood of the svg to the distal Cx. An svg to the AM (graft?/ no graft?) and perhaps a GEA to the distal Rt system. Any takers? > Thanks in advance. > > Mitch > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From drdharris at yahoo.co.uk Wed Mar 4 01:37:44 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Wed Mar 4 04:39:30 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: Message-ID: <203293.3371.qm@web24705.mail.ird.yahoo.com> I had this once in a paediatric case. Same story. Many drainages. After she came back with tamponade and nearly died, we did a pericardiectomy, and that fixed the problem immediately Dave --- On Wed, 4/3/09, Giuseppe Rescigno wrote: From: Giuseppe Rescigno Subject: Re: [HSF] Recurrent pericardial effusion To: OpenHeart-L@lists.hsforum.com Date: Wednesday, 4 March, 2009, 12:50 AM Prasanna, we have already used steroids without effect. Could you please explain how to create this fistula? Thanks Giuseppe Il giorno 03/mar/09, alle ore 17:16, Prasanna Simha M ha scritto: > I would make a pericardio peritoneal fistula into the bare area of the > liver. This has extensive lymphatics and will drain.Has tuberculosis > and sarcoid been ruled out ? I had one patient who drained and had an > autoimmune disease and it stopped after we started steroids. > Prasanna > > Prasanna > > On Tue, Mar 3, 2009 at 9:33 PM, Giuseppe Rescigno wrote: >> Tea, >> >> he still has a pigtail, inserted by our cardiologist into the pericardial cavity. Our windows do not work anymore. >> >> Giuseppe >> >> Giuseppe Rescigno M.D. >> Cardiothoracic Surgeon >> >> Lancisi Hospital >> Torrette - Ancona >> Italy >> >> >> >> On Tuesday, March 03, 2009, at 04:41PM, "Tea Acuff" wrote: >>> This is unusual and I do not understand it. Why does not the 200cc per day disappear into or become a pleural effusion? >>> >>> tea >>> >>> >>> >>> >>> ________________________________ >>> From: Giuseppe Rescigno >>> To: "OpenHeart-L@lists.hsforum.com" >>> Sent: Tuesday, March 3, 2009 9:30:30 AM >>> Subject: [HSF] Recurrent pericardial effusion >>> >>> >>> Dear Members, >>> >>> I need your advice concenrning a patient, operated on for CABG in another center, that we admitted for postoperative (1 mo) pericardial effusion. He underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial windows by left and right minithoracotomies. All cancer markers are negative as well as CT scans. Nervertheless he still produces 200 mL of effusion each day. We have tried all the possible drugs. Is there anyone who has experience with glue injection or some other voodoos? >>> >>> Thanks in advance >>> >>> 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 >> ----------------------------------------- >> > > > > --Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From drdharris at yahoo.co.uk Wed Mar 4 02:14:40 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Wed Mar 4 05:16:27 2009 Subject: [HSF] On pump vs Off In-Reply-To: Message-ID: <839986.48143.qm@web24716.mail.ird.yahoo.com> I agree fully with Erdinck, and do the proximals the same way. No problems with neurological side effects. In the ideal situation it would be nice to use IMA y graft for everything. But a lot of cases have moderate stenoses. If you do not gragt these, patient will be back in 3 years for stents of ungrafted vessels. Sometimes by letting the cardio`s stent the RCA (if good for stenting) we can create more patients for no touch left sided grafts. Obviously in patients with hard aorta`s there is no option for top ends there, but in the case of moderate stenoses one can put top ends on innominate artery. Dave --- On Sat, 7/2/09, erdin? naseri wrote: From: erdin? naseri Subject: RE: [HSF] On pump vs Off To: "HSF HSF" Date: Saturday, 7 February, 2009, 2:45 PM robertto I am aware of Don's excellent results with aortic no touch and arterial grafts but the fact is that it is not possible all the times .In a good percentage of our CABG cases still we use 1-2 vein grafts specially for RCa and branches with proximal anastomosis using side biting clamp.Mine was only my experience but I know many other surgeons who agree . erdinc> From: robertobattellini@hotmail.com> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] On pump vs Off> Date: Sat, 7 Feb 2009 09:45:55 +0100> > > Erdinc,> The cases 1001,1002 will have a cerebral embolization.> With our old population with peripheral arteriopathy and carotid stenosis, is very different.> I could send many very nice Rx from those aortas.> Most of the patients with carotid stenosis have "bad aortas".> Listen to Don, and read his letter to Csnet a year ago.> Roberto> From: enaseri@hotmail.com.tr> To: openheart-l@lists.hsforum.com> Subject: RE: [HSF] On pump vs Off> Date: Fri, 6 Feb 2009 18:12:18 +0000> > > Dear forum members,> Regarding proximal anastomotic tech.s :I have put side biting clamp on aorta in OPCAB cases for at least a thousand times and the immediate postop neurologic events were all in on pump patients.Our protocol is to decrease Bp before clampnig either pharmacologicaly or mechanically( many ways) ,inspect inside the aorta very carefu lly , don't knot the suture before releasing the clamp,put a bulldog clamp very proximal on the graft , make trendelenburg position , compress the carotids before release ( if there is no preop murmur or abnormal USG ) and then release the clamp and wait for several seconds and then knot the suture.erdinc> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages tr ansmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Mar 4 16:40:52 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Mar 4 06:11:15 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <14211287630034541604787844435911961481-Webmail@me.com> References: <14211287630034541604787844435911961481-Webmail@me.com> Message-ID: <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> Giuseppe what exactly was done when you say pleuropericardial windows ? Was it done percutaneously by the cardiologists or was it done surgically ? Prasanna On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno wrote: > > Dear Members, > > I need your advice concenrning a patient, operated on for CABG in another center, that we admitted for postoperative (1 mo) pericardial effusion. He underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial windows by left and right minithoracotomies. All cancer markers are negative as well as CT scans. Nervertheless he still produces 200 mL of effusion each day. We have tried all the possible drugs. Is there anyone who has experience with glue injection or some other voodoos? > > Thanks in advance > > 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 > ----------------------------------------- > -- Prasanna Simha M From grescigno at mac.com Wed Mar 4 12:17:36 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Wed Mar 4 06:24:39 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> References: <14211287630034541604787844435911961481-Webmail@me.com> <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> Message-ID: <9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com> Prasanna, we did them by ourselves. I do not know the exact term in english. Through a limited anterior thoracotomy, the pericardium is widely opened and a large hole is made. This allows to perform a pathological exam and the hope is that effusion will go into the pleural space. In this particular patient it was done bilaterally. Giuseppe Il giorno 04/mar/09, alle ore 12:10, Prasanna Simha M ha scritto: > Giuseppe what exactly was done when you say pleuropericardial windows > ? Was it done percutaneously by the cardiologists or was it done > surgically ? > Prasanna > > On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno > wrote: >> >> Dear Members, >> >> I need your advice concenrning a patient, operated on for CABG in >> another center, that we admitted for postoperative (1 mo) >> pericardial effusion. He underwent 2 percutaneous drainages and >> subsequently 2 pleuro-pericardial windows by left and right >> minithoracotomies. All cancer markers are negative as well as CT >> scans. Nervertheless he still produces 200 mL of effusion each >> day. We have tried all the possible drugs. Is there anyone who has >> experience with glue injection or some other voodoos? >> >> Thanks in advance >> >> 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 >> ----------------------------------------- >> > > > > -- > 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 Mar 4 17:00:16 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Mar 4 06:30:45 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com> References: <14211287630034541604787844435911961481-Webmail@me.com> <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> <9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com> Message-ID: <89c4ed2d0903040330k28561f41hf593e66c9ce30b51@mail.gmail.com> Ok so it was a surgical pericardiostomy. I would consier doing a peritoneal pericardial connection and alsoleave chest tubes till peruicardium gets adherent. I would also consider steroids. I had one case like this which was drained by the cardiologists nearly 8 times before sending them to me. I did the same thing. Patient had no evidence of tuberculosis (and incidentally was treated as MDR TB with no effect. Affter doing this and starting steroids with Vit A things settled and she is OK now. Incidentally can you check if she has SVC thrombosis . Prasanna On Wed, Mar 4, 2009 at 4:47 PM, Giuseppe Rescigno wrote: > Prasanna, > > we did them by ourselves. I do not know the exact term in english. Through a > limited anterior thoracotomy, the pericardium is widely opened and a large > hole is made. This allows to perform a pathological exam and the hope is > that effusion will go into the pleural space. In this particular patient it > was done bilaterally. > > Giuseppe > > Il giorno 04/mar/09, alle ore 12:10, Prasanna Simha M ha scritto: > >> Giuseppe what exactly was done when you say pleuropericardial windows >> ? Was it done percutaneously by the cardiologists or was it done >> surgically ? >> Prasanna >> >> On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno >> wrote: >>> >>> Dear Members, >>> >>> I need your advice concenrning a patient, operated on for CABG in another >>> center, that we admitted for postoperative (1 mo) pericardial effusion. He >>> underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial >>> windows by left and right minithoracotomies. All cancer markers are negative >>> as well as CT scans. Nervertheless he still produces 200 mL of effusion each >>> day. We have tried all the possible drugs. Is there anyone who has >>> experience with glue injection or some other voodoos? >>> >>> Thanks in advance >>> >>> 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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From anianyanwu at hotmail.com Wed Mar 4 11:44:30 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Wed Mar 4 06:45:19 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <89c4ed2d0903040330k28561f41hf593e66c9ce30b51@mail.gmail.com> References: <14211287630034541604787844435911961481-Webmail@me.com> <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> <9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com> <89c4ed2d0903040330k28561f41hf593e66c9ce30b51@mail.gmail.com> Message-ID: > Ok so it was a surgical pericardiostomy. I would consier doing a > peritoneal pericardial connection and alsoleave chest tubes till > peruicardium gets adherent. What is the essence of the pericardiostomy if we also wait for the pericardium to become adherent? Wont it also become adherent around the 'window' and then drainage (through window) stop as has happened already in this case? If two windows have already failed, why is a third likely to succeed? Ani > Date: Wed, 4 Mar 2009 17:00:16 +0530 > Subject: Re: [HSF] Recurrent pericardial effusion > From: prasannasimha@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > > Ok so it was a surgical pericardiostomy. I would consier doing a > peritoneal pericardial connection and alsoleave chest tubes till > peruicardium gets adherent. I would also consider steroids. > I had one case like this which was drained by the cardiologists nearly > 8 times before sending them to me. I did the same thing. Patient had > no evidence of tuberculosis (and incidentally was treated as MDR TB > with no effect. Affter doing this and starting steroids with Vit A > things settled and she is OK now. > Incidentally can you check if she has SVC thrombosis . > Prasanna > > On Wed, Mar 4, 2009 at 4:47 PM, Giuseppe Rescigno wrote: > > Prasanna, > > > > we did them by ourselves. I do not know the exact term in english. Through a > > limited anterior thoracotomy, the pericardium is widely opened and a large > > hole is made. This allows to perform a pathological exam and the hope is > > that effusion will go into the pleural space. In this particular patient it > > was done bilaterally. > > > > Giuseppe > > > > Il giorno 04/mar/09, alle ore 12:10, Prasanna Simha M ha scritto: > > > >> Giuseppe what exactly was done when you say pleuropericardial windows > >> ? Was it done percutaneously by the cardiologists or was it done > >> surgically ? > >> Prasanna > >> > >> On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno > >> wrote: > >>> > >>> Dear Members, > >>> > >>> I need your advice concenrning a patient, operated on for CABG in another > >>> center, that we admitted for postoperative (1 mo) pericardial effusion. He > >>> underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial > >>> windows by left and right minithoracotomies. All cancer markers are negative > >>> as well as CT scans. Nervertheless he still produces 200 mL of effusion each > >>> day. We have tried all the possible drugs. Is there anyone who has > >>> experience with glue injection or some other voodoos? > >>> > >>> Thanks in advance > >>> > >>> 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 > >>> ----------------------------------------- > >>> > >> > >> > >> > >> -- > >> Prasanna Simha M > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >> All messages transmitted by the OpenHeart-L are subject to the policies > >> and > >> disclaimers posted at: > >> http://www.hsforum.com/listdisclaim > >> ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > anddisclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ 25GB of FREE Online Storage ? Find out more http://clk.atdmt.com/UKM/go/134665320/direct/01/ From prasannasimha at gmail.com Wed Mar 4 17:35:55 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Mar 4 07:06:19 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: References: <14211287630034541604787844435911961481-Webmail@me.com> <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> <9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com> <89c4ed2d0903040330k28561f41hf593e66c9ce30b51@mail.gmail.com> Message-ID: <89c4ed2d0903040405w45bfb3f7m2ae7c2d39c3fbd6c@mail.gmail.com> Ani, ultimately all pericardiostomies work by eliminating the fluid, allowing adhesions which will prevent reaccumulation of fluid. You are allowing an alternative route to allow drainage till pericardial symphisis occurs. Obviously the previous two attempts failed due to premature blockage of the window prior to obliteration of the window. With the pericardio peritoneal shunt you are using the extensive lymphatic drainage in the bare area of the liver to mop up the fluid and IKeeping the tube for a longer time allows obliterative adhesions rather than loculated adhesions to form. that is the ratiionale. The immportant point is to do an agressive window and also not remove the pericardial tube prematurely. Unlike other cases in these cases I do not wait for the 100 ml/shift rule to remove the tubes. I wait till it comes down to a few ml. This may take quite a few days but I havent had to go back so far after this in these cases with recurrent effusions.. Prasanna On Wed, Mar 4, 2009 at 5:14 PM, Ani Anyanwu wrote: > >> Ok so it was a surgical pericardiostomy. I would consier doing a >> peritoneal pericardial connection and alsoleave chest tubes till >> peruicardium gets adherent. > > > > > > What is the essence of the pericardiostomy if we also wait for the pericardium to become adherent? Wont it also become adherent around the 'window' and then drainage (through window) stop as has happened already in this case? If two windows have already failed, why is a third likely to succeed? > > > > Ani > > > > > >> Date: Wed, 4 Mar 2009 17:00:16 +0530 >> Subject: Re: [HSF] Recurrent pericardial effusion >> From: prasannasimha@gmail.com >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Ok so it was a surgical pericardiostomy. I would consier doing a >> peritoneal pericardial connection and alsoleave chest tubes till >> peruicardium gets adherent. I would also consider steroids. >> I had one case like this which was drained by the cardiologists nearly >> 8 times before sending them to me. I did the same thing. Patient had >> no evidence of tuberculosis (and incidentally was treated as MDR TB >> with no effect. Affter doing this and starting steroids with Vit A >> things settled and she is OK now. >> Incidentally can you check if she has SVC thrombosis . >> Prasanna >> >> On Wed, Mar 4, 2009 at 4:47 PM, Giuseppe Rescigno wrote: >> > Prasanna, >> > >> > we did them by ourselves. I do not know the exact term in english. Through a >> > limited anterior thoracotomy, the pericardium is widely opened and a large >> > hole is made. This allows to perform a pathological exam and the hope is >> > that effusion will go into the pleural space. In this particular patient it >> > was done bilaterally. >> > >> > Giuseppe >> > >> > Il giorno 04/mar/09, alle ore 12:10, Prasanna Simha M ha scritto: >> > >> >> Giuseppe what exactly was done when you say pleuropericardial windows >> >> ? Was it done percutaneously by the cardiologists or was it done >> >> surgically ? >> >> Prasanna >> >> >> >> On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno >> >> wrote: >> >>> >> >>> Dear Members, >> >>> >> >>> I need your advice concenrning a patient, operated on for CABG in another >> >>> center, that we admitted for postoperative (1 mo) pericardial effusion. He >> >>> underwent 2 percutaneous drainages and subsequently 2 pleuro-pericardial >> >>> windows by left and right minithoracotomies. All cancer markers are negative >> >>> as well as CT scans. Nervertheless he still produces 200 mL of effusion each >> >>> day. We have tried all the possible drugs. Is there anyone who has >> >>> experience with glue injection or some other voodoos? >> >>> >> >>> Thanks in advance >> >>> >> >>> 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 >> >>> ----------------------------------------- >> >>> >> >> >> >> >> >> >> >> -- >> >> Prasanna Simha M >> >> _______________________________________________ >> >> OpenHeart-L mailing list >> >> >> >> Send postings to: >> >> ?OpenHeart-L@lists.hsforum.com >> >> >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> >> and >> >> disclaimers posted at: >> >> http://www.hsforum.com/listdisclaim >> >> ----------------------------------------- >> > >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > >> > All messages transmitted by the OpenHeart-L are subject to the policies >> > anddisclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > ?25GB of FREE Online Storage ? Find out more > http://clk.atdmt.com/UKM/go/134665320/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 From grescigno at mac.com Wed Mar 4 15:28:43 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Wed Mar 4 09:32:14 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <89c4ed2d0903040405w45bfb3f7m2ae7c2d39c3fbd6c@mail.gmail.com> References: <14211287630034541604787844435911961481-Webmail@me.com> <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> <9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com> <89c4ed2d0903040330k28561f41hf593e66c9ce30b51@mail.gmail.com> <89c4ed2d0903040405w45bfb3f7m2ae7c2d39c3fbd6c@mail.gmail.com> Message-ID: <168D0A6A-66E5-4466-BDDA-837B9521B42F@mac.com> Ani and Prasanna, the rationale of pleuro-pericardial windows has always seemed matter of debate for me as it is a little naif to think that it will stay open for a long time, in particular if you keep the tubes and do not allow the "window" to work by creating an alternative and more efficient way out. However, at least in Italy, this is the commonest way to proceed. I guess that this patient has been traeated by too many "hands" (operated in another center, cardiologists, our team, thoracic surgeons) (incidentally I did nothing at all but I find this guy very kind and I would really like to solve his problem). Anyway I will talk about this new route (peritoneum) with my collegues. BTW He had a TC scan with no thrombosis of SVC. Thank you Giuseppe Il giorno 04/mar/09, alle ore 13:05, Prasanna Simha M ha scritto: > Ani, ultimately all pericardiostomies work by eliminating the fluid, > allowing adhesions which will prevent reaccumulation of fluid. You are > allowing an alternative route to allow drainage till pericardial > symphisis occurs. Obviously the previous two attempts failed due to > premature blockage of the window prior to obliteration of the window. > With the pericardio peritoneal shunt you are using the extensive > lymphatic drainage in the bare area of the liver to mop up the fluid > and IKeeping the tube for a longer time allows obliterative adhesions > rather than loculated adhesions to form. that is the ratiionale. The > immportant point is to do an agressive window and also not remove the > pericardial tube prematurely. Unlike other cases in these cases I do > not wait for the 100 ml/shift rule to remove the tubes. I wait till > it comes down to a few ml. This may take quite a few days but I havent > had to go back so far after this in these cases with recurrent > effusions.. > Prasanna > > On Wed, Mar 4, 2009 at 5:14 PM, Ani Anyanwu > wrote: >> >>> Ok so it was a surgical pericardiostomy. I would consier doing a >>> peritoneal pericardial connection and alsoleave chest tubes till >>> peruicardium gets adherent. >> >> >> >> >> >> What is the essence of the pericardiostomy if we also wait for the >> pericardium to become adherent? Wont it also become adherent >> around the 'window' and then drainage (through window) stop as has >> happened already in this case? If two windows have already failed, >> why is a third likely to succeed? >> >> >> >> Ani >> >> >> >> >> >>> Date: Wed, 4 Mar 2009 17:00:16 +0530 >>> Subject: Re: [HSF] Recurrent pericardial effusion >>> From: prasannasimha@gmail.com >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> Ok so it was a surgical pericardiostomy. I would consier doing a >>> peritoneal pericardial connection and alsoleave chest tubes till >>> peruicardium gets adherent. I would also consider steroids. >>> I had one case like this which was drained by the cardiologists >>> nearly >>> 8 times before sending them to me. I did the same thing. Patient had >>> no evidence of tuberculosis (and incidentally was treated as MDR TB >>> with no effect. Affter doing this and starting steroids with Vit A >>> things settled and she is OK now. >>> Incidentally can you check if she has SVC thrombosis . >>> Prasanna >>> >>> On Wed, Mar 4, 2009 at 4:47 PM, Giuseppe Rescigno >>> wrote: >>>> Prasanna, >>>> >>>> we did them by ourselves. I do not know the exact term in >>>> english. Through a >>>> limited anterior thoracotomy, the pericardium is widely opened >>>> and a large >>>> hole is made. This allows to perform a pathological exam and the >>>> hope is >>>> that effusion will go into the pleural space. In this particular >>>> patient it >>>> was done bilaterally. >>>> >>>> Giuseppe >>>> >>>> Il giorno 04/mar/09, alle ore 12:10, Prasanna Simha M ha scritto: >>>> >>>>> Giuseppe what exactly was done when you say pleuropericardial >>>>> windows >>>>> ? Was it done percutaneously by the cardiologists or was it done >>>>> surgically ? >>>>> Prasanna >>>>> >>>>> On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno >>>>> >>>>> wrote: >>>>>> >>>>>> Dear Members, >>>>>> >>>>>> I need your advice concenrning a patient, operated on for CABG >>>>>> in another >>>>>> center, that we admitted for postoperative (1 mo) pericardial >>>>>> effusion. He >>>>>> underwent 2 percutaneous drainages and subsequently 2 pleuro- >>>>>> pericardial >>>>>> windows by left and right minithoracotomies. All cancer >>>>>> markers are negative >>>>>> as well as CT scans. Nervertheless he still produces 200 mL of >>>>>> effusion each >>>>>> day. We have tried all the possible drugs. Is there anyone who >>>>>> has >>>>>> experience with glue injection or some other voodoos? >>>>>> >>>>>> Thanks in advance >>>>>> >>>>>> 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 >>>>>> ----------------------------------------- >>>>>> >>>>> >>>>> >>>>> >>>>> -- >>>>> Prasanna Simha M >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> >>>>> All messages transmitted by the OpenHeart-L are subject to the >>>>> policies >>>>> and >>>>> disclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the >>>> policies >>>> anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _________________________________________________________________ >> 25GB of FREE Online Storage ? Find out more >> http://clk.atdmt.com/UKM/go/134665320/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 > ----------------------------------------- From enaseri at hotmail.com.tr Wed Mar 4 18:53:21 2009 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Wed Mar 4 13:53:48 2009 Subject: [HSF] arch surgery and MSCT In-Reply-To: <168D0A6A-66E5-4466-BDDA-837B9521B42F@mac.com> References: <14211287630034541604787844435911961481-Webmail@me.com> <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> <9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com> <89c4ed2d0903040330k28561f41hf593e66c9ce30b51@mail.gmail.com> <89c4ed2d0903040405w45bfb3f7m2ae7c2d39c3fbd6c@mail.gmail.com> <168D0A6A-66E5-4466-BDDA-837B9521B42F@mac.com> Message-ID: Patient with aortic arch aneurysm planned for surgery. Attempted CAG in another center had failed due to technical difficulty with a resultant CVA and motor dysphasia.CAG in our center was refused by our cardiology team. MSCT shows no coronary lesions . Can we proceed with arch operation assuming that there is no CAD? erdinc From robertobattellini at hotmail.com Wed Mar 4 20:23:33 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Wed Mar 4 14:24:00 2009 Subject: [HSF] arch surgery and MSCT In-Reply-To: References: <14211287630034541604787844435911961481-Webmail@me.com> <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> <9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com> <89c4ed2d0903040330k28561f41hf593e66c9ce30b51@mail.gmail.com> <89c4ed2d0903040405w45bfb3f7m2ae7c2d39c3fbd6c@mail.gmail.com> <168D0A6A-66E5-4466-BDDA-837B9521B42F@mac.com> Message-ID: you must, otherwise the patient will get a second CVA. An old friendd of mine, 80 yrs old, had coronariography one month ago, also got an CVA and his arteries not stented... I would operate him when his CVA is stabilized. Take care of that aorta, may be has floating atheromae...ulcus or so on. Roberto > From: enaseri@hotmail.com.tr > To: openheart-l@lists.hsforum.com > Date: Wed, 4 Mar 2009 18:53:21 +0000 > Subject: [HSF] arch surgery and MSCT > > > Patient with aortic arch aneurysm planned for surgery. Attempted CAG in another center had failed due to technical difficulty with a resultant CVA and motor dysphasia.CAG in our center was refused by our cardiology team. MSCT shows no coronary lesions . Can we proceed with arch operation assuming that there is no CAD? > > erdinc > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From prasannasimha at gmail.com Thu Mar 5 00:15:42 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Mar 4 14:46:58 2009 Subject: [HSF] "Internal Sleeve" Message-ID: <89c4ed2d0903041045w61b9cac0ma94dfefbf146059a@mail.gmail.com> 26 year old lady , Marfanoid presented with an ascending aortic aneurysm + severe AR. Leaflets looked normal and mechanism of AR appeared due to ST junction dilatation. She was AB positive and there was cncerns regarding adequate supply of blood products as there was a bleeder case which had reduced AB +ve donor pool in the city.