From mmlevinson at hsforum.com Fri May 1 01:51:56 2009 From: mmlevinson at hsforum.com (Mark Levinson) Date: Fri May 1 01:52:25 2009 Subject: [HSF] (no subject) In-Reply-To: <48BC2C85.129E.0028.0@health.qld.gov.au> References: <48BC2C85.129E.0028.0@health.qld.gov.au> Message-ID: On Sep 1, 2008, at 2:55 AM, Homayoun Jalali wrote: > He does not need aortic root if his autograft is not dilated. Also > In a redo Ross you are dealing with a living neo-aortic root not a > calcified Homograft. Replacing the valve if needed can be a lot more > straightforward. My approach would be a mitral repair, then conventional AVR using the retained pulmonary root (unless frankly aneurysmal), then TVR ring. As for the PI, if you do not have an endovalve available, then bioprosthetic PVR. The only precaution is to place the new valve more distally than the original valve and then patch the RVOT. Otherwise the new PVR sits underneath the sternum and closure can impinge on the RVOT. That is a lot of surgery, so the decision to operate is difficult. But the Ross root replacement probably can be left intact, sparing the need for a Bentall in a redo situation. Mark Mark Levinson, MD. Founder, Editor-in-Chief The Heart Surgery Forum? Multimedia Cardiothoracic Journal URL: http://www.hsforum.com URL: http://newoptionsinheartsurgery.com Emali: mmlevinson@hsforum.com From mmlevinson at hsforum.com Fri May 1 01:55:01 2009 From: mmlevinson at hsforum.com (Mark Levinson) Date: Fri May 1 01:55:05 2009 Subject: [HSF] (no subject) In-Reply-To: <90baeb280809030241h65526f73yd27ef25f9eea1a66@mail.gmail.com> References: <90baeb280809030047j7029e536wb26fcf0462823888@mail.gmail.com> <89c4ed2d0809030147x20601064w95ca4fa20ab5a644@mail.gmail.com> <90baeb280809030241h65526f73yd27ef25f9eea1a66@mail.gmail.com> Message-ID: <94A2E366-D5B5-4BF5-BDAC-742DA3EE2BD4@hsforum.com> On Sep 3, 2008, at 4:41 AM, eric manasse wrote: > it was just a simple AVR, absence of MR @ echo TEE preop; 5 days after > it showed up a MR +++ with possible retraction of AML not clarified @ > reintervention AVR sutures placed too deeply into the region of the left/non sinus??? Mark > > > 2008/9/3 Prasanna Simha M : >> LV dysfunction with annular dilatation. The other possibilty - >> understimation of MR in the first place. >> Other possibilituies - was a Manouguian done ? Endocarditis ? >> prasanna >> >> >> On Wed, Sep 3, 2008 at 1:17 PM, eric manasse >> wrote: >> >>> Hello, I'd like to know if anybody has ever encountered the >>> following >>> problem: >>> new onset on mitral regurgitation few days after aortic valve >>> replacement ? >>> what is the mechanism ? >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/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 > ----------------------------------------- Mark Levinson, MD. Founder, Editor-in-Chief The Heart Surgery Forum? Multimedia Cardiothoracic Journal URL: http://www.hsforum.com URL: http://newoptionsinheartsurgery.com Emali: mmlevinson@hsforum.com From grescigno at mac.com Fri May 1 10:11:08 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Fri May 1 03:16:45 2009 Subject: [HSF] follow-up of arrhythmic patient Message-ID: Dear Collegues, I finally operated on this patient (lima-lad OPCAB). In fact last night he had 38 (!!!!) DC shock. Our chief cardiologist did a viability study by contrast echo that was unconclusive. The procedure was uneventful. Good flow (40 mL PI 1.6). I hope this will help the patient. Thanks to all for your suggestions Giuseppe From Rwmfglycar at aol.com Fri May 1 04:40:30 2009 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Fri May 1 03:41:12 2009 Subject: [HSF] (no subject) Message-ID: Calcified valve? Method of removing calcium? Are you absolutely sure there is not a hole in the anterior leaflet? Bob In a message dated 5/1/2009 7:56:50 A.M. South Africa Standard Time, mmlevinson@hsforum.com writes: On Sep 3, 2008, at 4:41 AM, eric manasse wrote: > it was just a simple AVR, absence of MR @ echo TEE preop; 5 days after > it showed up a MR +++ with possible retraction of AML not clarified @ > reintervention AVR sutures placed too deeply into the region of the left/non sinus??? Mark > > > 2008/9/3 Prasanna Simha M : >> LV dysfunction with annular dilatation. The other possibilty - >> understimation of MR in the first place. >> Other possibilituies - was a Manouguian done ? Endocarditis ? >> prasanna >> >> >> On Wed, Sep 3, 2008 at 1:17 PM, eric manasse >> wrote: >> >>> Hello, I'd like to know if anybody has ever encountered the >>> following >>> problem: >>> new onset on mitral regurgitation few days after aortic valve >>> replacement ? >>> what is the mechanism ? >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/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 > ----------------------------------------- Mark Levinson, MD. Founder, Editor-in-Chief The Heart Surgery Forum? Multimedia Cardiothoracic Journal URL: http://www.hsforum.com URL: http://newoptionsinheartsurgery.com Emali: mmlevinson@hsforum.com _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************Join ChristianMingle.com? FREE! Meet Christian Singles in your area. Start now! (http://pr.atwola.com/promoclk/100126575x1221673648x1201419171/aol?redir=http://www.christianmingle.com/campaign.html%3Fcat%3Dadbuy%26 src%3Dplatforma%26adid%3Dfooter:050109%26newurl%3Dreg_path.html) From drdharris at yahoo.co.uk Fri May 1 02:53:51 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Fri May 1 04:55:21 2009 Subject: [HSF] (no subject) In-Reply-To: Message-ID: <875240.24964.qm@web24715.mail.ird.yahoo.com> I had a similar case recently with a magna valve distorting ant leaflet. Detected intra op and looked mild to moderate but progressed postop. Ant leaflet was small, some rheumatic changes and retracted upwards. Had to replace valve. Dave Rwmfglycar@aol.com wrote: > Calcified valve? Method of removing calcium? Are you absolutely sure there > is not a hole in the anterior leaflet? > Bob > In a message dated 5/1/2009 7:56:50 A.M. South Africa Standard Time, > mmlevinson@hsforum.com writes: > On Sep 3, 2008, at 4:41 AM, eric manasse wrote: >> it was just a simple AVR, absence of MR @ echo TEE preop; 5 days after >> it showed up a MR +++ with possible retraction of AML not clarified @ >> reintervention > AVR sutures placed too deeply into the region of the left/non sinus??? > Mark >> >> >> 2008/9/3 Prasanna Simha M : >>> LV dysfunction with annular dilatation. The other possibilty - >>> understimation of MR in the first place. >>> Other possibilituies - was a Manouguian done ? Endocarditis ? >>> prasanna >>> >>> >>> On Wed, Sep 3, 2008 at 1:17 PM, eric manasse >>> wrote: >>> >>>> Hello, I'd like to know if anybody has ever encountered the >>>> following >>>> problem: >>>> new onset on mitral regurgitation few days after aortic valve >>>> replacement ? >>>> what is the mechanism ? >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/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 >> ----------------------------------------- > Mark Levinson, MD. > Founder, Editor-in-Chief > The Heart Surgery Forum? > Multimedia Cardiothoracic Journal > URL: http://www.hsforum.com > URL: http://newoptionsinheartsurgery.com > Emali: mmlevinson@hsforum.com > _______________________________________________ > OpenHeart-L mailing list > Send postings to: > OpenHeart-L@lists.hsforum.com > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > **************Join ChristianMingle.com? FREE! Meet Christian Singles in > your area. Start now! > (http://pr.atwola.com/promoclk/100126575x1221673648x1201419171/aol?redir=http://www.christianmingle.com/campaign.html%3Fcat%3Dadbuy%26 > src%3Dplatforma%26adid%3Dfooter:050109%26newurl%3Dreg_path.html) > _______________________________________________ > OpenHeart-L mailing list > Send postings to: > OpenHeart-L@lists.hsforum.com > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Fri May 1 12:36:40 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri May 1 05:37:27 2009 Subject: =?iso-8859-2?Q?RE:_[HSF]_?= =?iso-8859-2?Q?=BEABP?= In-Reply-To: References: <89c4ed2d0904301020od6d9048ve058184201b9fe8c@mail.gmail.com> Message-ID: We have it since last year, functions perfectly. Roberto > Date: Thu, 30 Apr 2009 18:46:58 -0500 > Subject: Re: [HSF] ?ABP > From: ebender001@me.com > To: OpenHeart-L@lists.hsforum.com > CC: > > Our hospital just got the new datascope system with fiberoptic calibration > and wicked fast signal acquisition. Automatic timing, and tracking of fast > and irregular arrhythmias. No transducer needed, and idiot proof operation > (good for me). Here is the web site. > http://www.datascope.com/ca/sensation_cs300_sys.html > > Ed Bender, MD > > > On 4/30/09 12:20 PM, "prasannasimha" wrote: > > > Most are the same. Arrow has a sequence for firing in Afib that can be an > > advantage.We have both Datascope and Arrow in our hospital. > > Prasanna > > > > 2009/4/30 sbmd > > > >> Which brand would you prefer for IABP console? Arrow..Datascope.etc.Whats > >> superior? > >> thanks > >> > >> Serhat > >> Istanbul > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >> All messages transmitted by the OpenHeart-L are subject to the policies and > >> disclaimers posted at: > >> http://www.hsforum.com/listdisclaim > >> ----------------------------------------- > >> > > > > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Fri May 1 12:45:24 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri May 1 05:46:15 2009 Subject: [HSF] (no subject) In-Reply-To: <875240.24964.qm@web24715.mail.ird.yahoo.com> References: <875240.24964.qm@web24715.mail.ird.yahoo.com> Message-ID: I assisted once a case, an oversizing was tried, and of course, the Ant leaflet was retracted.It was diagnosed after routine TEE, the solution was a Cosgrove ring. Case very similar to Mark?s case. Roberto > Date: Fri, 1 May 2009 01:53:51 -0700 > From: drdharris@yahoo.co.uk > Subject: Re: [HSF] (no subject) > To: Rwmfglycar@aol.com; OpenHeart-L@lists.hsforum.com > CC: > > > I had a similar case recently with a magna valve distorting ant leaflet. Detected intra op and looked mild to moderate but progressed postop. Ant leaflet was small, some rheumatic changes and retracted upwards. Had to replace valve. Dave > > Rwmfglycar@aol.com wrote: > > Calcified valve? Method of removing calcium? Are you absolutely sure there > > is not a hole in the anterior leaflet? > > Bob > > In a message dated 5/1/2009 7:56:50 A.M. South Africa Standard Time, > > mmlevinson@hsforum.com writes: > > On Sep 3, 2008, at 4:41 AM, eric manasse wrote: > >> it was just a simple AVR, absence of MR @ echo TEE preop; 5 days after > >> it showed up a MR +++ with possible retraction of AML not clarified @ > >> reintervention > > AVR sutures placed too deeply into the region of the left/non sinus??? > > Mark > >> > >> > >> 2008/9/3 Prasanna Simha M : > >>> LV dysfunction with annular dilatation. The other possibilty - > >>> understimation of MR in the first place. > >>> Other possibilituies - was a Manouguian done ? Endocarditis ? > >>> prasanna > >>> > >>> > >>> On Wed, Sep 3, 2008 at 1:17 PM, eric manasse > >>> wrote: > >>> > >>>> Hello, I'd like to know if anybody has ever encountered the > >>>> following > >>>> problem: > >>>> new onset on mitral regurgitation few days after aortic valve > >>>> replacement ? > >>>> what is the mechanism ? > >>>> _______________________________________________ > >>>> OpenHeart-L mailing list > >>>> > >>>> Send postings to: > >>>> OpenHeart-L@lists.hsforum.com > >>>> > >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>>> http://mmp.cjp.com/mailman/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 > >> ----------------------------------------- > > Mark Levinson, MD. > > Founder, Editor-in-Chief > > The Heart Surgery Forum? > > Multimedia Cardiothoracic Journal > > URL: http://www.hsforum.com > > URL: http://newoptionsinheartsurgery.com > > Emali: mmlevinson@hsforum.com > > _______________________________________________ > > OpenHeart-L mailing list > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > **************Join ChristianMingle.com? FREE! Meet Christian Singles in > > your area. Start now! > > (http://pr.atwola.com/promoclk/100126575x1221673648x1201419171/aol?redir=http://www.christianmingle.com/campaign.html%3Fcat%3Dadbuy%26 > > src%3Dplatforma%26adid%3Dfooter:050109%26newurl%3Dreg_path.html) > > _______________________________________________ > > OpenHeart-L mailing list > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Fri May 1 05:46:42 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Fri May 1 07:48:10 2009 Subject: =?utf-8?B?UkU6IFtIU0ZdIMW+QUJQ?= In-Reply-To: Message-ID: <653275.87899.qm@web24716.mail.ird.yahoo.com> The Datascope is the best and less troublesome. Its the Rolls Royce of IABP 's. Dave Roberto Battellini wrote: > We have it since last year, functions perfectly. > Roberto > >> Date: Thu, 30 Apr 2009 18:46:58 -0500 >> Subject: Re: [HSF] ?ABP >> From: ebender001@me.com >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Our hospital just got the new datascope system with fiberoptic calibration >> and wicked fast signal acquisition. Automatic timing, and tracking of fast >> and irregular arrhythmias. No transducer needed, and idiot proof operation >> (good for me). Here is the web site. >> http://www.datascope.com/ca/sensation_cs300_sys.html >> >> Ed Bender, MD >> >> >> On 4/30/09 12:20 PM, "prasannasimha" wrote: >> >> > Most are the same. Arrow has a sequence for firing in Afib that can be an >> > advantage.We have both Datascope and Arrow in our hospital. >> > Prasanna >> > >> > 2009/4/30 sbmd >> > >> >> Which brand would you prefer for IABP console? Arrow..Datascope.etc.Whats >> >> superior? >> >> thanks >> >> >> >> Serhat >> >> Istanbul >> >> _______________________________________________ >> >> OpenHeart-L mailing list >> >> >> >> Send postings to: >> >> OpenHeart-L@lists.hsforum.com >> >> >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> >> disclaimers posted at: >> >> http://www.hsforum.com/listdisclaim >> >> ----------------------------------------- >> >> >> > >> > >> >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > Send postings to: > OpenHeart-L@lists.hsforum.com > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 mmlevinson at hsforum.com Sat May 2 03:06:03 2009 From: mmlevinson at hsforum.com (Mark Levinson) Date: Sat May 2 03:06:34 2009 Subject: [HSF] Axillary Artery Cannulation In-Reply-To: <513702.71021.qm@web50901.mail.re2.yahoo.com> References: <513702.71021.qm@web50901.mail.re2.yahoo.com> Message-ID: <74AE3B11-1484-4C51-9EDB-ED2C0318B8F1@hsforum.com> On Apr 23, 2009, at 12:18 AM, john streitman wrote: > > Hal, > > John Streitman here - finished with Tom in 2006 at UF and met you at > the last Southern Thoracic. Tom is dead on. I have done a hemiarch > with a 3 1/2 min circ arrest time with Tom as my assistant and > furthermore using the same technique as he trained us have done well > over 40 hemiarches in the last 3 years here in Pinehurst and am > disappointed if it takes longer than 10 minutes. Fascinating discussion. For non-dissection ascending aneurysms, I have adopted Calafiore's technique, with a circ arrest time of 0. Calafiore designed a special clamp to fit into the upper arch and isolate the underside of the arch. Pump flow from the groin goes over the top of the clamp into the head vessels while you can resect and graft the underside of the arch. My practice ( in a small community hospital) does not yield very many cases of this type, but the Calafiore technique simplified them when they occur. Now, I just cool to 30 C, clamp the arch, sew the distal (in whatever time it takes) and advance another clamp proximal to the suture line, and then complete the supracoronary anastomosis etc. The pump stays on throughout. The key is to evaluate the preop CAT for calcification or endoluminal plaque. This technique does not apply when the arch is calcified. But I have done several cases this way, with no strokes and no circ arrest. The clamps are commercially available. (I have not tried this with dissections, where I still use a felt sandwich technique under circ arrest). Mark Levinson, MD. Founder, Editor-in-Chief The Heart Surgery Forum? Multimedia Cardiothoracic Journal URL: http://www.hsforum.com URL: http://newoptionsinheartsurgery.com Emali: mmlevinson@hsforum.com From robertobattellini at hotmail.com Sat May 2 10:17:28 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sat May 2 03:17:57 2009 Subject: [HSF] Axillary Artery Cannulation In-Reply-To: <74AE3B11-1484-4C51-9EDB-ED2C0318B8F1@hsforum.com> References: <513702.71021.qm@web50901.mail.re2.yahoo.com> <74AE3B11-1484-4C51-9EDB-ED2C0318B8F1@hsforum.com> Message-ID: Mark, please, send a photo and company name of the clamp. Roberto > From: mmlevinson@hsforum.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Axillary Artery Cannulation > Date: Sat, 2 May 2009 02:06:03 -0500 > CC: > > > On Apr 23, 2009, at 12:18 AM, john streitman wrote: > > > > > Hal, > > > > John Streitman here - finished with Tom in 2006 at UF and met you at > > the last Southern Thoracic. Tom is dead on. I have done a hemiarch > > with a 3 1/2 min circ arrest time with Tom as my assistant and > > furthermore using the same technique as he trained us have done well > > over 40 hemiarches in the last 3 years here in Pinehurst and am > > disappointed if it takes longer than 10 minutes. > > > Fascinating discussion. For non-dissection ascending aneurysms, I > have adopted Calafiore's technique, with a circ arrest time of 0. > Calafiore designed a special clamp to fit into the upper arch and > isolate the underside of the arch. Pump flow from the groin goes over > the top of the clamp into the head vessels while you can resect and > graft the underside of the arch. My practice ( in a small > community hospital) does not yield very many cases of this type, but > the Calafiore technique simplified them when they occur. Now, I > just cool to 30 C, clamp the arch, sew the distal (in whatever time it > takes) and advance another clamp proximal to the suture line, and then > complete the supracoronary anastomosis etc. The pump stays on > throughout. > > The key is to evaluate the preop CAT for calcification or endoluminal > plaque. This technique does not apply when the arch is > calcified. But I have done several cases this way, with no strokes > and no circ arrest. The clamps are commercially available. (I > have not tried this with dissections, where I still use a felt > sandwich technique under circ arrest). > > Mark Levinson, MD. > Founder, Editor-in-Chief > The Heart Surgery Forum? > Multimedia Cardiothoracic Journal > URL: http://www.hsforum.com > URL: http://newoptionsinheartsurgery.com > Emali: mmlevinson@hsforum.com > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From msfirst at gmail.com Sat May 2 12:12:03 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sat May 2 12:13:38 2009 Subject: [HSF] Pacer Lead Induced TR Message-ID: With patients with mod/sev TR (normal or near normal annular sizes) from distortion of the leaflets from chronic RV pacing leads - does anyone have thoughts on "fixing" these? Or some other management insight? -michael From drmitch at cox.net Sat May 2 16:59:38 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Sat May 2 17:00:06 2009 Subject: [HSF] Persistent LSVC Message-ID: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> For the 3rd or 4th time in a span of two years, I've been confronted with/ identified at the time of surgery, patients with a persistent Lt SVC. For the routine CAB, it's not really a problem, but 2 of them have been for mitral surgery. If I remember correctly, one had a diminutive SVC and no innominate vein. The other and most recent, had no SVC at all and a giant retro-cardiac vessel. For future reference, I'll be accepting any and all tips, pearls, and general knowledge. Thanks, Mitch From TSalerno at med.miami.edu Sat May 2 18:20:58 2009 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Sat May 2 17:21:17 2009 Subject: [HSF] Persistent LSVC Message-ID: I have encountere left cava a few times in all types of procedure; 1) In CABG it is irrelevant since I do all cases of pump 2) In mitral valve with heart beating and aorta unclamped, aside from svc and ivc cannulation, I also cannulate the coronary sinus once right atrium is openeda, snare the mouth of the sinus and connect the cannula to the venous system; 3) In aortic valve with heart beating, I ony cannulate the left and right ostia for blood perfusion. With the use of single cannula left cava is irrelevant. One should be able to diagnose left cava via TEE, and the coronary sinus is usually very large. Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. One always has the option of snaring the left cava, is svc exists but I have not done that Tomas ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: OpenHeart-L@hsforum.com Sent: Sat May 02 16:59:38 2009 Subject: [HSF] Persistent LSVC For the 3rd or 4th time in a span of two years, I've been confronted with/ identified at the time of surgery, patients with a persistent Lt SVC. For the routine CAB, it's not really a problem, but 2 of them have been for mitral surgery. If I remember correctly, one had a diminutive SVC and no innominate vein. The other and most recent, had no SVC at all and a giant retro-cardiac vessel. For future reference, I'll be accepting any and all tips, pearls, and general knowledge. Thanks, 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 TSalerno at med.miami.edu Sat May 2 18:20:58 2009 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Sat May 2 17:21:27 2009 Subject: [HSF] Persistent LSVC Message-ID: I have encountere left cava a few times in all types of procedure; 1) In CABG it is irrelevant since I do all cases of pump 2) In mitral valve with heart beating and aorta unclamped, aside from svc and ivc cannulation, I also cannulate the coronary sinus once right atrium is openeda, snare the mouth of the sinus and connect the cannula to the venous system; 3) In aortic valve with heart beating, I ony cannulate the left and right ostia for blood perfusion. With the use of single cannula left cava is irrelevant. One should be able to diagnose left cava via TEE, and the coronary sinus is usually very large. Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. One always has the option of snaring the left cava, is svc exists but I have not done that Tomas ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: OpenHeart-L@hsforum.com Sent: Sat May 02 16:59:38 2009 Subject: [HSF] Persistent LSVC For the 3rd or 4th time in a span of two years, I've been confronted with/ identified at the time of surgery, patients with a persistent Lt SVC. For the routine CAB, it's not really a problem, but 2 of them have been for mitral surgery. If I remember correctly, one had a diminutive SVC and no innominate vein. The other and most recent, had no SVC at all and a giant retro-cardiac vessel. For future reference, I'll be accepting any and all tips, pearls, and general knowledge. Thanks, 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 drmitch at cox.net Sat May 2 17:46:15 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Sat May 2 17:47:43 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: <6.2.1.2.2.20090502164103.01dd7518@pop.east.cox.net> At 04:20 PM 5/2/2009, you wrote: >"One should be able to diagnose left cava via TEE, and the coronary sinus >is usually very large..." Yes, one should be able to see it, but I've been hosed a couple of times. If the cardiologist doesn't look for it, I won't see it. And yes, the sinus is large. Very large. I did an MVR/TVR one time with a Lt cava, I could have parked my car in that thing. Thanks for the advice. From Hgrmd at aol.com Sat May 2 19:48:38 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sat May 2 18:50:40 2009 Subject: [HSF] Persistent LSVC Message-ID: Mitch, I've seen similar a few times myself. As long as they have an SVC, I just snare the LSVC so that my retrograde cardioplegia will work. Those patients I handled this way seemed to do well. Hal In a message dated 5/2/2009 5:01:47 P.M. Eastern Daylight Time, drmitch@cox.net writes: For the 3rd or 4th time in a span of two years, I've been confronted with/ identified at the time of surgery, patients with a persistent Lt SVC. For the routine CAB, it's not really a problem, but 2 of them have been for mitral surgery. If I remember correctly, one had a diminutive SVC and no innominate vein. The other and most recent, had no SVC at all and a giant retro-cardiac vessel. For future reference, I'll be accepting any and all tips, pearls, and general knowledge. Thanks, 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 ----------------------------------------- **************Check all of your email inboxes from anywhere on the web. Try the new Email Toolbar now! (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027) From Hgrmd at aol.com Sat May 2 19:54:18 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sat May 2 18:55:24 2009 Subject: [HSF] Pacer Lead Induced TR Message-ID: Michael, It depends on what is producing the TR. Sometimes the lead actually perforates the leaflet. In that case, a triangular resection and subsequent autologous pericardial patch will take care of it. Other times, the lead is holding back the leaflet (usually posterior or septal), producing the TR. In those cases the lead should be shaved from the leaflet edge and then forced into the corner of the postero-septal commissure. It is held into place with a couple of sutures. If these measures don't work, then consider TVR (Mitral Magna is what I would use). Hal In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, msfirst@gmail.com writes: With patients with mod/sev TR (normal or near normal annular sizes) from distortion of the leaflets from chronic RV pacing leads - does anyone have thoughts on "fixing" these? Or some other management insight? -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 ----------------------------------------- **************Check all of your email inboxes from anywhere on the web. Try the new Email Toolbar now! (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027) From anianyanwu at hotmail.com Sun May 3 00:06:05 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sat May 2 19:06:34 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. > > Tomas What is the mechanism of the death in these cases? Ani > From: TSalerno@med.miami.edu > To: OpenHeart-L@lists.hsforum.com; OpenHeart-L@hsforum.com > Date: Sat, 2 May 2009 17:20:58 -0400 > Subject: Re: [HSF] Persistent LSVC > CC: > > I have encountere left cava a few times in all types of procedure; > > 1) In CABG it is irrelevant since I do all cases of pump > > 2) In mitral valve with heart beating and aorta unclamped, aside from svc and ivc cannulation, I also cannulate the coronary sinus once right atrium is openeda, snare the mouth of the sinus and connect the cannula to the venous system; > > 3) In aortic valve with heart beating, I ony cannulate the left and right ostia for blood perfusion. With the use of single cannula left cava is irrelevant. > > One should be able to diagnose left cava via TEE, and the coronary sinus is usually very large. Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. One always has the option of snaring the left cava, is svc exists but I have not done that > > Tomas > > ----- Original Message ----- > From: openheart-l-bounces@lists.hsforum.com > To: OpenHeart-L@hsforum.com > Sent: Sat May 02 16:59:38 2009 > Subject: [HSF] Persistent LSVC > > For the 3rd or 4th time in a span of two years, I've been confronted with/ > identified at the time of surgery, patients with a persistent Lt SVC. For > the routine CAB, it's not really a problem, but 2 of them have been for > mitral surgery. If I remember correctly, one had a diminutive SVC and no > innominate vein. The other and most recent, had no SVC at all and a giant > retro-cardiac vessel. > > For future reference, I'll be accepting any and all tips, pearls, and > general knowledge. > > Thanks, 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 > ----------------------------------------- _________________________________________________________________ Beyond Hotmail ? see what else you can do with Windows Live. http://clk.atdmt.com/UKM/go/134665375/direct/01/ From TSalerno at med.miami.edu Sat May 2 20:56:47 2009 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Sat May 2 19:57:05 2009 Subject: [HSF] Persistent LSVC Message-ID: Retrograde cardioplegia is given, sometimes alone for aortic valve by some surgeons (something I do not recommend) and the heart is not protected. Ts ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: open heart list Sent: Sat May 02 19:06:05 2009 Subject: RE: [HSF] Persistent LSVC Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. > > Tomas What is the mechanism of the death in these cases? Ani > From: TSalerno@med.miami.edu > To: OpenHeart-L@lists.hsforum.com; OpenHeart-L@hsforum.com > Date: Sat, 2 May 2009 17:20:58 -0400 > Subject: Re: [HSF] Persistent LSVC > CC: > > I have encountere left cava a few times in all types of procedure; > > 1) In CABG it is irrelevant since I do all cases of pump > > 2) In mitral valve with heart beating and aorta unclamped, aside from svc and ivc cannulation, I also cannulate the coronary sinus once right atrium is openeda, snare the mouth of the sinus and connect the cannula to the venous system; > > 3) In aortic valve with heart beating, I ony cannulate the left and right ostia for blood perfusion. With the use of single cannula left cava is irrelevant. > > One should be able to diagnose left cava via TEE, and the coronary sinus is usually very large. Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. One always has the option of snaring the left cava, is svc exists but I have not done that > > Tomas > > ----- Original Message ----- > From: openheart-l-bounces@lists.hsforum.com > To: OpenHeart-L@hsforum.com > Sent: Sat May 02 16:59:38 2009 > Subject: [HSF] Persistent LSVC > > For the 3rd or 4th time in a span of two years, I've been confronted with/ > identified at the time of surgery, patients with a persistent Lt SVC. For > the routine CAB, it's not really a problem, but 2 of them have been for > mitral surgery. If I remember correctly, one had a diminutive SVC and no > innominate vein. The other and most recent, had no SVC at all and a giant > retro-cardiac vessel. > > For future reference, I'll be accepting any and all tips, pearls, and > general knowledge. > > Thanks, 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 > ----------------------------------------- _________________________________________________________________ Beyond Hotmail ? see what else you can do with Windows Live. http://clk.atdmt.com/UKM/go/134665375/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From prasannasimha at gmail.com Sun May 3 08:15:26 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat May 2 21:52:47 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: <89c4ed2d0905021845s6412de09l85e6042b6bc7715b@mail.gmail.com> If a retorgrade cardioplegia is being used as a continuous technique or as a primary means of plegia it becomes unreliable simply because of the sink into the systemic circulation. Also when there is a left SVC the coronary sinus return ids highly variable and the Thebesian venous return may be draining a higher portion of the cardiac venous return and retoplegia becomes unreliable wespecially when a large part of the surgery is dependent on it. prasanna On Sun, May 3, 2009 at 4:36 AM, Ani Anyanwu wrote: > > Deaths have been seen when retrograde cardioplegia is administered in > non-diagnosed left cava. > > > Tomas > > > > > > > > What is the mechanism of the death in these cases? > > > > Ani > > > > From: TSalerno@med.miami.edu > > To: OpenHeart-L@lists.hsforum.com; OpenHeart-L@hsforum.com > > Date: Sat, 2 May 2009 17:20:58 -0400 > > Subject: Re: [HSF] Persistent LSVC > > CC: > > > > I have encountere left cava a few times in all types of procedure; > > > > 1) In CABG it is irrelevant since I do all cases of pump > > > > 2) In mitral valve with heart beating and aorta unclamped, aside from svc > and ivc cannulation, I also cannulate the coronary sinus once right atrium > is openeda, snare the mouth of the sinus and connect the cannula to the > venous system; > > > > 3) In aortic valve with heart beating, I ony cannulate the left and right > ostia for blood perfusion. With the use of single cannula left cava is > irrelevant. > > > > One should be able to diagnose left cava via TEE, and the coronary sinus > is usually very large. Deaths have been seen when retrograde cardioplegia is > administered in non-diagnosed left cava. One always has the option of > snaring the left cava, is svc exists but I have not done that > > > > Tomas > > > > ----- Original Message ----- > > From: openheart-l-bounces@lists.hsforum.com < > openheart-l-bounces@lists.hsforum.com> > > To: OpenHeart-L@hsforum.com > > Sent: Sat May 02 16:59:38 2009 > > Subject: [HSF] Persistent LSVC > > > > For the 3rd or 4th time in a span of two years, I've been confronted > with/ > > identified at the time of surgery, patients with a persistent Lt SVC. For > > the routine CAB, it's not really a problem, but 2 of them have been for > > mitral surgery. If I remember correctly, one had a diminutive SVC and no > > innominate vein. The other and most recent, had no SVC at all and a giant > > retro-cardiac vessel. > > > > For future reference, I'll be accepting any and all tips, pearls, and > > general knowledge. > > > > Thanks, 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 > > ----------------------------------------- > > _________________________________________________________________ > Beyond Hotmail ? see what else you can do with Windows Live. > > http://clk.atdmt.com/UKM/go/134665375/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun May 3 08:25:56 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat May 2 21:56:29 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: References: Message-ID: <89c4ed2d0905021855g6428a1fepcc44c2fe41bc43cb@mail.gmail.com> Depends on the mechanism. Varies from excision and pathing o fthe lealfet, replacing the lead in the posteroseptal commissure and suturing it or replacing the leead with a transc oronary sinus lead or an epicardial lead. If you need to do a TVR then place the lead first and out of the sewing rim or place a coronary sius or epicardial lead. Prasanna On Sat, May 2, 2009 at 8:42 PM, Michael Firstenberg wrote: > With patients with mod/sev TR (normal or near normal annular sizes) from > distortion of the leaflets from chronic RV pacing leads - does anyone have > thoughts on "fixing" these? Or some other management insight? > > > -michael > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From mmlevinson at hsforum.com Sun May 3 00:27:26 2009 From: mmlevinson at hsforum.com (Mark Levinson) Date: Sun May 3 00:27:56 2009 Subject: [HSF] intraop epicardial echocardiography In-Reply-To: References: <89c4ed2d0904200436k6543f381kb039303584117752@mail.gmail.com> Message-ID: <497A038B-F68B-469D-B6DE-87B65D247C3F@hsforum.com> On Apr 20, 2009, at 10:57 AM, erdin? naseri wrote: > > Today we operated a 67 Y/O lady , BW56 kg for MS with ON-X mitral > valve as the only available prosthesis .I preserved the posterior > valve structures ( irrepairable). The prosthesis was somehow large > for the lady so that I tied the posterior knots using dentists' > mirror.While weaning VF developed and didn't responded to > defibrilation .With no TEE probe available (malfunctioned in the > arch case and is still nonfunctional) and an addiction developed > for echocardiographic evaluation ,me and anesthesia team could rule > out any prosthetic dysfx and LVOTO (due to large prosthesis). > > It can be a useful tool it there is no TEE probe > > erdinc > Erdinc: I use epicardial echo to evaluate LV function and observe mitral leaflet motion. Until recently we did not have routine TEE for every case, so there were times when I needed to see the LV or mitral. We have the Sono-Site portable echo machine with a cardiac transducer which we place into a sterile sleeve and put it onto the heart surface and get superb images. However, the Sono-Site does not have good enough color flow to evaluate the degree of mitral regurgitation. In cases where we could not put a TEE probe down the esophagous (stricture, unable to safely intubate the esophagus), I have placed the TEE probe into a sterile sleeve and placed it onto the cardiac surface and obtained some very useful images. It is clumsy to use, but works Thanks, Mark Mark Levinson, MD. Founder, Editor-in-Chief The Heart Surgery Forum? Multimedia Cardiothoracic Journal URL: http://www.hsforum.com URL: http://newoptionsinheartsurgery.com Emali: mmlevinson@hsforum.com From mmlevinson at hsforum.com Sun May 3 00:55:53 2009 From: mmlevinson at hsforum.com (Mark Levinson) Date: Sun May 3 00:56:11 2009 Subject: [HSF] Axillary Artery Cannulation In-Reply-To: References: <513702.71021.qm@web50901.mail.re2.yahoo.com> <74AE3B11-1484-4C51-9EDB-ED2C0318B8F1@hsforum.com> Message-ID: <2ACF3A20-4DE1-465B-A034-DD60A06F230F@hsforum.com> On May 2, 2009, at 2:17 AM, Roberto Battellini wrote: > > Mark, > > please, send a photo and company name of the clamp. Better yet...here is the article (published in the HSF journal !) http://www.hsforum.com/vol7/issue3/2004-1020.html I will find the clamp manufacturers. There are two clamps with slightly different curves. Mark > > > Roberto > >> From: mmlevinson@hsforum.com >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Axillary Artery Cannulation >> Date: Sat, 2 May 2009 02:06:03 -0500 >> CC: >> >> >> On Apr 23, 2009, at 12:18 AM, john streitman wrote: >> >>> >>> Hal, >>> >>> John Streitman here - finished with Tom in 2006 at UF and met you at >>> the last Southern Thoracic. Tom is dead on. I have done a hemiarch >>> with a 3 1/2 min circ arrest time with Tom as my assistant and >>> furthermore using the same technique as he trained us have done well >>> over 40 hemiarches in the last 3 years here in Pinehurst and am >>> disappointed if it takes longer than 10 minutes. >> >> >> Fascinating discussion. For non-dissection ascending aneurysms, I >> have adopted Calafiore's technique, with a circ arrest time of 0. >> Calafiore designed a special clamp to fit into the upper arch and >> isolate the underside of the arch. Pump flow from the groin goes over >> the top of the clamp into the head vessels while you can resect and >> graft the underside of the arch. My practice ( in a small >> community hospital) does not yield very many cases of this type, but >> the Calafiore technique simplified them when they occur. Now, I >> just cool to 30 C, clamp the arch, sew the distal (in whatever time >> it >> takes) and advance another clamp proximal to the suture line, and >> then >> complete the supracoronary anastomosis etc. The pump stays on >> throughout. >> >> The key is to evaluate the preop CAT for calcification or endoluminal >> plaque. This technique does not apply when the arch is >> calcified. But I have done several cases this way, with no strokes >> and no circ arrest. The clamps are commercially available. (I >> have not tried this with dissections, where I still use a felt >> sandwich technique under circ arrest). >> >> Mark Levinson, MD. >> Founder, Editor-in-Chief >> The Heart Surgery Forum? >> Multimedia Cardiothoracic Journal >> URL: http://www.hsforum.com >> URL: http://newoptionsinheartsurgery.com >> Emali: mmlevinson@hsforum.com >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- Mark Levinson, MD. Founder, Editor-in-Chief The Heart Surgery Forum? Multimedia Cardiothoracic Journal URL: http://www.hsforum.com URL: http://newoptionsinheartsurgery.com Emali: mmlevinson@hsforum.com From prasannasimha at gmail.com Sun May 3 08:12:35 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 3 01:08:33 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> Message-ID: <89c4ed2d0905021842u1f8d23d2m6ccb6783d9330e67@mail.gmail.com> Mitch it probably is unusual for adult surgery but is pretty common in the pediatric set up. Acrtually ther isnt much of a problem if you are suddenly confornted with it and there is vacuum assit. Just plonk a straight venous cannula into the left SVC via the coronary sinus and connect it via a 1/4 inch line to the venous reservoir. If the innominate vein is good technically you can clamp the left SVC. Retrograde cardioplegia will be ineffective with a left SVC.Deaths have been reported when this has been done as the retroplegic distibution can be highly varied even if the left SVC is snared (If you depend on retroplegia for prolonged periods of arrest). On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman wrote: > For the 3rd or 4th time in a span of two years, I've been confronted with/ > identified at the time of surgery, patients with a persistent Lt SVC. For > the routine CAB, it's not really a problem, but 2 of them have been for > mitral surgery. If I remember correctly, one had a diminutive SVC and no > innominate vein. The other and most recent, had no SVC at all and a giant > retro-cardiac vessel. > > For future reference, I'll be accepting any and all tips, pearls, and > general knowledge. > > Thanks, 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 > ----------------------------------------- > -- Prasanna Simha M From msfirst at gmail.com Sun May 3 04:19:08 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun May 3 04:21:45 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: References: Message-ID: Hal, Since you are trading one disease for another - i.e. replacing the TV with a tissue valve in a patient who already has/needs a pacer (and I have a low threshold for epicardials myself) - do you have different criteria for when you would intervene on the valve in the first place - since you already know that having leads will produces some degree of TR. Does that change if you know that the annulus is normal? -michael On Sat, May 2, 2009 at 6:54 PM, wrote: > Michael, > It depends on what is producing the TR. Sometimes the lead actually > perforates the leaflet. In that case, a triangular resection and > subsequent > autologous pericardial patch will take care of it. Other times, the lead > is > holding back the leaflet (usually posterior or septal), producing the TR. > In those cases the lead should be shaved from the leaflet edge and then > forced into the corner of the postero-septal commissure. It is held into > place with a couple of sutures. If these measures don't work, then > consider > TVR (Mitral Magna is what I would use). > > Hal > > > In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, > msfirst@gmail.com writes: > > With patients with mod/sev TR (normal or near normal annular sizes) from > distortion of the leaflets from chronic RV pacing leads - does anyone have > thoughts on "fixing" these? Or some other management insight? > > > -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 > ----------------------------------------- > > > **************Check all of your email inboxes from anywhere on the web. > Try the new Email Toolbar now! > (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From nkkejriwal at gmail.com Sun May 3 09:56:08 2009 From: nkkejriwal at gmail.com (nand kejriwal) Date: Sun May 3 05:02:57 2009 Subject: [HSF] (no subject) In-Reply-To: References: <875240.24964.qm@web24715.mail.ird.yahoo.com> Message-ID: Interestingly I used my first Magna Ease valve last Wednesday. 77 year male. Calcific AS. Mild MR. Normal mitral leaflets. 23 prosthesis. Post bypass moderate MR. The A2 appeared slightly retracted. Came off bypass easily. No inotropes. Progressing well. Can't hear a murmur. The company is promoting that the prosthesis can be upsized with this model. The valve was a good fit. I did not think that I oversized it. Nand On Fri, May 1, 2009 at 9:45 AM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > I assisted once a case, an oversizing was tried, and of course, the Ant > leaflet was retracted.It was diagnosed after routine TEE, the solution was a > Cosgrove ring. > > Case very similar to Mark?s case. > > > > Roberto > > > Date: Fri, 1 May 2009 01:53:51 -0700 > > From: drdharris@yahoo.co.uk > > Subject: Re: [HSF] (no subject) > > To: Rwmfglycar@aol.com; OpenHeart-L@lists.hsforum.com > > CC: > > > > > > I had a similar case recently with a magna valve distorting ant leaflet. > Detected intra op and looked mild to moderate but progressed postop. Ant > leaflet was small, some rheumatic changes and retracted upwards. Had to > replace valve. Dave > > > > Rwmfglycar@aol.com wrote: > > > Calcified valve? Method of removing calcium? Are you absolutely sure > there > > > is not a hole in the anterior leaflet? > > > Bob > > > In a message dated 5/1/2009 7:56:50 A.M. South Africa Standard Time, > > > mmlevinson@hsforum.com writes: > > > On Sep 3, 2008, at 4:41 AM, eric manasse wrote: > > >> it was just a simple AVR, absence of MR @ echo TEE preop; 5 days after > > >> it showed up a MR +++ with possible retraction of AML not clarified @ > > >> reintervention > > > AVR sutures placed too deeply into the region of the left/non sinus??? > > > Mark > > >> > > >> > > >> 2008/9/3 Prasanna Simha M : > > >>> LV dysfunction with annular dilatation. The other possibilty - > > >>> understimation of MR in the first place. > > >>> Other possibilituies - was a Manouguian done ? Endocarditis ? > > >>> prasanna > > >>> > > >>> > > >>> On Wed, Sep 3, 2008 at 1:17 PM, eric manasse > > >>> wrote: > > >>> > > >>>> Hello, I'd like to know if anybody has ever encountered the > > >>>> following > > >>>> problem: > > >>>> new onset on mitral regurgitation few days after aortic valve > > >>>> replacement ? > > >>>> what is the mechanism ? > > >>>> _______________________________________________ > > >>>> OpenHeart-L mailing list > > >>>> > > >>>> Send postings to: > > >>>> OpenHeart-L@lists.hsforum.com > > >>>> > > >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > >>>> http://mmp.cjp.com/mailman/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 > > >> ----------------------------------------- > > > Mark Levinson, MD. > > > Founder, Editor-in-Chief > > > The Heart Surgery Forum? > > > Multimedia Cardiothoracic Journal > > > URL: http://www.hsforum.com > > > URL: http://newoptionsinheartsurgery.com > > > Emali: mmlevinson@hsforum.com > > > _______________________________________________ > > > OpenHeart-L mailing list > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > **************Join ChristianMingle.com? FREE! Meet Christian Singles in > > > your area. Start now! > > > ( > http://pr.atwola.com/promoclk/100126575x1221673648x1201419171/aol?redir=http://www.christianmingle.com/campaign.html%3Fcat%3Dadbuy%26 > > > src%3Dplatforma%26adid%3Dfooter:050109%26newurl%3Dreg_path.html) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 May 3 12:28:30 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sun May 3 05:29:20 2009 Subject: [HSF] (no subject) In-Reply-To: References: <875240.24964.qm@web24715.mail.ird.yahoo.com> Message-ID: One should collect in a study all these patients without mitral reconstruction after AVR,and follow up them. May be many will stabilized with a mild MI. A good idea is to look in our 2000 mitral mics and see how many have had AVR.Let see... I do not like to oversize. Roberto > Date: Sun, 3 May 2009 08:56:08 +0000 > Subject: Re: [HSF] (no subject) > From: nkkejriwal@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > > Interestingly I used my first Magna Ease valve last Wednesday. 77 year male. > Calcific AS. Mild MR. Normal mitral leaflets. 23 prosthesis. Post bypass > moderate MR. The A2 appeared slightly retracted. Came off bypass easily. No > inotropes. Progressing well. Can't hear a murmur. The company is promoting > that the prosthesis can be upsized with this model. The valve was a good > fit. I did not think that I oversized it. > Nand > > On Fri, May 1, 2009 at 9:45 AM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > > > > > I assisted once a case, an oversizing was tried, and of course, the Ant > > leaflet was retracted.It was diagnosed after routine TEE, the solution was a > > Cosgrove ring. > > > > Case very similar to Mark?s case. > > > > > > > > Roberto > > > > > Date: Fri, 1 May 2009 01:53:51 -0700 > > > From: drdharris@yahoo.co.uk > > > Subject: Re: [HSF] (no subject) > > > To: Rwmfglycar@aol.com; OpenHeart-L@lists.hsforum.com > > > CC: > > > > > > > > > I had a similar case recently with a magna valve distorting ant leaflet. > > Detected intra op and looked mild to moderate but progressed postop. Ant > > leaflet was small, some rheumatic changes and retracted upwards. Had to > > replace valve. Dave > > > > > > Rwmfglycar@aol.com wrote: > > > > Calcified valve? Method of removing calcium? Are you absolutely sure > > there > > > > is not a hole in the anterior leaflet? > > > > Bob > > > > In a message dated 5/1/2009 7:56:50 A.M. South Africa Standard Time, > > > > mmlevinson@hsforum.com writes: > > > > On Sep 3, 2008, at 4:41 AM, eric manasse wrote: > > > >> it was just a simple AVR, absence of MR @ echo TEE preop; 5 days after > > > >> it showed up a MR +++ with possible retraction of AML not clarified @ > > > >> reintervention > > > > AVR sutures placed too deeply into the region of the left/non sinus??? > > > > Mark > > > >> > > > >> > > > >> 2008/9/3 Prasanna Simha M : > > > >>> LV dysfunction with annular dilatation. The other possibilty - > > > >>> understimation of MR in the first place. > > > >>> Other possibilituies - was a Manouguian done ? Endocarditis ? > > > >>> prasanna > > > >>> > > > >>> > > > >>> On Wed, Sep 3, 2008 at 1:17 PM, eric manasse > > > >>> wrote: > > > >>> > > > >>>> Hello, I'd like to know if anybody has ever encountered the > > > >>>> following > > > >>>> problem: > > > >>>> new onset on mitral regurgitation few days after aortic valve > > > >>>> replacement ? > > > >>>> what is the mechanism ? > > > >>>> _______________________________________________ > > > >>>> OpenHeart-L mailing list > > > >>>> > > > >>>> Send postings to: > > > >>>> OpenHeart-L@lists.hsforum.com > > > >>>> > > > >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > >>>> http://mmp.cjp.com/mailman/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 > > > >> ----------------------------------------- > > > > Mark Levinson, MD. > > > > Founder, Editor-in-Chief > > > > The Heart Surgery Forum? > > > > Multimedia Cardiothoracic Journal > > > > URL: http://www.hsforum.com > > > > URL: http://newoptionsinheartsurgery.com > > > > Emali: mmlevinson@hsforum.com > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > > and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > **************Join ChristianMingle.com? FREE! Meet Christian Singles in > > > > your area. Start now! > > > > ( > > http://pr.atwola.com/promoclk/100126575x1221673648x1201419171/aol?redir=http://www.christianmingle.com/campaign.html%3Fcat%3Dadbuy%26 > > > > src%3Dplatforma%26adid%3Dfooter:050109%26newurl%3Dreg_path.html) > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 May 3 13:16:19 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sun May 3 06:16:46 2009 Subject: [HSF] intraop epicardial echocardiography In-Reply-To: <497A038B-F68B-469D-B6DE-87B65D247C3F@hsforum.com> References: <89c4ed2d0904200436k6543f381kb039303584117752@mail.gmail.com> <497A038B-F68B-469D-B6DE-87B65D247C3F@hsforum.com> Message-ID: how can you tie the knots with a dentist mirror?