(We had blood but not a very large donor pool) I planned to see the leaflets and if normal considered her for valve sparing ascending aortic replacement with root reconstruction. On table the aneurysm was up to the innominate and I cannulated the innominate artery for systemic perfusion and also for innominate artery perfusion. On opening the aorta there was thickened wall (Not marfanoid) which was sent for biopsy (Histopath awaited) .The leaflets looked normal and well preserved. I decided to use a technique described in Interactive journal of CT surgery (Original plan was for a Florida sleeve) and used an annular stabilizing suture as described by Lars Svensson (The LV aortic junction was not actually dilated) and then placed 3 tear drop patches fixed subannularly with pledgeted sutures in each sinus with fenestrations for the coronaries with the ostia fixed to the fenstrations. (The RCA ostium was painfully small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still not confident of doing it at higher temperatures) I did an intraluminal hemiarch placement.The tube was then attached to the teardrop patches which had been fixed at the ST junction.I then placed a prophylactic cabrol patch fistula as soon as I came off CPB as I was worried about blood and blood product usage (As you can see there wasnt much bleeding and the fistula hood is not distended so its use may be questioned). Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU was a worrisome 20 ml !! Patient was extubated within 6 hours and is doing well and will be discharged tomorrow when the HPE report comes.The postop transthoracic echo shows the Cabrol patch fistula has closed. Questions are how many of the members use innominate cannulation versus axillary cannulation and reasons for the preerence.What are the problems that the members have occurred with each strategy. What are the tips and tricks that people who do aortic sparing surgery use to judge aortic competence during intraop testing .(Not echocardiographic which requires going off CPB ) as I find my judgement with aortic repairs still hazy. Apart from holding water and visual inspection I also use the method of El Khoury of placing a sucker in the LVOT and allowing the leaflets to oppose and pull it (the sucker) out but somehow I am not able to get the leaflets to stay put as I feel that the negative suction gets lost by the time I pull the sucker out (Maybe It may be becuase I am using the big Yankauer sucker which may be part of the problem and am planning to use a dentist irrigation sucker for the same. -- Prasanna Simha M -------------- next part -------------- A non-text attachment was scrubbed... Name: Internal sleeve eml.jpg Type: image/jpeg Size: 56697 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090305/3f08d5d3/Internalsleeveeml-0001.jpg From grescigno at mac.com Wed Mar 4 23:53:43 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Wed Mar 4 17:58:00 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: Message-ID: <127782282141345871338618401122866491527-Webmail@me.com> Prasanna, very nice case. I have just 2 comments: 1. I think that you should switch to 26 ?C, at least for an end to end anastomosis. 2. I am not using the innominate trunk (even if I think that is a very good idea, as 90% of my circulatory arrests are for aortic dissections and I am too worried about an involvement of the innominate artery. Giuseppe Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" wrote: >26 year old lady , Marfanoid presented with an ascending aortic aneurysm + >severe AR. Leaflets looked normal and mechanism of AR appeared due to ST >junction dilatation. She was AB positive and there was cncerns regarding >adequate supply of blood products as there was a bleeder case which had >reduced AB +ve donor pool in the city.(We had blood but not a very large >donor pool) >I planned to see the leaflets and if normal considered her for valve >sparing ascending aortic replacement with root reconstruction. >On table the aneurysm was up to the innominate and I cannulated the >innominate artery for systemic perfusion and also for innominate artery >perfusion. >On opening the aorta there was thickened wall (Not marfanoid) which was sent >for biopsy (Histopath awaited) .The leaflets looked normal and well >preserved. I decided to use a technique described in Interactive journal of >CT surgery (Original plan was for a Florida sleeve) and used an annular >stabilizing suture as described by Lars Svensson (The LV aortic junction was >not actually dilated) and then placed 3 tear drop patches fixed subannularly >with pledgeted sutures in each sinus with fenestrations for the coronaries >with the ostia fixed to the fenstrations. (The RCA ostium was painfully >small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still >not confident of doing it at higher temperatures) I did an intraluminal >hemiarch placement.The tube was then attached to the teardrop patches which >had been fixed at the ST junction.I then placed a prophylactic cabrol patch >fistula as soon as I came off CPB as I was worried about blood and blood >product usage (As you can see there wasnt much bleeding and the fistula hood >is not distended so its use may be questioned). >Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU >was a worrisome 20 ml !! >Patient was extubated within 6 hours and is doing well and will be >discharged tomorrow when the HPE report comes.The postop transthoracic echo >shows the Cabrol patch fistula has closed. >Questions are how many of the members use innominate cannulation versus >axillary cannulation and reasons for the preerence.What are the problems >that the members have occurred with each strategy. >What are the tips and tricks that people who do aortic sparing surgery use >to judge aortic competence during intraop testing .(Not echocardiographic >which requires going off CPB ) as I find my judgement with aortic repairs >still hazy. Apart from holding water and visual inspection I also use the >method of El Khoury of placing a sucker in the LVOT and allowing the >leaflets to oppose and pull it (the sucker) out but somehow I am not able to >get the leaflets to stay put as I feel that the negative suction gets lost >by the time I pull the sucker out (Maybe It may be becuase I am using the >big Yankauer sucker which may be part of the problem and am planning to use >a dentist irrigation sucker for the same. > > >-- >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 tdmartin2000 at aol.com Wed Mar 4 20:38:45 2009 From: tdmartin2000 at aol.com (tdmartin2000@aol.com) Date: Thu Mar 5 00:00:09 2009 Subject: [HSF] arch surgery and MSCT In-Reply-To: References: <14211287630034541604787844435911961481-Webmail@me.com><89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com><9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com><89c4ed2d0903040330k28561f41hf593e66c9ce30b51@mail.gmail.com><89c4ed2d0903040405w45bfb3f7m2ae7c2d39c3fbd6c@mail.gmail.com> <168D0A6A-66E5-4466-BDDA-837B9521B42F@mac.com> Message-ID: <8CB6B4A42028348-142C-2248@WEBMAIL-DZ40.sysops.aol.com> Do you have CT's. Tom Martin U of Florida Gainesville -----Original Message----- From: erdin? naseri To: HSF HSF Sent: Wed, 4 Mar 2009 1:53 pm Subject: [HSF] arch surgery and MSCT atient with aortic arch aneurysm planned for surgery. Attempted CAG in another enter had failed due to technical difficulty with a resultant CVA and motor ysphasia.CAG in our center was refused by our cardiology team.. MSCT shows no oronary lesions . Can we proceed with arch operation assuming that there is no AD? erdinc ______________________________________________ penHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: ttp://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and isclaimers posted at: ttp://www.hsforum.com/listdisclaim ---------------------------------------- From tdmartin2000 at aol.com Wed Mar 4 20:50:20 2009 From: tdmartin2000 at aol.com (tdmartin2000@aol.com) Date: Thu Mar 5 00:00:10 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: <89c4ed2d0903041045w61b9cac0ma94dfefbf146059a@mail.gmail.com> References: <89c4ed2d0903041045w61b9cac0ma94dfefbf146059a@mail.gmail.com> Message-ID: <8CB6B4BDFEB3B4C-142C-22EB@WEBMAIL-DZ40.sysops.aol.com> Prasanna Why didn't you do a sleeve? Depending on the pts hct most of the young marfanoid pts do not get transfused here and we do the standard sleeve. I am not a axillary cannulation fan and in these cases i have no problem cannulating the innominate directly if it is large enough. Most of the time however we just cannulate the distal ascending or prox arch and then under circ arrest we take the cannula out. After doing the distal anastomosis, I usually cannulate the dacron graft directly after circ arrest however several of my partners use a side arm graft and use the side arm to perfuse through. As to testing the valve. The easiest and I think the best way is just after finishing the prox anastomosis at the STJ. I put a slotted cardioplegia needle into the ascending dacron graft, fill it up w cardioplegia and then clamp the graft. You can feel how well the root gets distended and see what and how much is coming back from your LV vent. I use crystalloid cardioplegia so it is easy to look at the vent and tell. If it turns clear, you have a problem!! Tom Martin U of Florida Gainesville -----Original Message----- From: Prasanna Simha M To: OpenHeart-L Sent: Wed, 4 Mar 2009 1:45 pm Subject: [HSF] "Internal Sleeve" 26 year old lady , Marfanoid presented with an ascending aortic aneurysm + severe AR. Leaflets looked normal and mechanism of AR appeared due to ST junction dilatation. She was AB positive and there was cncerns regarding adequate supply of blood products as there was a bleeder case which had reduced AB +ve donor pool in the city.(We had blood but not a very large donor pool) I planned to see the leaflets and if normal considered her for valve sparing ascending aortic replacement with root reconstruction. On table the aneurysm was up to the innominate and I cannulated the innominate artery for systemic perfusion and also for innominate artery perfusion. On opening the aorta there was thickened wall (Not marfanoid) which was sent for biopsy (Histopath awaited) .The leaflets looked normal and well preserved. I decided to use a technique described in Interactive journal of CT surgery (Original plan was for a Florida sleeve) and used an annular stabilizing suture as described by Lars Svensson (The LV aortic junction was not actually dilated) and then placed 3 tear drop patches fixed subannularly with pledgeted sutures in each sinus with fenestrations for the coronaries with the ostia fixed to the fenstrations. (The RCA ostium was painfully small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still not confident of doing it at higher temperatures) I did an intraluminal hemiarch placement.The tube was then attached to the teardrop patches which had been fixed at the ST junction.I then placed a prophylactic cabrol patch fistula as soon as I came off CPB as I was worried about blood and blood product usage (As you can see there wasnt much bleeding and the fistula hood is not distended so its use may be questioned). Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU was a worrisome 20 ml !! Patient was extubated within 6 hours and is doing well and will be discharged tomorrow when the HPE report comes.The postop transthoracic echo shows the Cabrol patch fistula has closed. Ques tions are how many of the members use innominate cannulation versus axillary cannulation and reasons for the preerence.What are the problems that the members have occurred with each strategy. What are the tips and tricks that people who do aortic sparing surgery use to judge aortic competence during intraop testing .(Not echocardiographic which requires going off CPB ) as I find my judgement with aortic repairs still hazy. Apart from holding water and visual inspection I also use the method of El Khoury of placing a sucker in the LVOT and allowing the leaflets to oppose and pull it (the sucker) out but somehow I am not able to get the leaflets to stay put as I feel that the negative suction gets lost by the time I pull the sucker out (Maybe It may be becuase I am using the big Yankauer sucker which may be part of the problem and am planning to use a dentist irrigation sucker for the same. -- 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 ----------------------------------------- [Image Removed] From drmitch at cox.net Wed Mar 4 20:31:44 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Thu Mar 5 00:00:12 2009 Subject: [HSF] Choice of conduit In-Reply-To: References: <6.2.1.2.2.20090303213534.0403b818@pop.east.cox.net> Message-ID: <6.2.1.2.2.20090304203102.03fe57d0@pop.east.cox.net> Hmmm. Food for thought. I'll give it considerable thought.At 10:41 PM 3/3/2009, you wrote: >Hold your breath ,Mitch, >Lima to Dl, Composite Rima-Radial through sinus to Cx & pda etc. >( This graft will reach to the acute marginal) >Treat potential lad stenosis with statins. >Don >On 04/03/2009, at 3:06 PM, Mitch Lirtzman wrote: > >>Greetings >> >>I really don't want to beat this subject to death, but varied >>opinions are sought: >> >>A 50yo AA male, non-diabetic, has had multiple PTCA's over the >>years. He returns with unstable pain. LHC shows a big, normal LAD >>save for the very apical bifurcation vessels. There is an 80% ISR in >>a good D2, and the OM. The "ongoing Cx" trifucates after the OM with >>a proximal 90% lesion in the "feeder" vessel. The RCA is a series of >>high-grade ISR with patent AM, PDA, and PLA. All good vessels. LV is >>normal. >> >>I'm kinda hesitant to take down the LIMA for a diag or a distal >>circ. A skeletonized RIMA won't reach all the way out. I think I do >>that op pretty well and I just don't think it'll go. >> >>So here's what I think: sequential svg to D and OM. RA from the hood >>of the svg to the distal Cx. An svg to the AM (graft?/ no graft?) >>and perhaps a GEA to the distal Rt system. Any takers? >>Thanks in advance. >> >>Mitch >> >>_______________________________________________ >>OpenHeart-L mailing list >> >>Send postings to: >>OpenHeart-L@lists.hsforum.com >> >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>http://mmp.cjp.com/mailman/listinfo/openheart-l >> >>All messages transmitted by the OpenHeart-L are subject to the >>policies and disclaimers posted at: >>http://www.hsforum.com/listdisclaim >>----------------------------------------- > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/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 drmitch at cox.net Wed Mar 4 20:32:55 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Thu Mar 5 00:00:14 2009 Subject: [HSF] Choice of conduit In-Reply-To: <560069.62662.qm@web24709.mail.ird.yahoo.com> References: <560069.62662.qm@web24709.mail.ird.yahoo.com> Message-ID: <6.2.1.2.2.20090304203244.04043678@pop.east.cox.net> Another good idea!At 03:30 AM 3/4/2009, you wrote: >I`m not too sure a radial on the hood of a vein is a good thing. I had a >case where they both went down at the ostium, so have never done it again. >If the aorta is thin, and the radial a good caliber (should only use if >good caliber) then put it on aorta. > >In this case I would do bilat skeletonised IMA, with OPCAB: LIMA to D1, >and RIMA off LIMA with sequentials to Cx system. Radial to distal right >branches. > >I did a similar case a few months ago, you can reach all the L sided >vessels nicely with the IMA s. > >The only instrumentation of the aorta is a single side clamp to the aorta >for the radial. >Dave Harris > > > >--- On Wed, 4/3/09, Donald Ross wrote: > >From: Donald Ross >Subject: Re: [HSF] Choice of conduit >To: OpenHeart-L@lists.hsforum.com >Date: Wednesday, 4 March, 2009, 6:41 AM > >Hold your breath ,Mitch, >Lima to Dl, Composite Rima-Radial through sinus to Cx & pda etc. ( This >graft will reach to the acute marginal) >Treat potential lad stenosis with statins. >Don >On 04/03/2009, at 3:06 PM, Mitch Lirtzman wrote: > > > Greetings > > > > I really don't want to beat this subject to death, but varied opinions >are sought: > > > > A 50yo AA male, non-diabetic, has had multiple PTCA's over the years. >He returns with unstable pain. LHC shows a big, normal LAD save for the very >apical bifurcation vessels. There is an 80% ISR in a good D2, and the OM. The >"ongoing Cx" trifucates after the OM with a proximal 90% lesion in the >"feeder" vessel. The RCA is a series of high-grade ISR with patent AM, >PDA, and PLA. All good vessels. LV is normal. > > > > I'm kinda hesitant to take down the LIMA for a diag or a distal circ. >A skeletonized RIMA won't reach all the way out. I think I do that op pretty >well and I just don't think it'll go. > > > > So here's what I think: sequential svg to D and OM. RA from the hood >of the svg to the distal Cx. An svg to the AM (graft?/ no graft?) and >perhaps a >GEA to the distal Rt system. Any takers? > > Thanks in advance. > > > > Mitch > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies >and disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies >anddisclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- From drmitch at cox.net Wed Mar 4 20:34:41 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Thu Mar 5 00:00:15 2009 Subject: [HSF] Choice of conduit In-Reply-To: <560069.62662.qm@web24709.mail.ird.yahoo.com> References: <560069.62662.qm@web24709.mail.ird.yahoo.com> Message-ID: <6.2.1.2.2.20090304203420.04024d30@pop.east.cox.net> Anyone care to comment on the acute marginal???At 03:30 AM 3/4/2009, you wrote: >I`m not too sure a radial on the hood of a vein is a good thing. I had a >case where they both went down at the ostium, so have never done it again. >If the aorta is thin, and the radial a good caliber (should only use if >good caliber) then put it on aorta. > >In this case I would do bilat skeletonised IMA, with OPCAB: LIMA to D1, >and RIMA off LIMA with sequentials to Cx system. Radial to distal right >branches. > >I did a similar case a few months ago, you can reach all the L sided >vessels nicely with the IMA s. > >The only instrumentation of the aorta is a single side clamp to the aorta >for the radial. >Dave Harris > > > >--- On Wed, 4/3/09, Donald Ross wrote: > >From: Donald Ross >Subject: Re: [HSF] Choice of conduit >To: OpenHeart-L@lists.hsforum.com >Date: Wednesday, 4 March, 2009, 6:41 AM > >Hold your breath ,Mitch, >Lima to Dl, Composite Rima-Radial through sinus to Cx & pda etc. ( This >graft will reach to the acute marginal) >Treat potential lad stenosis with statins. >Don >On 04/03/2009, at 3:06 PM, Mitch Lirtzman wrote: > > > Greetings > > > > I really don't want to beat this subject to death, but varied opinions >are sought: > > > > A 50yo AA male, non-diabetic, has had multiple PTCA's over the years. >He returns with unstable pain. LHC shows a big, normal LAD save for the very >apical bifurcation vessels. There is an 80% ISR in a good D2, and the OM. The >"ongoing Cx" trifucates after the OM with a proximal 90% lesion in the >"feeder" vessel. The RCA is a series of high-grade ISR with patent AM, >PDA, and PLA. All good vessels. LV is normal. > > > > I'm kinda hesitant to take down the LIMA for a diag or a distal circ. >A skeletonized RIMA won't reach all the way out. I think I do that op pretty >well and I just don't think it'll go. > > > > So here's what I think: sequential svg to D and OM. RA from the hood >of the svg to the distal Cx. An svg to the AM (graft?/ no graft?) and >perhaps a >GEA to the distal Rt system. Any takers? > > Thanks in advance. > > > > Mitch > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies >and disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies >anddisclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- From damle at cableone.net Wed Mar 4 22:11:57 2009 From: damle at cableone.net (Ajit Damle) Date: Thu Mar 5 00:00:17 2009 Subject: [HSF] Recurrent pleural effusion In-Reply-To: <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> References: <14211287630034541604787844435911961481-Webmail@me.com> <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> Message-ID: <000901c99d48$86cae5e0$9460b1a0$@net> In a different vein, how do you deal with a recurrent pleural (non-chylous) effusion after CABG with IMA? After a second or third pleurocentesis? Ajit Damle From donross at bigpond.com Thu Mar 5 16:17:42 2009 From: donross at bigpond.com (Donald Ross) Date: Thu Mar 5 00:18:29 2009 Subject: [HSF] Choice of conduit In-Reply-To: <6.2.1.2.2.20090304203420.04024d30@pop.east.cox.net> References: <560069.62662.qm@web24709.mail.ird.yahoo.com> <6.2.1.2.2.20090304203420.04024d30@pop.east.cox.net> Message-ID: <62F13202-3877-401C-B096-C76E3221071B@bigpond.com> I grafted one once but I was young and full of bravado or more likely a less flattering epithet . don On 05/03/2009, at 1:34 PM, Mitch Lirtzman wrote: > Anyone care to comment on the acute marginal???At 03:30 AM 3/4/2009, > you wrote: >> I`m not too sure a radial on the hood of a vein is a good thing. I >> had a case where they both went down at the ostium, so have never >> done it again. If the aorta is thin, and the radial a good caliber >> (should only use if good caliber) then put it on aorta. >> >> In this case I would do bilat skeletonised IMA, with OPCAB: LIMA to >> D1, and RIMA off LIMA with sequentials to Cx system. Radial to >> distal right branches. >> >> I did a similar case a few months ago, you can reach all the L >> sided vessels nicely with the IMA s. >> >> The only instrumentation of the aorta is a single side clamp to the >> aorta for the radial. >> Dave Harris >> >> >> >> --- On Wed, 4/3/09, Donald Ross wrote: >> >> From: Donald Ross >> Subject: Re: [HSF] Choice of conduit >> To: OpenHeart-L@lists.hsforum.com >> Date: Wednesday, 4 March, 2009, 6:41 AM >> >> Hold your breath ,Mitch, >> Lima to Dl, Composite Rima-Radial through sinus to Cx & pda etc. >> ( This >> graft will reach to the acute marginal) >> Treat potential lad stenosis with statins. >> Don >> On 04/03/2009, at 3:06 PM, Mitch Lirtzman wrote: >> >> > Greetings >> > >> > I really don't want to beat this subject to death, but varied >> opinions >> are sought: >> > >> > A 50yo AA male, non-diabetic, has had multiple PTCA's over the >> years. >> He returns with unstable pain. LHC shows a big, normal LAD save for >> the very >> apical bifurcation vessels. There is an 80% ISR in a good D2, and >> the OM. The >> "ongoing Cx" trifucates after the OM with a proximal 90% lesion in >> the >> "feeder" vessel. The RCA is a series of high-grade ISR with patent >> AM, >> PDA, and PLA. All good vessels. LV is normal. >> > >> > I'm kinda hesitant to take down the LIMA for a diag or a distal >> circ. >> A skeletonized RIMA won't reach all the way out. I think I do that >> op pretty >> well and I just don't think it'll go. >> > >> > So here's what I think: sequential svg to D and OM. RA from the >> hood >> of the svg to the distal Cx. An svg to the AM (graft?/ no graft?) >> and perhaps a >> GEA to the distal Rt system. Any takers? >> > Thanks in advance. >> > >> > Mitch >> > >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > >> > All messages transmitted by the OpenHeart-L are subject to the >> policies >> and disclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies >> anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From grescigno at mac.com Thu Mar 5 08:32:02 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Thu Mar 5 02:32:34 2009 Subject: [HSF] "Internal Sleeve" Message-ID: <39918451804698399112005769336567769631-Webmail@me.com> Dear Dr Martin, do you always prefer to do a classical Kazui? cannulating the innominate Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Thursday, March 05, 2009, at 02:50AM, wrote: >Prasanna >Why didn't you do a sleeve? Depending on the pts hct most of the young marfanoid pts do not get transfused here and we do the standard sleeve. I am not a axillary cannulation fan and in these cases i have no problem cannulating the innominate directly if it is large enough. Most of the time however we just cannulate the distal ascending or prox arch and then under circ arrest we take the cannula out. After doing the distal anastomosis, I usually cannulate the dacron graft directly after circ arrest however several of my partners use a side arm graft and use the side arm to perfuse through. >As to testing the valve. The easiest and I think the best way is just after finishing the prox anastomosis at the STJ. I put a slotted cardioplegia needle into the ascending dacron graft, fill it up w cardioplegia and then clamp the graft. You can feel how well the root gets distended and see what and how much is coming back from your LV vent. I use crystalloid cardioplegia so it is easy to look at the vent and tell. If it turns clear, you have a problem!! > >Tom Martin >U of Florida >Gainesville > > >-----Original Message----- >From: Prasanna Simha M >To: OpenHeart-L >Sent: Wed, 4 Mar 2009 1:45 pm >Subject: [HSF] "Internal Sleeve" > > > >26 year old lady , Marfanoid presented with an ascending aortic aneurysm + >severe AR. Leaflets looked normal and mechanism of AR appeared due to ST >junction dilatation. She was AB positive and there was cncerns regarding >adequate supply of blood products as there was a bleeder case which had >reduced AB +ve donor pool in the city.(We had blood but not a very large >donor pool) >I planned to see the leaflets and if normal considered her for valve >sparing ascending aortic replacement with root reconstruction. >On table the aneurysm was up to the innominate and I cannulated the >innominate artery for systemic perfusion and also for innominate artery >perfusion. >On opening the aorta there was thickened wall (Not marfanoid) which was sent >for biopsy (Histopath awaited) .The leaflets looked normal and well >preserved. I decided to use a technique described in Interactive journal of >CT surgery (Original plan was for a Florida sleeve) and used an annular >stabilizing suture as described by Lars Svensson (The LV aortic junction was >not actually dilated) and then placed 3 tear drop patches fixed subannularly >with pledgeted sutures in each sinus with fenestrations for the coronaries >with the ostia fixed to the fenstrations. (The RCA ostium was painfully >small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still >not confident of doing it at higher temperatures) I did an intraluminal >hemiarch placement.The tube was then attached to the teardrop patches which >had been fixed at the ST junction.I then placed a prophylactic cabrol patch >fistula as soon as I came off CPB as I was worried about blood and blood >product usage (As you can see there wasnt much bleeding and the fistula hood >is not distended so its use may be questioned). >Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU >was a worrisome 20 ml !! >Patient was extubated within 6 hours and is doing well and will be >discharged tomorrow when the HPE report comes.The postop transthoracic echo >shows the Cabrol patch fistula has closed. >Ques >tions are how many of the members use innominate cannulation versus >axillary cannulation and reasons for the preerence.What are the problems >that the members have occurred with each strategy. >What are the tips and tricks that people who do aortic sparing surgery use >to judge aortic competence during intraop testing .(Not echocardiographic >which requires going off CPB ) as I find my judgement with aortic repairs >still hazy. Apart from holding water and visual inspection I also use the >method of El Khoury of placing a sucker in the LVOT and allowing the >leaflets to oppose and pull it (the sucker) out but somehow I am not able to >get the leaflets to stay put as I feel that the negative suction gets lost >by the time I pull the sucker out (Maybe It may be becuase I am using the >big Yankauer sucker which may be part of the problem and am planning to use >a dentist irrigation sucker for the same. > > >-- >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 >----------------------------------------- > > > >[Image Removed] > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- > > From enaseri at hotmail.com.tr Thu Mar 5 07:40:03 2009 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Thu Mar 5 02:40:30 2009 Subject: [HSF] arch surgery and MSCT In-Reply-To: <8CB6B4A42028348-142C-2248@WEBMAIL-DZ40.sysops.aol.com> References: <14211287630034541604787844435911961481-Webmail@me.com><89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com><9480FC3C-BCF0-4086-B214-86B58EBBF56C@mac.com><89c4ed2d0903040330k28561f41hf593e66c9ce30b51@mail.gmail.com><89c4ed2d0903040405w45bfb3f7m2ae7c2d39c3fbd6c@mail.gmail.com> <168D0A6A-66E5-4466-BDDA-837B9521B42F@mac.com> <8CB6B4A42028348-142C-2248@WEBMAIL-DZ40.sysops.aol.com> Message-ID: Yes and I will try to mail them or send them to prassana . erdinc > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] arch surgery and MSCT > Date: Wed, 4 Mar 2009 20:38:45 -0500 > From: tdmartin2000@aol.com > CC: > > Do you have CT's. > > Tom Martin > U of Florida > Gainesville > > > -----Original Message----- > From: erdin? naseri > To: HSF HSF > Sent: Wed, 4 Mar 2009 1:53 pm > Subject: [HSF] arch surgery and MSCT > > > > > atient with aortic arch aneurysm planned for surgery. Attempted CAG in another > enter had failed due to technical difficulty with a resultant CVA and motor > ysphasia.CAG in our center was refused by our cardiology team.. MSCT shows no > oronary lesions . Can we proceed with arch operation assuming that there is no > AD? > erdinc > ______________________________________________ > penHeart-L mailing list > Send postings to: > OpenHeart-L@lists.hsforum.com > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > ttp://mmp.cjp.com/mailman/listinfo/openheart-l > All messages transmitted by the OpenHeart-L are subject to the policies and > isclaimers posted at: > ttp://www.hsforum.com/listdisclaim > ---------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Thu Mar 5 08:56:04 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Thu Mar 5 03:00:27 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: Message-ID: <13865055825456100545220112532841452270-Webmail@me.com> Dear Dr Martin, do you always perform a classical Kazui? Axillary or innominate artery cannulation may avoid to put at least one of the cannulae. Secondly, I have always found cumbersome the haemostasis of direct prosthesis cannulation site and the side branch has changed my surgical life. Thirdly, what do you think about perfusing the IVC for abdomen protection? Thank you Giuseppe Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Thursday, March 05, 2009, at 02:50AM, wrote: >Prasanna >Why didn't you do a sleeve? Depending on the pts hct most of the young marfanoid pts do not get transfused here and we do the standard sleeve. I am not a axillary cannulation fan and in these cases i have no problem cannulating the innominate directly if it is large enough. Most of the time however we just cannulate the distal ascending or prox arch and then under circ arrest we take the cannula out. After doing the distal anastomosis, I usually cannulate the dacron graft directly after circ arrest however several of my partners use a side arm graft and use the side arm to perfuse through. >As to testing the valve. The easiest and I think the best way is just after finishing the prox anastomosis at the STJ. I put a slotted cardioplegia needle into the ascending dacron graft, fill it up w cardioplegia and then clamp the graft. You can feel how well the root gets distended and see what and how much is coming back from your LV vent. I use crystalloid cardioplegia so it is easy to look at the vent and tell. If it turns clear, you have a problem!! > >Tom Martin >U of Florida >Gainesville > > >-----Original Message----- >From: Prasanna Simha M >To: OpenHeart-L >Sent: Wed, 4 Mar 2009 1:45 pm >Subject: [HSF] "Internal Sleeve" > > > >26 year old lady , Marfanoid presented with an ascending aortic aneurysm + >severe AR. Leaflets looked normal and mechanism of AR appeared due to ST >junction dilatation. She was AB positive and there was cncerns regarding >adequate supply of blood products as there was a bleeder case which had >reduced AB +ve donor pool in the city.(We had blood but not a very large >donor pool) >I planned to see the leaflets and if normal considered her for valve >sparing ascending aortic replacement with root reconstruction. >On table the aneurysm was up to the innominate and I cannulated the >innominate artery for systemic perfusion and also for innominate artery >perfusion. >On opening the aorta there was thickened wall (Not marfanoid) which was sent >for biopsy (Histopath awaited) .The leaflets looked normal and well >preserved. I decided to use a technique described in Interactive journal of >CT surgery (Original plan was for a Florida sleeve) and used an annular >stabilizing suture as described by Lars Svensson (The LV aortic junction was >not actually dilated) and then placed 3 tear drop patches fixed subannularly >with pledgeted sutures in each sinus with fenestrations for the coronaries >with the ostia fixed to the fenstrations. (The RCA ostium was painfully >small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still >not confident of doing it at higher temperatures) I did an intraluminal >hemiarch placement.The tube was then attached to the teardrop patches which >had been fixed at the ST junction.I then placed a prophylactic cabrol patch >fistula as soon as I came off CPB as I was worried about blood and blood >product usage (As you can see there wasnt much bleeding and the fistula hood >is not distended so its use may be questioned). >Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU >was a worrisome 20 ml !! >Patient was extubated within 6 hours and is doing well and will be >discharged tomorrow when the HPE report comes.The postop transthoracic echo >shows the Cabrol patch fistula has closed. >Ques >tions are how many of the members use innominate cannulation versus >axillary cannulation and reasons for the preerence.What are the problems >that the members have occurred with each strategy. >What are the tips and tricks that people who do aortic sparing surgery use >to judge aortic competence during intraop testing .(Not echocardiographic >which requires going off CPB ) as I find my judgement with aortic repairs >still hazy. Apart from holding water and visual inspection I also use the >method of El Khoury of placing a sucker in the LVOT and allowing the >leaflets to oppose and pull it (the sucker) out but somehow I am not able to >get the leaflets to stay put as I feel that the negative suction gets lost >by the time I pull the sucker out (Maybe It may be becuase I am using the >big Yankauer sucker which may be part of the problem and am planning to use >a dentist irrigation sucker for the same. > > >-- >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 >----------------------------------------- > > > >[Image Removed] > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- > > From robertobattellini at hotmail.com Thu Mar 5 11:18:43 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Thu Mar 5 05:19:32 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: <127782282141345871338618401122866491527-Webmail@me.com> References: <127782282141345871338618401122866491527-Webmail@me.com> Message-ID: Prasanna, Look at Strauch et al EJCTS 2004, he studied the spinal cord of pigs under normothermia and 32 degrees, a reduction of 5 degrees centigrades helped to prolongue the ischemia tolerance up to 50 minutes. If you extrapolate this to the arch surgery, and you DO perfuse the innominate artery and the left carotid and block or perfuse the left subclavia, you can perform your operation at 26 degrees as Giuseppe says, providing you do the distal in less than 30 minutes (for security).And if you need distal aortic perfusion, use the Dalla Torre technique of using a tracheal cannula and perfuse distally.You need a second arterial line in Y and that?s all. Of course, we have a little extra heat exchanger for that line, so if the core temperature is 26, we can perfuse the brain at 20?C. We do all that surgery at 25-26 degrees, axillary cannulation. Roberto > Date: Wed, 4 Mar 2009 23:53:43 +0100 > From: grescigno@mac.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] "Internal Sleeve" > CC: > > Prasanna, > > very nice case. I have just 2 comments: 1. I think that you should switch to 26 ?C, at least for an end to end anastomosis. 2. I am not using the innominate trunk (even if I think that is a very good idea, as 90% of my circulatory arrests are for aortic dissections and I am too worried about an involvement of the innominate artery. > > Giuseppe > > > Giuseppe Rescigno M.D. > Cardiothoracic Surgeon > > Lancisi Hospital > Torrette - Ancona > Italy > > > > On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" wrote: > >26 year old lady , Marfanoid presented with an ascending aortic aneurysm + > >severe AR. Leaflets looked normal and mechanism of AR appeared due to ST > >junction dilatation. She was AB positive and there was cncerns regarding > >adequate supply of blood products as there was a bleeder case which had > >reduced AB +ve donor pool in the city.(We had blood but not a very large > >donor pool) > >I planned to see the leaflets and if normal considered her for valve > >sparing ascending aortic replacement with root reconstruction. > >On table the aneurysm was up to the innominate and I cannulated the > >innominate artery for systemic perfusion and also for innominate artery > >perfusion. > >On opening the aorta there was thickened wall (Not marfanoid) which was sent > >for biopsy (Histopath awaited) .The leaflets looked normal and well > >preserved. I decided to use a technique described in Interactive journal of > >CT surgery (Original plan was for a Florida sleeve) and used an annular > >stabilizing suture as described by Lars Svensson (The LV aortic junction was > >not actually dilated) and then placed 3 tear drop patches fixed subannularly > >with pledgeted sutures in each sinus with fenestrations for the coronaries > >with the ostia fixed to the fenstrations. (The RCA ostium was painfully > >small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still > >not confident of doing it at higher temperatures) I did an intraluminal > >hemiarch placement.The tube was then attached to the teardrop patches which > >had been fixed at the ST junction.I then placed a prophylactic cabrol patch > >fistula as soon as I came off CPB as I was worried about blood and blood > >product usage (As you can see there wasnt much bleeding and the fistula hood > >is not distended so its use may be questioned). > >Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU > >was a worrisome 20 ml !! > >Patient was extubated within 6 hours and is doing well and will be > >discharged tomorrow when the HPE report comes.The postop transthoracic echo > >shows the Cabrol patch fistula has closed. > >Questions are how many of the members use innominate cannulation versus > >axillary cannulation and reasons for the preerence.What are the problems > >that the members have occurred with each strategy. > >What are the tips and tricks that people who do aortic sparing surgery use > >to judge aortic competence during intraop testing .(Not echocardiographic > >which requires going off CPB ) as I find my judgement with aortic repairs > >still hazy. Apart from holding water and visual inspection I also use the > >method of El Khoury of placing a sucker in the LVOT and allowing the > >leaflets to oppose and pull it (the sucker) out but somehow I am not able to > >get the leaflets to stay put as I feel that the negative suction gets lost > >by the time I pull the sucker out (Maybe It may be becuase I am using the > >big Yankauer sucker which may be part of the problem and am planning to use > >a dentist irrigation sucker for the same. > > > > > >-- > >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 tdmartin2000 at aol.com Thu Mar 5 05:39:27 2009 From: tdmartin2000 at aol.com (tdmartin2000@aol.com) Date: Thu Mar 5 05:40:36 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: <39918451804698399112005769336567769631-Webmail@me.com> References: <39918451804698399112005769336567769631-Webmail@me.com> Message-ID: <8CB6B95CACE8B2F-30C-27DC@WEBMAIL-DZ29.sysops.aol.com> No, most of the time we cannulate the distal ascending or the mid arch. Tom Martin U of Florida Gainesville -----Original Message----- From: Giuseppe Rescigno To: OpenHeart-L@lists.hsforum.com Sent: Thu, 5 Mar 2009 2:32 am Subject: Re: [HSF] "Internal Sleeve" Dear Dr Martin, do you always prefer to do a classical Kazui? cannulating the innominate Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Thursday, March 05, 2009, at 02:50AM, wrote: >Prasanna >Why didn't you do a sleeve? Depending on the pts hct most of the young marfanoid pts do not get transfused here and we do the standard sleeve. I am not a axillary cannulation fan and in these cases i have no problem cannulating the innominate directly if it is large enough. Most of the time however we just cannulate the distal ascending or prox arch and then under circ arrest we take the cannula out. After doing the distal anastomosis, I usually cannulate the dacron graft directly after circ arrest however several of my partners use a side arm graft and use the side arm to perfuse through. >As to testing the valve. The easiest and I think the best way is just after finishing the prox anastomosis at the STJ. I put a slotted cardioplegia needle into the ascending dacron graft, fill it up w cardioplegia and then clamp the graft. You can feel how well the root gets distended and see what and how much is coming back from your LV vent. I use crystalloid cardioplegia so it is easy to look at the vent and tell. If it turns clear, you have a problem!! > >Tom Martin >U of Florida >Gainesville > > >-----Original Message----- >From: Prasanna Simha M >To: OpenHeart-L >Sent: Wed, 4 Mar 2009 1:45 pm >Subject: [HSF] "Internal Sleeve" > > > >26 year old lady , Marfanoid presented with an ascending aortic aneurysm + >severe AR. Leaflets looked normal and mechanism of AR appeared due to ST >junction dilatation. She was AB positive and there was cncerns regarding >adequate supply of blood products as there was a bleeder case which had >reduced AB +ve donor pool in the city.(We had blood but not a very large >donor pool) >I planned to see the leaflets and if normal considered her for valve >sparing ascending aortic replacement with root reconstruction. >On table the aneurysm was up to the innominate and I cannulated the >innominate artery for systemic perfusion and also for innominate artery >perfusion. >On opening the aorta there was thickened wall (Not marfanoid) which was sent >for biopsy (Histopath awaited) .The leaflets looked normal and well >preserved. I decided to use a technique described in Interactive journal of >CT surgery (Original plan was for a Florida sleeve) and used an annular >stabilizing suture as described by Lars Svensson (The LV aortic junction was >not actually dilated) and then placed 3 tear drop patches fixed subannularly >with pledgeted sutures in each sinus with fenestrations for the coronaries >with the ostia fixed to the fenstrations. (The RCA ostium was painfully >small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still >not confident of doing it at higher temperatures) I did an intraluminal >hemiarch placement.The tube was then attached to the teardrop patches which >had been fixed at the ST junction.I then placed a prophylactic cabrol patch >fistula as soon as I came off CPB as I was worried about blood and blood >product usage (As you can see there wasnt much bleeding and the fistula hood >is not distended so its use may be questioned). >Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU >was a worrisome 20 ml !! >Patient was extubated within 6 hours and is doing well and will be >discharged tomorrow when the HPE report comes.The postop transthoracic echo >shows the Cabrol patch fistula has closed. >Ques >tions are how many of the members use innominate cannulation versus >axillary cannulation and reasons for the preerence.What are the problems >that the members have occurred with each strategy. >What are the tips and tricks that people who do aortic sparing surgery use >to judge aortic competence during intraop testing .