`? > From: mmlevinson@hsforum.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] intraop epicardial echocardiography > Date: Sat, 2 May 2009 23:27:26 -0500 > CC: > > > On Apr 20, 2009, at 10:57 AM, erdin? naseri wrote: > > > > > Today we operated a 67 Y/O lady , BW56 kg for MS with ON-X mitral > > valve as the only available prosthesis .I preserved the posterior > > valve structures ( irrepairable). The prosthesis was somehow large > > for the lady so that I tied the posterior knots using dentists' > > mirror.While weaning VF developed and didn't responded to > > defibrilation .With no TEE probe available (malfunctioned in the > > arch case and is still nonfunctional) and an addiction developed > > for echocardiographic evaluation ,me and anesthesia team could rule > > out any prosthetic dysfx and LVOTO (due to large prosthesis). > > > > It can be a useful tool it there is no TEE probe > > > > erdinc > > > > Erdinc: > > I use epicardial echo to evaluate LV function and observe mitral > leaflet motion. Until recently we did not have routine TEE for > every case, so there were times when I needed to see the LV or > mitral. We have the Sono-Site portable echo machine with a cardiac > transducer which we place into a sterile sleeve and put it onto the > heart surface and get superb images. However, the Sono-Site does > not have good enough color flow to evaluate the degree of mitral > regurgitation. > > In cases where we could not put a TEE probe down the esophagous > (stricture, unable to safely intubate the esophagus), I have placed > the TEE probe into a sterile sleeve and placed it onto the cardiac > surface and obtained some very useful images. It is clumsy to use, > but works > > Thanks, > > Mark > > Mark Levinson, MD. > Founder, Editor-in-Chief > The Heart Surgery Forum? > Multimedia Cardiothoracic Journal > URL: http://www.hsforum.com > URL: http://newoptionsinheartsurgery.com > Emali: mmlevinson@hsforum.com > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Sun May 3 13:18:57 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sun May 3 06:19:46 2009 Subject: [HSF] Axillary Artery Cannulation In-Reply-To: <2ACF3A20-4DE1-465B-A034-DD60A06F230F@hsforum.com> References: <513702.71021.qm@web50901.mail.re2.yahoo.com> <74AE3B11-1484-4C51-9EDB-ED2C0318B8F1@hsforum.com> <2ACF3A20-4DE1-465B-A034-DD60A06F230F@hsforum.com> Message-ID: Thanks!, Mark I have heard about his technique, but not about his clamp. Roberto > From: mmlevinson@hsforum.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Axillary Artery Cannulation > Date: Sat, 2 May 2009 23:55:53 -0500 > CC: > > > On May 2, 2009, at 2:17 AM, Roberto Battellini wrote: > > > > > Mark, > > > > please, send a photo and company name of the clamp. > > Better yet...here is the article (published in the HSF journal !) > > http://www.hsforum.com/vol7/issue3/2004-1020.html > > I will find the clamp manufacturers. There are two clamps with > slightly different curves. > > Mark > > > > > > > > Roberto > > > >> From: mmlevinson@hsforum.com > >> To: OpenHeart-L@lists.hsforum.com > >> Subject: Re: [HSF] Axillary Artery Cannulation > >> Date: Sat, 2 May 2009 02:06:03 -0500 > >> CC: > >> > >> > >> On Apr 23, 2009, at 12:18 AM, john streitman wrote: > >> > >>> > >>> Hal, > >>> > >>> John Streitman here - finished with Tom in 2006 at UF and met you at > >>> the last Southern Thoracic. Tom is dead on. I have done a hemiarch > >>> with a 3 1/2 min circ arrest time with Tom as my assistant and > >>> furthermore using the same technique as he trained us have done well > >>> over 40 hemiarches in the last 3 years here in Pinehurst and am > >>> disappointed if it takes longer than 10 minutes. > >> > >> > >> Fascinating discussion. For non-dissection ascending aneurysms, I > >> have adopted Calafiore's technique, with a circ arrest time of 0. > >> Calafiore designed a special clamp to fit into the upper arch and > >> isolate the underside of the arch. Pump flow from the groin goes over > >> the top of the clamp into the head vessels while you can resect and > >> graft the underside of the arch. My practice ( in a small > >> community hospital) does not yield very many cases of this type, but > >> the Calafiore technique simplified them when they occur. Now, I > >> just cool to 30 C, clamp the arch, sew the distal (in whatever time > >> it > >> takes) and advance another clamp proximal to the suture line, and > >> then > >> complete the supracoronary anastomosis etc. The pump stays on > >> throughout. > >> > >> The key is to evaluate the preop CAT for calcification or endoluminal > >> plaque. This technique does not apply when the arch is > >> calcified. But I have done several cases this way, with no strokes > >> and no circ arrest. The clamps are commercially available. (I > >> have not tried this with dissections, where I still use a felt > >> sandwich technique under circ arrest). > >> > >> Mark Levinson, MD. > >> Founder, Editor-in-Chief > >> The Heart Surgery Forum? > >> Multimedia Cardiothoracic Journal > >> URL: http://www.hsforum.com > >> URL: http://newoptionsinheartsurgery.com > >> Emali: mmlevinson@hsforum.com > >> > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >> All messages transmitted by the OpenHeart-L are subject to the > >> policies and > >> disclaimers posted at: > >> http://www.hsforum.com/listdisclaim > >> ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > Mark Levinson, MD. > Founder, Editor-in-Chief > The Heart Surgery Forum? > Multimedia Cardiothoracic Journal > URL: http://www.hsforum.com > URL: http://newoptionsinheartsurgery.com > Emali: mmlevinson@hsforum.com > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Sun May 3 13:23:01 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sun May 3 06:23:29 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <89c4ed2d0905021842u1f8d23d2m6ccb6783d9330e67@mail.gmail.com> References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> <89c4ed2d0905021842u1f8d23d2m6ccb6783d9330e67@mail.gmail.com> Message-ID: I have had the case may be 2 years ago in a mitro-tricuspid case. I did it without preop diagnosis. It came soooo much blood back,first i thougt was a big Foramen Ovale, and did a couple of stitches, then I recognized it and cannulated the left cava from the coronary sinus. I cut my stitches, of course. Roberto > From: prasannasimha@gmail.com > Date: Sun, 3 May 2009 07:12:35 +0530 > Subject: Re: [HSF] Persistent LSVC > To: OpenHeart-L@lists.hsforum.com > CC: > > Mitch it probably is unusual for adult surgery but is pretty common in the > pediatric set up. Acrtually ther isnt much of a problem if you are suddenly > confornted with it and there is vacuum assit. Just plonk a straight venous > cannula into the left SVC via the coronary sinus and connect it via a 1/4 > inch line to the venous reservoir. > If the innominate vein is good technically you can clamp the left SVC. > Retrograde cardioplegia will be ineffective with a left SVC.Deaths have been > reported when this has been done as the retroplegic distibution can be > highly varied even if the left SVC is snared (If you depend on retroplegia > for prolonged periods of arrest). > > On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman wrote: > > > For the 3rd or 4th time in a span of two years, I've been confronted with/ > > identified at the time of surgery, patients with a persistent Lt SVC. For > > the routine CAB, it's not really a problem, but 2 of them have been for > > mitral surgery. If I remember correctly, one had a diminutive SVC and no > > innominate vein. The other and most recent, had no SVC at all and a giant > > retro-cardiac vessel. > > > > For future reference, I'll be accepting any and all tips, pearls, and > > general knowledge. > > > > Thanks, 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 > > ----------------------------------------- > > > > > > -- > 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 anianyanwu at hotmail.com Sun May 3 11:38:22 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun May 3 06:39:55 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: Dr Salerno Would the coronary artery presures still be high in this scenario? Would there not be a difficuly in raising the pressure with sinus perfusion? Also I presume if the myocardial temperature is monitored this would be detected? Are you saying you do not recommend basing protection on cold retrograde alone in any case? Do you refer to induction, maintenance or both? Thanks Ani > From: TSalerno@med.miami.edu > To: OpenHeart-L@lists.hsforum.com > Date: Sat, 2 May 2009 19:56:47 -0400 > Subject: Re: [HSF] Persistent LSVC > CC: > > Retrograde cardioplegia is given, sometimes alone for aortic valve by some surgeons (something I do not recommend) and the heart is not protected. > > Ts > > ----- Original Message ----- > From: openheart-l-bounces@lists.hsforum.com > To: open heart list > Sent: Sat May 02 19:06:05 2009 > Subject: RE: [HSF] Persistent LSVC > > > Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. > > > Tomas > > > > > > > > What is the mechanism of the death in these cases? > > > > Ani > > > > From: TSalerno@med.miami.edu > > To: OpenHeart-L@lists.hsforum.com; OpenHeart-L@hsforum.com > > Date: Sat, 2 May 2009 17:20:58 -0400 > > Subject: Re: [HSF] Persistent LSVC > > CC: > > > > I have encountere left cava a few times in all types of procedure; > > > > 1) In CABG it is irrelevant since I do all cases of pump > > > > 2) In mitral valve with heart beating and aorta unclamped, aside from svc and ivc cannulation, I also cannulate the coronary sinus once right atrium is openeda, snare the mouth of the sinus and connect the cannula to the venous system; > > > > 3) In aortic valve with heart beating, I ony cannulate the left and right ostia for blood perfusion. With the use of single cannula left cava is irrelevant. > > > > One should be able to diagnose left cava via TEE, and the coronary sinus is usually very large. Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. One always has the option of snaring the left cava, is svc exists but I have not done that > > > > Tomas > > > > ----- Original Message ----- > > From: openheart-l-bounces@lists.hsforum.com > > To: OpenHeart-L@hsforum.com > > Sent: Sat May 02 16:59:38 2009 > > Subject: [HSF] Persistent LSVC > > > > For the 3rd or 4th time in a span of two years, I've been confronted with/ > > identified at the time of surgery, patients with a persistent Lt SVC. For > > the routine CAB, it's not really a problem, but 2 of them have been for > > mitral surgery. If I remember correctly, one had a diminutive SVC and no > > innominate vein. The other and most recent, had no SVC at all and a giant > > retro-cardiac vessel. > > > > For future reference, I'll be accepting any and all tips, pearls, and > > general knowledge. > > > > Thanks, 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 > > ----------------------------------------- > > _________________________________________________________________ > Beyond Hotmail ? see what else you can do with Windows Live. > http://clk.atdmt.com/UKM/go/134665375/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ Share your photos with Windows Live Photos ? Free. http://clk.atdmt.com/UKM/go/134665338/direct/01/ From prasannasimha at gmail.com Sun May 3 17:17:30 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 3 06:54:11 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: <89c4ed2d0905030347va2a6ba5p883b7172266596f4@mail.gmail.com> One of the reasons for a low CS pressure is obviously a left SVC.Unfortunately you can wedge it in some cases into a feeder vein that can make a mistake if one is not quick to notice it. Prasanna On Sun, May 3, 2009 at 4:08 PM, Ani Anyanwu wrote: > > Dr Salerno > > > > Would the coronary artery presures still be high in this scenario? Would > there not be a difficuly in raising the pressure with sinus perfusion? Also > I presume if the myocardial temperature is monitored this would be detected? > > > > Are you saying you do not recommend basing protection on cold retrograde > alone in any case? Do you refer to induction, maintenance or both? > > > > Thanks > > > > Ani > > > > > > > From: TSalerno@med.miami.edu > > To: OpenHeart-L@lists.hsforum.com > > Date: Sat, 2 May 2009 19:56:47 -0400 > > Subject: Re: [HSF] Persistent LSVC > > CC: > > > > Retrograde cardioplegia is given, sometimes alone for aortic valve by > some surgeons (something I do not recommend) and the heart is not protected. > > > > Ts > > > > ----- Original Message ----- > > From: openheart-l-bounces@lists.hsforum.com < > openheart-l-bounces@lists.hsforum.com> > > To: open heart list > > Sent: Sat May 02 19:06:05 2009 > > Subject: RE: [HSF] Persistent LSVC > > > > > > Deaths have been seen when retrograde cardioplegia is administered in > non-diagnosed left cava. > > > > Tomas > > > > > > > > > > > > > > > > What is the mechanism of the death in these cases? > > > > > > > > Ani > > > > > > > From: TSalerno@med.miami.edu > > > To: OpenHeart-L@lists.hsforum.com; OpenHeart-L@hsforum.com > > > Date: Sat, 2 May 2009 17:20:58 -0400 > > > Subject: Re: [HSF] Persistent LSVC > > > CC: > > > > > > I have encountere left cava a few times in all types of procedure; > > > > > > 1) In CABG it is irrelevant since I do all cases of pump > > > > > > 2) In mitral valve with heart beating and aorta unclamped, aside from > svc and ivc cannulation, I also cannulate the coronary sinus once right > atrium is openeda, snare the mouth of the sinus and connect the cannula to > the venous system; > > > > > > 3) In aortic valve with heart beating, I ony cannulate the left and > right ostia for blood perfusion. With the use of single cannula left cava is > irrelevant. > > > > > > One should be able to diagnose left cava via TEE, and the coronary > sinus is usually very large. Deaths have been seen when retrograde > cardioplegia is administered in non-diagnosed left cava. One always has the > option of snaring the left cava, is svc exists but I have not done that > > > > > > Tomas > > > > > > ----- Original Message ----- > > > From: openheart-l-bounces@lists.hsforum.com < > openheart-l-bounces@lists.hsforum.com> > > > To: OpenHeart-L@hsforum.com > > > Sent: Sat May 02 16:59:38 2009 > > > Subject: [HSF] Persistent LSVC > > > > > > For the 3rd or 4th time in a span of two years, I've been confronted > with/ > > > identified at the time of surgery, patients with a persistent Lt SVC. > For > > > the routine CAB, it's not really a problem, but 2 of them have been for > > > mitral surgery. If I remember correctly, one had a diminutive SVC and > no > > > innominate vein. The other and most recent, had no SVC at all and a > giant > > > retro-cardiac vessel. > > > > > > For future reference, I'll be accepting any and all tips, pearls, and > > > general knowledge. > > > > > > Thanks, 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 > > > ----------------------------------------- > > > > _________________________________________________________________ > > Beyond Hotmail ? see what else you can do with Windows Live. > > > http://clk.atdmt.com/UKM/go/134665375/direct/01/_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun May 3 17:11:20 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 3 07:27:10 2009 Subject: [HSF] intraop epicardial echocardiography In-Reply-To: References: <89c4ed2d0904200436k6543f381kb039303584117752@mail.gmail.com> <497A038B-F68B-469D-B6DE-87B65D247C3F@hsforum.com> Message-ID: <89c4ed2d0905030341i4165eb1s16c2d9af31c71a75@mail.gmail.com> You can if you practice !! Dentists do it !! Prasanna On Sun, May 3, 2009 at 3:46 PM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > how can you tie the knots with a dentist mirror?`? > > > From: mmlevinson@hsforum.com > > To: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] intraop epicardial echocardiography > > Date: Sat, 2 May 2009 23:27:26 -0500 > > CC: > > > > > > On Apr 20, 2009, at 10:57 AM, erdin? naseri wrote: > > > > > > > > Today we operated a 67 Y/O lady , BW56 kg for MS with ON-X mitral > > > valve as the only available prosthesis .I preserved the posterior > > > valve structures ( irrepairable). The prosthesis was somehow large > > > for the lady so that I tied the posterior knots using dentists' > > > mirror.While weaning VF developed and didn't responded to > > > defibrilation .With no TEE probe available (malfunctioned in the > > > arch case and is still nonfunctional) and an addiction developed > > > for echocardiographic evaluation ,me and anesthesia team could rule > > > out any prosthetic dysfx and LVOTO (due to large prosthesis). > > > > > > It can be a useful tool it there is no TEE probe > > > > > > erdinc > > > > > > > Erdinc: > > > > I use epicardial echo to evaluate LV function and observe mitral > > leaflet motion. Until recently we did not have routine TEE for > > every case, so there were times when I needed to see the LV or > > mitral. We have the Sono-Site portable echo machine with a cardiac > > transducer which we place into a sterile sleeve and put it onto the > > heart surface and get superb images. However, the Sono-Site does > > not have good enough color flow to evaluate the degree of mitral > > regurgitation. > > > > In cases where we could not put a TEE probe down the esophagous > > (stricture, unable to safely intubate the esophagus), I have placed > > the TEE probe into a sterile sleeve and placed it onto the cardiac > > surface and obtained some very useful images. It is clumsy to use, > > but works > > > > Thanks, > > > > Mark > > > > Mark Levinson, MD. > > Founder, Editor-in-Chief > > The Heart Surgery Forum? > > Multimedia Cardiothoracic Journal > > URL: http://www.hsforum.com > > URL: http://newoptionsinheartsurgery.com > > Emali: mmlevinson@hsforum.com > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From Hgrmd at aol.com Sun May 3 08:57:10 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun May 3 07:58:33 2009 Subject: [HSF] Persistent LSVC Message-ID: Prasanna, All I know is the couple of times I've snared the LSVC and used retrograde, there were no problems. Hal In a message dated 5/3/2009 1:09:57 A.M. Eastern Daylight Time, prasannasimha@gmail.com writes: Mitch it probably is unusual for adult surgery but is pretty common in the pediatric set up. Acrtually ther isnt much of a problem if you are suddenly confornted with it and there is vacuum assit. Just plonk a straight venous cannula into the left SVC via the coronary sinus and connect it via a 1/4 inch line to the venous reservoir. If the innominate vein is good technically you can clamp the left SVC. Retrograde cardioplegia will be ineffective with a left SVC.Deaths have been reported when this has been done as the retroplegic distibution can be highly varied even if the left SVC is snared (If you depend on retroplegia for prolonged periods of arrest). On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman wrote: > For the 3rd or 4th time in a span of two years, I've been confronted with/ > identified at the time of surgery, patients with a persistent Lt SVC. For > the routine CAB, it's not really a problem, but 2 of them have been for > mitral surgery. If I remember correctly, one had a diminutive SVC and no > innominate vein. The other and most recent, had no SVC at all and a giant > retro-cardiac vessel. > > For future reference, I'll be accepting any and all tips, pearls, and > general knowledge. > > Thanks, 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 > ----------------------------------------- > -- 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 ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201 454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62) From Hgrmd at aol.com Sun May 3 09:00:35 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun May 3 08:01:38 2009 Subject: [HSF] Pacer Lead Induced TR Message-ID: Michael, From the way your initial post read, I assume you were referring to clinically important TR associated with permanent pacing leads. It is well documented in the literature that moderate or worse TR adversely impacts the 10 yr survival, similar to moderate or worse MR. I would rather leave a patient with a bioprosthesis instead of severe TR. Hal In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time, msfirst@gmail.com writes: Hal, Since you are trading one disease for another - i.e. replacing the TV with a tissue valve in a patient who already has/needs a pacer (and I have a low threshold for epicardials myself) - do you have different criteria for when you would intervene on the valve in the first place - since you already know that having leads will produces some degree of TR. Does that change if you know that the annulus is normal? -michael On Sat, May 2, 2009 at 6:54 PM, wrote: > Michael, > It depends on what is producing the TR. Sometimes the lead actually > perforates the leaflet. In that case, a triangular resection and > subsequent > autologous pericardial patch will take care of it. Other times, the lead > is > holding back the leaflet (usually posterior or septal), producing the TR. > In those cases the lead should be shaved from the leaflet edge and then > forced into the corner of the postero-septal commissure. It is held into > place with a couple of sutures. If these measures don't work, then > consider > TVR (Mitral Magna is what I would use). > > Hal > > > In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, > msfirst@gmail.com writes: > > With patients with mod/sev TR (normal or near normal annular sizes) from > distortion of the leaflets from chronic RV pacing leads - does anyone have > thoughts on "fixing" these? Or some other management insight? > > > -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 > ----------------------------------------- > > > **************Check all of your email inboxes from anywhere on the web. > Try the new Email Toolbar now! > (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62) From Hgrmd at aol.com Sun May 3 09:02:42 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun May 3 08:03:40 2009 Subject: [HSF] (no subject) Message-ID: Roberto, I agree with you. The currently available bioprostheses make the need to oversize less of a problem. Hal In a message dated 5/3/2009 5:31:07 A.M. Eastern Daylight Time, robertobattellini@hotmail.com writes: One should collect in a study all these patients without mitral reconstruction after AVR,and follow up them. May be many will stabilized with a mild MI. A good idea is to look in our 2000 mitral mics and see how many have had AVR.Let see... I do not like to oversize. Roberto > Date: Sun, 3 May 2009 08:56:08 +0000 > Subject: Re: [HSF] (no subject) > From: nkkejriwal@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > > Interestingly I used my first Magna Ease valve last Wednesday. 77 year male. > Calcific AS. Mild MR. Normal mitral leaflets. 