(Not echocardiographic >which requires going off CPB ) as I find my judgement with aortic repairs >still h azy. Apart from holding water and visual inspection I also use the >method of El Khoury of placing a sucker in the LVOT and allowing the >leaflets to oppose and pull it (the sucker) out but somehow I am not able to >get the leaflets to stay put as I feel that the negative suction gets lost >by the time I pull the sucker out (Maybe It may be becuase I am using the >big Yankauer sucker which may be part of the problem and am planning to use >a dentist irrigation sucker for the same. > > >-- >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 >----------------------------------------- > > > >[Image Removed] > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- > > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 tdmartin2000 at aol.com Thu Mar 5 05:44:28 2009 From: tdmartin2000 at aol.com (tdmartin2000@aol.com) Date: Thu Mar 5 05:45:38 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: <13865055825456100545220112532841452270-Webmail@me.com> References: <13865055825456100545220112532841452270-Webmail@me.com> Message-ID: <8CB6B967DB96E18-30C-27EE@WEBMAIL-DZ29.sysops.aol.com> Not sure exactly what is a classical Kazui. We really have no problem w hemostasis with cannulating the graft. I don't use the side arm much as the cost of the graft is twice the cost, and I have never perfused the IVC. Not sure there is any data for that and even with a difficult elephant trunk or debranching the longest lower body ischemia times are 50 to 60 min. Most of our lower body ischemia times are less than 15 min and I see no real problems at less than 25 degrees. Tom Martin U of Florida Gainesville -----Original Message----- From: Giuseppe Rescigno To: OpenHeart-L@lists.hsforum.com Sent: Thu, 5 Mar 2009 2:56 am Subject: Re: [HSF] "Internal Sleeve" Dear Dr Martin, do you always perform a classical Kazui? Axillary or innominate artery cannulation may avoid to put at least one of the cannulae. Secondly, I have always found cumbersome the haemostasis of direct prosthesis cannulation site and the side branch has changed my surgical life. Thirdly, what do you think about perfusing the IVC for abdomen protection? Thank you Giuseppe Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Thursday, March 05, 2009, at 02:50AM, wrote: >Prasanna >Why didn't you do a sleeve? Depending on the pts hct most of the young marfanoid pts do not get transfused here and we do the standard sleeve. I am not a axillary cannulation fan and in these cases i have no problem cannulating the innominate directly if it is large enough. Most of the time however we just cannulate the distal ascending or prox arch and then under circ arrest we take the cannula out. After doing the distal anastomosis, I usually cannulate the dacron graft directly after circ arrest however several of my partners use a side arm graft and use the side arm to perfuse through. >As to testing the valve. The easiest and I think the best way is just after finishing the prox anastomosis at the STJ. I put a slotted cardioplegia needle into the ascending dacron graft, fill it up w cardioplegia and then clamp the graft. You can feel how well the root gets distended and see what and how much is coming back from your LV vent. I use crystalloid cardioplegia so it is easy to look at the vent and tell. If it turns clear, you have a problem!! > >Tom Martin >U of Florida >Gainesville > > >-----Original Message----- >From: Prasanna Simha M >To: OpenHeart-L >Sent: Wed, 4 Mar 2009 1:45 pm >Subject: [HSF] "Internal Sleeve" > > > >26 year old lady , Marfanoid presented with an ascending aortic aneurysm + >severe AR. Leaflets looked normal and mechanism of AR appeared due to ST >junction di latation. She was AB positive and there was cncerns regarding >adequate supply of blood products as there was a bleeder case which had >reduced AB +ve donor pool in the city.(We had blood but not a very large >donor pool) >I planned to see the leaflets and if normal considered her for valve >sparing ascending aortic replacement with root reconstruction. >On table the aneurysm was up to the innominate and I cannulated the >innominate artery for systemic perfusion and also for innominate artery >perfusion. >On opening the aorta there was thickened wall (Not marfanoid) which was sent >for biopsy (Histopath awaited) .The leaflets looked normal and well >preserved. I decided to use a technique described in Interactive journal of >CT surgery (Original plan was for a Florida sleeve) and used an annular >stabilizing suture as described by Lars Svensson (The LV aortic junction was >not actually dilated) and then placed 3 tear drop patches fixed subannularly >with pledgeted sutures in each sinus with fenestrations for the coronaries >with the ostia fixed to the fenstrations. (The RCA ostium was painfully >small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still >not confident of doing it at higher temperatures) I did an intraluminal >hemiarch placement.The tube was then attached to the teardrop patches which >had been fixed at the ST junction.I then placed a prophylactic cabrol patch >fistula as soon as I came off CPB as I was worried about blood and blood >product usage (As you can see there wasnt much bleeding and the fistula hood >is not distended so its use may be questioned). >Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU >was a worrisome 20 ml !! >Patient was extubated within 6 hours and is doing well and will be >discharged tomorrow when the HPE report comes.The postop transthoracic echo >shows the Cabrol patch fistula has closed. >Ques >tions are how many of the members use innominate cannulation versus >axillary cannulation and reasons for the preerence.What are the problems >that the members have occurred with each strategy. >What are the tips and tricks that people who do aortic sparing surgery use >to judge aortic competence during intraop testing .(Not echocardiographic >which requires going off CPB ) as I find my judgement with aortic repairs >still hazy. Apart from holding water and visual inspection I also use the >method of El Khoury of placing a sucker in the LVOT and allowing the >leaflets to oppose and pull it (the sucker) out but somehow I am not able to >get the leaflets to stay put as I feel that the negative suction gets lost >by the time I pull the sucker out (Maybe It may be becuase I am using the >big Yankauer sucker which may be part of the problem and am planning to use >a dentist irrigation sucker for the same. > > >-- >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 >----------------------------------------- > > > >[Image Removed] > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- > > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://w ww.hsforum.com/listdisclaim ----------------------------------------- From grescigno at mac.com Thu Mar 5 15:17:37 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Thu Mar 5 09:21:07 2009 Subject: [HSF] Recurrent pericardial effusion In-Reply-To: <677830.13543.qm@web81603.mail.mud.yahoo.com> References: <001201c75d90$0c189580$b3160a06@HZLPC0679> <8C92E6BBF13CD53-6F8-112B@webmail-mf17.sysops.aol.com> <8C92E75F01F1761-6F8-13D6@webmail-mf17.sysops.aol.com> <45EEC794.5030500@gmail.com> <007301c760f9$0bda0830$b3160a06@HZLPC0679> <45EF641E.3090608@gmail.com> <009101c7615a$d3bc1c60$b3160a06@HZLPC0679> <155667659108027853901098758090316571256-Webmail@me.com> <677830.13543.qm@web81603.mail.mud.yahoo.com> Message-ID: Tea, we clamped the pigtai today and we will repeat the echo in 2 days Thanks G Il giorno 03/mar/09, alle ore 17:13, Tea Acuff ha scritto: > If he has two windows, why not pull the pigtail out? The solution > in this disease is not to close but to open. You may be reluctant > but at some point more excised pericardium perhaps with strips to > pervent herniation if no adhsions are present will have to prevent > accumulation of "pericardial" fluid. > > tea > > > > > ________________________________ > From: Giuseppe Rescigno > To: OpenHeart-L@lists.hsforum.com > Sent: Tuesday, March 3, 2009 10:02:28 AM > Subject: Re: [HSF] Recurrent pericardial effusion > > Prasanna, > > Thank you as usual. No it is not chylopericardium. We are really > worried because this patient is in our Dept since January! Moreover > a postop bleeding of one thoracotomy near failed to kill him! He > has still a pigtail into the pericardial cavity and each day 200 mL > of serous fluid comes out. > > Giuseppe Rescigno M.D. > Cardiothoracic Surgeon > > Lancisi Hospital > Torrette - Ancona > Italy > > > > On Tuesday, March 03, 2009, at 04:40PM, "Prasanna Simha M" > wrote: >> Has chylopericardium been ruled out. Some patients with CCF drain for >> days and benefit by drying them out.In some cases leaving a chest >> tube >> for a week or so causes d >> adhesions and stopsthe effusion. i would not add sclerosants for fear >> of constricition and scarring and encasing of grafts. >> Prasanna >> On Tue, Mar 3, 2009 at 9:00 PM, Giuseppe Rescigno >> wrote: >>> >>> Dear Members, >>> >>> I need your advice concenrning a patient, operated on for CABG in >>> another center, that we admitted for postoperative (1 mo) >>> pericardial effusion. He underwent 2 percutaneous drainages and >>> subsequently 2 pleuro-pericardial windows by left and right >>> minithoracotomies. All cancer markers are negative as well as CT >>> scans. Nervertheless he still produces 200 mL of effusion each >>> day. We have tried all the possible drugs. Is there anyone who >>> has experience with glue injection or some other voodoos? >>> >>> Thanks in advance >>> >>> 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 >>> ----------------------------------------- >>> >> >> >> >> -- >> 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 enaseri at hotmail.com.tr Thu Mar 5 15:16:33 2009 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Thu Mar 5 10:17:21 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: <8CB6B967DB96E18-30C-27EE@WEBMAIL-DZ29.sysops.aol.com> References: <13865055825456100545220112532841452270-Webmail@me.com> <8CB6B967DB96E18-30C-27EE@WEBMAIL-DZ29.sysops.aol.com> Message-ID: Dear Dr. Martin, Forum server automatically rejected my postings, so I will send the pictures to Prassana. erdinc > From prasannasimha at gmail.com Thu Mar 5 21:06:00 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Mar 5 10:36:27 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: <8CB6B4BDFEB3B4C-142C-22EB@WEBMAIL-DZ40.sysops.aol.com> References: <89c4ed2d0903041045w61b9cac0ma94dfefbf146059a@mail.gmail.com> <8CB6B4BDFEB3B4C-142C-22EB@WEBMAIL-DZ40.sysops.aol.com> Message-ID: <89c4ed2d0903050736q7980f756m46b0c5d949662a4d@mail.gmail.com> This appeared an easier operation than even the sleeve and with far lesser dissection so I kept it as an option. It seems to work well. Prasanna On Thu, Mar 5, 2009 at 7:20 AM, wrote: > Prasanna > Why didn't you do a sleeve? Depending on the pts hct most of the young > marfanoid pts do not get transfused here and we do the standard sleeve. I am > not a axillary cannulation fan and in these cases i have no problem > cannulating the innominate directly if it is large enough. Most of the time > however we just cannulate the distal ascending or prox arch and then under > circ arrest we take the cannula out. After doing the distal anastomosis, I > usually cannulate the dacron graft directly after circ arrest however > several of my partners use a side arm graft and use the side arm to perfuse > through. > As to testing the valve. The easiest and I think the best way is just after > finishing the prox anastomosis at the STJ. I put a slotted cardioplegia > needle into the ascending dacron graft, fill it up w cardioplegia and then > clamp the graft. You can feel how well the root gets distended and see what > and how much is coming back from your LV vent. I use crystalloid > cardioplegia so it is easy to look at the vent and tell. If it turns clear, > you have a problem!! > > Tom Martin > U of Florida > Gainesville > > > -----Original Message----- > From: Prasanna Simha M > To: OpenHeart-L > Sent: Wed, 4 Mar 2009 1:45 pm > Subject: [HSF] "Internal Sleeve" > > > > 26 year old lady , Marfanoid presented with an ascending aortic aneurysm + > severe AR. Leaflets looked normal and mechanism of AR appeared due to ST > junction dilatation. She was AB positive and there was cncerns regarding > adequate supply of blood products as there was a bleeder case which had > reduced AB +ve donor pool in the city.(We had blood but not a very large > donor pool) > I planned to see the leaflets and if normal considered her for valve > sparing ascending aortic replacement with root reconstruction. > On table the aneurysm was up to the innominate and I cannulated the > innominate artery for systemic perfusion and also for innominate artery > perfusion. > On opening the aorta there was thickened wall (Not marfanoid) which was > sent > for biopsy (Histopath awaited) .The leaflets looked normal and well > preserved. I decided to use a technique described in Interactive journal > of > CT surgery (Original plan was for a Florida sleeve) and used an annular > stabilizing suture as described by Lars Svensson (The LV aortic junction > was > not actually dilated) and then placed 3 tear drop patches fixed > subannularly > with pledgeted sutures in each sinus with fenestrations for the coronaries > with the ostia fixed to the fenstrations. (The RCA ostium was painfully > small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still > not confident of doing it at higher temperatures) I did an intraluminal > hemiarch placement.The tube was then attached to the teardrop patches > which > had been fixed at the ST junction.I then placed a prophylactic cabrol patch > fistula as soon as I came off CPB as I was worried about blood and blood > product usage (As you can see there wasnt much bleeding and the fistula > hood > is not distended so its use may be questioned). > Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU > was a worrisome 20 ml !! > Patient was extubated within 6 hours and is doing well and will be > discharged tomorrow when the HPE report comes.The postop transthoracic echo > shows the Cabrol patch fistula has closed. > Ques > tions are how many of the members use innominate cannulation versus > axillary cannulation and reasons for the preerence.What are the problems > that the members have occurred with each strategy. > What are the tips and tricks that people who do aortic sparing surgery use > to judge aortic competence during intraop testing .(Not echocardiographic > which requires going off CPB ) as I find my judgement with aortic repairs > still hazy. Apart from holding water and visual inspection I also use the > method of El Khoury of placing a sucker in the LVOT and allowing the > leaflets to oppose and pull it (the sucker) out but somehow I am not able > to > get the leaflets to stay put as I feel that the negative suction gets lost > by the time I pull the sucker out (Maybe It may be becuase I am using the > big Yankauer sucker which may be part of the problem and am planning to use > a dentist irrigation sucker for the same. > > > -- > 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 > ----------------------------------------- > > > > [Image Removed] > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Thu Mar 5 21:10:16 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Mar 5 10:40:45 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: <127782282141345871338618401122866491527-Webmail@me.com> Message-ID: <89c4ed2d0903050740n3b247dccrc305ea206d87ab3b@mail.gmail.com> I agree Roberto but something makes me hesitate to go up in temperature. Maybe will do it at a higher temperature in the next case !! Prasanna On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > Prasanna, > > > > Look at Strauch et al EJCTS 2004, he studied the spinal cord of pigs under > normothermia and 32 degrees, a reduction of 5 degrees centigrades helped to > prolongue the ischemia tolerance up to 50 minutes. > > If you extrapolate this to the arch surgery, and you DO perfuse the > innominate artery and the left carotid and block or perfuse the left > subclavia, you can perform your operation at 26 degrees as Giuseppe says, > providing you do the distal in less than 30 minutes (for security).And if > you need distal aortic perfusion, use the Dalla Torre technique of using a > tracheal cannula and perfuse distally.You need a second arterial line in Y > and that?s all. > > Of course, we have a little extra heat exchanger for that line, so if the > core temperature is 26, we can perfuse the brain at 20?C. > > We do all that surgery at 25-26 degrees, axillary cannulation. > > Roberto > > > Date: Wed, 4 Mar 2009 23:53:43 +0100 > > From: grescigno@mac.com > > To: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] "Internal Sleeve" > > CC: > > > > Prasanna, > > > > very nice case. I have just 2 comments: 1. I think that you should switch > to 26 ?C, at least for an end to end anastomosis. 2. I am not using the > innominate trunk (even if I think that is a very good idea, as 90% of my > circulatory arrests are for aortic dissections and I am too worried about an > involvement of the innominate artery. > > > > Giuseppe > > > > > > Giuseppe Rescigno M.D. > > Cardiothoracic Surgeon > > > > Lancisi Hospital > > Torrette - Ancona > > Italy > > > > > > > > On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < > prasannasimha@gmail.com> wrote: > > >26 year old lady , Marfanoid presented with an ascending aortic aneurysm > + > > >severe AR. Leaflets looked normal and mechanism of AR appeared due to ST > > >junction dilatation. She was AB positive and there was cncerns regarding > > >adequate supply of blood products as there was a bleeder case which had > > >reduced AB +ve donor pool in the city.(We had blood but not a very large > > >donor pool) > > >I planned to see the leaflets and if normal considered her for valve > > >sparing ascending aortic replacement with root reconstruction. > > >On table the aneurysm was up to the innominate and I cannulated the > > >innominate artery for systemic perfusion and also for innominate artery > > >perfusion. > > >On opening the aorta there was thickened wall (Not marfanoid) which was > sent > > >for biopsy (Histopath awaited) .The leaflets looked normal and well > > >preserved. I decided to use a technique described in Interactive journal > of > > >CT surgery (Original plan was for a Florida sleeve) and used an annular > > >stabilizing suture as described by Lars Svensson (The LV aortic junction > was > > >not actually dilated) and then placed 3 tear drop patches fixed > subannularly > > >with pledgeted sutures in each sinus with fenestrations for the > coronaries > > >with the ostia fixed to the fenstrations. (The RCA ostium was painfully > > >small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am > still > > >not confident of doing it at higher temperatures) I did an intraluminal > > >hemiarch placement.The tube was then attached to the teardrop patches > which > > >had been fixed at the ST junction.I then placed a prophylactic cabrol > patch > > >fistula as soon as I came off CPB as I was worried about blood and blood > > >product usage (As you can see there wasnt much bleeding and the fistula > hood > > >is not distended so its use may be questioned). > > >Intraop Echo showed Mild AR and was accepted. Total blood loss in the > ICU > > >was a worrisome 20 ml !! > > >Patient was extubated within 6 hours and is doing well and will be > > >discharged tomorrow when the HPE report comes.The postop transthoracic > echo > > >shows the Cabrol patch fistula has closed. > > >Questions are how many of the members use innominate cannulation versus > > >axillary cannulation and reasons for the preerence.What are the problems > > >that the members have occurred with each strategy. > > >What are the tips and tricks that people who do aortic sparing surgery > use > > >to judge aortic competence during intraop testing .(Not > echocardiographic > > >which requires going off CPB ) as I find my judgement with aortic > repairs > > >still hazy. Apart from holding water and visual inspection I also use > the > > >method of El Khoury of placing a sucker in the LVOT and allowing the > > >leaflets to oppose and pull it (the sucker) out but somehow I am not > able to > > >get the leaflets to stay put as I feel that the negative suction gets > lost > > >by the time I pull the sucker out (Maybe It may be becuase I am using > the > > >big Yankauer sucker which may be part of the problem and am planning to > use > > >a dentist irrigation sucker for the same. > > > > > > > > >-- > > >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 prasannasimha at gmail.com Thu Mar 5 21:08:15 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Mar 5 11:36:55 2009 Subject: [HSF] Recurrent pleural effusion In-Reply-To: <000901c99d48$86cae5e0$9460b1a0$@net> References: <14211287630034541604787844435911961481-Webmail@me.com> <89c4ed2d0903040310g7b6dd53fo469463d5043a3a09@mail.gmail.com> <000901c99d48$86cae5e0$9460b1a0$@net> Message-ID: <89c4ed2d0903050738l32ca5e27n557fa2cbc0b4e466@mail.gmail.com> This is often due to fluid accumulation and premptive diuretic usage sharply decreases the incidence of these effusions.If they are persistent I put a chest tube and continue diuresis. (As I said preemptive diuresis diminishes the need for this) Prasanna On Thu, Mar 5, 2009 at 9:41 AM, Ajit Damle wrote: > In a different vein, how do you deal with a recurrent pleural (non-chylous) > effusion after CABG with IMA? After a second or third pleurocentesis? > > Ajit Damle > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From enaseri at hotmail.com.tr Thu Mar 5 16:39:21 2009 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Thu Mar 5 11:40:12 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: <127782282141345871338618401122866491527-Webmail@me.com> Message-ID: Robertto, Do you perfuse the carotids and other organs with a single pump head or 2 seperate heads.And if you use a single pump head how do you manage to maintain ASCP at a fixed flow.I am asking this because we use 2 seperate heads in series which makes the CPB somehow complicated for a single perfusionist and somebody must assist him. The line from the 1.st head is divided to 2 . One goes to a seperate reservoir and the second to the lines used for ASCP. A second pump head gets its blood from the seperate reservoir and pumps it to the rest of the body. erdinc > From prasannasimha at gmail.com Thu Mar 5 21:44:13 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Mar 5 11:43:45 2009 Subject: [HSF] Mega Aorta Erdinc's case Message-ID: <89c4ed2d0903050814r76e4e0a5m498d70155eb21ef1@mail.gmail.com> Erdinc's case. He will discuss it. Erdinc the server rejexts file sizes greater than 512 Kb so you need to resize it using any picture software . You can use Irfanview which is a freeware or Paintdotnet(Which is also a freeware) -- Prasanna Simha M -------------- next part -------------- A non-text attachment was scrubbed... Name: erdinc megaaorta.jpg Type: image/jpeg Size: 45011 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090305/4eff7645/erdincmegaaorta.jpg -------------- next part -------------- A non-text attachment was scrubbed... Name: megaaorta2.jpg Type: image/jpeg Size: 51677 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20090305/4eff7645/megaaorta2.jpg From robertobattellini at hotmail.com Thu Mar 5 18:11:55 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Thu Mar 5 12:12:25 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: <89c4ed2d0903050740n3b247dccrc305ea206d87ab3b@mail.gmail.com> References: <127782282141345871338618401122866491527-Webmail@me.com> <89c4ed2d0903050740n3b247dccrc305ea206d87ab3b@mail.gmail.com> Message-ID: Prasanna, go 2 grades upper each case until you feel yourself comfortable. Roberto > Date: Thu, 5 Mar 2009 21:10:16 +0530 > Subject: Re: [HSF] "Internal Sleeve" > From: prasannasimha@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > > I agree Roberto but something makes me hesitate to go up in temperature. > Maybe will do it at a higher temperature in the next case !! > Prasanna > > On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > > > > > Prasanna, > > > > > > > > Look at Strauch et al EJCTS 2004, he studied the spinal cord of pigs under > > normothermia and 32 degrees, a reduction of 5 degrees centigrades helped to > > prolongue the ischemia tolerance up to 50 minutes. > > > > If you extrapolate this to the arch surgery, and you DO perfuse the > > innominate artery and the left carotid and block or perfuse the left > > subclavia, you can perform your operation at 26 degrees as Giuseppe says, > > providing you do the distal in less than 30 minutes (for security).And if > > you need distal aortic perfusion, use the Dalla Torre technique of using a > > tracheal cannula and perfuse distally.You need a second arterial line in Y > > and that?s all. > > > > Of course, we have a little extra heat exchanger for that line, so if the > > core temperature is 26, we can perfuse the brain at 20?C. > > > > We do all that surgery at 25-26 degrees, axillary cannulation. > > > > Roberto > > > > > Date: Wed, 4 Mar 2009 23:53:43 +0100 > > > From: grescigno@mac.com > > > To: OpenHeart-L@lists.hsforum.com > > > Subject: Re: [HSF] "Internal Sleeve" > > > CC: > > > > > > Prasanna, > > > > > > very nice case. I have just 2 comments: 1. I think that you should switch > > to 26 ?C, at least for an end to end anastomosis. 2. I am not using the > > innominate trunk (even if I think that is a very good idea, as 90% of my > > circulatory arrests are for aortic dissections and I am too worried about an > > involvement of the innominate artery. > > > > > > Giuseppe > > > > > > > > > Giuseppe Rescigno M.D. > > > Cardiothoracic Surgeon > > > > > > Lancisi Hospital > > > Torrette - Ancona > > > Italy > > > > > > > > > > > > On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < > > prasannasimha@gmail.com> wrote: > > > >26 year old lady , Marfanoid presented with an ascending aortic aneurysm > > + > > > >severe AR. Leaflets looked normal and mechanism of AR appeared due to ST > > > >junction dilatation. She was AB positive and there was cncerns regarding > > > >adequate supply of blood products as there was a bleeder case which had > > > >reduced AB +ve donor pool in the city.(We had blood but not a very large > > > >donor pool) > > > >I planned to see the leaflets and if normal considered her for valve > > > >sparing ascending aortic replacement with root reconstruction. > > > >On table the aneurysm was up to the innominate and I cannulated the > > > >innominate artery for systemic perfusion and also for innominate artery > > > >perfusion. > > > >On opening the aorta there was thickened wall (Not marfanoid) which was > > sent > > > >for biopsy (Histopath awaited) .The leaflets looked normal and well > > > >preserved. I decided to use a technique described in Interactive journal > > of > > > >CT surgery (Original plan was for a Florida sleeve) and used an annular > > > >stabilizing suture as described by Lars Svensson (The LV aortic junction > > was > > > >not actually dilated) and then placed 3 tear drop patches fixed > > subannularly > > > >with pledgeted sutures in each sinus with fenestrations for the > > coronaries > > > >with the ostia fixed to the fenstrations. (The RCA ostium was painfully > > > >small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am > > still > > > >not confident of doing it at higher temperatures) I did an intraluminal > > > >hemiarch placement.The tube was then attached to the teardrop patches > > which > > > >had been fixed at the ST junction.I then placed a prophylactic cabrol > > patch > > > >fistula as soon as I came off CPB as I was worried about blood and blood > > > >product usage (As you can see there wasnt much bleeding and the fistula > > hood > > > >is not distended so its use may be questioned). > > > >Intraop Echo showed Mild AR and was accepted. Total blood loss in the > > ICU > > > >was a worrisome 20 ml !! > > > >Patient was extubated within 6 hours and is doing well and will be > > > >discharged tomorrow when the HPE report comes.The postop transthoracic > > echo > > > >shows the Cabrol patch fistula has closed. > > > >Questions are how many of the members use innominate cannulation versus > > > >axillary cannulation and reasons for the preerence.What are the problems > > > >that the members have occurred with each strategy. > > > >What are the tips and tricks that people who do aortic sparing surgery > > use > > > >to judge aortic competence during intraop testing .(Not > > echocardiographic > > > >which requires going off CPB ) as I find my judgement with aortic > > repairs > > > >still hazy. Apart from holding water and visual inspection I also use > > the > > > >method of El Khoury of placing a sucker in the LVOT and allowing the > > > >leaflets to oppose and pull it (the sucker) out but somehow I am not > > able to > > > >get the leaflets to stay put as I feel that the negative suction gets > > lost > > > >by the time I pull the sucker out (Maybe It may be becuase I am using > > the > > > >big Yankauer sucker which may be part of the problem and am planning to > > use > > > >a dentist irrigation sucker for the same. > > > > > > > > > > > >-- > > > >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 grescigno at mac.com Thu Mar 5 20:56:36 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Thu Mar 5 15:04:00 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: <127782282141345871338618401122866491527-Webmail@me.com> <89c4ed2d0903050740n3b247dccrc305ea206d87ab3b@mail.gmail.com> Message-ID: Roberto, I am planning for the next arrest to perfuse retrogradely through the IVC the abdomen etc. IMHO this may add some extra protection that may allow almost to stay almost warm (32?C). Of course I will go down to 26 as usual but I will monitor splancnic perfusion by means of abdominal NIRS. What is your opinion? are you skeptical as Dr Martin? If we open our mind then we may start to find better new ways to do the same things. The first who did retrograde cardioplegia was considered a crazy guy by the others. There was a very nice script I read once that was accreditated to Walton Lillehei about the steps of knowledge in surgery: at each step there was an advancement and the comments of the collegues.... Thank you Giuseppe Il giorno 05/mar/09, alle ore 18:11, Roberto Battellini ha scritto: > > Prasanna, > > go 2 grades upper each case until you feel yourself comfortable. > > Roberto > >> Date: Thu, 5 Mar 2009 21:10:16 +0530 >> Subject: Re: [HSF] "Internal Sleeve" >> From: prasannasimha@gmail.com >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> I agree Roberto but something makes me hesitate to go up in >> temperature. >> Maybe will do it at a higher temperature in the next case !! >> Prasanna >> >> On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < >> robertobattellini@hotmail.com> wrote: >> >>> >>> Prasanna, >>> >>> >>> >>> Look at Strauch et al EJCTS 2004, he studied the spinal cord of >>> pigs under >>> normothermia and 32 degrees, a reduction of 5 degrees centigrades >>> helped to >>> prolongue the ischemia tolerance up to 50 minutes. >>> >>> If you extrapolate this to the arch surgery, and you DO perfuse the >>> innominate artery and the left carotid and block or perfuse the left >>> subclavia, you can perform your operation at 26 degrees as >>> Giuseppe says, >>> providing you do the distal in less than 30 minutes (for >>> security).And if >>> you need distal aortic perfusion, use the Dalla Torre technique >>> of using a >>> tracheal cannula and perfuse distally.You need a second arterial >>> line in Y >>> and that?s all. >>> >>> Of course, we have a little extra heat exchanger for that line, >>> so if the >>> core temperature is 26, we can perfuse the brain at 20?C. >>> >>> We do all that surgery at 25-26 degrees, axillary cannulation. >>> >>> Roberto >>> >>>> Date: Wed, 4 Mar 2009 23:53:43 +0100 >>>> From: grescigno@mac.com >>>> To: OpenHeart-L@lists.hsforum.com >>>> Subject: Re: [HSF] "Internal Sleeve" >>>> CC: >>>> >>>> Prasanna, >>>> >>>> very nice case. I have just 2 comments: 1. I think that you >>>> should switch >>> to 26 ?C, at least for an end to end anastomosis. 2. I am not >>> using the >>> innominate trunk (even if I think that is a very good idea, as >>> 90% of my >>> circulatory arrests are for aortic dissections and I am too >>> worried about an >>> involvement of the innominate artery. >>>> >>>> Giuseppe >>>> >>>> >>>> Giuseppe Rescigno M.D. >>>> Cardiothoracic Surgeon >>>> >>>> Lancisi Hospital >>>> Torrette - Ancona >>>> Italy >>>> >>>> >>>> >>>> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < >>> prasannasimha@gmail.com> wrote: >>>>> 26 year old lady , Marfanoid presented with an ascending aortic >>>>> aneurysm >>> + >>>>> severe AR. Leaflets looked normal and mechanism of AR appeared >>>>> due to ST >>>>> junction dilatation. She was AB positive and there was cncerns >>>>> regarding >>>>> adequate supply of blood products as there was a bleeder case >>>>> which had >>>>> reduced AB +ve donor pool in the city.(We had blood but not a >>>>> very large >>>>> donor pool) >>>>> I planned to see the leaflets and if normal considered her for >>>>> valve >>>>> sparing ascending aortic replacement with root reconstruction. >>>>> On table the aneurysm was up to the innominate and I cannulated >>>>> the >>>>> innominate artery for systemic perfusion and also for >>>>> innominate artery >>>>> perfusion. >>>>> On opening the aorta there was thickened wall (Not marfanoid) >>>>> which was >>> sent >>>>> for biopsy (Histopath awaited) .The leaflets looked normal and >>>>> well >>>>> preserved. I decided to use a technique described in >>>>> Interactive journal >>> of >>>>> CT surgery (Original plan was for a Florida sleeve) and used an >>>>> annular >>>>> stabilizing suture as described by Lars Svensson (The LV aortic >>>>> junction >>> was >>>>> not actually dilated) and then placed 3 tear drop patches fixed >>> subannularly >>>>> with pledgeted sutures in each sinus with fenestrations for the >>> coronaries >>>>> with the ostia fixed to the fenstrations. (The RCA ostium was >>>>> painfully >>>>> small !!). This allowed good coaptation. Under ACP at 18 Deg C >>>>> (I am >>> still >>>>> not confident of doing it at higher temperatures) I did an >>>>> intraluminal >>>>> hemiarch placement.The tube was then attached to the teardrop >>>>> patches >>> which >>>>> had been fixed at the ST junction.I then placed a prophylactic >>>>> cabrol >>> patch >>>>> fistula as soon as I came off CPB as I was worried about blood >>>>> and blood >>>>> product usage (As you can see there wasnt much bleeding and the >>>>> fistula >>> hood >>>>> is not distended so its use may be questioned). >>>>> Intraop Echo showed Mild AR and was accepted. Total blood loss >>>>> in the >>> ICU >>>>> was a worrisome 20 ml !! >>>>> Patient was extubated within 6 hours and is doing well and will be >>>>> discharged tomorrow when the HPE report comes.The postop >>>>> transthoracic >>> echo >>>>> shows the Cabrol patch fistula has closed. >>>>> Questions are how many of the members use innominate >>>>> cannulation versus >>>>> axillary cannulation and reasons for the preerence.What are the >>>>> problems >>>>> that the members have occurred with each strategy. >>>>> What are the tips and tricks that people who do aortic sparing >>>>> surgery >>> use >>>>> to judge aortic competence during intraop testing .(Not >>> echocardiographic >>>>> which requires going off CPB ) as I find my judgement with aortic >>> repairs >>>>> still hazy. Apart from holding water and visual inspection I >>>>> also use >>> the >>>>> method of El Khoury of placing a sucker in the LVOT and >>>>> allowing the >>>>> leaflets to oppose and pull it (the sucker) out but somehow I >>>>> am not >>> able to >>>>> get the leaflets to stay put as I feel that the negative >>>>> suction gets >>> lost >>>>> by the time I pull the sucker out (Maybe It may be becuase I am >>>>> using >>> the >>>>> big Yankauer sucker which may be part of the problem and am >>>>> planning to >>> use >>>>> a dentist irrigation sucker for the same. >>>>> >>>>> >>>>> -- >>>>> 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 >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Thu Mar 5 20:51:32 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Thu Mar 5 15:52:00 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: <127782282141345871338618401122866491527-Webmail@me.com> <89c4ed2d0903050740n3b247dccrc305ea206d87ab3b@mail.gmail.com> Message-ID: > I am planning for the next arrest to perfuse retrogradely through the > IVC the abdomen etc. IMHO this may add some extra protection that may > allow almost to stay almost warm (32?C). > Giuseppe But what would your reason to want to try this technique? Why do have desire to stay warm? Why not try this technique in animals first (or not done so) before you advance our years old techniques in humans! Odd the very strong and religious oppositions we get to the evils of conventional surgery in our speciality. Usually it is the off-pump brigade (cursing all the bad things the pump does but yet doing AVRs on pump), or the beating heart brigade (cursing all the bad things cardioplegia does to the heart, yet not hestistant to arrest heart for an arch replacement or transplant - i suppose though they can work out creative ways to keep heart beating through both), the reference surgery battallion, of which I am a member (that swear low volume occasional surgery is bad, yet themselves doing less than 20 CABGs per year, not believing anymore in need for expertise), or the anaortic regiment (cursing the use of murderous clamps on aortae, yet performing AVRs with clamps on same vessel). But now its about temperature? We now want to circ arrest at normothermia??? I have seen many things, but a patient having arch surgery who died of moderate hypothermia I have not found. Now these HSF religious movements are getting to me!!!! What next? Any takers for awake surgery...surely it cant be a physiological to put patients to sleep just because you are operating on their heart??? Ani > From: grescigno@mac.com > Subject: Re: [HSF] "Internal Sleeve" > Date: Thu, 5 Mar 2009 20:56:36 +0100 > To: OpenHeart-L@lists.hsforum.com > CC: > > Roberto, > > I am planning for the next arrest to perfuse retrogradely through the > IVC the abdomen etc. IMHO this may add some extra protection that may > allow almost to stay almost warm (32?C). Of course I will go down to > 26 as usual but I will monitor splancnic perfusion by means of > abdominal NIRS. What is your opinion? are you skeptical as Dr Martin? > If we open our mind then we may start to find better new ways to do > the same things. The first who did retrograde cardioplegia was > considered a crazy guy by the others. There was a very nice script I > read once that was accreditated to Walton Lillehei about the steps of > knowledge in surgery: at each step there was an advancement and the > comments of the collegues.... > > Thank you > > > Giuseppe > > > Il giorno 05/mar/09, alle ore 18:11, Roberto Battellini ha scritto: > > > > > Prasanna, > > > > go 2 grades upper each case until you feel yourself comfortable. > > > > Roberto > > > >> Date: Thu, 5 Mar 2009 21:10:16 +0530 > >> Subject: Re: [HSF] "Internal Sleeve" > >> From: prasannasimha@gmail.com > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> > >> I agree Roberto but something makes me hesitate to go up in > >> temperature. > >> Maybe will do it at a higher temperature in the next case !! > >> Prasanna > >> > >> On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < > >> robertobattellini@hotmail.com> wrote: > >> > >>> > >>> Prasanna, > >>> > >>> > >>> > >>> Look at Strauch et al EJCTS 2004, he studied the spinal cord of > >>> pigs under > >>> normothermia and 32 degrees, a reduction of 5 degrees centigrades > >>> helped to > >>> prolongue the ischemia tolerance up to 50 minutes. > >>> > >>> If you extrapolate this to the arch surgery, and you DO perfuse the > >>> innominate artery and the left carotid and block or perfuse the left > >>> subclavia, you can perform your operation at 26 degrees as > >>> Giuseppe says, > >>> providing you do the distal in less than 30 minutes (for > >>> security).And if > >>> you need distal aortic perfusion, use the Dalla Torre technique > >>> of using a > >>> tracheal cannula and perfuse distally.You need a second arterial > >>> line in Y > >>> and that?s all. > >>> > >>> Of course, we have a little extra heat exchanger for that line, > >>> so if the > >>> core temperature is 26, we can perfuse the brain at 20?C. > >>> > >>> We do all that surgery at 25-26 degrees, axillary cannulation. > >>> > >>> Roberto > >>> > >>>> Date: Wed, 4 Mar 2009 23:53:43 +0100 > >>>> From: grescigno@mac.com > >>>> To: OpenHeart-L@lists.hsforum.com > >>>> Subject: Re: [HSF] "Internal Sleeve" > >>>> CC: > >>>> > >>>> Prasanna, > >>>> > >>>> very nice case. I have just 2 comments: 1. I think that you > >>>> should switch > >>> to 26 ?C, at least for an end to end anastomosis. 2. I am not > >>> using the > >>> innominate trunk (even if I think that is a very good idea, as > >>> 90% of my > >>> circulatory arrests are for aortic dissections and I am too > >>> worried about an > >>> involvement of the innominate artery. > >>>> > >>>> Giuseppe > >>>> > >>>> > >>>> Giuseppe Rescigno M.D. > >>>> Cardiothoracic Surgeon > >>>> > >>>> Lancisi Hospital > >>>> Torrette - Ancona > >>>> Italy > >>>> > >>>> > >>>> > >>>> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < > >>> prasannasimha@gmail.com> wrote: > >>>>> 26 year old lady , Marfanoid presented with an ascending aortic > >>>>> aneurysm > >>> + > >>>>> severe AR. Leaflets looked normal and mechanism of AR appeared > >>>>> due to ST > >>>>> junction dilatation. She was AB positive and there was cncerns > >>>>> regarding > >>>>> adequate supply of blood products as there was a bleeder case > >>>>> which had > >>>>> reduced AB +ve donor pool in the city.(We had blood but not a > >>>>> very large > >>>>> donor pool) > >>>>> I planned to see the leaflets and if normal considered her for > >>>>> valve > >>>>> sparing ascending aortic replacement with root reconstruction. > >>>>> On table the aneurysm was up to the innominate and I cannulated > >>>>> the > >>>>> innominate artery for systemic perfusion and also for > >>>>> innominate artery > >>>>> perfusion. > >>>>> On opening the aorta there was thickened wall (Not marfanoid) > >>>>> which was > >>> sent > >>>>> for biopsy (Histopath awaited) .The leaflets looked normal and > >>>>> well > >>>>> preserved. I decided to use a technique described in > >>>>> Interactive journal > >>> of > >>>>> CT surgery (Original plan was for a Florida sleeve) and used an > >>>>> annular > >>>>> stabilizing suture as described by Lars Svensson (The LV aortic > >>>>> junction > >>> was > >>>>> not actually dilated) and then placed 3 tear drop patches fixed > >>> subannularly > >>>>> with pledgeted sutures in each sinus with fenestrations for the > >>> coronaries > >>>>> with the ostia fixed to the fenstrations. (The RCA ostium was > >>>>> painfully > >>>>> small !!). This allowed good coaptation. Under ACP at 18 Deg C > >>>>> (I am > >>> still > >>>>> not confident of doing it at higher temperatures) I did an > >>>>> intraluminal > >>>>> hemiarch placement.The tube was then attached to the teardrop > >>>>> patches > >>> which > >>>>> had been fixed at the ST junction.I then placed a prophylactic > >>>>> cabrol > >>> patch > >>>>> fistula as soon as I came off CPB as I was worried about blood > >>>>> and blood > >>>>> product usage (As you can see there wasnt much bleeding and the > >>>>> fistula > >>> hood > >>>>> is not distended so its use may be questioned). > >>>>> Intraop Echo showed Mild AR and was accepted. Total blood loss > >>>>> in the > >>> ICU > >>>>> was a worrisome 20 ml !! > >>>>> Patient was extubated within 6 hours and is doing well and will be > >>>>> discharged tomorrow when the HPE report comes.The postop > >>>>> transthoracic > >>> echo > >>>>> shows the Cabrol patch fistula has closed. > >>>>> Questions are how many of the members use innominate > >>>>> cannulation versus > >>>>> axillary cannulation and reasons for the preerence.What are the > >>>>> problems > >>>>> that the members have occurred with each strategy. > >>>>> What are the tips and tricks that people who do aortic sparing > >>>>> surgery > >>> use > >>>>> to judge aortic competence during intraop testing .(Not > >>> echocardiographic > >>>>> which requires going off CPB ) as I find my judgement with aortic > >>> repairs > >>>>> still hazy. Apart from holding water and visual inspection I > >>>>> also use > >>> the > >>>>> method of El Khoury of placing a sucker in the LVOT and > >>>>> allowing the > >>>>> leaflets to oppose and pull it (the sucker) out but somehow I > >>>>> am not > >>> able to > >>>>> get the leaflets to stay put as I feel that the negative > >>>>> suction gets > >>> lost > >>>>> by the time I pull the sucker out (Maybe It may be becuase I am > >>>>> using > >>> the > >>>>> big Yankauer sucker which may be part of the problem and am > >>>>> planning to > >>> use > >>>>> a dentist irrigation sucker for the same. > >>>>> > >>>>> > >>>>> -- > >>>>> 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 > >> ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ 25GB of FREE Online Storage ? Find out more http://clk.atdmt.com/UKM/go/134665320/direct/01/ From drdharris at yahoo.co.uk Thu Mar 5 13:13:08 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Thu Mar 5 16:14:55 2009 Subject: FW: Re: [HSF] "Internal Sleeve" Message-ID: <599042.88600.qm@web24702.mail.ird.yahoo.com> ----- Original Message ----- Subject: Re: [HSF] "Internal Sleeve" Date: Thu, 5 Mar 2009 21:10:13 From: David Harris To: grescigno@mac.com Its ok to tty these new things but we need to document them, and honestly report complications. I would agree with the extra protection with ivc perfusion but would go slowly with the temp. Increasing temp may offset any benefits. I had a bad experience with gut ischaemia after a moderate hypothermia arch - despite perfusing everything above and below. Ask the experienced guys, they have done it all before and possibly wo'nt admit mistakes, but say 'stay cold!' Safi from :ouston says if you leave a piece of fish on the street for 20 min it will stink (its SO hot in Houston).so why do that with someone's brain. My idea:go cold, rewarm early. Dave Giuseppe Rescigno wrote: > Roberto, > I am planning for the next arrest to perfuse retrogradely through the IVC the abdomen etc. IMHO this may add some extra protection that may allow almost to stay almost warm (32?C). Of course I will go down to 26 as usual but I will monitor splancnic perfusion by means of abdominal NIRS. What is your opinion? are you skeptical as Dr Martin? If we open our mind then we may start to find better new ways to do the same things. The first who did retrograde cardioplegia was considered a crazy guy by the others. There was a very nice script I read once that was accreditated to Walton Lillehei about the steps of knowledge in surgery: at each step there was an advancement and the comments of the collegues.... > Thank you > Giuseppe > Il giorno 05/mar/09, alle ore 18:11, Roberto Battellini ha scritto: >> >> Prasanna, >> >> go 2 grades upper each case until you feel yourself comfortable. >> >> Roberto >> >>> Date: Thu, 5 Mar 2009 21:10:16 +0530 >>> Subject: Re: [HSF] "Internal Sleeve" >>> From: prasannasimha@gmail.com >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> I agree Roberto but something makes me hesitate to go up in temperature. >>> Maybe will do it at a higher temperature in the next case !! >>> Prasanna >>> >>> On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < >>> robertobattellini@hotmail.com> wrote: >>> >>>> >>>> Prasanna, >>>> >>>> >>>> >>>> Look at Strauch et al EJCTS 2004, he studied the spinal cord of pigs under >>>> normothermia and 32 degrees, a reduction of 5 degrees centigrades helped to >>>> prolongue the ischemia tolerance up to 50 minutes. >>>> >>>> If you extrapolate this to the arch surgery, and you DO perfuse the >>>> innominate artery and the left carotid and block or perfuse the left >>>> subclavia, you can perform your operation at 26 degrees as Giuseppe says, >>>> providing you do the distal in less than 30 minutes (for security).And if >>>> you need distal aortic perfusion, use the Dalla Torre technique of using a >>>> tracheal cannula and perfuse distally.You need a second arterial line in Y >>>> and that?s all. >>>> >>>> Of course, we have a little extra heat exchanger for that line, so if the >>>> core temperature is 26, we can perfuse the brain at 20?C. >>>> >>>> We do all that surgery at 25-26 degrees, axillary cannulation. >>>> >>>> Roberto >>>> >>>>> Date: Wed, 4 Mar 2009 23:53:43 +0100 >>>>> From: grescigno@mac.com >>>>> To: OpenHeart-L@lists.hsforum.com >>>>> Subject: Re: [HSF] "Internal Sleeve" >>>>> CC: >>>>> >>>>> Prasanna, >>>>> >>>>> very nice case. I have just 2 comments: 1. I think that you should switch >>>> to 26 ?C, at least for an end to end anastomosis. 2. I am not using the >>>> innominate trunk (even if I think that is a very good idea, as 90% of my >>>> circulatory arrests are for aortic dissections and I am too worried about an >>>> involvement of the innominate artery. >>>>> >>>>> Giuseppe >>>>> >>>>> >>>>> Giuseppe Rescigno M.D. >>>>> Cardiothoracic Surgeon >>>>> >>>>> Lancisi Hospital >>>>> Torrette - Ancona >>>>> Italy >>>>> >>>>> >>>>> >>>>> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < >>>> prasannasimha@gmail.com> wrote: >>>>>> 26 year old lady , Marfanoid presented with an ascending aortic aneurysm >>>> + >>>>>> severe AR. Leaflets looked normal and mechanism of AR appeared due to ST >>>>>> junction dilatation. She was AB positive and there was cncerns regarding >>>>>> adequate supply of blood products as there was a bleeder case which had >>>>>> reduced AB +ve donor pool in the city.