23 prosthesis. Post bypass > moderate MR. The A2 appeared slightly retracted. Came off bypass easily. No > inotropes. Progressing well. Can't hear a murmur. The company is promoting > that the prosthesis can be upsized with this model. The valve was a good > fit. I did not think that I oversized it. > Nand > > On Fri, May 1, 2009 at 9:45 AM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > > > > > I assisted once a case, an oversizing was tried, and of course, the Ant > > leaflet was retracted.It was diagnosed after routine TEE, the solution was a > > Cosgrove ring. > > > > Case very similar to Mark?s case. > > > > > > > > Roberto > > > > > Date: Fri, 1 May 2009 01:53:51 -0700 > > > From: drdharris@yahoo.co.uk > > > Subject: Re: [HSF] (no subject) > > > To: Rwmfglycar@aol.com; OpenHeart-L@lists.hsforum.com > > > CC: > > > > > > > > > I had a similar case recently with a magna valve distorting ant leaflet. > > Detected intra op and looked mild to moderate but progressed postop. Ant > > leaflet was small, some rheumatic changes and retracted upwards. Had to > > replace valve. Dave > > > > > > Rwmfglycar@aol.com wrote: > > > > Calcified valve? Method of removing calcium? Are you absolutely sure > > there > > > > is not a hole in the anterior leaflet? > > > > Bob > > > > In a message dated 5/1/2009 7:56:50 A.M. South Africa Standard Time, > > > > mmlevinson@hsforum.com writes: > > > > On Sep 3, 2008, at 4:41 AM, eric manasse wrote: > > > >> it was just a simple AVR, absence of MR @ echo TEE preop; 5 days after > > > >> it showed up a MR +++ with possible retraction of AML not clarified @ > > > >> reintervention > > > > AVR sutures placed too deeply into the region of the left/non sinus??? > > > > Mark > > > >> > > > >> > > > >> 2008/9/3 Prasanna Simha M : > > > >>> LV dysfunction with annular dilatation. The other possibilty - > > > >>> understimation of MR in the first place. > > > >>> Other possibilituies - was a Manouguian done ? Endocarditis ? > > > >>> prasanna > > > >>> > > > >>> > > > >>> On Wed, Sep 3, 2008 at 1:17 PM, eric manasse > > > >>> wrote: > > > >>> > > > >>>> Hello, I'd like to know if anybody has ever encountered the > > > >>>> following > > > >>>> problem: > > > >>>> new onset on mitral regurgitation few days after aortic valve > > > >>>> replacement ? > > > >>>> what is the mechanism ? > > > >>>> _______________________________________________ > > > >>>> OpenHeart-L mailing list > > > >>>> > > > >>>> Send postings to: > > > >>>> OpenHeart-L@lists.hsforum.com > > > >>>> > > > >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > >>>> http://mmp.cjp.com/mailman/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 > > > >> ----------------------------------------- > > > > Mark Levinson, MD. > > > > Founder, Editor-in-Chief > > > > The Heart Surgery Forum? > > > > Multimedia Cardiothoracic Journal > > > > URL: http://www.hsforum.com > > > > URL: http://newoptionsinheartsurgery.com > > > > Emali: mmlevinson@hsforum.com > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > > and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > **************Join ChristianMingle.com? FREE! Meet Christian Singles in > > > > your area. Start now! > > > > ( > > http://pr.atwola.com/promoclk/100126575x1221673648x1201419171/aol?redir=http://www.christianmingle.com/campaign.html%3Fcat%3Dadbuy%26 > > > > src%3Dplatforma%26adid%3Dfooter:050109%26newurl%3Dreg_path.html) > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62) From prasannasimha at gmail.com Sun May 3 18:41:44 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 3 08:12:17 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: <89c4ed2d0905030511v506e4ef7mff6350e28aa7b347@mail.gmail.com> Unfortunately Hal you must also agree that an n=2 doesn't guarantee that a problem may not occur the next time !! (All the more when there has been documentation of disasters in that setting)I must assume that you did not use retrograde in isolation so any faults wrt the retrograde could have been covered up with adequate preservation by antegrade shots. Also a left SVC that allows clamping without problems (and has a good communication with the right SVC by an innominate) is not usually significant by itself. If there is a poor intercommunication and a significant left SVC two things can happend - cerebral edema or fall in venous return. Prasanna On Sun, May 3, 2009 at 5:27 PM, wrote: > Prasanna, > All I know is the couple of times I've snared the LSVC and used > retrograde, there were no problems. > > Hal > > > In a message dated 5/3/2009 1:09:57 A.M. Eastern Daylight Time, > prasannasimha@gmail.com writes: > > Mitch it probably is unusual for adult surgery but is pretty common in the > pediatric set up. Acrtually ther isnt much of a problem if you are > suddenly > confornted with it and there is vacuum assit. Just plonk a straight venous > cannula into the left SVC via the coronary sinus and connect it via a 1/4 > inch line to the venous reservoir. > If the innominate vein is good technically you can clamp the left SVC. > Retrograde cardioplegia will be ineffective with a left SVC.Deaths have > been > reported when this has been done as the retroplegic distibution can be > highly varied even if the left SVC is snared (If you depend on retroplegia > for prolonged periods of arrest). > > On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman wrote: > > > For the 3rd or 4th time in a span of two years, I've been confronted > with/ > > identified at the time of surgery, patients with a persistent Lt SVC. > For > > the routine CAB, it's not really a problem, but 2 of them have been for > > mitral surgery. If I remember correctly, one had a diminutive SVC and > no > > innominate vein. The other and most recent, had no SVC at all and a > giant > > retro-cardiac vessel. > > > > For future reference, I'll be accepting any and all tips, pearls, and > > general knowledge. > > > > Thanks, 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 > > ----------------------------------------- > > > > > > -- > 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 > ----------------------------------------- > > > **************The Average US Credit Score is 692. See Yours in Just 2 Easy > Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201 > > 454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > ay5309AvgfooterNO62 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From Hgrmd at aol.com Sun May 3 09:20:03 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun May 3 08:21:09 2009 Subject: [HSF] Persistent LSVC Message-ID: Prassanna, I agree that 2 cases doesn't make me an expert. However, it's a start. By trial snaring the LSVC before proceeding with retrograde cardioplegia, I made sure that the venous return was going to be adequate. Do you have any experience or documentation in the literature where cerebral edema has been caused by temporarily snaring the LSVC? Personally, I have my doubts since head and neck surgeons routinely excise the IJ's with radical neck dissections. As long as one IJ remains patent, the venous drainage from the brain should be adequate. Hal In a message dated 5/3/2009 8:14:00 A.M. Eastern Daylight Time, prasannasimha@gmail.com writes: Unfortunately Hal you must also agree that an n=2 doesn't guarantee that a problem may not occur the next time !! (All the more when there has been documentation of disasters in that setting)I must assume that you did not use retrograde in isolation so any faults wrt the retrograde could have been covered up with adequate preservation by antegrade shots. Also a left SVC that allows clamping without problems (and has a good communication with the right SVC by an innominate) is not usually significant by itself. If there is a poor intercommunication and a significant left SVC two things can happend - cerebral edema or fall in venous return. Prasanna On Sun, May 3, 2009 at 5:27 PM, wrote: > Prasanna, > All I know is the couple of times I've snared the LSVC and used > retrograde, there were no problems. > > Hal > > > In a message dated 5/3/2009 1:09:57 A.M. Eastern Daylight Time, > prasannasimha@gmail.com writes: > > Mitch it probably is unusual for adult surgery but is pretty common in the > pediatric set up. Acrtually ther isnt much of a problem if you are > suddenly > confornted with it and there is vacuum assit. Just plonk a straight venous > cannula into the left SVC via the coronary sinus and connect it via a 1/4 > inch line to the venous reservoir. > If the innominate vein is good technically you can clamp the left SVC. > Retrograde cardioplegia will be ineffective with a left SVC.Deaths have > been > reported when this has been done as the retroplegic distibution can be > highly varied even if the left SVC is snared (If you depend on retroplegia > for prolonged periods of arrest). > > On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman wrote: > > > For the 3rd or 4th time in a span of two years, I've been confronted > with/ > > identified at the time of surgery, patients with a persistent Lt SVC. > For > > the routine CAB, it's not really a problem, but 2 of them have been for > > mitral surgery. If I remember correctly, one had a diminutive SVC and > no > > innominate vein. The other and most recent, had no SVC at all and a > giant > > retro-cardiac vessel. > > > > For future reference, I'll be accepting any and all tips, pearls, and > > general knowledge. > > > > Thanks, 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 > > ----------------------------------------- > > > > > > -- > 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 > ----------------------------------------- > > > **************The Average US Credit Score is 692. See Yours in Just 2 Easy > Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201 > > 454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > ay5309AvgfooterNO62 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62) From prasannasimha at gmail.com Sun May 3 19:02:45 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 3 08:40:11 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: <89c4ed2d0905030532w335f94a9ub74460b57a7eb19a@mail.gmail.com> There are literature reports of it happening. Remember that when you have a left SVC without a good intercommunication the Left jugular pressure can rise well above 20 cm H20 (In fact that is measured when we clamp and proceed in such cases and there have been cases of cerebral malperfusion occuring when it goes above 20). I bet you would not want the CVP to be in the greater 20's or 30's when on non pulsatile CPB with a perfusion pressure in the 40-60 range.Just see what happens when a Glenn nor Fontan goes wrong. You would be worried. The ligation by neck surgeons is based on adequate intercommunication (And I have done enough commando operations !!) but the situation in a left SVC is different for that half of the brain. Prasanna On Sun, May 3, 2009 at 5:50 PM, wrote: > Prassanna, > I agree that 2 cases doesn't make me an expert. However, it's a start. > By trial snaring the LSVC before proceeding with retrograde cardioplegia, > I made sure that the venous return was going to be adequate. Do you have > any experience or documentation in the literature where cerebral edema has > been caused by temporarily snaring the LSVC? Personally, I have my doubts > since head and neck surgeons routinely excise the IJ's with radical neck > dissections. As long as one IJ remains patent, the venous drainage from > the > brain should be adequate. > > Hal > > > In a message dated 5/3/2009 8:14:00 A.M. Eastern Daylight Time, > prasannasimha@gmail.com writes: > > Unfortunately Hal you must also agree that an n=2 doesn't guarantee that a > problem may not occur the next time !! (All the more when there has been > documentation of disasters in that setting)I must assume that you did not > use retrograde in isolation so any faults wrt the retrograde could have > been > covered up with adequate preservation by antegrade shots. > Also a left SVC that allows clamping without problems (and has a good > communication with the right SVC by an innominate) is not usually > significant by itself. If there is a poor intercommunication and a > significant left SVC two things can happend - cerebral edema or fall in > venous return. > Prasanna > > On Sun, May 3, 2009 at 5:27 PM, wrote: > > > Prasanna, > > All I know is the couple of times I've snared the LSVC and used > > retrograde, there were no problems. > > > > Hal > > > > > > In a message dated 5/3/2009 1:09:57 A.M. Eastern Daylight Time, > > prasannasimha@gmail.com writes: > > > > Mitch it probably is unusual for adult surgery but is pretty common in > the > > pediatric set up. Acrtually ther isnt much of a problem if you are > > suddenly > > confornted with it and there is vacuum assit. Just plonk a straight > venous > > cannula into the left SVC via the coronary sinus and connect it via a > 1/4 > > inch line to the venous reservoir. > > If the innominate vein is good technically you can clamp the left SVC. > > Retrograde cardioplegia will be ineffective with a left SVC.Deaths have > > been > > reported when this has been done as the retroplegic distibution can be > > highly varied even if the left SVC is snared (If you depend on > retroplegia > > for prolonged periods of arrest). > > > > On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman > wrote: > > > > > For the 3rd or 4th time in a span of two years, I've been confronted > > with/ > > > identified at the time of surgery, patients with a persistent Lt SVC. > > For > > > the routine CAB, it's not really a problem, but 2 of them have been > for > > > mitral surgery. If I remember correctly, one had a diminutive SVC and > > no > > > innominate vein. The other and most recent, had no SVC at all and a > > giant > > > retro-cardiac vessel. > > > > > > For future reference, I'll be accepting any and all tips, pearls, and > > > general knowledge. > > > > > > Thanks, 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 > > > ----------------------------------------- > > > > > > > > > > > -- > > 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 > > ----------------------------------------- > > > > > > **************The Average US Credit Score is 692. See Yours in Just 2 > Easy > > Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201 > > > > > 454298/aol?redir= > http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > > > ay5309AvgfooterNO62< > http://pr.atwola.com/promoclk/100126575x1222376998x1201%0A454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668 > 072&hmpgID=62&bcd=M%0Aay5309AvgfooterNO62 > > > > ) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 > ----------------------------------------- > > > **************The Average US Credit Score is 692. See Yours in Just 2 Easy > Steps! > ( > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > ay5309AvgfooterNO62) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 TSalerno at med.miami.edu Sun May 3 12:40:01 2009 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Sun May 3 11:40:32 2009 Subject: [HSF] Persistent LSVC Message-ID: Ideal protection requires infusion of blood or cardioplegia either alternating retro/antegrade or simultaneously as I use (Buckberg and Salerno). With left svc and hypertrophied heart, by the time one recognizes that there is a ledt svc, severe myocardial injury may have occurred. For those relying on cold cardioplegia one must measure septal temperature Ante/retro for induction and maintenance always Ts ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: open heart list Sent: Sun May 03 06:38:22 2009 Subject: RE: [HSF] Persistent LSVC Dr Salerno Would the coronary artery presures still be high in this scenario? Would there not be a difficuly in raising the pressure with sinus perfusion? Also I presume if the myocardial temperature is monitored this would be detected? Are you saying you do not recommend basing protection on cold retrograde alone in any case? Do you refer to induction, maintenance or both? Thanks Ani > From: TSalerno@med.miami.edu > To: OpenHeart-L@lists.hsforum.com > Date: Sat, 2 May 2009 19:56:47 -0400 > Subject: Re: [HSF] Persistent LSVC > CC: > > Retrograde cardioplegia is given, sometimes alone for aortic valve by some surgeons (something I do not recommend) and the heart is not protected. > > Ts > > ----- Original Message ----- > From: openheart-l-bounces@lists.hsforum.com > To: open heart list > Sent: Sat May 02 19:06:05 2009 > Subject: RE: [HSF] Persistent LSVC > > > Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. > > > Tomas > > > > > > > > What is the mechanism of the death in these cases? > > > > Ani > > > > From: TSalerno@med.miami.edu > > To: OpenHeart-L@lists.hsforum.com; OpenHeart-L@hsforum.com > > Date: Sat, 2 May 2009 17:20:58 -0400 > > Subject: Re: [HSF] Persistent LSVC > > CC: > > > > I have encountere left cava a few times in all types of procedure; > > > > 1) In CABG it is irrelevant since I do all cases of pump > > > > 2) In mitral valve with heart beating and aorta unclamped, aside from svc and ivc cannulation, I also cannulate the coronary sinus once right atrium is openeda, snare the mouth of the sinus and connect the cannula to the venous system; > > > > 3) In aortic valve with heart beating, I ony cannulate the left and right ostia for blood perfusion. With the use of single cannula left cava is irrelevant. > > > > One should be able to diagnose left cava via TEE, and the coronary sinus is usually very large. Deaths have been seen when retrograde cardioplegia is administered in non-diagnosed left cava. One always has the option of snaring the left cava, is svc exists but I have not done that > > > > Tomas > > > > ----- Original Message ----- > > From: openheart-l-bounces@lists.hsforum.com > > To: OpenHeart-L@hsforum.com > > Sent: Sat May 02 16:59:38 2009 > > Subject: [HSF] Persistent LSVC > > > > For the 3rd or 4th time in a span of two years, I've been confronted with/ > > identified at the time of surgery, patients with a persistent Lt SVC. For > > the routine CAB, it's not really a problem, but 2 of them have been for > > mitral surgery. If I remember correctly, one had a diminutive SVC and no > > innominate vein. The other and most recent, had no SVC at all and a giant > > retro-cardiac vessel. > > > > For future reference, I'll be accepting any and all tips, pearls, and > > general knowledge. > > > > Thanks, 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 > > ----------------------------------------- > > _________________________________________________________________ > Beyond Hotmail ? see what else you can do with Windows Live. > http://clk.atdmt.com/UKM/go/134665375/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ Share your photos with Windows Live Photos ? Free. http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From flege19 at gmail.com Sun May 3 13:07:52 2009 From: flege19 at gmail.com (John Flege) Date: Sun May 3 12:15:25 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: Safe effective cardiac surgery was done by many surgeons, including me, before retrograde cardioplegic techniques were introduced, and even before potassium cardioplegia was introduced. John Flege On May 3, 2009, at 11:40 AM, Salerno, Tomas wrote: > Ideal protection requires infusion of blood or cardioplegia either > alternating retro/antegrade or simultaneously as I use (Buckberg and > Salerno). With left svc and hypertrophied heart, by the time one > recognizes that there is a ledt svc, severe myocardial injury may > have occurred. > > For those relying on cold cardioplegia one must measure septal > temperature > > Ante/retro for induction and maintenance always > > Ts > > ----- Original Message ----- > From: openheart-l-bounces@lists.hsforum.com > > To: open heart list > Sent: Sun May 03 06:38:22 2009 > Subject: RE: [HSF] Persistent LSVC > > > Dr Salerno > > > > Would the coronary artery presures still be high in this scenario? > Would there not be a difficuly in raising the pressure with sinus > perfusion? Also I presume if the myocardial temperature is monitored > this would be detected? > > > > Are you saying you do not recommend basing protection on cold > retrograde alone in any case? Do you refer to induction, maintenance > or both? > > > > Thanks > > > > Ani > > > > > >> From: TSalerno@med.miami.edu >> To: OpenHeart-L@lists.hsforum.com >> Date: Sat, 2 May 2009 19:56:47 -0400 >> Subject: Re: [HSF] Persistent LSVC >> CC: >> >> Retrograde cardioplegia is given, sometimes alone for aortic valve >> by some surgeons (something I do not recommend) and the heart is >> not protected. >> >> Ts >> >> ----- Original Message ----- >> From: openheart-l-bounces@lists.hsforum.com > > >> To: open heart list >> Sent: Sat May 02 19:06:05 2009 >> Subject: RE: [HSF] Persistent LSVC >> >> >> Deaths have been seen when retrograde cardioplegia is administered >> in non-diagnosed left cava. > >>> Tomas >> >> >> >> >> >> >> >> What is the mechanism of the death in these cases? >> >> >> >> Ani >> >> >>> From: TSalerno@med.miami.edu >>> To: OpenHeart-L@lists.hsforum.com; OpenHeart-L@hsforum.com >>> Date: Sat, 2 May 2009 17:20:58 -0400 >>> Subject: Re: [HSF] Persistent LSVC >>> CC: >>> >>> I have encountere left cava a few times in all types of procedure; >>> >>> 1) In CABG it is irrelevant since I do all cases of pump >>> >>> 2) In mitral valve with heart beating and aorta unclamped, aside >>> from svc and ivc cannulation, I also cannulate the coronary sinus >>> once right atrium is openeda, snare the mouth of the sinus and >>> connect the cannula to the venous system; >>> >>> 3) In aortic valve with heart beating, I ony cannulate the left >>> and right ostia for blood perfusion. With the use of single >>> cannula left cava is irrelevant. >>> >>> One should be able to diagnose left cava via TEE, and the coronary >>> sinus is usually very large. Deaths have been seen when retrograde >>> cardioplegia is administered in non-diagnosed left cava. One >>> always has the option of snaring the left cava, is svc exists but >>> I have not done that >>> >>> Tomas >>> >>> ----- Original Message ----- >>> From: openheart-l-bounces@lists.hsforum.com >> > >>> To: OpenHeart-L@hsforum.com >>> Sent: Sat May 02 16:59:38 2009 >>> Subject: [HSF] Persistent LSVC >>> >>> For the 3rd or 4th time in a span of two years, I've been >>> confronted with/ >>> identified at the time of surgery, patients with a persistent Lt >>> SVC. For >>> the routine CAB, it's not really a problem, but 2 of them have >>> been for >>> mitral surgery. If I remember correctly, one had a diminutive SVC >>> and no >>> innominate vein. The other and most recent, had no SVC at all and >>> a giant >>> retro-cardiac vessel. >>> >>> For future reference, I'll be accepting any and all tips, pearls, >>> and >>> general knowledge. >>> >>> Thanks, 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 >>> ----------------------------------------- >> >> _________________________________________________________________ >> Beyond Hotmail ? see what else you can do with Windows Live. >> http://clk.atdmt.com/UKM/go/134665375/direct/01/_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 flege19 at gmail.com Sun May 3 12:48:31 2009 From: flege19 at gmail.com (John Flege) Date: Sun May 3 12:18:12 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> Message-ID: <64644569-274F-4F80-8834-085A056E5CD6@gmail.com> You can cannulate via the coronary sinus and if you need to open the right atrium, with an endotracheal tube. I have not done it. John Flege On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > For the 3rd or 4th time in a span of two years, I've been > confronted with/ identified at the time of surgery, patients with a > persistent Lt SVC. For the routine CAB, it's not really a problem, > but 2 of them have been for mitral surgery. If I remember correctly, > one had a diminutive SVC and no innominate vein. The other and most > recent, had no SVC at all and a giant retro-cardiac vessel. > > For future reference, I'll be accepting any and all tips, pearls, > and general knowledge. > > Thanks, 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 msfirst at gmail.com Sun May 3 13:02:01 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun May 3 12:49:44 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: References: Message-ID: How much TR would be left after putting a lead through a new TV? Not to mention the risks for lead infections? -michael On Sun, May 3, 2009 at 8:00 AM, wrote: > Michael, > From the way your initial post read, I assume you were referring to > clinically important TR associated with permanent pacing leads. It is well > documented in the literature that moderate or worse TR adversely impacts > the 10 > yr survival, similar to moderate or worse MR. I would rather leave a > patient with a bioprosthesis instead of severe TR. > > Hal > > > In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time, > msfirst@gmail.com writes: > > Hal, > Since you are trading one disease for another - i.e. replacing the TV with > a > tissue valve in a patient who already has/needs a pacer (and I have a low > threshold for epicardials myself) - do you have different criteria for > when > you would intervene on the valve in the first place - since you already > know > that having leads will produces some degree of TR. Does that change if > you > know that the annulus is normal? > > -michael > > On Sat, May 2, 2009 at 6:54 PM, wrote: > > > Michael, > > It depends on what is producing the TR. Sometimes the lead actually > > perforates the leaflet. In that case, a triangular resection and > > subsequent > > autologous pericardial patch will take care of it. Other times, the > lead > > is > > holding back the leaflet (usually posterior or septal), producing the > TR. > > In those cases the lead should be shaved from the leaflet edge and > then > > forced into the corner of the postero-septal commissure. It is held > into > > place with a couple of sutures. If these measures don't work, then > > consider > > TVR (Mitral Magna is what I would use). > > > > Hal > > > > > > In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, > > msfirst@gmail.com writes: > > > > With patients with mod/sev TR (normal or near normal annular sizes) > from > > distortion of the leaflets from chronic RV pacing leads - does anyone > have > > thoughts on "fixing" these? Or some other management insight? > > > > > > -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 > > ----------------------------------------- > > > > > > **************Check all of your email inboxes from anywhere on the web. > > Try the new Email Toolbar now! > > (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > **************The Average US Credit Score is 692. See Yours in Just 2 Easy > Steps! > ( > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > ay5309AvgfooterNO62) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Sun May 3 17:56:06 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sun May 3 12:55:14 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: References: Message-ID: <542477451-1241369685-cardhu_decombobulator_blackberry.rim.net-1202115105-@bxe1016.bisx.prod.on.blackberry> 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aHR0cDovL21tcC5janAuY29tL21haWxtYW4vbGlzdGluZm8vb3BlbmhlYXJ0LWwNCg0KQWxsIG1l c3NhZ2VzIHRyYW5zbWl0dGVkIGJ5IHRoZSBPcGVuSGVhcnQtTCBhcmUgc3ViamVjdCB0byB0aGUg cG9saWNpZXMgYW5kIA0KZGlzY2xhaW1lcnMgcG9zdGVkIGF0Og0KaHR0cDovL3d3dy5oc2ZvcnVt LmNvbS9saXN0ZGlzY2xhaW0NCi0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0t LS0tDQo= From prasannasimha at gmail.com Sun May 3 23:27:35 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 3 13:04:56 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: References: Message-ID: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> new tricuspid valve ? You dont put the lead through the new valve you put it outside - between the sewing rim and the true annulus . Prasanna On Sun, May 3, 2009 at 9:32 PM, Michael Firstenberg wrote: > How much TR would be left after putting a lead through a new TV? > Not to mention the risks for lead infections? > > -michael > > On Sun, May 3, 2009 at 8:00 AM, wrote: > > > Michael, > > From the way your initial post read, I assume you were referring to > > clinically important TR associated with permanent pacing leads. It is > well > > documented in the literature that moderate or worse TR adversely impacts > > the 10 > > yr survival, similar to moderate or worse MR. I would rather leave a > > patient with a bioprosthesis instead of severe TR. > > > > Hal > > > > > > In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time, > > msfirst@gmail.com writes: > > > > Hal, > > Since you are trading one disease for another - i.e. replacing the TV > with > > a > > tissue valve in a patient who already has/needs a pacer (and I have a > low > > threshold for epicardials myself) - do you have different criteria for > > when > > you would intervene on the valve in the first place - since you already > > know > > that having leads will produces some degree of TR. Does that change if > > you > > know that the annulus is normal? > > > > -michael > > > > On Sat, May 2, 2009 at 6:54 PM, wrote: > > > > > Michael, > > > It depends on what is producing the TR. Sometimes the lead actually > > > perforates the leaflet. In that case, a triangular resection and > > > subsequent > > > autologous pericardial patch will take care of it. Other times, the > > lead > > > is > > > holding back the leaflet (usually posterior or septal), producing the > > TR. > > > In those cases the lead should be shaved from the leaflet edge and > > then > > > forced into the corner of the postero-septal commissure. It is held > > into > > > place with a couple of sutures. If these measures don't work, then > > > consider > > > TVR (Mitral Magna is what I would use). > > > > > > Hal > > > > > > > > > In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, > > > msfirst@gmail.com writes: > > > > > > With patients with mod/sev TR (normal or near normal annular sizes) > > from > > > distortion of the leaflets from chronic RV pacing leads - does anyone > > have > > > thoughts on "fixing" these? Or some other management insight? > > > > > > > > > -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 > > > ----------------------------------------- > > > > > > > > > **************Check all of your email inboxes from anywhere on the > web. > > > Try the new Email Toolbar now! > > > (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the > policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > **************The Average US Credit Score is 692. See Yours in Just 2 > Easy > > Steps! > > ( > > > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > > ay5309AvgfooterNO62) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Sun May 3 23:26:43 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 3 13:05:08 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <64644569-274F-4F80-8834-085A056E5CD6@gmail.com> References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> <64644569-274F-4F80-8834-085A056E5CD6@gmail.com> Message-ID: <89c4ed2d0905030956y2662224fp78933aa08723e76@mail.gmail.com> I have done it in the past but today with vacuum its so easy - just plonk a straight cannula inside and connect it to the reservoir with a 1/4th tube and then it is out of sight and out of mind. Why worry of even a potential for brain injury ? (We have enough potential as it is !!)You can also very often just manage with a sucker inside for less complex cases. Prasanna On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: > You can cannulate via the coronary sinus and if you need to open the right > atrium, with an endotracheal tube. I have not done it. John Flege > > On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > > For the 3rd or 4th time in a span of two years, I've been confronted >> with/ identified at the time of surgery, patients with a persistent Lt SVC. >> For the routine CAB, it's not really a problem, but 2 of them have been for >> mitral surgery. If I remember correctly, one had a diminutive SVC and no >> innominate vein. The other and most recent, had no SVC at all and a giant >> retro-cardiac vessel. >> >> For future reference, I'll be accepting any and all tips, pearls, and >> general knowledge. >> >> Thanks, 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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun May 3 23:35:00 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 3 13:05:17 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> References: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> Message-ID: <89c4ed2d0905031005u6ec6cet9578e3b520513674@mail.gmail.com> You can also use a coronary sinus lead and pace the LV. Prasanna On Sun, May 3, 2009 at 10:27 PM, Prasanna Simha M wrote: > new tricuspid valve ? You dont put the lead through the new valve you put > it outside - between the sewing rim and the true annulus . > Prasanna > > > On Sun, May 3, 2009 at 9:32 PM, Michael Firstenberg wrote: > >> How much TR would be left after putting a lead through a new TV? >> Not to mention the risks for lead infections? >> >> -michael >> >> On Sun, May 3, 2009 at 8:00 AM, wrote: >> >> > Michael, >> > From the way your initial post read, I assume you were referring to >> > clinically important TR associated with permanent pacing leads. It is >> well >> > documented in the literature that moderate or worse TR adversely impacts >> > the 10 >> > yr survival, similar to moderate or worse MR. I would rather leave a >> > patient with a bioprosthesis instead of severe TR. >> > >> > Hal >> > >> > >> > In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time, >> > msfirst@gmail.com writes: >> > >> > Hal, >> > Since you are trading one disease for another - i.e. replacing the TV >> with >> > a >> > tissue valve in a patient who already has/needs a pacer (and I have a >> low >> > threshold for epicardials myself) - do you have different criteria for >> > when >> > you would intervene on the valve in the first place - since you already >> > know >> > that having leads will produces some degree of TR. Does that change if >> > you >> > know that the annulus is normal? >> > >> > -michael >> > >> > On Sat, May 2, 2009 at 6:54 PM, wrote: >> > >> > > Michael, >> > > It depends on what is producing the TR. Sometimes the lead >> actually >> > > perforates the leaflet. In that case, a triangular resection and >> > > subsequent >> > > autologous pericardial patch will take care of it. Other times, the >> > lead >> > > is >> > > holding back the leaflet (usually posterior or septal), producing >> the >> > TR. >> > > In those cases the lead should be shaved from the leaflet edge and >> > then >> > > forced into the corner of the postero-septal commissure. It is held >> > into >> > > place with a couple of sutures. If these measures don't work, then >> > > consider >> > > TVR (Mitral Magna is what I would use). >> > > >> > > Hal >> > > >> > > >> > > In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, >> > > msfirst@gmail.com writes: >> > > >> > > With patients with mod/sev TR (normal or near normal annular sizes) >> > from >> > > distortion of the leaflets from chronic RV pacing leads - does anyone >> > have >> > > thoughts on "fixing" these? Or some other management insight? >> > > >> > > >> > > -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 >> > > ----------------------------------------- >> > > >> > > >> > > **************Check all of your email inboxes from anywhere on the >> web. >> > > Try the new Email Toolbar now! >> > > (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027 >> ) >> > > _______________________________________________ >> > > OpenHeart-L mailing list >> > > >> > > Send postings to: >> > > OpenHeart-L@lists.hsforum.com >> > > >> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > > >> > > All messages transmitted by the OpenHeart-L are subject to the >> policies >> > and >> > > disclaimers posted at: >> > > http://www.hsforum.com/listdisclaim >> > > ----------------------------------------- >> > > >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > >> > All messages transmitted by the OpenHeart-L are subject to the policies >> > and >> > disclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> > >> > >> > **************The Average US Credit Score is 692. See Yours in Just 2 >> Easy >> > Steps! >> > ( >> > >> http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M >> > ay5309AvgfooterNO62) >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > >> > All messages transmitted by the OpenHeart-L are subject to the policies >> and >> > disclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> > >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From anianyanwu at hotmail.com Sun May 3 18:46:34 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun May 3 13:47:02 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <89c4ed2d0905030956y2662224fp78933aa08723e76@mail.gmail.com> References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> <64644569-274F-4F80-8834-085A056E5CD6@gmail.com> <89c4ed2d0905030956y2662224fp78933aa08723e76@mail.gmail.com> Message-ID: You can also very > often just manage with a sucker inside for less complex cases. > Prasanna Yes - we seem to be making a simple matter very complicated. I am sure the likes of Ed Raines will be wondering what all the mystery is about as they do all mitrals with a single two stage or long venous cannula and do not have problems with drainage. Why a need to drain the left cava separately - doesnt the blood all end up in the same place as the IVC blood? Ani > From: prasannasimha@gmail.com > Date: Sun, 3 May 2009 22:26:43 +0530 > Subject: Re: [HSF] Persistent LSVC > To: OpenHeart-L@lists.hsforum.com > CC: > > I have done it in the past but today with vacuum its so easy - just plonk a > straight cannula inside and connect it to the reservoir with a 1/4th tube > and then it is out of sight and out of mind. Why worry of even a potential > for brain injury ? (We have enough potential as it is !!)You can also very > often just manage with a sucker inside for less complex cases. > Prasanna > > On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: > > > You can cannulate via the coronary sinus and if you need to open the right > > atrium, with an endotracheal tube. I have not done it. John Flege > > > > On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > > > > For the 3rd or 4th time in a span of two years, I've been confronted > >> with/ identified at the time of surgery, patients with a persistent Lt SVC. > >> For the routine CAB, it's not really a problem, but 2 of them have been for > >> mitral surgery. If I remember correctly, one had a diminutive SVC and no > >> innominate vein. The other and most recent, had no SVC at all and a giant > >> retro-cardiac vessel. > >> > >> For future reference, I'll be accepting any and all tips, pearls, and > >> general knowledge. > >> > >> Thanks, 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 > > ----------------------------------------- > > > > > > -- > 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 > ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/ From TSalerno at med.miami.edu Sun May 3 14:51:43 2009 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Sun May 3 13:52:01 2009 Subject: [HSF] Persistent LSVC Message-ID: The search forbthe "ideal" cardioplegic technique continues.... We are not at a stage of perfect protection, although a variety of techniques and cardioplegic solutions are used, all claiming good protection Ts ----- Original Message ----- From: openheart-l-bounces@lists.hsforum.com To: OpenHeart-L@lists.hsforum.com Sent: Sun May 03 12:07:52 2009 Subject: Re: [HSF] Persistent LSVC Safe effective cardiac surgery was done by many surgeons, including me, before retrograde cardioplegic techniques were introduced, and even before potassium cardioplegia was introduced. John Flege On May 3, 2009, at 11:40 AM, Salerno, Tomas wrote: > Ideal protection requires infusion of blood or cardioplegia either > alternating retro/antegrade or simultaneously as I use (Buckberg and > Salerno). With left svc and hypertrophied heart, by the time one > recognizes that there is a ledt svc, severe myocardial injury may > have occurred. > > For those relying on cold cardioplegia one must measure septal > temperature > > Ante/retro for induction and maintenance always > > Ts > > ----- Original Message ----- > From: openheart-l-bounces@lists.hsforum.com > > To: open heart list > Sent: Sun May 03 06:38:22 2009 > Subject: RE: [HSF] Persistent LSVC > > > Dr Salerno > > > > Would the coronary artery presures still be high in this scenario? > Would there not be a difficuly in raising the pressure with sinus > perfusion? Also I presume if the myocardial temperature is monitored > this would be detected? > > > > Are you saying you do not recommend basing protection on cold > retrograde alone in any case? Do you refer to induction, maintenance > or both? > > > > Thanks > > > > Ani > > > > > >> From: TSalerno@med.miami.edu >> To: OpenHeart-L@lists.hsforum.com >> Date: Sat, 2 May 2009 19:56:47 -0400 >> Subject: Re: [HSF] Persistent LSVC >> CC: >> >> Retrograde cardioplegia is given, sometimes alone for aortic valve >> by some surgeons (something I do not recommend) and the heart is >> not protected. >> >> Ts >> >> ----- Original Message ----- >> From: openheart-l-bounces@lists.hsforum.com > > >> To: open heart list >> Sent: Sat May 02 19:06:05 2009 >> Subject: RE: [HSF] Persistent LSVC >> >> >> Deaths have been seen when retrograde cardioplegia is administered >> in non-diagnosed left cava. > >>> Tomas >> >> >> >> >> >> >> >> What is the mechanism of the death in these cases? >> >> >> >> Ani >> >> >>> From: TSalerno@med.miami.edu >>> To: OpenHeart-L@lists.hsforum.com; OpenHeart-L@hsforum.com >>> Date: Sat, 2 May 2009 17:20:58 -0400 >>> Subject: Re: [HSF] Persistent LSVC >>> CC: >>> >>> I have encountere left cava a few times in all types of procedure; >>> >>> 1) In CABG it is irrelevant since I do all cases of pump >>> >>> 2) In mitral valve with heart beating and aorta unclamped, aside >>> from svc and ivc cannulation, I also cannulate the coronary sinus >>> once right atrium is openeda, snare the mouth of the sinus and >>> connect the cannula to the venous system; >>> >>> 3) In aortic valve with heart beating, I ony cannulate the left >>> and right ostia for blood perfusion. With the use of single >>> cannula left cava is irrelevant. >>> >>> One should be able to diagnose left cava via TEE, and the coronary >>> sinus is usually very large. Deaths have been seen when retrograde >>> cardioplegia is administered in non-diagnosed left cava. One >>> always has the option of snaring the left cava, is svc exists but >>> I have not done that >>> >>> Tomas >>> >>> ----- Original Message ----- >>> From: openheart-l-bounces@lists.hsforum.com >> > >>> To: OpenHeart-L@hsforum.com >>> Sent: Sat May 02 16:59:38 2009 >>> Subject: [HSF] Persistent LSVC >>> >>> For the 3rd or 4th time in a span of two years, I've been >>> confronted with/ >>> identified at the time of surgery, patients with a persistent Lt >>> SVC. For >>> the routine CAB, it's not really a problem, but 2 of them have >>> been for >>> mitral surgery. If I remember correctly, one had a diminutive SVC >>> and no >>> innominate vein. The other and most recent, had no SVC at all and >>> a giant >>> retro-cardiac vessel. >>> >>> For future reference, I'll be accepting any and all tips, pearls, >>> and >>> general knowledge. >>> >>> Thanks, 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 >>> ----------------------------------------- >> >> _________________________________________________________________ >> Beyond Hotmail ? see what else you can do with Windows Live. >> http://clk.atdmt.com/UKM/go/134665375/direct/01/_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 May 4 00:34:28 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun May 3 14:05:07 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> <64644569-274F-4F80-8834-085A056E5CD6@gmail.com> <89c4ed2d0905030956y2662224fp78933aa08723e76@mail.gmail.com> Message-ID: <89c4ed2d0905031104g54156bd0g395ee760ea1ec413@mail.gmail.com> Not if you are opening the RA. If you don't open the RA you don't need to separately drain the left SVC.(Or if you need to snug the SVC and IVC with the RA unopened for whatever reason. Prasanna On Sun, May 3, 20' > > th a sucker inside for less complex cases. > > Prasanna > > > Yes - we seem to be making a simple matter very complicated. I am sure the > likes of Ed Raines will be wondering what all the mystery is about as they > do all mitrals with a single two stage or long venous cannula and do not > have problems with drainage. Why a need to drain the left cava separately - > doesnt the blood all end up in the same place as the IVC blood? > > > > Ani > > > > > > > From: prasannasimha@gmail.com > > Date: Sun, 3 May 2009 22:26:43 +0530 > > Subject: Re: [HSF] Persistent LSVC > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > I have done it in the past but today with vacuum its so easy - just plonk > a > > straight cannula inside and connect it to the reservoir with a 1/4th tube > > and then it is out of sight and out of mind. Why worry of even a > potential > > for brain injury ? (We have enough potential as it is !!)You can also > very > > often just manage with a sucker inside for less complex cases. > > Prasanna > > > > On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: > > > > > You can cannulate via the coronary sinus and if you need to open the > right > > > atrium, with an endotracheal tube. I have not done it. John Flege > > > > > > On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > > > > > > For the 3rd or 4th time in a span of two years, I've been confronted > > >> with/ identified at the time of surgery, patients with a persistent Lt > SVC. > > >> For the routine CAB, it's not really a problem, but 2 of them have > been for > > >> mitral surgery. If I remember correctly, one had a diminutive SVC and > no > > >> innominate vein. The other and most recent, had no SVC at all and a > giant > > >> retro-cardiac vessel. > > >> > > >> For future reference, I'll be accepting any and all tips, pearls, and > > >> general knowledge. > > >> > > >> Thanks, 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 > > > ----------------------------------------- > > > > > > > > > > > -- > > 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 > > ----------------------------------------- > > _________________________________________________________________ > View your Twitter and Flickr updates from one place ? Learn more! > > http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From gabuin at intramed.net Sun May 3 16:47:36 2009 From: gabuin at intramed.net (gustavo abuin) Date: Sun May 3 14:51:19 2009 Subject: [HSF] Persistent LSVC References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net><89c4ed2d0905021842u1f8d23d2m6ccb6783d9330e67@mail.gmail.com> Message-ID: <006c01c9cc1f$a114b0b0$30d9e818@LIBERTAD> -If there is a good innominate vein and RSVC, don`t worry, you can clamp the left cava and go as usual. -If the right vena cava is small you can cannulate directly the left superior vena cava with a 24Fr. pacifico cannula. -If you are in doubt because you have two venae cavae of good quality, you can cannulate both. -If there is "no" innomintate venous trunk, be careful, because there may be a posterior innominate vein, retroaortic, and nothing matters regarding the venous return, but the aortic clamp may be dangerous. gustavo ----- Original Message ----- From: "Roberto Battellini" To: "lists HSF" Sent: Sunday, May 03, 2009 7:23 AM Subject: RE: [HSF] Persistent LSVC I have had the case may be 2 years ago in a mitro-tricuspid case. I did it without preop diagnosis. It came soooo much blood back,first i thougt was a big Foramen Ovale, and did a couple of stitches, then I recognized it and cannulated the left cava from the coronary sinus. I cut my stitches, of course. Roberto > From: prasannasimha@gmail.com > Date: Sun, 3 May 2009 07:12:35 +0530 > Subject: Re: [HSF] Persistent LSVC > To: OpenHeart-L@lists.hsforum.com > CC: > > Mitch it probably is unusual for adult surgery but is pretty common in the > pediatric set up. Acrtually ther isnt much of a problem if you are > suddenly > confornted with it and there is vacuum assit. Just plonk a straight venous > cannula into the left SVC via the coronary sinus and connect it via a 1/4 > inch line to the venous reservoir. > If the innominate vein is good technically you can clamp the left SVC. > Retrograde cardioplegia will be ineffective with a left SVC.Deaths have > been > reported when this has been done as the retroplegic distibution can be > highly varied even if the left SVC is snared (If you depend on retroplegia > for prolonged periods of arrest). > > On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman wrote: > > > For the 3rd or 4th time in a span of two years, I've been confronted > > with/ > > identified at the time of surgery, patients with a persistent Lt SVC. > > For > > the routine CAB, it's not really a problem, but 2 of them have been for > > mitral surgery. If I remember correctly, one had a diminutive SVC and no > > innominate vein. The other and most recent, had no SVC at all and a > > giant > > retro-cardiac vessel. > > > > For future reference, I'll be accepting any and all tips, pearls, and > > general knowledge. > > > > Thanks, 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 > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -------------------------------------------------------------------------------- No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.325 / Virus Database: 270.12.15/2093 - Release Date: 05/02/09 14:23:00 From tacuff at swbell.net Sun May 3 13:22:59 2009 From: tacuff at swbell.net (Tea Acuff) Date: Sun May 3 15:24:23 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> <64644569-274F-4F80-8834-085A056E5CD6@gmail.com> <89c4ed2d0905030956y2662224fp78933aa08723e76@mail.gmail.com> Message-ID: <456239.23509.qm@web81601.mail.mud.yahoo.com> Or back to the axillary cannulation thread just stick the arterial cannula in the true lumen, false lumen of a dissection or any other "convenient" location. We are like a bunch of old women arguing over our favorite hat. Of course the sun hat might not do that well in a down pour....damn details tea ________________________________ From: Ani Anyanwu To: open heart list Sent: Sunday, May 3, 2009 12:46:34 PM Subject: RE: [HSF] Persistent LSVC You can also very > often just manage with a sucker inside for less complex cases. > Prasanna Yes - we seem to be making a simple matter very complicated. I am sure the likes of Ed Raines will be wondering what all the mystery is about as they do all mitrals with a single two stage or long venous cannula and do not have problems with drainage. Why a need to drain the left cava separately - doesnt the blood all end up in the same place as the IVC blood? Ani > From: prasannasimha@gmail.com > Date: Sun, 3 May 2009 22:26:43 +0530 > Subject: Re: [HSF] Persistent LSVC > To: OpenHeart-L@lists.hsforum.com > CC: > > I have done it in the past but today with vacuum its so easy - just plonk a > straight cannula inside and connect it to the reservoir with a 1/4th tube > and then it is out of sight and out of mind. Why worry of even a potential > for brain injury ? (We have enough potential as it is !!)You can also very > often just manage with a sucker inside for less complex cases. > Prasanna > > On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: > > > You can cannulate via the coronary sinus and if you need to open the right > > atrium, with an endotracheal tube. I have not done it. John Flege > > > > On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > > > > For the 3rd or 4th time in a span of two years, I've been confronted > >> with/ identified at the time of surgery, patients with a persistent Lt SVC. > >> For the routine CAB, it's not really a problem, but 2 of them have been for > >> mitral surgery. If I remember correctly, one had a diminutive SVC and no > >> innominate vein. The other and most recent, had no SVC at all and a giant > >> retro-cardiac vessel. > >> > >> For future reference, I'll be accepting any and all tips, pearls, and > >> general knowledge. > >> > >> Thanks, 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 > > ----------------------------------------- > > > > > > -- > 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 > ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From msfirst at gmail.com Sun May 3 16:49:27 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun May 3 15:50:01 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> References: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> Message-ID: Then what happens when they get infected and need to come out? -michael. On May 3, 2009, at 12:57 PM, Prasanna Simha M wrote: > new tricuspid valve ? You dont put the lead through the new valve > you put it > outside - between the sewing rim and the true annulus . > Prasanna > > On Sun, May 3, 2009 at 9:32 PM, Michael Firstenberg > wrote: > >> How much TR would be left after putting a lead through a new TV? >> Not to mention the risks for lead infections? >> >> -michael >> >> On Sun, May 3, 2009 at 8:00 AM, wrote: >> >>> Michael, >>> From the way your initial post read, I assume you were referring to >>> clinically important TR associated with permanent pacing leads. >>> It is >> well >>> documented in the literature that moderate or worse TR adversely >>> impacts >>> the 10 >>> yr survival, similar to moderate or worse MR. I would rather >>> leave a >>> patient with a bioprosthesis instead of severe TR. >>> >>> Hal >>> >>> >>> In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time, >>> msfirst@gmail.com writes: >>> >>> Hal, >>> Since you are trading one disease for another - i.e. replacing >>> the TV >> with >>> a >>> tissue valve in a patient who already has/needs a pacer (and I >>> have a >> low >>> threshold for epicardials myself) - do you have different >>> criteria for >>> when >>> you would intervene on the valve in the first place - since you >>> already >>> know >>> that having leads will produces some degree of TR. Does that >>> change if >>> you >>> know that the annulus is normal? >>> >>> -michael >>> >>> On Sat, May 2, 2009 at 6:54 PM, wrote: >>> >>>> Michael, >>>> It depends on what is producing the TR. Sometimes the lead >>>> actually >>>> perforates the leaflet. In that case, a triangular resection and >>>> subsequent >>>> autologous pericardial patch will take care of it. Other >>>> times, the >>> lead >>>> is >>>> holding back the leaflet (usually posterior or septal), >>>> producing the >>> TR. >>>> In those cases the lead should be shaved from the leaflet edge and >>> then >>>> forced into the corner of the postero-septal commissure. It is >>>> held >>> into >>>> place with a couple of sutures. If these measures don't work, >>>> then >>>> consider >>>> TVR (Mitral Magna is what I would use). >>>> >>>> Hal >>>> >>>> >>>> In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, >>>> msfirst@gmail.com writes: >>>> >>>> With patients with mod/sev TR (normal or near normal annular >>>> sizes) >>> from >>>> distortion of the leaflets from chronic RV pacing leads - does >>>> anyone >>> have >>>> thoughts on "fixing" these? Or some other management insight? >>>> >>>> >>>> -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 >>>> ----------------------------------------- >>>> >>>> >>>> **************Check all of your email inboxes from anywhere on the >> web. >>>> Try the new Email Toolbar now! >>>> (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027 >>>> ) >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the >> policies >>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> >>> **************The Average US Credit Score is 692. See Yours in >>> Just 2 >> Easy >>> Steps! >>> ( >>> >> http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M >>> ay5309AvgfooterNO62) >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 anianyanwu at hotmail.com Sun May 3 20:56:43 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun May 3 15:57:05 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: References: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> Message-ID: Just extract them like any other pacemaker. I had a tricuspid replacement I did with the AICD lead left insitu outside the ring as described and 7 months later there was suspected infection of AICD and was extracted transvenously without problem. Ani > From: msfirst@gmail.