(We had blood but not a very large >>>>>> donor pool) >>>>>> I planned to see the leaflets and if normal considered her for valve >>>>>> sparing ascending aortic replacement with root reconstruction. >>>>>> On table the aneurysm was up to the innominate and I cannulated the >>>>>> innominate artery for systemic perfusion and also for innominate artery >>>>>> perfusion. >>>>>> On opening the aorta there was thickened wall (Not marfanoid) which was >>>> sent >>>>>> for biopsy (Histopath awaited) .The leaflets looked normal and well >>>>>> preserved. I decided to use a technique described in Interactive journal >>>> of >>>>>> CT surgery (Original plan was for a Florida sleeve) and used an annular >>>>>> stabilizing suture as described by Lars Svensson (The LV aortic junction >>>> was >>>>>> not actually dilated) and then placed 3 tear drop patches fixed >>>> subannularly >>>>>> with pledgeted sutures in each sinus with fenestrations for the >>>> coronaries >>>>>> with the ostia fixed to the fenstrations. (The RCA ostium was painfully >>>>>> small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am >>>> still >>>>>> not confident of doing it at higher temperatures) I did an intraluminal >>>>>> hemiarch placement.The tube was then attached to the teardrop patches >>>> which >>>>>> had been fixed at the ST junction.I then placed a prophylactic cabrol >>>> patch >>>>>> fistula as soon as I came off CPB as I was worried about blood and blood >>>>>> product usage (As you can see there wasnt much bleeding and the fistula >>>> hood >>>>>> is not distended so its use may be questioned). >>>>>> Intraop Echo showed Mild AR and was accepted. Total blood loss in the >>>> ICU >>>>>> was a worrisome 20 ml !! >>>>>> Patient was extubated within 6 hours and is doing well and will be >>>>>> discharged tomorrow when the HPE report comes.The postop transthoracic >>>> echo >>>>>> shows the Cabrol patch fistula has closed. >>>>>> Questions are how many of the members use innominate cannulation versus >>>>>> axillary cannulation and reasons for the preerence.What are the problems >>>>>> that the members have occurred with each strategy. >>>>>> What are the tips and tricks that people who do aortic sparing surgery >>>> use >>>>>> to judge aortic competence during intraop testing .(Not >>>> echocardiographic >>>>>> which requires going off CPB ) as I find my judgement with aortic >>>> repairs >>>>>> still hazy. Apart from holding water and visual inspection I also use >>>> the >>>>>> method of El Khoury of placing a sucker in the LVOT and allowing the >>>>>> leaflets to oppose and pull it (the sucker) out but somehow I am not >>>> able to >>>>>> get the leaflets to stay put as I feel that the negative suction gets >>>> lost >>>>>> by the time I pull the sucker out (Maybe It may be becuase I am using >>>> the >>>>>> big Yankauer sucker which may be part of the problem and am planning to >>>> use >>>>>> a dentist irrigation sucker for the same. >>>>>> >>>>>> >>>>>> -- >>>>>> 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 >>> ----------------------------------------- >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > Send postings to: > OpenHeart-L@lists.hsforum.com > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 drdharris at yahoo.co.uk Thu Mar 5 13:23:52 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Thu Mar 5 16:25:39 2009 Subject: FW: RE: [HSF] "Internal Sleeve" Message-ID: <629770.78183.qm@web24707.mail.ird.yahoo.com> ----- Original Message ----- Subject: RE: [HSF] "Internal Sleeve" Date: Thu, 5 Mar 2009 21:21:55 From: David Harris To: anianyanwu@hotmail.com Yes Ani, Muneretto is doing CABG on awake patients (hundreds already) - all on pump.....and claims better results because they are never intubated. As for me, do me on or off, if on, a little bit cold, but - would not like to be aware....knock me out for a day! Dave Ani Anyanwu wrote: >> I am planning for the next arrest to perfuse retrogradely through the >> IVC the abdomen etc. IMHO this may add some extra protection that may >> allow almost to stay almost warm (32?C). >> Giuseppe > > > > But what would your reason to want to try this technique? Why do have desire to stay warm? > > Why not try this technique in animals first (or not done so) before you advance our years old techniques in humans! > > Odd the very strong and religious oppositions we get to the evils of conventional surgery in our speciality. Usually it is the off-pump brigade (cursing all the bad things the pump does but yet doing AVRs on pump), or the beating heart brigade (cursing all the bad things cardioplegia does to the heart, yet not hestistant to arrest heart for an arch replacement or transplant - i suppose though they can work out creative ways to keep heart beating through both), the reference surgery battallion, of which I am a member (that swear low volume occasional surgery is bad, yet themselves doing less than 20 CABGs per year, not believing anymore in need for expertise), or the anaortic regiment (cursing the use of murderous clamps on aortae, yet performing AVRs with clamps on same vessel). > > But now its about temperature? We now want to circ arrest at normothermia??? I have seen many things, but a patient having arch surgery who died of moderate hypothermia I have not found. > > Now these HSF religious movements are getting to me!!!! What next? Any takers for awake surgery...surely it cant be a physiological to put patients to sleep just because you are operating on their heart??? > > Ani > > >> From: grescigno@mac.com >> Subject: Re: [HSF] "Internal Sleeve" >> Date: Thu, 5 Mar 2009 20:56:36 +0100 >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Roberto, >> >> I am planning for the next arrest to perfuse retrogradely through the >> IVC the abdomen etc. IMHO this may add some extra protection that may >> allow almost to stay almost warm (32?C). Of course I will go down to >> 26 as usual but I will monitor splancnic perfusion by means of >> abdominal NIRS. What is your opinion? are you skeptical as Dr Martin? >> If we open our mind then we may start to find better new ways to do >> the same things. The first who did retrograde cardioplegia was >> considered a crazy guy by the others. There was a very nice script I >> read once that was accreditated to Walton Lillehei about the steps of >> knowledge in surgery: at each step there was an advancement and the >> comments of the collegues.... >> >> Thank you >> >> >> Giuseppe >> >> >> Il giorno 05/mar/09, alle ore 18:11, Roberto Battellini ha scritto: >> >> > >> > Prasanna, >> > >> > go 2 grades upper each case until you feel yourself comfortable. >> > >> > Roberto >> > >> >> Date: Thu, 5 Mar 2009 21:10:16 +0530 >> >> Subject: Re: [HSF] "Internal Sleeve" >> >> From: prasannasimha@gmail.com >> >> To: OpenHeart-L@lists.hsforum.com >> >> CC: >> >> >> >> I agree Roberto but something makes me hesitate to go up in >> >> temperature. >> >> Maybe will do it at a higher temperature in the next case !! >> >> Prasanna >> >> >> >> On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < >> >> robertobattellini@hotmail.com> wrote: >> >> >> >>> >> >>> Prasanna, >> >>> >> >>> >> >>> >> >>> Look at Strauch et al EJCTS 2004, he studied the spinal cord of >> >>> pigs under >> >>> normothermia and 32 degrees, a reduction of 5 degrees centigrades >> >>> helped to >> >>> prolongue the ischemia tolerance up to 50 minutes. >> >>> >> >>> If you extrapolate this to the arch surgery, and you DO perfuse the >> >>> innominate artery and the left carotid and block or perfuse the left >> >>> subclavia, you can perform your operation at 26 degrees as >> >>> Giuseppe says, >> >>> providing you do the distal in less than 30 minutes (for >> >>> security).And if >> >>> you need distal aortic perfusion, use the Dalla Torre technique >> >>> of using a >> >>> tracheal cannula and perfuse distally.You need a second arterial >> >>> line in Y >> >>> and that?s all. >> >>> >> >>> Of course, we have a little extra heat exchanger for that line, >> >>> so if the >> >>> core temperature is 26, we can perfuse the brain at 20?C. >> >>> >> >>> We do all that surgery at 25-26 degrees, axillary cannulation. >> >>> >> >>> Roberto >> >>> >> >>>> Date: Wed, 4 Mar 2009 23:53:43 +0100 >> >>>> From: grescigno@mac.com >> >>>> To: OpenHeart-L@lists.hsforum.com >> >>>> Subject: Re: [HSF] "Internal Sleeve" >> >>>> CC: >> >>>> >> >>>> Prasanna, >> >>>> >> >>>> very nice case. I have just 2 comments: 1. I think that you >> >>>> should switch >> >>> to 26 ?C, at least for an end to end anastomosis. 2. I am not >> >>> using the >> >>> innominate trunk (even if I think that is a very good idea, as >> >>> 90% of my >> >>> circulatory arrests are for aortic dissections and I am too >> >>> worried about an >> >>> involvement of the innominate artery. >> >>>> >> >>>> Giuseppe >> >>>> >> >>>> >> >>>> Giuseppe Rescigno M.D. >> >>>> Cardiothoracic Surgeon >> >>>> >> >>>> Lancisi Hospital >> >>>> Torrette - Ancona >> >>>> Italy >> >>>> >> >>>> >> >>>> >> >>>> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < >> >>> prasannasimha@gmail.com> wrote: >> >>>>> 26 year old lady , Marfanoid presented with an ascending aortic >> >>>>> aneurysm >> >>> + >> >>>>> severe AR. Leaflets looked normal and mechanism of AR appeared >> >>>>> due to ST >> >>>>> junction dilatation. She was AB positive and there was cncerns >> >>>>> regarding >> >>>>> adequate supply of blood products as there was a bleeder case >> >>>>> which had >> >>>>> reduced AB +ve donor pool in the city.(We had blood but not a >> >>>>> very large >> >>>>> donor pool) >> >>>>> I planned to see the leaflets and if normal considered her for >> >>>>> valve >> >>>>> sparing ascending aortic replacement with root reconstruction. >> >>>>> On table the aneurysm was up to the innominate and I cannulated >> >>>>> the >> >>>>> innominate artery for systemic perfusion and also for >> >>>>> innominate artery >> >>>>> perfusion. >> >>>>> On opening the aorta there was thickened wall (Not marfanoid) >> >>>>> which was >> >>> sent >> >>>>> for biopsy (Histopath awaited) .The leaflets looked normal and >> >>>>> well >> >>>>> preserved. I decided to use a technique described in >> >>>>> Interactive journal >> >>> of >> >>>>> CT surgery (Original plan was for a Florida sleeve) and used an >> >>>>> annular >> >>>>> stabilizing suture as described by Lars Svensson (The LV aortic >> >>>>> junction >> >>> was >> >>>>> not actually dilated) and then placed 3 tear drop patches fixed >> >>> subannularly >> >>>>> with pledgeted sutures in each sinus with fenestrations for the >> >>> coronaries >> >>>>> with the ostia fixed to the fenstrations. (The RCA ostium was >> >>>>> painfully >> >>>>> small !!). This allowed good coaptation. Under ACP at 18 Deg C >> >>>>> (I am >> >>> still >> >>>>> not confident of doing it at higher temperatures) I did an >> >>>>> intraluminal >> >>>>> hemiarch placement.The tube was then attached to the teardrop >> >>>>> patches >> >>> which >> >>>>> had been fixed at the ST junction.I then placed a prophylactic >> >>>>> cabrol >> >>> patch >> >>>>> fistula as soon as I came off CPB as I was worried about blood >> >>>>> and blood >> >>>>> product usage (As you can see there wasnt much bleeding and the >> >>>>> fistula >> >>> hood >> >>>>> is not distended so its use may be questioned). >> >>>>> Intraop Echo showed Mild AR and was accepted. Total blood loss >> >>>>> in the >> >>> ICU >> >>>>> was a worrisome 20 ml !! >> >>>>> Patient was extubated within 6 hours and is doing well and will be >> >>>>> discharged tomorrow when the HPE report comes.The postop >> >>>>> transthoracic >> >>> echo >> >>>>> shows the Cabrol patch fistula has closed. >> >>>>> Questions are how many of the members use innominate >> >>>>> cannulation versus >> >>>>> axillary cannulation and reasons for the preerence.What are the >> >>>>> problems >> >>>>> that the members have occurred with each strategy. >> >>>>> What are the tips and tricks that people who do aortic sparing >> >>>>> surgery >> >>> use >> >>>>> to judge aortic competence during intraop testing .(Not >> >>> echocardiographic >> >>>>> which requires going off CPB ) as I find my judgement with aortic >> >>> repairs >> >>>>> still hazy. Apart from holding water and visual inspection I >> >>>>> also use >> >>> the >> >>>>> method of El Khoury of placing a sucker in the LVOT and >> >>>>> allowing the >> >>>>> leaflets to oppose and pull it (the sucker) out but somehow I >> >>>>> am not >> >>> able to >> >>>>> get the leaflets to stay put as I feel that the negative >> >>>>> suction gets >> >>> lost >> >>>>> by the time I pull the sucker out (Maybe It may be becuase I am >> >>>>> using >> >>> the >> >>>>> big Yankauer sucker which may be part of the problem and am >> >>>>> planning to >> >>> use >> >>>>> a dentist irrigation sucker for the same. >> >>>>> >> >>>>> >> >>>>> -- >> >>>>> 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 >> >> ----------------------------------------- >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > >> > All messages transmitted by the OpenHeart-L are subject to the >> > policies and >> > disclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www..hsforum.com/listdisclaim >> ----------------------------------------- > _________________________________________________________________ > 25GB of FREE Online Storage ? Find out more > http://clk.atdmt.com/UKM/go/134665320/direct/01/_______________________________________________ > OpenHeart-L mailing list > Send postings to: > OpenHeart-L@lists.hsforum.com > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From grescigno at mac.com Thu Mar 5 22:53:02 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Thu Mar 5 17:01:14 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: <127782282141345871338618401122866491527-Webmail@me.com> <89c4ed2d0903050740n3b247dccrc305ea206d87ab3b@mail.gmail.com> Message-ID: <0BFAD7A3-4F7E-4E58-B18E-E66AA4BAB4F3@mac.com> Ani, I said that I will stay cold anyway (at least before I am quite sure of the opportunity to increase the temp a little). Retrograde SVC perfusion is an accepted technique to protect the brain. Retrograde IVC perfusion has been already used (you can check in Pubmed). Why your reaction? One hour of circ arrest may be deleterious for the gut even with moderate hypothermia, and it would not kill the patient. Concerning the animal experiments, I am not discussing about an experimental technique; it is just an adjunctive way to protect abdominal organs. Coselli, Guilmet, Martin, Bachet and others would probably not need this as they are outstanding arch surgeons; a standard surgeon like me would benefit from every new improvement in working without the (excessive) pressure of time. These are just my very simple toughts.... Giuseppe Il giorno 05/mar/09, alle ore 21:51, Ani Anyanwu ha scritto: > >> I am planning for the next arrest to perfuse retrogradely through the >> IVC the abdomen etc. IMHO this may add some extra protection that may >> allow almost to stay almost warm (32?C). >> Giuseppe > > > > > > > > But what would your reason to want to try this technique? Why do > have desire to stay warm? > > > > Why not try this technique in animals first (or not done so) before > you advance our years old techniques in humans! > > > > Odd the very strong and religious oppositions we get to the evils > of conventional surgery in our speciality. Usually it is the off- > pump brigade (cursing all the bad things the pump does but yet > doing AVRs on pump), or the beating heart brigade (cursing all the > bad things cardioplegia does to the heart, yet not hestistant to > arrest heart for an arch replacement or transplant - i suppose > though they can work out creative ways to keep heart beating > through both), the reference surgery battallion, of which I am a > member (that swear low volume occasional surgery is bad, yet > themselves doing less than 20 CABGs per year, not believing anymore > in need for expertise), or the anaortic regiment (cursing the use > of murderous clamps on aortae, yet performing AVRs with clamps on > same vessel). > > > > But now its about temperature? We now want to circ arrest at > normothermia??? I have seen many things, but a patient having arch > surgery who died of moderate hypothermia I have not found. > > > > Now these HSF religious movements are getting to me!!!! What next? > Any takers for awake surgery...surely it cant be a physiological to > put patients to sleep just because you are operating on their heart??? > > > > Ani > > > > > >> From: grescigno@mac.com >> Subject: Re: [HSF] "Internal Sleeve" >> Date: Thu, 5 Mar 2009 20:56:36 +0100 >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Roberto, >> >> I am planning for the next arrest to perfuse retrogradely through the >> IVC the abdomen etc. IMHO this may add some extra protection that may >> allow almost to stay almost warm (32?C). Of course I will go down to >> 26 as usual but I will monitor splancnic perfusion by means of >> abdominal NIRS. What is your opinion? are you skeptical as Dr Martin? >> If we open our mind then we may start to find better new ways to do >> the same things. The first who did retrograde cardioplegia was >> considered a crazy guy by the others. There was a very nice script I >> read once that was accreditated to Walton Lillehei about the steps of >> knowledge in surgery: at each step there was an advancement and the >> comments of the collegues.... >> >> Thank you >> >> >> Giuseppe >> >> >> Il giorno 05/mar/09, alle ore 18:11, Roberto Battellini ha scritto: >> >>> >>> Prasanna, >>> >>> go 2 grades upper each case until you feel yourself comfortable. >>> >>> Roberto >>> >>>> Date: Thu, 5 Mar 2009 21:10:16 +0530 >>>> Subject: Re: [HSF] "Internal Sleeve" >>>> From: prasannasimha@gmail.com >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> >>>> I agree Roberto but something makes me hesitate to go up in >>>> temperature. >>>> Maybe will do it at a higher temperature in the next case !! >>>> Prasanna >>>> >>>> On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < >>>> robertobattellini@hotmail.com> wrote: >>>> >>>>> >>>>> Prasanna, >>>>> >>>>> >>>>> >>>>> Look at Strauch et al EJCTS 2004, he studied the spinal cord of >>>>> pigs under >>>>> normothermia and 32 degrees, a reduction of 5 degrees centigrades >>>>> helped to >>>>> prolongue the ischemia tolerance up to 50 minutes. >>>>> >>>>> If you extrapolate this to the arch surgery, and you DO perfuse >>>>> the >>>>> innominate artery and the left carotid and block or perfuse the >>>>> left >>>>> subclavia, you can perform your operation at 26 degrees as >>>>> Giuseppe says, >>>>> providing you do the distal in less than 30 minutes (for >>>>> security).And if >>>>> you need distal aortic perfusion, use the Dalla Torre technique >>>>> of using a >>>>> tracheal cannula and perfuse distally.You need a second arterial >>>>> line in Y >>>>> and that?s all. >>>>> >>>>> Of course, we have a little extra heat exchanger for that line, >>>>> so if the >>>>> core temperature is 26, we can perfuse the brain at 20?C. >>>>> >>>>> We do all that surgery at 25-26 degrees, axillary cannulation. >>>>> >>>>> Roberto >>>>> >>>>>> Date: Wed, 4 Mar 2009 23:53:43 +0100 >>>>>> From: grescigno@mac.com >>>>>> To: OpenHeart-L@lists.hsforum.com >>>>>> Subject: Re: [HSF] "Internal Sleeve" >>>>>> CC: >>>>>> >>>>>> Prasanna, >>>>>> >>>>>> very nice case. I have just 2 comments: 1. I think that you >>>>>> should switch >>>>> to 26 ?C, at least for an end to end anastomosis. 2. I am not >>>>> using the >>>>> innominate trunk (even if I think that is a very good idea, as >>>>> 90% of my >>>>> circulatory arrests are for aortic dissections and I am too >>>>> worried about an >>>>> involvement of the innominate artery. >>>>>> >>>>>> Giuseppe >>>>>> >>>>>> >>>>>> Giuseppe Rescigno M.D. >>>>>> Cardiothoracic Surgeon >>>>>> >>>>>> Lancisi Hospital >>>>>> Torrette - Ancona >>>>>> Italy >>>>>> >>>>>> >>>>>> >>>>>> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < >>>>> prasannasimha@gmail.com> wrote: >>>>>>> 26 year old lady , Marfanoid presented with an ascending aortic >>>>>>> aneurysm >>>>> + >>>>>>> severe AR. Leaflets looked normal and mechanism of AR appeared >>>>>>> due to ST >>>>>>> junction dilatation. She was AB positive and there was cncerns >>>>>>> regarding >>>>>>> adequate supply of blood products as there was a bleeder case >>>>>>> which had >>>>>>> reduced AB +ve donor pool in the city.(We had blood but not a >>>>>>> very large >>>>>>> donor pool) >>>>>>> I planned to see the leaflets and if normal considered her for >>>>>>> valve >>>>>>> sparing ascending aortic replacement with root reconstruction. >>>>>>> On table the aneurysm was up to the innominate and I cannulated >>>>>>> the >>>>>>> innominate artery for systemic perfusion and also for >>>>>>> innominate artery >>>>>>> perfusion. >>>>>>> On opening the aorta there was thickened wall (Not marfanoid) >>>>>>> which was >>>>> sent >>>>>>> for biopsy (Histopath awaited) .The leaflets looked normal and >>>>>>> well >>>>>>> preserved. I decided to use a technique described in >>>>>>> Interactive journal >>>>> of >>>>>>> CT surgery (Original plan was for a Florida sleeve) and used an >>>>>>> annular >>>>>>> stabilizing suture as described by Lars Svensson (The LV aortic >>>>>>> junction >>>>> was >>>>>>> not actually dilated) and then placed 3 tear drop patches fixed >>>>> subannularly >>>>>>> with pledgeted sutures in each sinus with fenestrations for the >>>>> coronaries >>>>>>> with the ostia fixed to the fenstrations. (The RCA ostium was >>>>>>> painfully >>>>>>> small !!). This allowed good coaptation. Under ACP at 18 Deg C >>>>>>> (I am >>>>> still >>>>>>> not confident of doing it at higher temperatures) I did an >>>>>>> intraluminal >>>>>>> hemiarch placement.The tube was then attached to the teardrop >>>>>>> patches >>>>> which >>>>>>> had been fixed at the ST junction.I then placed a prophylactic >>>>>>> cabrol >>>>> patch >>>>>>> fistula as soon as I came off CPB as I was worried about blood >>>>>>> and blood >>>>>>> product usage (As you can see there wasnt much bleeding and the >>>>>>> fistula >>>>> hood >>>>>>> is not distended so its use may be questioned). >>>>>>> Intraop Echo showed Mild AR and was accepted. Total blood loss >>>>>>> in the >>>>> ICU >>>>>>> was a worrisome 20 ml !! >>>>>>> Patient was extubated within 6 hours and is doing well and >>>>>>> will be >>>>>>> discharged tomorrow when the HPE report comes.The postop >>>>>>> transthoracic >>>>> echo >>>>>>> shows the Cabrol patch fistula has closed. >>>>>>> Questions are how many of the members use innominate >>>>>>> cannulation versus >>>>>>> axillary cannulation and reasons for the preerence.What are the >>>>>>> problems >>>>>>> that the members have occurred with each strategy. >>>>>>> What are the tips and tricks that people who do aortic sparing >>>>>>> surgery >>>>> use >>>>>>> to judge aortic competence during intraop testing .(Not >>>>> echocardiographic >>>>>>> which requires going off CPB ) as I find my judgement with >>>>>>> aortic >>>>> repairs >>>>>>> still hazy. Apart from holding water and visual inspection I >>>>>>> also use >>>>> the >>>>>>> method of El Khoury of placing a sucker in the LVOT and >>>>>>> allowing the >>>>>>> leaflets to oppose and pull it (the sucker) out but somehow I >>>>>>> am not >>>>> able to >>>>>>> get the leaflets to stay put as I feel that the negative >>>>>>> suction gets >>>>> lost >>>>>>> by the time I pull the sucker out (Maybe It may be becuase I am >>>>>>> using >>>>> the >>>>>>> big Yankauer sucker which may be part of the problem and am >>>>>>> planning to >>>>> use >>>>>>> a dentist irrigation sucker for the same. >>>>>>> >>>>>>> >>>>>>> -- >>>>>>> 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 >>>> ----------------------------------------- >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > 25GB of FREE Online Storage ? Find out more > http://clk.atdmt.com/UKM/go/134665320/direct/01/ > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From Hgrmd at aol.com Thu Mar 5 20:23:51 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Thu Mar 5 20:27:01 2009 Subject: [HSF] "Internal Sleeve" Message-ID: Roberto, A week ago, I did a hemiarch replacement on an 84 yo man at 26 degrees. I directly cannulated the innominate. During selective perfusion, I clamped the take off of the innominate and gave half the flow down the arterial cannula. The other half went down an autoinflating regrograde cannula placed in the left common. I just let the left subclavian backbleed. The arrest time was 27 minutes. The patient did fine. My question is whether it is necessary to block or perfuse the left subclavian. Other than preventing steal from the left vertebral, I don't really see the advantage. Hal In a message dated 3/5/2009 5:21:30 A.M. Eastern Standard Time, robertobattellini@hotmail.com writes: Prasanna, Look at Strauch et al EJCTS 2004, he studied the spinal cord of pigs under normothermia and 32 degrees, a reduction of 5 degrees centigrades helped to prolongue the ischemia tolerance up to 50 minutes. If you extrapolate this to the arch surgery, and you DO perfuse the innominate artery and the left carotid and block or perfuse the left subclavia, you can perform your operation at 26 degrees as Giuseppe says, providing you do the distal in less than 30 minutes (for security).And if you need distal aortic perfusion, use the Dalla Torre technique of using a tracheal cannula and perfuse distally.You need a second arterial line in Y and that?s all. Of course, we have a little extra heat exchanger for that line, so if the core temperature is 26, we can perfuse the brain at 20?C. We do all that surgery at 25-26 degrees, axillary cannulation. Roberto > Date: Wed, 4 Mar 2009 23:53:43 +0100 > From: grescigno@mac.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] "Internal Sleeve" > CC: > > Prasanna, > > very nice case. I have just 2 comments: 1. I think that you should switch to 26 ?C, at least for an end to end anastomosis. 2. I am not using the innominate trunk (even if I think that is a very good idea, as 90% of my circulatory arrests are for aortic dissections and I am too worried about an involvement of the innominate artery. > > Giuseppe > > > Giuseppe Rescigno M.D. > Cardiothoracic Surgeon > > Lancisi Hospital > Torrette - Ancona > Italy > > > > On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" wrote: > >26 year old lady , Marfanoid presented with an ascending aortic aneurysm + > >severe AR. Leaflets looked normal and mechanism of AR appeared due to ST > >junction dilatation. She was AB positive and there was cncerns regarding > >adequate supply of blood products as there was a bleeder case which had > >reduced AB +ve donor pool in the city.(We had blood but not a very large > >donor pool) > >I planned to see the leaflets and if normal considered her for valve > >sparing ascending aortic replacement with root reconstruction. > >On table the aneurysm was up to the innominate and I cannulated the > >innominate artery for systemic perfusion and also for innominate artery > >perfusion. > >On opening the aorta there was thickened wall (Not marfanoid) which was sent > >for biopsy (Histopath awaited) .The leaflets looked normal and well > >preserved. I decided to use a technique described in Interactive journal of > >CT surgery (Original plan was for a Florida sleeve) and used an annular > >stabilizing suture as described by Lars Svensson (The LV aortic junction was > >not actually dilated) and then placed 3 tear drop patches fixed subannularly > >with pledgeted sutures in each sinus with fenestrations for the coronaries > >with the ostia fixed to the fenstrations. (The RCA ostium was painfully > >small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am still > >not confident of doing it at higher temperatures) I did an intraluminal > >hemiarch placement.The tube was then attached to the teardrop patches which > >had been fixed at the ST junction.I then placed a prophylactic cabrol patch > >fistula as soon as I came off CPB as I was worried about blood and blood > >product usage (As you can see there wasnt much bleeding and the fistula hood > >is not distended so its use may be questioned). > >Intraop Echo showed Mild AR and was accepted. Total blood loss in the ICU > >was a worrisome 20 ml !! > >Patient was extubated within 6 hours and is doing well and will be > >discharged tomorrow when the HPE report comes.The postop transthoracic echo > >shows the Cabrol patch fistula has closed. > >Questions are how many of the members use innominate cannulation versus > >axillary cannulation and reasons for the preerence.What are the problems > >that the members have occurred with each strategy. > >What are the tips and tricks that people who do aortic sparing surgery use > >to judge aortic competence during intraop testing .(Not echocardiographic > >which requires going off CPB ) as I find my judgement with aortic repairs > >still hazy. Apart from holding water and visual inspection I also use the > >method of El Khoury of placing a sucker in the LVOT and allowing the > >leaflets to oppose and pull it (the sucker) out but somehow I am not able to > >get the leaflets to stay put as I feel that the negative suction gets lost > >by the time I pull the sucker out (Maybe It may be becuase I am using the > >big Yankauer sucker which may be part of the problem and am planning to use > >a dentist irrigation sucker for the same. > > > > > >-- > >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 ----------------------------------------- **************Need a job? Find employment help in your area. (http://yellowpages.aol.com/search?query=employment_agencies&ncid=emlcntusyelp00000005) From Hgrmd at aol.com Thu Mar 5 20:30:41 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Thu Mar 5 20:32:38 2009 Subject: [HSF] "Internal Sleeve" Message-ID: Ani, The cynicism is a little more potent than usual! I first began doing selective cerebral perfusion about 2 years ago, thanks to the postings of our friend Roberto. I like it a lot, because it can be safely done at 26 C. For me, that shaves at least 2 hours off the case. In addition, I believe the coagulopathy is less. Saving time and blood products is well worth the little bit of extra set up. Hal In a message dated 3/5/2009 3:53:38 P.M. Eastern Standard Time, anianyanwu@h otmail.com writes: > I am planning for the next arrest to perfuse retrogradely through the > IVC the abdomen etc. IMHO this may add some extra protection that may > allow almost to stay almost warm (32?C). > Giuseppe But what would your reason to want to try this technique? Why do have desire to stay warm? Why not try this technique in animals first (or not done so) before you advance our years old techniques in humans! Odd the very strong and religious oppositions we get to the evils of conventional surgery in our speciality. Usually it is the off-pump brigade (cursing all the bad things the pump does but yet doing AVRs on pump), or the beating heart brigade (cursing all the bad things cardioplegia does to the heart, yet not hestistant to arrest heart for an arch replacement or transplant - i suppose though they can work out creative ways to keep heart beating through both), the reference surgery battallion, of which I am a member (that swear low volume occasional surgery is bad, yet themselves doing less than 20 CABGs per year, not believing anymore in need for expertise), or the anaortic regiment (cursing the use of murderous clamps on aortae, yet performing AVRs with clamps on same vessel). But now its about temperature? We now want to circ arrest at normothermia??? I have seen many things, but a patient having arch surgery who died of moderate hypothermia I have not found. Now these HSF religious movements are getting to me!!!! What next? Any takers for awake surgery...surely it cant be a physiological to put patients to sleep just because you are operating on their heart??? Ani > From: grescigno@mac.com > Subject: Re: [HSF] "Internal Sleeve" > Date: Thu, 5 Mar 2009 20:56:36 +0100 > To: OpenHeart-L@lists.hsforum.com > CC: > > Roberto, > > I am planning for the next arrest to perfuse retrogradely through the > IVC the abdomen etc. IMHO this may add some extra protection that may > allow almost to stay almost warm (32?C). Of course I will go down to > 26 as usual but I will monitor splancnic perfusion by means of > abdominal NIRS. What is your opinion? are you skeptical as Dr Martin? > If we open our mind then we may start to find better new ways to do > the same things. The first who did retrograde cardioplegia was > considered a crazy guy by the others. There was a very nice script I > read once that was accreditated to Walton Lillehei about the steps of > knowledge in surgery: at each step there was an advancement and the > comments of the collegues.... > > Thank you > > > Giuseppe > > > Il giorno 05/mar/09, alle ore 18:11, Roberto Battellini ha scritto: > > > > > Prasanna, > > > > go 2 grades upper each case until you feel yourself comfortable. > > > > Roberto > > > >> Date: Thu, 5 Mar 2009 21:10:16 +0530 > >> Subject: Re: [HSF] "Internal Sleeve" > >> From: prasannasimha@gmail.com > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> > >> I agree Roberto but something makes me hesitate to go up in > >> temperature. > >> Maybe will do it at a higher temperature in the next case !! > >> Prasanna > >> > >> On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < > >> robertobattellini@hotmail.com> wrote: > >> > >>> > >>> Prasanna, > >>> > >>> > >>> > >>> Look at Strauch et al EJCTS 2004, he studied the spinal cord of > >>> pigs under > >>> normothermia and 32 degrees, a reduction of 5 degrees centigrades > >>> helped to > >>> prolongue the ischemia tolerance up to 50 minutes. > >>> > >>> If you extrapolate this to the arch surgery, and you DO perfuse the > >>> innominate artery and the left carotid and block or perfuse the left > >>> subclavia, you can perform your operation at 26 degrees as > >>> Giuseppe says, > >>> providing you do the distal in less than 30 minutes (for > >>> security).And if > >>> you need distal aortic perfusion, use the Dalla Torre technique > >>> of using a > >>> tracheal cannula and perfuse distally.You need a second arterial > >>> line in Y > >>> and that?s all. > >>> > >>> Of course, we have a little extra heat exchanger for that line, > >>> so if the > >>> core temperature is 26, we can perfuse the brain at 20?C. > >>> > >>> We do all that surgery at 25-26 degrees, axillary cannulation. > >>> > >>> Roberto > >>> > >>>> Date: Wed, 4 Mar 2009 23:53:43 +0100 > >>>> From: grescigno@mac.com > >>>> To: OpenHeart-L@lists.hsforum.com > >>>> Subject: Re: [HSF] "Internal Sleeve" > >>>> CC: > >>>> > >>>> Prasanna, > >>>> > >>>> very nice case. I have just 2 comments: 1. I think that you > >>>> should switch > >>> to 26 ?C, at least for an end to end anastomosis. 2. I am not > >>> using the > >>> innominate trunk (even if I think that is a very good idea, as > >>> 90% of my > >>> circulatory arrests are for aortic dissections and I am too > >>> worried about an > >>> involvement of the innominate artery. > >>>> > >>>> Giuseppe > >>>> > >>>> > >>>> Giuseppe Rescigno M.D. > >>>> Cardiothoracic Surgeon > >>>> > >>>> Lancisi Hospital > >>>> Torrette - Ancona > >>>> Italy > >>>> > >>>> > >>>> > >>>> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < > >>> prasannasimha@gmail.com> wrote: > >>>>> 26 year old lady , Marfanoid presented with an ascending aortic > >>>>> aneurysm > >>> + > >>>>> severe AR. Leaflets looked normal and mechanism of AR appeared > >>>>> due to ST > >>>>> junction dilatation. She was AB positive and there was cncerns > >>>>> regarding > >>>>> adequate supply of blood products as there was a bleeder case > >>>>> which had > >>>>> reduced AB +ve donor pool in the city.(We had blood but not a > >>>>> very large > >>>>> donor pool) > >>>>> I planned to see the leaflets and if normal considered her for > >>>>> valve > >>>>> sparing ascending aortic replacement with root reconstruction. > >>>>> On table the aneurysm was up to the innominate and I cannulated > >>>>> the > >>>>> innominate artery for systemic perfusion and also for > >>>>> innominate artery > >>>>> perfusion. > >>>>> On opening the aorta there was thickened wall (Not marfanoid) > >>>>> which was > >>> sent > >>>>> for biopsy (Histopath awaited) .The leaflets looked normal and > >>>>> well > >>>>> preserved. I decided to use a technique described in > >>>>> Interactive journal > >>> of > >>>>> CT surgery (Original plan was for a Florida sleeve) and used an > >>>>> annular > >>>>> stabilizing suture as described by Lars Svensson (The LV aortic > >>>>> junction > >>> was > >>>>> not actually dilated) and then placed 3 tear drop patches fixed > >>> subannularly > >>>>> with pledgeted sutures in each sinus with fenestrations for the > >>> coronaries > >>>>> with the ostia fixed to the fenstrations. (The RCA ostium was > >>>>> painfully > >>>>> small !!). This allowed good coaptation. Under ACP at 18 Deg C > >>>>> (I am > >>> still > >>>>> not confident of doing it at higher temperatures) I did an > >>>>> intraluminal > >>>>> hemiarch placement.The tube was then attached to the teardrop > >>>>> patches > >>> which > >>>>> had been fixed at the ST junction.I then placed a prophylactic > >>>>> cabrol > >>> patch > >>>>> fistula as soon as I came off CPB as I was worried about blood > >>>>> and blood > >>>>> product usage (As you can see there wasnt much bleeding and the > >>>>> fistula > >>> hood > >>>>> is not distended so its use may be questioned). > >>>>> Intraop Echo showed Mild AR and was accepted. Total blood loss > >>>>> in the > >>> ICU > >>>>> was a worrisome 20 ml !! > >>>>> Patient was extubated within 6 hours and is doing well and will be > >>>>> discharged tomorrow when the HPE report comes.The postop > >>>>> transthoracic > >>> echo > >>>>> shows the Cabrol patch fistula has closed. > >>>>> Questions are how many of the members use innominate > >>>>> cannulation versus > >>>>> axillary cannulation and reasons for the preerence.What are the > >>>>> problems > >>>>> that the members have occurred with each strategy. > >>>>> What are the tips and tricks that people who do aortic sparing > >>>>> surgery > >>> use > >>>>> to judge aortic competence during intraop testing .(Not > >>> echocardiographic > >>>>> which requires going off CPB ) as I find my judgement with aortic > >>> repairs > >>>>> still hazy. Apart from holding water and visual inspection I > >>>>> also use > >>> the > >>>>> method of El Khoury of placing a sucker in the LVOT and > >>>>> allowing the > >>>>> leaflets to oppose and pull it (the sucker) out but somehow I > >>>>> am not > >>> able to > >>>>> get the leaflets to stay put as I feel that the negative > >>>>> suction gets > >>> lost > >>>>> by the time I pull the sucker out (Maybe It may be becuase I am > >>>>> using > >>> the > >>>>> big Yankauer sucker which may be part of the problem and am > >>>>> planning to > >>> use > >>>>> a dentist irrigation sucker for the same. > >>>>> > >>>>> > >>>>> -- > >>>>> 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 > >> ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ 25GB of FREE Online Storage ? Find out more http://clk.atdmt.com/UKM/go/134665320/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 ----------------------------------------- **************Need a job? Find employment help in your area. (http://yellowpages.aol.com/search?query=employment_agencies&ncid=emlcntusyelp00000005) From benjamin.bidstrup at bigpond.com Fri Mar 6 11:40:16 2009 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Thu Mar 5 20:40:52 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: Message-ID: <224EB825-D652-4F7E-AD88-C9F1D7DB2F33@bigpond.com> This all sounds better than digging out the axillary artery. How often is the innominate diseased in your opinion as to cause concern re distal embolism? Also over time with some organisation, you could get total arrest time down to a few minutes only. I take it you mean distal body arrest whilst you do the distal arch anastomosis. I have made some of those grafts with 3/0 prolene and Gelseal and they work well no need to spend a fortune on the premade ones. Ben Bidstrup FRACS FRCSEd FEBCTS Cardiothoracic Surgeon On 06/03/2009, at 11:23 AM, Hgrmd@aol.com wrote: > Roberto, > A week ago, I did a hemiarch replacement on an 84 yo man at 26 > degrees. I > directly cannulated the innominate. During selective perfusion, I > clamped > the take off of the innominate and gave half the flow down the > arterial > cannula. The other half went down an autoinflating regrograde > cannula placed in > the left common. I just let the left subclavian backbleed. The > arrest time > was 27 minutes. The patient did fine. My question is whether it > is necessary > to block or perfuse the left subclavian. Other than preventing > steal from > the left vertebral, I don't really see the advantage. > > Hal > > > In a message dated 3/5/2009 5:21:30 A.M. Eastern Standard Time, > robertobattellini@hotmail.com writes: > > > Prasanna, > > > > Look at Strauch et al EJCTS 2004, he studied the spinal cord of > pigs under > normothermia and 32 degrees, a reduction of 5 degrees centigrades > helped to > prolongue the ischemia tolerance up to 50 minutes. > > If you extrapolate this to the arch surgery, and you DO perfuse the > innominate artery and the left carotid and block or perfuse the > left subclavia, you > can perform your operation at 26 degrees as Giuseppe says, > providing you do > the distal in less than 30 minutes (for security).And if you need > distal aortic > perfusion, use the Dalla Torre technique of using a tracheal > cannula and > perfuse distally.You need a second arterial line in Y and that?s all. > > Of course, we have a little extra heat exchanger for that line, so > if the > core temperature is 26, we can perfuse the brain at 20?C. > > We do all that surgery at 25-26 degrees, axillary cannulation. > > Roberto > >> Date: Wed, 4 Mar 2009 23:53:43 +0100 >> From: grescigno@mac.com >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] "Internal Sleeve" >> CC: >> >> Prasanna, >> >> very nice case. I have just 2 comments: 1. I think that you should >> switch > to 26 ?C, at least for an end to end anastomosis. 2. I am not using > the > innominate trunk (even if I think that is a very good idea, as 90% > of my > circulatory arrests are for aortic dissections and I am too worried > about an > involvement of the innominate artery. >> >> Giuseppe >> >> >> Giuseppe Rescigno M.D. >> Cardiothoracic Surgeon >> >> Lancisi Hospital >> Torrette - Ancona >> Italy >> >> >> >> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" > wrote: >>> 26 year old lady , Marfanoid presented with an ascending aortic >>> aneurysm + >>> severe AR. Leaflets looked normal and mechanism of AR appeared >>> due to ST >>> junction dilatation. She was AB positive and there was cncerns >>> regarding >>> adequate supply of blood products as there was a bleeder case >>> which had >>> reduced AB +ve donor pool in the city.(We had blood but not a >>> very large >>> donor pool) >>> I planned to see the leaflets and if normal considered her for >>> valve >>> sparing ascending aortic replacement with root reconstruction. >>> On table the aneurysm was up to the innominate and I cannulated the >>> innominate artery for systemic perfusion and also for innominate >>> artery >>> perfusion. >>> On opening the aorta there was thickened wall (Not marfanoid) >>> which was > sent >>> for biopsy (Histopath awaited) .The leaflets looked normal and well >>> preserved. I decided to use a technique described in Interactive >>> journal > of >>> CT surgery (Original plan was for a Florida sleeve) and used an >>> annular >>> stabilizing suture as described by Lars Svensson (The LV aortic >>> junction > was >>> not actually dilated) and then placed 3 tear drop patches fixed > subannularly >>> with pledgeted sutures in each sinus with fenestrations for the >>> coronaries >>> with the ostia fixed to the fenstrations. (The RCA ostium was >>> painfully >>> small !!). This allowed good coaptation. Under ACP at 18 Deg C (I >>> am still >>> not confident of doing it at higher temperatures) I did an >>> intraluminal >>> hemiarch placement.The tube was then attached to the teardrop >>> patches > which >>> had been fixed at the ST junction.I then placed a prophylactic >>> cabrol > patch >>> fistula as soon as I came off CPB as I was worried about blood >>> and blood >>> product usage (As you can see there wasnt much bleeding and the >>> fistula > hood >>> is not distended so its use may be questioned). >>> Intraop Echo showed Mild AR and was accepted. Total blood loss in >>> the ICU >>> was a worrisome 20 ml !! >>> Patient was extubated within 6 hours and is doing well and will be >>> discharged tomorrow when the HPE report comes.The postop >>> transthoracic > echo >>> shows the Cabrol patch fistula has closed. >>> Questions are how many of the members use innominate cannulation >>> versus >>> axillary cannulation and reasons for the preerence.What are the >>> problems >>> that the members have occurred with each strategy. >>> What are the tips and tricks that people who do aortic sparing >>> surgery use >>> to judge aortic competence during intraop testing .(Not >>> echocardiographic >>> which requires going off CPB ) as I find my judgement with aortic >>> repairs >>> still hazy. Apart from holding water and visual inspection I also >>> use the >>> method of El Khoury of placing a sucker in the LVOT and allowing >>> the >>> leaflets to oppose and pull it (the sucker) out but somehow I am >>> not able > to >>> get the leaflets to stay put as I feel that the negative suction >>> gets lost >>> by the time I pull the sucker out (Maybe It may be becuase I am >>> using the >>> big Yankauer sucker which may be part of the problem and am >>> planning to > use >>> a dentist irrigation sucker for the same. >>> >>> >>> -- >>> 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 > ----------------------------------------- > > **************Need a job? Find employment help in your area. > (http://yellowpages.aol.com/search?query=employment_agencies&ncid=emlcntusyelp00000005 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mar 6 07:09:37 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Mar 5 20:46:53 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: <127782282141345871338618401122866491527-Webmail@me.com> <89c4ed2d0903050740n3b247dccrc305ea206d87ab3b@mail.gmail.com> Message-ID: <89c4ed2d0903051739r5e04b8cg4f4f5ac4d26d0375@mail.gmail.com> Ani, Since you are on a rant I will bait you. We did do awake surgery and use it selectively now based on our previous trial that we did in our hospital. I will say awake surgery is not for every case but certain subsets do benefit from it. Prasanna On Fri, Mar 6, 2009 at 2:21 AM, Ani Anyanwu wrote: > > > I am planning for the next arrest to perfuse retrogradely through the > > IVC the abdomen etc. IMHO this may add some extra protection that may > > allow almost to stay almost warm (32?C). > > Giuseppe > > > > > > > > But what would your reason to want to try this technique? Why do have > desire to stay warm? > > > > Why not try this technique in animals first (or not done so) before you > advance our years old techniques in humans! > > > > Odd the very strong and religious oppositions we get to the evils of > conventional surgery in our speciality. Usually it is the off-pump brigade > (cursing all the bad things the pump does but yet doing AVRs on pump), or > the beating heart brigade (cursing all the bad things cardioplegia does to > the heart, yet not hestistant to arrest heart for an arch replacement or > transplant - i suppose though they can work out creative ways to keep heart > beating through both), the reference surgery battallion, of which I am a > member (that swear low volume occasional surgery is bad, yet themselves > doing less than 20 CABGs per year, not believing anymore in need for > expertise), or the anaortic regiment (cursing the use of murderous clamps on > aortae, yet performing AVRs with clamps on same vessel). > > > > But now its about temperature? We now want to circ arrest at > normothermia??? I have seen many things, but a patient having arch surgery > who died of moderate hypothermia I have not found. > > > > Now these HSF religious movements are getting to me!!!! What next? Any > takers for awake surgery...surely it cant be a physiological to put patients > to sleep just because you are operating on their heart??? > > > > Ani > > > > > > > From: grescigno@mac.com > > Subject: Re: [HSF] "Internal Sleeve" > > Date: Thu, 5 Mar 2009 20:56:36 +0100 > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > Roberto, > > > > I am planning for the next arrest to perfuse retrogradely through the > > IVC the abdomen etc. IMHO this may add some extra protection that may > > allow almost to stay almost warm (32?C). Of course I will go down to > > 26 as usual but I will monitor splancnic perfusion by means of > > abdominal NIRS. What is your opinion? are you skeptical as Dr Martin? > > If we open our mind then we may start to find better new ways to do > > the same things. The first who did retrograde cardioplegia was > > considered a crazy guy by the others. There was a very nice script I > > read once that was accreditated to Walton Lillehei about the steps of > > knowledge in surgery: at each step there was an advancement and the > > comments of the collegues.... > > > > Thank you > > > > > > Giuseppe > > > > > > Il giorno 05/mar/09, alle ore 18:11, Roberto Battellini ha scritto: > > > > > > > > Prasanna, > > > > > > go 2 grades upper each case until you feel yourself comfortable. > > > > > > Roberto > > > > > >> Date: Thu, 5 Mar 2009 21:10:16 +0530 > > >> Subject: Re: [HSF] "Internal Sleeve" > > >> From: prasannasimha@gmail.com > > >> To: OpenHeart-L@lists.hsforum.com > > >> CC: > > >> > > >> I agree Roberto but something makes me hesitate to go up in > > >> temperature. > > >> Maybe will do it at a higher temperature in the next case !! > > >> Prasanna > > >> > > >> On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < > > >> robertobattellini@hotmail.com> wrote: > > >> > > >>> > > >>> Prasanna, > > >>> > > >>> > > >>> > > >>> Look at Strauch et al EJCTS 2004, he studied the spinal cord of > > >>> pigs under > > >>> normothermia and 32 degrees, a reduction of 5 degrees centigrades > > >>> helped to > > >>> prolongue the ischemia tolerance up to 50 minutes. > > >>> > > >>> If you extrapolate this to the arch surgery, and you DO perfuse the > > >>> innominate artery and the left carotid and block or perfuse the left > > >>> subclavia, you can perform your operation at 26 degrees as > > >>> Giuseppe says, > > >>> providing you do the distal in less than 30 minutes (for > > >>> security).And if > > >>> you need distal aortic perfusion, use the Dalla Torre technique > > >>> of using a > > >>> tracheal cannula and perfuse distally.You need a second arterial > > >>> line in Y > > >>> and that?s all. > > >>> > > >>> Of course, we have a little extra heat exchanger for that line, > > >>> so if the > > >>> core temperature is 26, we can perfuse the brain at 20?C. > > >>> > > >>> We do all that surgery at 25-26 degrees, axillary cannulation. > > >>> > > >>> Roberto > > >>> > > >>>> Date: Wed, 4 Mar 2009 23:53:43 +0100 > > >>>> From: grescigno@mac.com > > >>>> To: OpenHeart-L@lists.hsforum.com > > >>>> Subject: Re: [HSF] "Internal Sleeve" > > >>>> CC: > > >>>> > > >>>> Prasanna, > > >>>> > > >>>> very nice case. I have just 2 comments: 1. I think that you > > >>>> should switch > > >>> to 26 ?C, at least for an end to end anastomosis. 