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Pacer Lead Induced TR > Date: Sun, 3 May 2009 15:49:27 -0400 > CC: > > Then what happens when they get infected and need to come out? > > -michael. > > On May 3, 2009, at 12:57 PM, Prasanna Simha M > wrote: > > > new tricuspid valve ? You dont put the lead through the new valve > > you put it > > outside - between the sewing rim and the true annulus . > > Prasanna > > > > On Sun, May 3, 2009 at 9:32 PM, Michael Firstenberg > > wrote: > > > >> How much TR would be left after putting a lead through a new TV? > >> Not to mention the risks for lead infections? > >> > >> -michael > >> > >> On Sun, May 3, 2009 at 8:00 AM, wrote: > >> > >>> Michael, > >>> From the way your initial post read, I assume you were referring to > >>> clinically important TR associated with permanent pacing leads. > >>> It is > >> well > >>> documented in the literature that moderate or worse TR adversely > >>> impacts > >>> the 10 > >>> yr survival, similar to moderate or worse MR. I would rather > >>> leave a > >>> patient with a bioprosthesis instead of severe TR. > >>> > >>> Hal > >>> > >>> > >>> In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time, > >>> msfirst@gmail.com writes: > >>> > >>> Hal, > >>> Since you are trading one disease for another - i.e. replacing > >>> the TV > >> with > >>> a > >>> tissue valve in a patient who already has/needs a pacer (and I > >>> have a > >> low > >>> threshold for epicardials myself) - do you have different > >>> criteria for > >>> when > >>> you would intervene on the valve in the first place - since you > >>> already > >>> know > >>> that having leads will produces some degree of TR. Does that > >>> change if > >>> you > >>> know that the annulus is normal? > >>> > >>> -michael > >>> > >>> On Sat, May 2, 2009 at 6:54 PM, wrote: > >>> > >>>> Michael, > >>>> It depends on what is producing the TR. Sometimes the lead > >>>> actually > >>>> perforates the leaflet. In that case, a triangular resection and > >>>> subsequent > >>>> autologous pericardial patch will take care of it. Other > >>>> times, the > >>> lead > >>>> is > >>>> holding back the leaflet (usually posterior or septal), > >>>> producing the > >>> TR. > >>>> In those cases the lead should be shaved from the leaflet edge and > >>> then > >>>> forced into the corner of the postero-septal commissure. It is > >>>> held > >>> into > >>>> place with a couple of sutures. If these measures don't work, > >>>> then > >>>> consider > >>>> TVR (Mitral Magna is what I would use). > >>>> > >>>> Hal > >>>> > >>>> > >>>> In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, > >>>> msfirst@gmail.com writes: > >>>> > >>>> With patients with mod/sev TR (normal or near normal annular > >>>> sizes) > >>> from > >>>> distortion of the leaflets from chronic RV pacing leads - does > >>>> anyone > >>> have > >>>> thoughts on "fixing" these? Or some other management insight? > >>>> > >>>> > >>>> -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 > >>>> ----------------------------------------- > >>>> > >>>> > >>>> **************Check all of your email inboxes from anywhere on the > >> web. > >>>> Try the new Email Toolbar now! > >>>> (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027 > >>>> ) > >>>> _______________________________________________ > >>>> OpenHeart-L mailing list > >>>> > >>>> Send postings to: > >>>> OpenHeart-L@lists.hsforum.com > >>>> > >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l > >>>> > >>>> All messages transmitted by the OpenHeart-L are subject to the > >> policies > >>> and > >>>> disclaimers posted at: > >>>> http://www.hsforum.com/listdisclaim > >>>> ----------------------------------------- > >>>> > >>> _______________________________________________ > >>> OpenHeart-L mailing list > >>> > >>> Send postings to: > >>> OpenHeart-L@lists.hsforum.com > >>> > >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>> http://mmp.cjp.com/mailman/listinfo/openheart-l > >>> > >>> All messages transmitted by the OpenHeart-L are subject to the > >>> policies > >>> and > >>> disclaimers posted at: > >>> http://www.hsforum.com/listdisclaim > >>> ----------------------------------------- > >>> > >>> > >>> **************The Average US Credit Score is 692. See Yours in > >>> Just 2 > >> Easy > >>> Steps! > >>> ( > >>> > >> http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > >>> ay5309AvgfooterNO62) > >>> _______________________________________________ > >>> OpenHeart-L mailing list > >>> > >>> Send postings to: > >>> OpenHeart-L@lists.hsforum.com > >>> > >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>> http://mmp.cjp.com/mailman/listinfo/openheart-l > >>> > >>> All messages transmitted by the OpenHeart-L are subject to the > >>> policies > >> and > >>> disclaimers posted at: > >>> http://www.hsforum.com/listdisclaim > >>> ----------------------------------------- > >>> > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 > ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/ From msfirst at gmail.com Sun May 3 17:10:13 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun May 3 16:11:25 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <456239.23509.qm@web81601.mail.mud.yahoo.com> References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> <64644569-274F-4F80-8834-085A056E5CD6@gmail.com> <89c4ed2d0905030956y2662224fp78933aa08723e76@mail.gmail.com> <456239.23509.qm@web81601.mail.mud.yahoo.com> Message-ID: Those damn details define our trade -michael. On May 3, 2009, at 3:22 PM, Tea Acuff wrote: > Or back to the axillary cannulation thread just stick the arterial > cannula in the true lumen, false lumen of a dissection or any other > "convenient" location. We are like a bunch of old women arguing over > our favorite hat. Of course the sun hat might not do that well in a > down pour....damn details > tea > > > > ________________________________ > From: Ani Anyanwu > To: open heart list > Sent: Sunday, May 3, 2009 12:46:34 PM > Subject: RE: [HSF] Persistent LSVC > > > You can also very >> often just manage with a sucker inside for less complex cases. >> Prasanna > > > Yes - we seem to be making a simple matter very complicated. I am > sure the likes of Ed Raines will be wondering what all the mystery > is about as they do all mitrals with a single two stage or long > venous cannula and do not have problems with drainage. Why a need to > drain the left cava separately - doesnt the blood all end up in the > same place as the IVC blood? > > > > Ani > > > > > >> From: prasannasimha@gmail.com >> Date: Sun, 3 May 2009 22:26:43 +0530 >> Subject: Re: [HSF] Persistent LSVC >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> I have done it in the past but today with vacuum its so easy - just >> plonk a >> straight cannula inside and connect it to the reservoir with a >> 1/4th tube >> and then it is out of sight and out of mind. Why worry of even a >> potential >> for brain injury ? (We have enough potential as it is !!)You can >> also very >> often just manage with a sucker inside for less complex cases. >> Prasanna >> >> On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: >> >>> You can cannulate via the coronary sinus and if you need to open >>> the right >>> atrium, with an endotracheal tube. I have not done it. John Flege >>> >>> On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: >>> >>> For the 3rd or 4th time in a span of two years, I've been confronted >>>> with/ identified at the time of surgery, patients with a >>>> persistent Lt SVC. >>>> For the routine CAB, it's not really a problem, but 2 of them >>>> have been for >>>> mitral surgery. If I remember correctly, one had a diminutive SVC >>>> and no >>>> innominate vein. The other and most recent, had no SVC at all and >>>> a giant >>>> retro-cardiac vessel. >>>> >>>> For future reference, I'll be accepting any and all tips, pearls, >>>> and >>>> general knowledge. >>>> >>>> Thanks, 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 >>> ----------------------------------------- >>> >> >> >> >> -- >> 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 >> ----------------------------------------- > > _________________________________________________________________ > View your Twitter and Flickr updates from one place ? Learn more! > http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Sun May 3 23:38:26 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sun May 3 16:38:48 2009 Subject: [HSF] intraop epicardial echocardiography In-Reply-To: <89c4ed2d0905030341i4165eb1s16c2d9af31c71a75@mail.gmail.com> References: <89c4ed2d0904200436k6543f381kb039303584117752@mail.gmail.com> <497A038B-F68B-469D-B6DE-87B65D247C3F@hsforum.com> <89c4ed2d0905030341i4165eb1s16c2d9af31c71a75@mail.gmail.com> Message-ID: Tie a knot with a Mirror? Mirror...Spiegel, to look the mouth, your face, is not a knotter.... ?????? > From: prasannasimha@gmail.com > Date: Sun, 3 May 2009 16:11:20 +0530 > Subject: Re: [HSF] intraop epicardial echocardiography > To: OpenHeart-L@lists.hsforum.com > CC: > > You can if you practice !! > Dentists do it !! > Prasanna > > On Sun, May 3, 2009 at 3:46 PM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > > > > > how can you tie the knots with a dentist mirror?`? > > > > > From: mmlevinson@hsforum.com > > > To: OpenHeart-L@lists.hsforum.com > > > Subject: Re: [HSF] intraop epicardial echocardiography > > > Date: Sat, 2 May 2009 23:27:26 -0500 > > > CC: > > > > > > > > > On Apr 20, 2009, at 10:57 AM, erdin? naseri wrote: > > > > > > > > > > > Today we operated a 67 Y/O lady , BW56 kg for MS with ON-X mitral > > > > valve as the only available prosthesis .I preserved the posterior > > > > valve structures ( irrepairable). The prosthesis was somehow large > > > > for the lady so that I tied the posterior knots using dentists' > > > > mirror.While weaning VF developed and didn't responded to > > > > defibrilation .With no TEE probe available (malfunctioned in the > > > > arch case and is still nonfunctional) and an addiction developed > > > > for echocardiographic evaluation ,me and anesthesia team could rule > > > > out any prosthetic dysfx and LVOTO (due to large prosthesis). > > > > > > > > It can be a useful tool it there is no TEE probe > > > > > > > > erdinc > > > > > > > > > > Erdinc: > > > > > > I use epicardial echo to evaluate LV function and observe mitral > > > leaflet motion. Until recently we did not have routine TEE for > > > every case, so there were times when I needed to see the LV or > > > mitral. We have the Sono-Site portable echo machine with a cardiac > > > transducer which we place into a sterile sleeve and put it onto the > > > heart surface and get superb images. However, the Sono-Site does > > > not have good enough color flow to evaluate the degree of mitral > > > regurgitation. > > > > > > In cases where we could not put a TEE probe down the esophagous > > > (stricture, unable to safely intubate the esophagus), I have placed > > > the TEE probe into a sterile sleeve and placed it onto the cardiac > > > surface and obtained some very useful images. It is clumsy to use, > > > but works > > > > > > Thanks, > > > > > > Mark > > > > > > Mark Levinson, MD. > > > Founder, Editor-in-Chief > > > The Heart Surgery Forum? > > > Multimedia Cardiothoracic Journal > > > URL: http://www.hsforum.com > > > URL: http://newoptionsinheartsurgery.com > > > Emali: mmlevinson@hsforum.com > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Sun May 3 23:53:22 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sun May 3 16:54:04 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <006c01c9cc1f$a114b0b0$30d9e818@LIBERTAD> References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net><89c4ed2d0905021842u1f8d23d2m6ccb6783d9330e67@mail.gmail.com> <006c01c9cc1f$a114b0b0$30d9e818@LIBERTAD> Message-ID: the problem is when you have no preop diagnosis... Roberto > From: gabuin@intramed.net > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Persistent LSVC > Date: Sun, 3 May 2009 15:47:36 -0300 > CC: > > -If there is a good innominate vein and RSVC, don`t worry, you can clamp the > left cava and go as usual. > > -If the right vena cava is small you can cannulate directly the left > superior vena cava with a 24Fr. pacifico cannula. > > -If you are in doubt because you have two venae cavae of good quality, you > can cannulate both. > > -If there is "no" innomintate venous trunk, be careful, because there may be > a posterior innominate vein, retroaortic, and nothing matters regarding the > venous return, but the aortic clamp may be dangerous. > > gustavo > ----- Original Message ----- > From: "Roberto Battellini" > To: "lists HSF" > Sent: Sunday, May 03, 2009 7:23 AM > Subject: RE: [HSF] Persistent LSVC > > > > I have had the case may be 2 years ago in a mitro-tricuspid case. I did it > without preop diagnosis. > > It came soooo much blood back,first i thougt was a big Foramen Ovale, and > did a couple of stitches, > > then I recognized it and cannulated the left cava from the coronary sinus. I > cut my stitches, of course. > > Roberto > > > From: prasannasimha@gmail.com > > Date: Sun, 3 May 2009 07:12:35 +0530 > > Subject: Re: [HSF] Persistent LSVC > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > Mitch it probably is unusual for adult surgery but is pretty common in the > > pediatric set up. Acrtually ther isnt much of a problem if you are > > suddenly > > confornted with it and there is vacuum assit. Just plonk a straight venous > > cannula into the left SVC via the coronary sinus and connect it via a 1/4 > > inch line to the venous reservoir. > > If the innominate vein is good technically you can clamp the left SVC. > > Retrograde cardioplegia will be ineffective with a left SVC.Deaths have > > been > > reported when this has been done as the retroplegic distibution can be > > highly varied even if the left SVC is snared (If you depend on retroplegia > > for prolonged periods of arrest). > > > > On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman wrote: > > > > > For the 3rd or 4th time in a span of two years, I've been confronted > > > with/ > > > identified at the time of surgery, patients with a persistent Lt SVC. > > > For > > > the routine CAB, it's not really a problem, but 2 of them have been for > > > mitral surgery. If I remember correctly, one had a diminutive SVC and no > > > innominate vein. The other and most recent, had no SVC at all and a > > > giant > > > retro-cardiac vessel. > > > > > > For future reference, I'll be accepting any and all tips, pearls, and > > > general knowledge. > > > > > > Thanks, 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 > > > ----------------------------------------- > > > > > > > > > > > -- > > Prasanna Simha M > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > -------------------------------------------------------------------------------- > > > > No virus found in this incoming message. > Checked by AVG - www.avg.com > Version: 8.5.325 / Virus Database: 270.12.15/2093 - Release Date: 05/02/09 > 14:23:00 > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Sun May 3 23:55:34 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sun May 3 16:56:16 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> References: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> Message-ID: Paravalvular leak??? Roberto > From: prasannasimha@gmail.com > Date: Sun, 3 May 2009 22:27:35 +0530 > Subject: Re: [HSF] Pacer Lead Induced TR > To: OpenHeart-L@lists.hsforum.com > CC: > > new tricuspid valve ? You dont put the lead through the new valve you put it > outside - between the sewing rim and the true annulus . > Prasanna > > On Sun, May 3, 2009 at 9:32 PM, Michael Firstenberg wrote: > > > How much TR would be left after putting a lead through a new TV? > > Not to mention the risks for lead infections? > > > > -michael > > > > On Sun, May 3, 2009 at 8:00 AM, wrote: > > > > > Michael, > > > From the way your initial post read, I assume you were referring to > > > clinically important TR associated with permanent pacing leads. It is > > well > > > documented in the literature that moderate or worse TR adversely impacts > > > the 10 > > > yr survival, similar to moderate or worse MR. I would rather leave a > > > patient with a bioprosthesis instead of severe TR. > > > > > > Hal > > > > > > > > > In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time, > > > msfirst@gmail.com writes: > > > > > > Hal, > > > Since you are trading one disease for another - i.e. replacing the TV > > with > > > a > > > tissue valve in a patient who already has/needs a pacer (and I have a > > low > > > threshold for epicardials myself) - do you have different criteria for > > > when > > > you would intervene on the valve in the first place - since you already > > > know > > > that having leads will produces some degree of TR. Does that change if > > > you > > > know that the annulus is normal? > > > > > > -michael > > > > > > On Sat, May 2, 2009 at 6:54 PM, wrote: > > > > > > > Michael, > > > > It depends on what is producing the TR. Sometimes the lead actually > > > > perforates the leaflet. In that case, a triangular resection and > > > > subsequent > > > > autologous pericardial patch will take care of it. Other times, the > > > lead > > > > is > > > > holding back the leaflet (usually posterior or septal), producing the > > > TR. > > > > In those cases the lead should be shaved from the leaflet edge and > > > then > > > > forced into the corner of the postero-septal commissure. It is held > > > into > > > > place with a couple of sutures. If these measures don't work, then > > > > consider > > > > TVR (Mitral Magna is what I would use). > > > > > > > > Hal > > > > > > > > > > > > In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, > > > > msfirst@gmail.com writes: > > > > > > > > With patients with mod/sev TR (normal or near normal annular sizes) > > > from > > > > distortion of the leaflets from chronic RV pacing leads - does anyone > > > have > > > > thoughts on "fixing" these? Or some other management insight? > > > > > > > > > > > > -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 > > > > ----------------------------------------- > > > > > > > > > > > > **************Check all of your email inboxes from anywhere on the > > web. > > > > Try the new Email Toolbar now! > > > > (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027) > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies > > > and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > > > > **************The Average US Credit Score is 692. See Yours in Just 2 > > Easy > > > Steps! > > > ( > > > > > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > > > ay5309AvgfooterNO62) > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From msfirst at gmail.com Sun May 3 17:58:29 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun May 3 16:58:43 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: <6.2.1.2.2.20090502155029.01e27ce0@pop.east.cox.net> <89c4ed2d0905021842u1f8d23d2m6ccb6783d9330e67@mail.gmail.com> <006c01c9cc1f$a114b0b0$30d9e818@LIBERTAD> Message-ID: not to disgress too much - but how often do people "encounter" surprises (and what kind, besides MR that was worse than expected). How much of a routine work-up do people do. for example - for AS do you get CT scans looking for an enlarged aorta? -michael On Sun, May 3, 2009 at 4:53 PM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > the problem is when you have no preop diagnosis... > > Roberto > > > From: gabuin@intramed.net > > To: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Persistent LSVC > > Date: Sun, 3 May 2009 15:47:36 -0300 > > CC: > > > > -If there is a good innominate vein and RSVC, don`t worry, you can clamp > the > > left cava and go as usual. > > > > -If the right vena cava is small you can cannulate directly the left > > superior vena cava with a 24Fr. pacifico cannula. > > > > -If you are in doubt because you have two venae cavae of good quality, > you > > can cannulate both. > > > > -If there is "no" innomintate venous trunk, be careful, because there may > be > > a posterior innominate vein, retroaortic, and nothing matters regarding > the > > venous return, but the aortic clamp may be dangerous. > > > > gustavo > > ----- Original Message ----- > > From: "Roberto Battellini" > > To: "lists HSF" > > Sent: Sunday, May 03, 2009 7:23 AM > > Subject: RE: [HSF] Persistent LSVC > > > > > > > > I have had the case may be 2 years ago in a mitro-tricuspid case. I did > it > > without preop diagnosis. > > > > It came soooo much blood back,first i thougt was a big Foramen Ovale, and > > did a couple of stitches, > > > > then I recognized it and cannulated the left cava from the coronary > sinus. I > > cut my stitches, of course. > > > > Roberto > > > > > From: prasannasimha@gmail.com > > > Date: Sun, 3 May 2009 07:12:35 +0530 > > > Subject: Re: [HSF] Persistent LSVC > > > To: OpenHeart-L@lists.hsforum.com > > > CC: > > > > > > Mitch it probably is unusual for adult surgery but is pretty common in > the > > > pediatric set up. Acrtually ther isnt much of a problem if you are > > > suddenly > > > confornted with it and there is vacuum assit. Just plonk a straight > venous > > > cannula into the left SVC via the coronary sinus and connect it via a > 1/4 > > > inch line to the venous reservoir. > > > If the innominate vein is good technically you can clamp the left SVC. > > > Retrograde cardioplegia will be ineffective with a left SVC.Deaths have > > > been > > > reported when this has been done as the retroplegic distibution can be > > > highly varied even if the left SVC is snared (If you depend on > retroplegia > > > for prolonged periods of arrest). > > > > > > On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman > wrote: > > > > > > > For the 3rd or 4th time in a span of two years, I've been confronted > > > > with/ > > > > identified at the time of surgery, patients with a persistent Lt SVC. > > > > For > > > > the routine CAB, it's not really a problem, but 2 of them have been > for > > > > mitral surgery. If I remember correctly, one had a diminutive SVC and > no > > > > innominate vein. The other and most recent, had no SVC at all and a > > > > giant > > > > retro-cardiac vessel. > > > > > > > > For future reference, I'll be accepting any and all tips, pearls, and > > > > general knowledge. > > > > > > > > Thanks, 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 > > > > ----------------------------------------- > > > > > > > > > > > > > > > > -- > > > Prasanna Simha M > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > > -------------------------------------------------------------------------------- > > > > > > > > No virus found in this incoming message. > > Checked by AVG - www.avg.com > > Version: 8.5.325 / Virus Database: 270.12.15/2093 - Release Date: > 05/02/09 > > 14:23:00 > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From msfirst at gmail.com Sun May 3 18:02:09 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun May 3 17:02:32 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: References: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> Message-ID: These are all things that I have seen and done, but I get the sense that sometimes we are trading 1 disease for potentially several - that might have difficult or interesting management implications. For example, I am dealing now with infected