2. I am not > > >>> using the > > >>> innominate trunk (even if I think that is a very good idea, as > > >>> 90% of my > > >>> circulatory arrests are for aortic dissections and I am too > > >>> worried about an > > >>> involvement of the innominate artery. > > >>>> > > >>>> Giuseppe > > >>>> > > >>>> > > >>>> Giuseppe Rescigno M.D. > > >>>> Cardiothoracic Surgeon > > >>>> > > >>>> Lancisi Hospital > > >>>> Torrette - Ancona > > >>>> Italy > > >>>> > > >>>> > > >>>> > > >>>> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < > > >>> prasannasimha@gmail.com> wrote: > > >>>>> 26 year old lady , Marfanoid presented with an ascending aortic > > >>>>> aneurysm > > >>> + > > >>>>> severe AR. Leaflets looked normal and mechanism of AR appeared > > >>>>> due to ST > > >>>>> junction dilatation. She was AB positive and there was cncerns > > >>>>> regarding > > >>>>> adequate supply of blood products as there was a bleeder case > > >>>>> which had > > >>>>> reduced AB +ve donor pool in the city.(We had blood but not a > > >>>>> very large > > >>>>> donor pool) > > >>>>> I planned to see the leaflets and if normal considered her for > > >>>>> valve > > >>>>> sparing ascending aortic replacement with root reconstruction. > > >>>>> On table the aneurysm was up to the innominate and I cannulated > > >>>>> the > > >>>>> innominate artery for systemic perfusion and also for > > >>>>> innominate artery > > >>>>> perfusion. > > >>>>> On opening the aorta there was thickened wall (Not marfanoid) > > >>>>> which was > > >>> sent > > >>>>> for biopsy (Histopath awaited) .The leaflets looked normal and > > >>>>> well > > >>>>> preserved. I decided to use a technique described in > > >>>>> Interactive journal > > >>> of > > >>>>> CT surgery (Original plan was for a Florida sleeve) and used an > > >>>>> annular > > >>>>> stabilizing suture as described by Lars Svensson (The LV aortic > > >>>>> junction > > >>> was > > >>>>> not actually dilated) and then placed 3 tear drop patches fixed > > >>> subannularly > > >>>>> with pledgeted sutures in each sinus with fenestrations for the > > >>> coronaries > > >>>>> with the ostia fixed to the fenstrations. (The RCA ostium was > > >>>>> painfully > > >>>>> small !!). This allowed good coaptation. Under ACP at 18 Deg C > > >>>>> (I am > > >>> still > > >>>>> not confident of doing it at higher temperatures) I did an > > >>>>> intraluminal > > >>>>> hemiarch placement.The tube was then attached to the teardrop > > >>>>> patches > > >>> which > > >>>>> had been fixed at the ST junction.I then placed a prophylactic > > >>>>> cabrol > > >>> patch > > >>>>> fistula as soon as I came off CPB as I was worried about blood > > >>>>> and blood > > >>>>> product usage (As you can see there wasnt much bleeding and the > > >>>>> fistula > > >>> hood > > >>>>> is not distended so its use may be questioned). > > >>>>> Intraop Echo showed Mild AR and was accepted. Total blood loss > > >>>>> in the > > >>> ICU > > >>>>> was a worrisome 20 ml !! > > >>>>> Patient was extubated within 6 hours and is doing well and will be > > >>>>> discharged tomorrow when the HPE report comes.The postop > > >>>>> transthoracic > > >>> echo > > >>>>> shows the Cabrol patch fistula has closed. > > >>>>> Questions are how many of the members use innominate > > >>>>> cannulation versus > > >>>>> axillary cannulation and reasons for the preerence.What are the > > >>>>> problems > > >>>>> that the members have occurred with each strategy. > > >>>>> What are the tips and tricks that people who do aortic sparing > > >>>>> surgery > > >>> use > > >>>>> to judge aortic competence during intraop testing .(Not > > >>> echocardiographic > > >>>>> which requires going off CPB ) as I find my judgement with aortic > > >>> repairs > > >>>>> still hazy. Apart from holding water and visual inspection I > > >>>>> also use > > >>> the > > >>>>> method of El Khoury of placing a sucker in the LVOT and > > >>>>> allowing the > > >>>>> leaflets to oppose and pull it (the sucker) out but somehow I > > >>>>> am not > > >>> able to > > >>>>> get the leaflets to stay put as I feel that the negative > > >>>>> suction gets > > >>> lost > > >>>>> by the time I pull the sucker out (Maybe It may be becuase I am > > >>>>> using > > >>> the > > >>>>> big Yankauer sucker which may be part of the problem and am > > >>>>> planning to > > >>> use > > >>>>> a dentist irrigation sucker for the same. > > >>>>> > > >>>>> > > >>>>> -- > > >>>>> 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 > > >> ----------------------------------------- > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > > policies and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _________________________________________________________________ > 25GB of FREE Online Storage ? Find out more > > http://clk.atdmt.com/UKM/go/134665320/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 From prasannasimha at gmail.com Fri Mar 6 07:12:48 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Mar 5 21:09:00 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: <127782282141345871338618401122866491527-Webmail@me.com> <89c4ed2d0903050740n3b247dccrc305ea206d87ab3b@mail.gmail.com> Message-ID: <89c4ed2d0903051742w30783b9ah3e2d074f87c15960@mail.gmail.com> Giuseppe, we did use retrograde whole body perfusion but gave it up as we did not see tangible benefits. Thi s may be related to venous valves etc which are not present in cerenral and cardiac cirrculation.Antegrade perfusion either with an femoral cannula and occluding the distal arch with a balloon or via an antegrade balloon cannula or inflatable ET tube seems easier and safer. On Fri, Mar 6, 2009 at 1:26 AM, Giuseppe Rescigno wrote: > Roberto, > > I am planning for the next arrest to perfuse retrogradely through the IVC > the abdomen etc. IMHO this may add some extra protection that may allow > almost to stay almost warm (32?C). Of course I will go down to 26 as usual > but I will monitor splancnic perfusion by means of abdominal NIRS. What is > your opinion? are you skeptical as Dr Martin? If we open our mind then we > may start to find better new ways to do the same things. The first who did > retrograde cardioplegia was considered a crazy guy by the others. There was > a very nice script I read once that was accreditated to Walton Lillehei > about the steps of knowledge in surgery: at each step there was an > advancement and the comments of the collegues.... > > Thank you > > > Giuseppe > > > Il giorno 05/mar/09, alle ore 18:11, Roberto Battellini ha scritto: > > > >> Prasanna, >> >> go 2 grades upper each case until you feel yourself comfortable. >> >> Roberto >> >> Date: Thu, 5 Mar 2009 21:10:16 +0530 >>> Subject: Re: [HSF] "Internal Sleeve" >>> From: prasannasimha@gmail.com >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> I agree Roberto but something makes me hesitate to go up in temperature. >>> Maybe will do it at a higher temperature in the next case !! >>> Prasanna >>> >>> On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < >>> robertobattellini@hotmail.com> wrote: >>> >>> >>>> Prasanna, >>>> >>>> >>>> >>>> Look at Strauch et al EJCTS 2004, he studied the spinal cord of pigs >>>> under >>>> normothermia and 32 degrees, a reduction of 5 degrees centigrades helped >>>> to >>>> prolongue the ischemia tolerance up to 50 minutes. >>>> >>>> If you extrapolate this to the arch surgery, and you DO perfuse the >>>> innominate artery and the left carotid and block or perfuse the left >>>> subclavia, you can perform your operation at 26 degrees as Giuseppe >>>> says, >>>> providing you do the distal in less than 30 minutes (for security).And >>>> if >>>> you need distal aortic perfusion, use the Dalla Torre technique of using >>>> a >>>> tracheal cannula and perfuse distally.You need a second arterial line in >>>> Y >>>> and that?s all. >>>> >>>> Of course, we have a little extra heat exchanger for that line, so if >>>> the >>>> core temperature is 26, we can perfuse the brain at 20?C. >>>> >>>> We do all that surgery at 25-26 degrees, axillary cannulation. >>>> >>>> Roberto >>>> >>>> Date: Wed, 4 Mar 2009 23:53:43 +0100 >>>>> From: grescigno@mac.com >>>>> To: OpenHeart-L@lists.hsforum.com >>>>> Subject: Re: [HSF] "Internal Sleeve" >>>>> CC: >>>>> >>>>> Prasanna, >>>>> >>>>> very nice case. I have just 2 comments: 1. I think that you should >>>>> switch >>>>> >>>> to 26 ?C, at least for an end to end anastomosis. 2. I am not using the >>>> innominate trunk (even if I think that is a very good idea, as 90% of my >>>> circulatory arrests are for aortic dissections and I am too worried >>>> about an >>>> involvement of the innominate artery. >>>> >>>>> >>>>> Giuseppe >>>>> >>>>> >>>>> Giuseppe Rescigno M.D. >>>>> Cardiothoracic Surgeon >>>>> >>>>> Lancisi Hospital >>>>> Torrette - Ancona >>>>> Italy >>>>> >>>>> >>>>> >>>>> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < >>>>> >>>> prasannasimha@gmail.com> wrote: >>>> >>>>> 26 year old lady , Marfanoid presented with an ascending aortic >>>>>> aneurysm >>>>>> >>>>> + >>>> >>>>> severe AR. Leaflets looked normal and mechanism of AR appeared due to >>>>>> ST >>>>>> junction dilatation. She was AB positive and there was cncerns >>>>>> regarding >>>>>> adequate supply of blood products as there was a bleeder case which >>>>>> had >>>>>> reduced AB +ve donor pool in the city.(We had blood but not a very >>>>>> large >>>>>> donor pool) >>>>>> I planned to see the leaflets and if normal considered her for valve >>>>>> sparing ascending aortic replacement with root reconstruction. >>>>>> On table the aneurysm was up to the innominate and I cannulated the >>>>>> innominate artery for systemic perfusion and also for innominate >>>>>> artery >>>>>> perfusion. >>>>>> On opening the aorta there was thickened wall (Not marfanoid) which >>>>>> was >>>>>> >>>>> sent >>>> >>>>> for biopsy (Histopath awaited) .The leaflets looked normal and well >>>>>> preserved. I decided to use a technique described in Interactive >>>>>> journal >>>>>> >>>>> of >>>> >>>>> CT surgery (Original plan was for a Florida sleeve) and used an annular >>>>>> stabilizing suture as described by Lars Svensson (The LV aortic >>>>>> junction >>>>>> >>>>> was >>>> >>>>> not actually dilated) and then placed 3 tear drop patches fixed >>>>>> >>>>> subannularly >>>> >>>>> with pledgeted sutures in each sinus with fenestrations for the >>>>>> >>>>> coronaries >>>> >>>>> with the ostia fixed to the fenstrations. (The RCA ostium was painfully >>>>>> small !!). This allowed good coaptation. Under ACP at 18 Deg C (I am >>>>>> >>>>> still >>>> >>>>> not confident of doing it at higher temperatures) I did an intraluminal >>>>>> hemiarch placement.The tube was then attached to the teardrop patches >>>>>> >>>>> which >>>> >>>>> had been fixed at the ST junction.I then placed a prophylactic cabrol >>>>>> >>>>> patch >>>> >>>>> fistula as soon as I came off CPB as I was worried about blood and >>>>>> blood >>>>>> product usage (As you can see there wasnt much bleeding and the >>>>>> fistula >>>>>> >>>>> hood >>>> >>>>> is not distended so its use may be questioned). >>>>>> Intraop Echo showed Mild AR and was accepted. Total blood loss in the >>>>>> >>>>> ICU >>>> >>>>> was a worrisome 20 ml !! >>>>>> Patient was extubated within 6 hours and is doing well and will be >>>>>> discharged tomorrow when the HPE report comes.The postop transthoracic >>>>>> >>>>> echo >>>> >>>>> shows the Cabrol patch fistula has closed. >>>>>> Questions are how many of the members use innominate cannulation >>>>>> versus >>>>>> axillary cannulation and reasons for the preerence.What are the >>>>>> problems >>>>>> that the members have occurred with each strategy. >>>>>> What are the tips and tricks that people who do aortic sparing surgery >>>>>> >>>>> use >>>> >>>>> to judge aortic competence during intraop testing .(Not >>>>>> >>>>> echocardiographic >>>> >>>>> which requires going off CPB ) as I find my judgement with aortic >>>>>> >>>>> repairs >>>> >>>>> still hazy. Apart from holding water and visual inspection I also use >>>>>> >>>>> the >>>> >>>>> method of El Khoury of placing a sucker in the LVOT and allowing the >>>>>> leaflets to oppose and pull it (the sucker) out but somehow I am not >>>>>> >>>>> able to >>>> >>>>> get the leaflets to stay put as I feel that the negative suction gets >>>>>> >>>>> lost >>>> >>>>> by the time I pull the sucker out (Maybe It may be becuase I am using >>>>>> >>>>> the >>>> >>>>> big Yankauer sucker which may be part of the problem and am planning to >>>>>> >>>>> use >>>> >>>>> a dentist irrigation sucker for the same. >>>>>> >>>>>> >>>>>> -- >>>>>> 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 >>> ----------------------------------------- >>> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Fri Mar 6 07:34:50 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Mar 5 21:11:50 2009 Subject: [HSF] "Internal Sleeve" In-Reply-To: References: <127782282141345871338618401122866491527-Webmail@me.com> <89c4ed2d0903050740n3b247dccrc305ea206d87ab3b@mail.gmail.com> Message-ID: <89c4ed2d0903051804m2a7b172eyc32e3913741be18d@mail.gmail.com> There is a constant striving to improve our results and techniques are being added on. What we practiced 10 years ago is not the same today and because of these changes cardiac surgery is safer and better.There will be people who will stick to conventional techniques and there will be people who will explore (Like in Star treck - to boldly go where no man has gone before) As Guiseppe said maybe it works well (TCA for some surgeons) but if it was so perfect we wouldnt have the plethora of resarch going on. Why did I switch over to innominate cannulation - axillary is messy, additional incision, , if no graft is used it requires a delicate repair and if a graft is used there is a messy leakfrom needle holes on full heparin around it which can be managed with a sucker but still......Also I am not a "fast " surgeon so would like to have the luxury of some time just in case things dont go exactly the way I planned. The preop plan was to do a replacement with a curved clamp just at the base of the innominate on but I realized intraop that a hemiarch would be required so decided to switch. I did the anastomosis with 13 minutes of antegrade perfusion but I would just say I was lucky that day and things just fell in place. (Incidnetally I dont think we have progressed to the state where we can circ arrest at normothermia yet !!) For those who think ACP etc are new please refer to the Chauker Pandey Shunt which was used by my "Grand Daddy Teachers" in KEM Hosptial (Dr Pandey has passed away) in the 70's on which all this (axillary perfusion) is now based. Basically an Inter carotid graft or right axillary to left carotid was placed a few days before surgery and then bilateral cerebral perfusion was established by perfusing the right axillary artery. Prasanna > > But what would your reason to want to try this technique? Why do have > desire to stay warm? > > > > Why not try this technique in animals first (or not done so) before you > advance our years old techniques in humans! > > > > Odd the very strong and religious oppositions we get to the evils of > conventional surgery in our speciality. Usually it is the off-pump brigade > (cursing all the bad things the pump does but yet doing AVRs on pump), or > the beating heart brigade (cursing all the bad things cardioplegia does to > the heart, yet not hestistant to arrest heart for an arch replacement or > transplant - i suppose though they can work out creative ways to keep heart > beating through both), the reference surgery battallion, of which I am a > member (that swear low volume occasional surgery is bad, yet themselves > doing less than 20 CABGs per year, not believing anymore in need for > expertise), or the anaortic regiment (cursing the use of murderous clamps on > aortae, yet performing AVRs with clamps on same vessel). > > > > But now its about temperature? We now want to circ arrest at > normothermia??? I have seen many things, but a patient having arch surgery > who died of moderate hypothermia I have not found. > > > > Now these HSF religious movements are getting to me!!!! What next? Any > takers for awake surgery...surely it cant be a physiological to put patients > to sleep just because you are operating on their heart??? > > > > Ani > > > > > > > From: grescigno@mac.com > > Subject: Re: [HSF] "Internal Sleeve" > > Date: Thu, 5 Mar 2009 20:56:36 +0100 > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > Roberto, > > > > I am planning for the next arrest to perfuse retrogradely through the > > IVC the abdomen etc. IMHO this may add some extra protection that may > > allow almost to stay almost warm (32?C). Of course I will go down to > > 26 as usual but I will monitor splancnic perfusion by means of > > abdominal NIRS. What is your opinion? are you skeptical as Dr Martin? > > If we open our mind then we may start to find better new ways to do > > the same things. The first who did retrograde cardioplegia was > > considered a crazy guy by the others. There was a very nice script I > > read once that was accreditated to Walton Lillehei about the steps of > > knowledge in surgery: at each step there was an advancement and the > > comments of the collegues.... > > > > Thank you > > > > > > Giuseppe > > > > > > Il giorno 05/mar/09, alle ore 18:11, Roberto Battellini ha scritto: > > > > > > > > Prasanna, > > > > > > go 2 grades upper each case until you feel yourself comfortable. > > > > > > Roberto > > > > > >> Date: Thu, 5 Mar 2009 21:10:16 +0530 > > >> Subject: Re: [HSF] "Internal Sleeve" > > >> From: prasannasimha@gmail.com > > >> To: OpenHeart-L@lists.hsforum.com > > >> CC: > > >> > > >> I agree Roberto but something makes me hesitate to go up in > > >> temperature. > > >> Maybe will do it at a higher temperature in the next case !! > > >> Prasanna > > >> > > >> On Thu, Mar 5, 2009 at 3:48 PM, Roberto Battellini < > > >> robertobattellini@hotmail.com> wrote: > > >> > > >>> > > >>> Prasanna, > > >>> > > >>> > > >>> > > >>> Look at Strauch et al EJCTS 2004, he studied the spinal cord of > > >>> pigs under > > >>> normothermia and 32 degrees, a reduction of 5 degrees centigrades > > >>> helped to > > >>> prolongue the ischemia tolerance up to 50 minutes. > > >>> > > >>> If you extrapolate this to the arch surgery, and you DO perfuse the > > >>> innominate artery and the left carotid and block or perfuse the left > > >>> subclavia, you can perform your operation at 26 degrees as > > >>> Giuseppe says, > > >>> providing you do the distal in less than 30 minutes (for > > >>> security).And if > > >>> you need distal aortic perfusion, use the Dalla Torre technique > > >>> of using a > > >>> tracheal cannula and perfuse distally.You need a second arterial > > >>> line in Y > > >>> and that?s all. > > >>> > > >>> Of course, we have a little extra heat exchanger for that line, > > >>> so if the > > >>> core temperature is 26, we can perfuse the brain at 20?C. > > >>> > > >>> We do all that surgery at 25-26 degrees, axillary cannulation. > > >>> > > >>> Roberto > > >>> > > >>>> Date: Wed, 4 Mar 2009 23:53:43 +0100 > > >>>> From: grescigno@mac.com > > >>>> To: OpenHeart-L@lists.hsforum.com > > >>>> Subject: Re: [HSF] "Internal Sleeve" > > >>>> CC: > > >>>> > > >>>> Prasanna, > > >>>> > > >>>> very nice case. I have just 2 comments: 1. I think that you > > >>>> should switch > > >>> to 26 ?C, at least for an end to end anastomosis. 2. I am not > > >>> using the > > >>> innominate trunk (even if I think that is a very good idea, as > > >>> 90% of my > > >>> circulatory arrests are for aortic dissections and I am too > > >>> worried about an > > >>> involvement of the innominate artery. > > >>>> > > >>>> Giuseppe > > >>>> > > >>>> > > >>>> Giuseppe Rescigno M.D. > > >>>> Cardiothoracic Surgeon > > >>>> > > >>>> Lancisi Hospital > > >>>> Torrette - Ancona > > >>>> Italy > > >>>> > > >>>> > > >>>> > > >>>> On Wednesday, March 04, 2009, at 07:45PM, "Prasanna Simha M" < > > >>> prasannasimha@gmail.com> wrote: > > >>>>> 26 year old lady , Marfanoid presented with an ascending aortic > > >>>>> aneurysm > > >>> + > > >>>>> severe AR. Leaflets looked normal and mechanism of AR appeared > > >>>>> due to ST > > >>>>> junction dilatation. She was AB positive and there was cncerns > > >>>>> regarding > > >>>>> adequate supply of blood products as there was a bleeder case > > >>>>> which had > > >>>>> reduced AB +ve donor pool in the city.(We had blood but not a > > >>>>> very large > > >>>>> donor pool) > > >>>>> I planned to see the leaflets and if normal considered her for > > >>>>> valve > > >>>>> sparing ascending aortic replacement with root reconstruction. > > >>>>> On table the aneurysm was up to the innominate and I cannulated > > >>>>> the > > >>>>> innominate artery for systemic perfusion and also for > > >>>>> innominate artery > > >>>>> perfusion. > > >>>>> On opening the aorta there was thickened wall (Not marfanoid) > > >>>>> which was > > >>> sent > > >>>>> for biopsy (Histopath awaited) .The leaflets looked normal and > > >>>>> well > > >>>>> preserved. I decided to use a technique described in > > >>>>> Interactive journal > > >>> of > > >>>>> CT surgery (Original plan was for a Florida sleeve) and used an > > >>>>> annular > > >>>>> stabilizing suture as described by Lars Svensson (The LV aortic > > >>>>> junction > > >>> was > > >>>>> not actually dilated) and then placed 3 tear drop patches fixed > > >>> subannularly > > >>>>> with pledgeted sutures in each sinus with fenestrations for the > > >>> coronaries > > >>>>> with the ostia fixed to the fenstrations. (The RCA ostium was > > >>>>> painfully > > >>>>> small !!). This allowed good coaptation. Under ACP at 18 Deg C > > >>>>> (I am > > >>> still > > >>>>> not confident of doing it at higher temperatures) I did an > > >>>>> intraluminal > > >>>>> hemiarch placement.The tube was then attached to the teardrop > > >>>>> patches > > >>> which > > >>>>> had been fixed at the ST junction.I then placed a prophylactic > > >>>>> cabrol > > >>> patch > > >>>>> fistula as soon as I came off CPB as I was worried about blood > > >>>>> and blood > > >>>>> product usage (As you can see there wasnt much bleeding and the > > >>>>> fistula > > >>> hood > > >>>>> is not distended so its use may be questioned). > > >>>>> Intraop Echo showed Mild AR and was accepted. Total blood loss > > >>>>> in the > > >>> IC