epicardial pacing leads - 2 years post-op which has been a real headache for the patient (and me also). We have a very busy EP group here and without any evidence, I am not sure long-term CS leads are a great idea and extracted leads can be hard enough as it it- to pull them through outside of a valve cuff sounds like a disaster in the making. I am sure Tea will have some insightful comments on this. -michael On Sun, May 3, 2009 at 4:55 PM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > Paravalvular leak??? > > Roberto > > > From: prasannasimha@gmail.com > > Date: Sun, 3 May 2009 22:27:35 +0530 > > Subject: Re: [HSF] Pacer Lead Induced TR > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > new tricuspid valve ? You dont put the lead through the new valve you put > it > > outside - between the sewing rim and the true annulus . > > Prasanna > > > > On Sun, May 3, 2009 at 9:32 PM, Michael Firstenberg >wrote: > > > > > How much TR would be left after putting a lead through a new TV? > > > Not to mention the risks for lead infections? > > > > > > -michael > > > > > > On Sun, May 3, 2009 at 8:00 AM, wrote: > > > > > > > Michael, > > > > From the way your initial post read, I assume you were referring to > > > > clinically important TR associated with permanent pacing leads. It is > > > well > > > > documented in the literature that moderate or worse TR adversely > impacts > > > > the 10 > > > > yr survival, similar to moderate or worse MR. I would rather leave a > > > > patient with a bioprosthesis instead of severe TR. > > > > > > > > Hal > > > > > > > > > > > > In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time, > > > > msfirst@gmail.com writes: > > > > > > > > Hal, > > > > Since you are trading one disease for another - i.e. replacing the TV > > > with > > > > a > > > > tissue valve in a patient who already has/needs a pacer (and I have a > > > low > > > > threshold for epicardials myself) - do you have different criteria > for > > > > when > > > > you would intervene on the valve in the first place - since you > already > > > > know > > > > that having leads will produces some degree of TR. Does that change > if > > > > you > > > > know that the annulus is normal? > > > > > > > > -michael > > > > > > > > On Sat, May 2, 2009 at 6:54 PM, wrote: > > > > > > > > > Michael, > > > > > It depends on what is producing the TR. Sometimes the lead actually > > > > > perforates the leaflet. In that case, a triangular resection and > > > > > subsequent > > > > > autologous pericardial patch will take care of it. Other times, the > > > > lead > > > > > is > > > > > holding back the leaflet (usually posterior or septal), producing > the > > > > TR. > > > > > In those cases the lead should be shaved from the leaflet edge and > > > > then > > > > > forced into the corner of the postero-septal commissure. It is held > > > > into > > > > > place with a couple of sutures. If these measures don't work, then > > > > > consider > > > > > TVR (Mitral Magna is what I would use). > > > > > > > > > > Hal > > > > > > > > > > > > > > > In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, > > > > > msfirst@gmail.com writes: > > > > > > > > > > With patients with mod/sev TR (normal or near normal annular sizes) > > > > from > > > > > distortion of the leaflets from chronic RV pacing leads - does > anyone > > > > have > > > > > thoughts on "fixing" these? Or some other management insight? > > > > > > > > > > > > > > > -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 > > > > > ----------------------------------------- > > > > > > > > > > > > > > > **************Check all of your email inboxes from anywhere on the > > > web. > > > > > Try the new Email Toolbar now! > > > > > ( > http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027) > > > > > _______________________________________________ > > > > > OpenHeart-L mailing list > > > > > > > > > > Send postings to: > > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > > policies > > > > and > > > > > disclaimers posted at: > > > > > http://www.hsforum.com/listdisclaim > > > > > ----------------------------------------- > > > > > > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > policies > > > > and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > > > > > > > > > **************The Average US Credit Score is 692. See Yours in Just 2 > > > Easy > > > > Steps! > > > > ( > > > > > > > > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > > > > ay5309AvgfooterNO62) > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > policies > > > and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/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 jpym at erols.com Sun May 3 18:32:08 2009 From: jpym at erols.com (John Pym) Date: Sun May 3 17:32:27 2009 Subject: [HSF] Pacer Lead Induced TR In-Reply-To: References: <89c4ed2d0905030957y789a8441m1b1111517c84b6d@mail.gmail.com> Message-ID: Speaking as one who has done >3500 pacemakers and ICDs and who has substantial lead extraction experience, I would not advise fixing a lead outside the sewing ring of a tricuspid prosthesis. Ani's case illustrates what you can get away with . . . sometimes. If that ICD lead was several years out, rather than 7 months, the outcome would have been very different. I have personally followed two patients for greater than 10 years with pacemaker leads across a tricuspid bioprosthesis without any evidence of valve dysfunction. (I know, n=2 is not a series, but I doubt whether anyone has a large number of these.) I believe that it is OK to place a pacemaker lead across a tricuspid bioprosthesis if it is small, floppy and polyurethane-insulated (less likely to adhere) e.g. Boston Scientific Fineline or Medtronic 4074. I wouldn't do this with ICD leads which are much firmer and could hold a leaflet open. As Michael points out, epicardial leads have their own problems. The major one is high chronic pacing thresholds and a very significant rate of exit block with screw-in epicardial leads. (The steroid-eluting pad electrodes are rarely applicable outside the pediatric population.) Unfortunately, it is not economically viable for industry to develop a new design of epicardial lead and get it through the FDA. I am preparing to write up a series of epicardial / intramyocardial leads with excellent thresholds (most < 1 V @ 0.5 msec.) up to 5 years; unfortunately, this is an "off-label" use of existing leads, but that is another story. John Pym On Sun, May 3, 2009 at 5:02 PM, Michael Firstenberg wrote: > These are all things that I have seen and done, but I get the sense that > sometimes we are trading 1 disease for potentially several - that might > have > difficult or interesting management implications. For example, I am > dealing > now with infected epicardial pacing leads - 2 years post-op which has been > a > real headache for the patient (and me also). > > We have a very busy EP group here and without any evidence, I am not sure > long-term CS leads are a great idea and extracted leads can be hard enough > as it it- to pull them through outside of a valve cuff sounds like a > disaster in the making. > > I am sure Tea will have some insightful comments on this. > > -michael > > On Sun, May 3, 2009 at 4:55 PM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > > > > > Paravalvular leak??? > > > > Roberto > > > > > From: prasannasimha@gmail.com > > > Date: Sun, 3 May 2009 22:27:35 +0530 > > > Subject: Re: [HSF] Pacer Lead Induced TR > > > To: OpenHeart-L@lists.hsforum.com > > > CC: > > > > > > new tricuspid valve ? You dont put the lead through the new valve you > put > > it > > > outside - between the sewing rim and the true annulus . > > > Prasanna > > > > > > On Sun, May 3, 2009 at 9:32 PM, Michael Firstenberg > >wrote: > > > > > > > How much TR would be left after putting a lead through a new TV? > > > > Not to mention the risks for lead infections? > > > > > > > > -michael > > > > > > > > On Sun, May 3, 2009 at 8:00 AM, wrote: > > > > > > > > > Michael, > > > > > From the way your initial post read, I assume you were referring to > > > > > clinically important TR associated with permanent pacing leads. It > is > > > > well > > > > > documented in the literature that moderate or worse TR adversely > > impacts > > > > > the 10 > > > > > yr survival, similar to moderate or worse MR. I would rather leave > a > > > > > patient with a bioprosthesis instead of severe TR. > > > > > > > > > > Hal > > > > > > > > > > > > > > > In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time, > > > > > msfirst@gmail.com writes: > > > > > > > > > > Hal, > > > > > Since you are trading one disease for another - i.e. replacing the > TV > > > > with > > > > > a > > > > > tissue valve in a patient who already has/needs a pacer (and I have > a > > > > low > > > > > threshold for epicardials myself) - do you have different criteria > > for > > > > > when > > > > > you would intervene on the valve in the first place - since you > > already > > > > > know > > > > > that having leads will produces some degree of TR. Does that change > > if > > > > > you > > > > > know that the annulus is normal? > > > > > > > > > > -michael > > > > > > > > > > On Sat, May 2, 2009 at 6:54 PM, wrote: > > > > > > > > > > > Michael, > > > > > > It depends on what is producing the TR. Sometimes the lead > actually > > > > > > perforates the leaflet. In that case, a triangular resection and > > > > > > subsequent > > > > > > autologous pericardial patch will take care of it. Other times, > the > > > > > lead > > > > > > is > > > > > > holding back the leaflet (usually posterior or septal), producing > > the > > > > > TR. > > > > > > In those cases the lead should be shaved from the leaflet edge > and > > > > > then > > > > > > forced into the corner of the postero-septal commissure. It is > held > > > > > into > > > > > > place with a couple of sutures. If these measures don't work, > then > > > > > > consider > > > > > > TVR (Mitral Magna is what I would use). > > > > > > > > > > > > Hal > > > > > > > > > > > > > > > > > > In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time, > > > > > > msfirst@gmail.com writes: > > > > > > > > > > > > With patients with mod/sev TR (normal or near normal annular > sizes) > > > > > from > > > > > > distortion of the leaflets from chronic RV pacing leads - does > > anyone > > > > > have > > > > > > thoughts on "fixing" these? Or some other management insight? > > > > > > > > > > > > > > > > > > -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 > > > > > > ----------------------------------------- > > > > > > > > > > > > > > > > > > **************Check all of your email inboxes from anywhere on > the > > > > web. > > > > > > Try the new Email Toolbar now! > > > > > > ( > > http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027) > > > > > > _______________________________________________ > > > > > > OpenHeart-L mailing list > > > > > > > > > > > > Send postings to: > > > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > > > policies > > > > > and > > > > > > disclaimers posted at: > > > > > > http://www.hsforum.com/listdisclaim > > > > > > ----------------------------------------- > > > > > > > > > > > _______________________________________________ > > > > > OpenHeart-L mailing list > > > > > > > > > > Send postings to: > > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies > > > > > and > > > > > disclaimers posted at: > > > > > http://www.hsforum.com/listdisclaim > > > > > ----------------------------------------- > > > > > > > > > > > > > > > **************The Average US Credit Score is 692. See Yours in Just > 2 > > > > Easy > > > > > Steps! > > > > > ( > > > > > > > > > > > > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > > > > > ay5309AvgfooterNO62) > > > > > _______________________________________________ > > > > > OpenHeart-L mailing list > > > > > > > > > > Send postings to: > > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies > > > > and > > > > > disclaimers posted at: > > > > > http://www.hsforum.com/listdisclaim > > > > > ----------------------------------------- > > > > > > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/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 > ----------------------------------------- > -- John Pym MB, BS, FRACS, FRCSC, FACS Professor of Surgery From Hgrmd at aol.com Sun May 3 18:39:29 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun May 3 17:41:53 2009 Subject: [HSF] Persistent LSVC Message-ID: Michael, As a matter of fact, for AS and AI patients, if no LV gram is done and the aorta isn't visualized, I do a CT of the chest to make sure that the ascending aorta doesn't need to be replaced. The older I get, the less I leave to chance. Hal In a message dated 5/3/2009 4:59:37 P.M. Eastern Daylight Time, msfirst@gmail.com writes: not to disgress too much - but how often do people "encounter" surprises (and what kind, besides MR that was worse than expected). How much of a routine work-up do people do. for example - for AS do you get CT scans looking for an enlarged aorta? -michael On Sun, May 3, 2009 at 4:53 PM, Roberto Battellini < robertobattellini@hotmail.com> wrote: > > the problem is when you have no preop diagnosis... > > Roberto > > > From: gabuin@intramed.net > > To: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Persistent LSVC > > Date: Sun, 3 May 2009 15:47:36 -0300 > > CC: > > > > -If there is a good innominate vein and RSVC, don`t worry, you can clamp > the > > left cava and go as usual. > > > > -If the right vena cava is small you can cannulate directly the left > > superior vena cava with a 24Fr. pacifico cannula. > > > > -If you are in doubt because you have two venae cavae of good quality, > you > > can cannulate both. > > > > -If there is "no" innomintate venous trunk, be careful, because there may > be > > a posterior innominate vein, retroaortic, and nothing matters regarding > the > > venous return, but the aortic clamp may be dangerous. > > > > gustavo > > ----- Original Message ----- > > From: "Roberto Battellini" > > To: "lists HSF" > > Sent: Sunday, May 03, 2009 7:23 AM > > Subject: RE: [HSF] Persistent LSVC > > > > > > > > I have had the case may be 2 years ago in a mitro-tricuspid case. I did > it > > without preop diagnosis. > > > > It came soooo much blood back,first i thougt was a big Foramen Ovale, and > > did a couple of stitches, > > > > then I recognized it and cannulated the left cava from the coronary > sinus. I > > cut my stitches, of course. > > > > Roberto > > > > > From: prasannasimha@gmail.com > > > Date: Sun, 3 May 2009 07:12:35 +0530 > > > Subject: Re: [HSF] Persistent LSVC > > > To: OpenHeart-L@lists.hsforum.com > > > CC: > > > > > > Mitch it probably is unusual for adult surgery but is pretty common in > the > > > pediatric set up. Acrtually ther isnt much of a problem if you are > > > suddenly > > > confornted with it and there is vacuum assit. Just plonk a straight > venous > > > cannula into the left SVC via the coronary sinus and connect it via a > 1/4 > > > inch line to the venous reservoir. > > > If the innominate vein is good technically you can clamp the left SVC. > > > Retrograde cardioplegia will be ineffective with a left SVC.Deaths have > > > been > > > reported when this has been done as the retroplegic distibution can be > > > highly varied even if the left SVC is snared (If you depend on > retroplegia > > > for prolonged periods of arrest). > > > > > > On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman > wrote: > > > > > > > For the 3rd or 4th time in a span of two years, I've been confronted > > > > with/ > > > > identified at the time of surgery, patients with a persistent Lt SVC. > > > > For > > > > the routine CAB, it's not really a problem, but 2 of them have been > for > > > > mitral surgery. If I remember correctly, one had a diminutive SVC and > no > > > > innominate vein. The other and most recent, had no SVC at all and a > > > > giant > > > > retro-cardiac vessel. > > > > > > > > For future reference, I'll be accepting any and all tips, pearls, and > > > > general knowledge. > > > > > > > > Thanks, 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 > > > > ----------------------------------------- > > > > > > > > > > > > > > > > -- > > > Prasanna Simha M > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > > -------------------------------------------------------------------------------- > > > > > > > > No virus found in this incoming message. > > Checked by AVG - www.avg.com > > Version: 8.5.325 / Virus Database: 270.12.15/2093 - Release Date: > 05/02/09 > > 14:23:00 > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62) From msfirst at gmail.com Sun May 3 18:52:52 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun May 3 18:41:22 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: I also have been getting more and more CT scan - typically without contrast (I have enough renal problems and anyone who doesnt believe in contrast nephropathy obviously doesnt follow patients long enough - probably worse than aprotinin!) so that I can see the aorta size and calcifications. I dont like surprises...... On May 3, 2009, at 5:39 PM, hgrmd@aol.com wrote: > Michael, > As a matter of fact, for AS and AI patients, if no LV gram is done > and > the aorta isn't visualized, I do a CT of the chest to make sure that > the > ascending aorta doesn't need to be replaced. The older I get, the > less I > leave to chance. > > Hal > > > In a message dated 5/3/2009 4:59:37 P.M. Eastern Daylight Time, > msfirst@gmail.com writes: > > not to disgress too much - but how often do people "encounter" > surprises > (and what kind, besides MR that was worse than expected). How much > of a > routine work-up do people do. for example - for AS do you get CT > scans > looking for an enlarged aorta? > > -michael > > > > > On Sun, May 3, 2009 at 4:53 PM, Roberto Battellini < > robertobattellini@hotmail.com> wrote: > >> >> the problem is when you have no preop diagnosis... >> >> Roberto >> >>> From: gabuin@intramed.net >>> To: OpenHeart-L@lists.hsforum.com >>> Subject: Re: [HSF] Persistent LSVC >>> Date: Sun, 3 May 2009 15:47:36 -0300 >>> CC: >>> >>> -If there is a good innominate vein and RSVC, don`t worry, you can > clamp >> the >>> left cava and go as usual. >>> >>> -If the right vena cava is small you can cannulate directly the >>> left >>> superior vena cava with a 24Fr. pacifico cannula. >>> >>> -If you are in doubt because you have two venae cavae of good >>> quality, >> you >>> can cannulate both. >>> >>> -If there is "no" innomintate venous trunk, be careful, because >>> there > may >> be >>> a posterior innominate vein, retroaortic, and nothing matters >>> regarding >> the >>> venous return, but the aortic clamp may be dangerous. >>> >>> gustavo >>> ----- Original Message ----- >>> From: "Roberto Battellini" >>> To: "lists HSF" > >>> Sent: Sunday, May 03, 2009 7:23 AM >>> Subject: RE: [HSF] Persistent LSVC >>> >>> >>> >>> I have had the case may be 2 years ago in a mitro-tricuspid case. >>> I did >> it >>> without preop diagnosis. >>> >>> It came soooo much blood back,first i thougt was a big Foramen >>> Ovale, > and >>> did a couple of stitches, >>> >>> then I recognized it and cannulated the left cava from the coronary >> sinus. I >>> cut my stitches, of course. >>> >>> Roberto >>> >>>> From: prasannasimha@gmail.com >>>> Date: Sun, 3 May 2009 07:12:35 +0530 >>>> Subject: Re: [HSF] Persistent LSVC >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> >>>> Mitch it probably is unusual for adult surgery but is pretty >>>> common > in >> the >>>> pediatric set up. Acrtually ther isnt much of a problem if you are >>>> suddenly >>>> confornted with it and there is vacuum assit. Just plonk a >>>> straight >> venous >>>> cannula into the left SVC via the coronary sinus and connect it >>>> via a >> 1/4 >>>> inch line to the venous reservoir. >>>> If the innominate vein is good technically you can clamp the left > SVC. >>>> Retrograde cardioplegia will be ineffective with a left SVC.Deaths > have >>>> been >>>> reported when this has been done as the retroplegic distibution >>>> can > be >>>> highly varied even if the left SVC is snared (If you depend on >> retroplegia >>>> for prolonged periods of arrest). >>>> >>>> On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman >> wrote: >>>> >>>>> For the 3rd or 4th time in a span of two years, I've been > confronted >>>>> with/ >>>>> identified at the time of surgery, patients with a persistent Lt > SVC. >>>>> For >>>>> the routine CAB, it's not really a problem, but 2 of them have >>>>> been >> for >>>>> mitral surgery. If I remember correctly, one had a diminutive SVC > and >> no >>>>> innominate vein. The other and most recent, had no SVC at all >>>>> and a >>>>> giant >>>>> retro-cardiac vessel. >>>>> >>>>> For future reference, I'll be accepting any and all tips, pearls, > and >>>>> general knowledge. >>>>> >>>>> Thanks, 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 >>>>> ----------------------------------------- >>>>> >>>> >>>> >>>> >>>> -- >>>> Prasanna Simha M >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the > policies >>>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> >>> >> > -------------------------------------------------------------------------------- >>> >>> >>> >>> No virus found in this incoming message. >>> Checked by AVG - www.avg.com >>> Version: 8.5.325 / Virus Database: 270.12.15/2093 - Release Date: >> 05/02/09 >>> 14:23:00 >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies > and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > **************The Average US Credit Score is 692. See Yours in Just > 2 Easy > Steps! > (http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx > ?sc=668072&hmpgID=62&bcd=M > ay5309AvgfooterNO62) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Sun May 3 17:29:50 2009 From: tacuff at swbell.net (Tea Acuff) Date: Sun May 3 19:31:14 2009 Subject: [HSF] Persistent LSVC Message-ID: <60160.64108.qm@web81605.mail.mud.yahoo.com> And there are no universally useful hats... Tea Sent from my iPhone On May 3, 2009, at 3:10 PM, Michael Firstenberg wrote: Those damn details define our trade -michael. On May 3, 2009, at 3:22 PM, Tea Acuff wrote: Or back to the axillary cannulation thread just stick the arterial cannula in the true lumen, false lumen of a dissection or any other "convenient" location. We are like a bunch of old women arguing over our favorite hat. Of course the sun hat might not do that well in a down pour....damn details tea ________________________________ From: Ani Anyanwu To: open heart list Sent: Sunday, May 3, 2009 12:46:34 PM Subject: RE: [HSF] Persistent LSVC You can also very often just manage with a sucker inside for less complex cases. Prasanna Yes - we seem to be making a simple matter very complicated. I am sure the likes of Ed Raines will be wondering what all the mystery is about as they do all mitrals with a single two stage or long venous cannula and do not have problems with drainage. Why a need to drain the left cava separately - doesnt the blood all end up in the same place as the IVC blood? Ani From: prasannasimha@gmail.com Date: Sun, 3 May 2009 22:26:43 +0530 Subject: Re: [HSF] Persistent LSVC To: OpenHeart-L@lists.hsforum.com CC: I have done it in the past but today with vacuum its so easy - just plonk a straight cannula inside and connect it to the reservoir with a 1/4th tube and then it is out of sight and out of mind. Why worry of even a potential for brain injury ? (We have enough potential as it is !!)You can also very often just manage with a sucker inside for less complex cases. Prasanna On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: You can cannulate via the coronary sinus and if you need to open the right atrium, with an endotracheal tube. I have not done it. John Flege On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: For the 3rd or 4th time in a span of two years, I've been confronted with/ identified at the time of surgery, patients with a persistent Lt SVC. For the routine CAB, it's not really a problem, but 2 of them have been for mitral surgery. If I remember correctly, one had a diminutive SVC and no innominate vein. The other and most recent, had no SVC at all and a giant retro-cardiac vessel. For future reference, I'll be accepting any and all tips, pearls, and general knowledge. Thanks, 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 ----------------------------------------- -- 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 ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From benjamin.bidstrup at bigpond.com Mon May 4 11:27:55 2009 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Sun May 3 20:28:31 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: <4B173E91-4C08-4727-A070-1D9B36FA8D3F@bigpond.com> One wonders how many of the issues attributed to aprotinin were in fact due to other causes - contrast, simply long bypass times. But now that is all a matter of conjecture. Very much like Tea's n= 1 or 2, vs population studies that do not or rather cannot take into account all factors simply because they are not collected and analysed. Ben Bidstrup FRACS FRCSEd FEBCTS Cardiothoracic Surgeon On 04/05/2009, at 7:52 AM, Michael Firstenberg wrote: > I also have been getting more and more CT scan - typically without > contrast (I have enough renal problems and anyone who doesnt believe > in contrast nephropathy obviously doesnt follow patients long enough > - probably worse than aprotinin!) so that I can see the aorta size > and calcifications. > > I dont like surprises...... > > > > On May 3, 2009, at 5:39 PM, hgrmd@aol.com wrote: > >> Michael, >> As a matter of fact, for AS and AI patients, if no LV gram is done >> and >> the aorta isn't visualized, I do a CT of the chest to make sure >> that the >> ascending aorta doesn't need to be replaced. The older I get, the >> less I >> leave to chance. >> >> Hal >> >> >> In a message dated 5/3/2009 4:59:37 P.M. Eastern Daylight Time, >> msfirst@gmail.com writes: >> >> not to disgress too much - but how often do people "encounter" >> surprises >> (and what kind, besides MR that was worse than expected). How >> much of a >> routine work-up do people do. for example - for AS do you get CT >> scans >> looking for an enlarged aorta? >> >> -michael >> >> >> >> >> On Sun, May 3, 2009 at 4:53 PM, Roberto Battellini < >> robertobattellini@hotmail.com> wrote: >> >>> >>> the problem is when you have no preop diagnosis... >>> >>> Roberto >>> >>>> From: gabuin@intramed.net >>>> To: OpenHeart-L@lists.hsforum.com >>>> Subject: Re: [HSF] Persistent LSVC >>>> Date: Sun, 3 May 2009 15:47:36 -0300 >>>> CC: >>>> >>>> -If there is a good innominate vein and RSVC, don`t worry, you can >> clamp >>> the >>>> left cava and go as usual. >>>> >>>> -If the right vena cava is small you can cannulate directly the >>>> left >>>> superior vena cava with a 24Fr. pacifico cannula. >>>> >>>> -If you are in doubt because you have two venae cavae of good >>>> quality, >>> you >>>> can cannulate both. >>>> >>>> -If there is "no" innomintate venous trunk, be careful, because >>>> there >> may >>> be >>>> a posterior innominate vein, retroaortic, and nothing matters >>>> regarding >>> the >>>> venous return, but the aortic clamp may be dangerous. >>>> >>>> gustavo >>>> ----- Original Message ----- >>>> From: "Roberto Battellini" >>>> To: "lists HSF" >> >>>> Sent: Sunday, May 03, 2009 7:23 AM >>>> Subject: RE: [HSF] Persistent LSVC >>>> >>>> >>>> >>>> I have had the case may be 2 years ago in a mitro-tricuspid >>>> case. I did >>> it >>>> without preop diagnosis. >>>> >>>> It came soooo much blood back,first i thougt was a big Foramen >>>> Ovale, >> and >>>> did a couple of stitches, >>>> >>>> then I recognized it and cannulated the left cava from the >>>> coronary >>> sinus. I >>>> cut my stitches, of course. >>>> >>>> Roberto >>>> >>>>> From: prasannasimha@gmail.com >>>>> Date: Sun, 3 May 2009 07:12:35 +0530 >>>>> Subject: Re: [HSF] Persistent LSVC >>>>> To: OpenHeart-L@lists.hsforum.com >>>>> CC: >>>>> >>>>> Mitch it probably is unusual for adult surgery but is pretty >>>>> common >> in >>> the >>>>> pediatric set up. Acrtually ther isnt much of a problem if you >>>>> are >>>>> suddenly >>>>> confornted with it and there is vacuum assit. Just plonk a >>>>> straight >>> venous >>>>> cannula into the left SVC via the coronary sinus and connect it >>>>> via a >>> 1/4 >>>>> inch line to the venous reservoir. >>>>> If the innominate vein is good technically you can clamp the left >> SVC. >>>>> Retrograde cardioplegia will be ineffective with a left >>>>> SVC.Deaths >> have >>>>> been >>>>> reported when this has been done as the retroplegic distibution >>>>> can >> be >>>>> highly varied even if the left SVC is snared (If you depend on >>> retroplegia >>>>> for prolonged periods of arrest). >>>>> >>>>> On Sun, May 3, 2009 at 2:29 AM, Mitch Lirtzman >>> wrote: >>>>> >>>>>> For the 3rd or 4th time in a span of two years, I've been >> confronted >>>>>> with/ >>>>>> identified at the time of surgery, patients with a persistent Lt >> SVC. >>>>>> For >>>>>> the routine CAB, it's not really a problem, but 2 of them have >>>>>> been >>> for >>>>>> mitral surgery. If I remember correctly, one had a diminutive >>>>>> SVC >> and >>> no >>>>>> innominate vein. The other and most recent, had no SVC at all >>>>>> and a >>>>>> giant >>>>>> retro-cardiac vessel. >>>>>> >>>>>> For future reference, I'll be accepting any and all tips, >>>>>> pearls, >> and >>>>>> general knowledge. >>>>>> >>>>>> Thanks, 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 >>>>>> ----------------------------------------- >>>>>> >>>>> >>>>> >>>>> >>>>> -- >>>>> Prasanna Simha M >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> >>>>> All messages transmitted by the OpenHeart-L are subject to the >> policies >>>>> and >>>>> disclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the >>>> policies >>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>>> >>>> >>>> >>> >> -------------------------------------------------------------------------------- >>>> >>>> >>>> >>>> No virus found in this incoming message. >>>> Checked by AVG - www.avg.com >>>> Version: 8.5.325 / Virus Database: 270.12.15/2093 - Release Date: >>> 05/02/09 >>>> 14:23:00 >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the >>>> policies >>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> >> **************The Average US Credit Score is 692. See Yours in Just >> 2 Easy >> Steps! >> (http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx >> ?sc=668072&hmpgID=62&bcd=M >> ay5309AvgfooterNO62) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, 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 ICHFNO at aol.com Sun May 3 23:38:44 2009 From: ICHFNO at aol.com (ICHFNO@aol.com) Date: Sun May 3 22:39:36 2009 Subject: [HSF] Persistent LSVC Message-ID: Interesting thread. We do not routinely use retrograde, rather antegrade and religiously give it every 15 minutes, however, if there is an LSVC we cannulate it if there is a chance the cross-clamp time is going to be greater than 30 minutes. The wash out that occurs is detrimental to protection. So, my simple answer is cannulate the LSVC, do so outside the heart, then you can give retrograde without any problems if that is what you would like to do. We see kids with an LSVC in about 15% of our cases, so it is a frequent issue for us, perhaps that is why we have a routine to deal with it and do not let it become an issue in terms of myocardial protection. WNovick In a message dated 5/3/2009 1:06:26 P.M. Central Daylight Time, prasannasimha@gmail.com writes: Not if you are opening the RA. If you don't open the RA you don't need to separately drain the left SVC.(Or if you need to snug the SVC and IVC with the RA unopened for whatever reason. Prasanna On Sun, May 3, 20' > > th a sucker inside for less complex cases. > > Prasanna > > > Yes - we seem to be making a simple matter very complicated. I am sure the > likes of Ed Raines will be wondering what all the mystery is about as they > do all mitrals with a single two stage or long venous cannula and do not > have problems with drainage. Why a need to drain the left cava separately - > doesnt the blood all end up in the same place as the IVC blood? > > > > Ani > > > > > > > From: prasannasimha@gmail.com > > Date: Sun, 3 May 2009 22:26:43 +0530 > > Subject: Re: [HSF] Persistent LSVC > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > I have done it in the past but today with vacuum its so easy - just plonk > a > > straight cannula inside and connect it to the reservoir with a 1/4th tube > > and then it is out of sight and out of mind. Why worry of even a > potential > > for brain injury ? (We have enough potential as it is !!)You can also > very > > often just manage with a sucker inside for less complex cases. > > Prasanna > > > > On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: > > > > > You can cannulate via the coronary sinus and if you need to open the > right > > > atrium, with an endotracheal tube. I have not done it. John Flege > > > > > > On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > > > > > > For the 3rd or 4th time in a span of two years, I've been confronted > > >> with/ identified at the time of surgery, patients with a persistent Lt > SVC. > > >> For the routine CAB, it's not really a problem, but 2 of them have > been for > > >> mitral surgery. If I remember correctly, one had a diminutive SVC and > no > > >> innominate vein. The other and most recent, had no SVC at all and a > giant > > >> retro-cardiac vessel. > > >> > > >> For future reference, I'll be accepting any and all tips, pearls, and > > >> general knowledge. > > >> > > >> Thanks, 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 > > > ----------------------------------------- > > > > > > > > > > > -- > > 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 > > ----------------------------------------- > > _________________________________________________________________ > View your Twitter and Flickr updates from one place ? Learn more! > > http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62) From prasannasimha at gmail.com Mon May 4 10:38:36 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon May 4 00:09:14 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: <89c4ed2d0905032108k4554f713le8ef83fb11b6877c@mail.gmail.com> In fact I Initially thought why it was an issue (since we see it so often in kids) and realized that we hardly encounter it in adult surgery unless we need to open the right atrium. So people dealing with adults exclusively would not see it often. If a retrograde cardioplegia cannula is put in blind it would easily enter and if one were to depend on it then a left SVC could give major myocardial protection issues. Prasanna On Mon, May 4, 2009 at 8:08 AM, wrote: > Interesting thread. We do not routinely use retrograde, rather antegrade > and religiously give it every 15 minutes, however, if there is an LSVC we > cannulate it if there is a chance the cross-clamp time is going to be > greater > than 30 minutes. The wash out that occurs is detrimental to protection. So, > my simple answer is cannulate the LSVC, do so outside the heart, then you > can give retrograde without any problems if that is what you would like to > do. We see kids with an LSVC in about 15% of our cases, so it is a > frequent > issue for us, perhaps that is why we have a routine to deal with it and do > not let it become an issue in terms of myocardial protection. > > WNovick > > > In a message dated 5/3/2009 1:06:26 P.M. Central Daylight Time, > prasannasimha@gmail.com writes: > > Not if you are opening the RA. > If you don't open the RA you don't need to separately drain the left > SVC.(Or > if you need to snug the SVC and IVC with the RA unopened for whatever > reason. > > Prasanna > > On Sun, May 3, 20' > > > > th a sucker inside for less complex cases. > > > Prasanna > > > > > > Yes - we seem to be making a simple matter very complicated. I am sure > the > > likes of Ed Raines will be wondering what all the mystery is about as > they > > do all mitrals with a single two stage or long venous cannula and do not > > have problems with drainage. Why a need to drain the left cava > separately - > > doesnt the blood all end up in the same place as the IVC blood? > > > > > > > > Ani > > > > > > > > > > > > > From: prasannasimha@gmail.com > > > Date: Sun, 3 May 2009 22:26:43 +0530 > > > Subject: Re: [HSF] Persistent LSVC > > > To: OpenHeart-L@lists.hsforum.com > > > CC: > > > > > > I have done it in the past but today with vacuum its so easy - just > plonk > > a > > > straight cannula inside and connect it to the reservoir with a 1/4th > tube > > > and then it is out of sight and out of mind. Why worry of even a > > potential > > > for brain injury ? (We have enough potential as it is !!)You can also > > very > > > often just manage with a sucker inside for less complex cases. > > > Prasanna > > > > > > On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: > > > > > > > You can cannulate via the coronary sinus and if you need to open the > > right > > > > atrium, with an endotracheal tube. I have not done it. John Flege > > > > > > > > On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > > > > > > > > For the 3rd or 4th time in a span of two years, I've been confronted > > > >> with/ identified at the time of surgery, patients with a persistent > Lt > > SVC. > > > >> For the routine CAB, it's not really a problem, but 2 of them have > > been for > > > >> mitral surgery. If I remember correctly, one had a diminutive SVC > and > > no > > > >> innominate vein. The other and most recent, had no SVC at all and > a > > giant > > > >> retro-cardiac vessel. > > > >> > > > >> For future reference, I'll be accepting any and all tips, pearls, > and > > > >> general knowledge. > > > >> > > > >> Thanks, 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 > > > > ----------------------------------------- > > > > > > > > > > > > > > > > -- > > > 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 > > > ----------------------------------------- > > > > _________________________________________________________________ > > View your Twitter and Flickr updates from one place ? Learn more! > > > > > > http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > **************The Average US Credit Score is 692. See Yours in Just 2 Easy > Steps! > ( > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > ay5309AvgfooterNO62 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Mon May 4 12:47:49 2009 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Mon May 4 07:48:33 2009 Subject: [HSF] Type II acute dissection + subacute hemorrhagic CVA In-Reply-To: <4B173E91-4C08-4727-A070-1D9B36FA8D3F@bigpond.com> References: <4B173E91-4C08-4727-A070-1D9B36FA8D3F@bigpond.com> Message-ID: Urgent opinion requested: 42 Y/O male ,operated CABG X 3 ( 9 months ago) ,7 days ago acute hemorrhagic infarction with minimal sequalae.today admitted with severe chest pain and anterolateral AMI.CAG:3 vessel disease, RCA graft open ,Diagonal graft occluded ,lima occluded,Aortography:acute aortic dissection, CT:Type II dissection ( no involvement of arch is seen),TTE: EF moderate,AR +++ erdinc From tacuff at swbell.net Mon May 4 10:13:54 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon May 4 12:14:17 2009 Subject: [HSF] Persistent LSVC In-Reply-To: References: Message-ID: <682369.59749.qm@web81605.mail.mud.yahoo.com> As i was trying to?recreate your logic, for us duffers: Even with antegrade cardioplegia "alone" a PLSVC is like simulataneous retrograde warm unoxygenated blood "plegia" with a perfusion pressure inversely related the effectiveness of LSVC drainage, which in turn is an unmeasured variable. tea ________________________________ From: "ICHFNO@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Sunday, May 3, 2009 9:38:44 PM Subject: Re: [HSF] Persistent LSVC Interesting thread. We do not routinely use retrograde, rather antegrade and religiously give it every 15 minutes, however, if there is an LSVC we cannulate it if there is a chance the cross-clamp time is going to be greater than 30 minutes. The wash out that occurs is detrimental to protection. So, my? simple answer is cannulate the LSVC, do so outside the heart, then you can give? retrograde without any problems if that is what you would like to do. We see? kids with an LSVC in about 15% of our cases, so it is a frequent issue for us,? perhaps that is why we have a routine to deal with it and do not let it become? an issue in terms of myocardial protection. WNovick In a message dated 5/3/2009 1:06:26 P.M. Central Daylight Time, prasannasimha@gmail.com writes: Not if? you are opening the RA. If you don't open the RA you don't need to? separately drain the left SVC.(Or if you need to snug the SVC and IVC with? the RA unopened for whatever reason. Prasanna On Sun, May 3,? 20' > > th a sucker inside for less complex cases. > >? Prasanna > > > Yes - we seem to be making a simple matter? very complicated. I am sure the > likes of Ed Raines will be wondering? what all the mystery is about as they > do all mitrals with a single two? stage or long venous cannula and do not > have problems with drainage.? Why a need to drain the left cava separately - > doesnt the blood all? end up in the same place as the IVC blood? > > > >? Ani > > > > > > > From:? prasannasimha@gmail.com > > Date: Sun, 3 May 2009 22:26:43? +0530 > > Subject: Re: [HSF] Persistent LSVC > > To:? OpenHeart-L@lists.hsforum.com > > CC: > > > > I? have done it in the past but today with vacuum its so easy - just plonk > a > > straight cannula inside and connect it to the? reservoir with a 1/4th tube > > and then it is out of sight and out? of mind. Why worry of even a > potential > > for brain injury ?? (We have enough potential as it is !!)You can also > very > >? often just manage with a sucker inside for less complex cases. > >? Prasanna > > > > On Sun, May 3, 2009 at 9:18 PM, John Flege? wrote: > > > > > You can? cannulate via the coronary sinus and if you need to open the >? right > > > atrium, with an endotracheal tube. I have not done it.? John Flege > > > > > > On May 2, 2009, at 4:59 PM,? Mitch Lirtzman wrote: > > > > > > For the 3rd or 4th? time in a span of two years, I've been confronted > > >> with/? identified at the time of surgery, patients with a persistent Lt >? SVC. > > >> For the routine CAB, it's not really a problem, but? 2 of them have > been for > > >> mitral surgery. If I? remember correctly, one had a diminutive SVC and > no > >? >> innominate vein. The other and most recent, had no SVC at all and? a > giant > > >> retro-cardiac vessel. > >? >> > > >> For future reference, I'll be accepting any and? all tips, pearls, and > > >> general knowledge. > >? >> > > >> Thanks, 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 > > >? ----------------------------------------- > > > >? > > > > > > > -- > > 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 > >? ----------------------------------------- > >? _________________________________________________________________ > View? your Twitter and Flickr updates from one place ? Learn more! > > http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ >? OpenHeart-L mailing list > > Send postings to: >? OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email? address, or to view archives: >? http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages? transmitted by the OpenHeart-L are subject to the policies and >? disclaimers posted at: > http://www.hsforum.com/listdisclaim >? ----------------------------------------- > -- Prasanna Simha? M _______________________________________________ OpenHeart-L mailing? list Send postings to: OpenHeart-L@lists.hsforum.com To? UNSUBSCRIBE, to CHANGE email address, or to view? archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All? messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted? at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! (http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 May 4 22:51:59 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon May 4 12:52:21 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <682369.59749.qm@web81605.mail.mud.yahoo.com> References: <682369.59749.qm@web81605.mail.mud.yahoo.com> Message-ID: <89c4ed2d0905040921q3553860gab664c6f4866dc94@mail.gmail.com> Sorry. it is like telling that noncoronary collateral flow which washes out cardioplegia and rewarms the heart is good for myocardial protection. Prasanna On Mon, May 4, 2009 at 9:43 PM, Tea Acuff wrote: > As i was trying to recreate your logic, for us duffers: Even with antegrade > cardioplegia "alone" a PLSVC is like simulataneous retrograde warm > unoxygenated blood "plegia" with a perfusion pressure inversely related the > effectiveness of LSVC drainage, which in turn is an unmeasured variable. > > tea > > > > > ________________________________ > From: "ICHFNO@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Sunday, May 3, 2009 9:38:44 PM > Subject: Re: [HSF] Persistent LSVC > > Interesting thread. We do not routinely use retrograde, rather antegrade > and religiously give it every 15 minutes, however, if there is an LSVC we > cannulate it if there is a chance the cross-clamp time is going to be > greater > than 30 minutes. The wash out that occurs is detrimental to protection. So, > my simple answer is cannulate the LSVC, do so outside the heart, then you > can give retrograde without any problems if that is what you would like to > do. We see kids with an LSVC in about 15% of our cases, so it is a > frequent > issue for us, perhaps that is why we have a routine to deal with it and do > not let it become an issue in terms of myocardial protection. > > WNovick > > > In a message dated 5/3/2009 1:06:26 P.M. Central Daylight Time, > prasannasimha@gmail.com writes: > > Not if you are opening the RA. > If you don't open the RA you don't need to separately drain the left > SVC.(Or > if you need to snug the SVC and IVC with the RA unopened for whatever > reason. > > Prasanna > > On Sun, May 3, 20' > > > > th a sucker inside for less complex cases. > > > Prasanna > > > > > > Yes - we seem to be making a simple matter very complicated. I am sure > the > > likes of Ed Raines will be wondering what all the mystery is about as > they > > do all mitrals with a single two stage or long venous cannula and do not > > have problems with drainage. Why a need to drain the left cava > separately - > > doesnt the blood all end up in the same place as the IVC blood? > > > > > > > > Ani > > > > > > > > > > > > > From: prasannasimha@gmail.com > > > Date: Sun, 3 May 2009 22:26:43 +0530 > > > Subject: Re: [HSF] Persistent LSVC > > > To: OpenHeart-L@lists.hsforum.com > > > CC: > > > > > > I have done it in the past but today with vacuum its so easy - just > plonk > > a > > > straight cannula inside and connect it to the reservoir with a 1/4th > tube > > > and then it is out of sight and out of mind. Why worry of even a > > potential > > > for brain injury ? (We have enough potential as it is !!)You can also > > very > > > often just manage with a sucker inside for less complex cases. > > > Prasanna > > > > > > On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: > > > > > > > You can cannulate via the coronary sinus and if you need to open the > > right > > > > atrium, with an endotracheal tube. I have not done it. John Flege > > > > > > > > On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > > > > > > > > For the 3rd or 4th time in a span of two years, I've been confronted > > > >> with/ identified at the time of surgery, patients with a persistent > Lt > > SVC. > > > >> For the routine CAB, it's not really a problem, but 2 of them have > > been for > > > >> mitral surgery. If I remember correctly, one had a diminutive SVC > and > > no > > > >> innominate vein. The other and most recent, had no SVC at all and > a > > giant > > > >> retro-cardiac vessel. > > > >> > > > >> For future reference, I'll be accepting any and all tips, pearls, > and > > > >> general knowledge. > > > >> > > > >> Thanks, 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 > > > > ----------------------------------------- > > > > > > > > > > > > > > > > -- > > > 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 > > > ----------------------------------------- > > > > _________________________________________________________________ > > View your Twitter and Flickr updates from one place ? Learn more! > > > > > > http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > **************The Average US Credit Score is 692. See Yours in Just 2 Easy > Steps! > ( > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > ay5309AvgfooterNO62 > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 May 4 11:08:49 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon May 4 13:09:27 2009 Subject: [HSF] Persistent LSVC Message-ID: <433021.97732.qm@web81605.mail.mud.yahoo.com> Exactly. Hence the need for drainage Tea Sent from my iPhone On May 4, 2009, at 11:21 AM, Prasanna Simha M wrote: Sorry. it is like telling that noncoronary collateral flow which washes out cardioplegia and rewarms the heart is good for myocardial protection. Prasanna On Mon, May 4, 2009 at 9:43 PM, Tea Acuff wrote: As i was trying to recreate your logic, for us duffers: Even with antegrade cardioplegia "alone" a PLSVC is like simulataneous retrograde warm unoxygenated blood "plegia" with a perfusion pressure inversely related the effectiveness of LSVC drainage, which in turn is an unmeasured variable. tea ________________________________ From: "ICHFNO@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Sunday, May 3, 2009 9:38:44 PM Subject: Re: [HSF] Persistent LSVC Interesting thread. We do not routinely use retrograde, rather antegrade and religiously give it every 15 minutes, however, if there is an LSVC we cannulate it if there is a chance the cross-clamp time is going to be greater than 30 minutes. The wash out that occurs is detrimental to protection. So, my simple answer is cannulate the LSVC, do so outside the heart, then you can give retrograde without any problems if that is what you would like to do. We see kids with an LSVC in about 15% of our cases, so it is a frequent issue for us, perhaps that is why we have a routine to deal with it and do not let it become an issue in terms of myocardial protection. WNovick In a message dated 5/3/2009 1:06:26 P.M. Central Daylight Time, prasannasimha@gmail.com writes: Not if you are opening the RA. If you don't open the RA you don't need to separately drain the left SVC.(Or if you need to snug the SVC and IVC with the RA unopened for whatever reason. Prasanna On Sun, May 3, 20' th a sucker inside for less complex cases. Prasanna Yes - we seem to be making a simple matter very complicated. I am sure the likes of Ed Raines will be wondering what all the mystery is about as they do all mitrals with a single two stage or long venous cannula and do not have problems with drainage. Why a need to drain the left cava separately - doesnt the blood all end up in the same place as the IVC blood? Ani From: prasannasimha@gmail.com Date: Sun, 3 May 2009 22:26:43 +0530 Subject: Re: [HSF] Persistent LSVC To: OpenHeart-L@lists.hsforum.com CC: I have done it in the past but today with vacuum its so easy - just plonk a straight cannula inside and connect it to the reservoir with a 1/4th tube and then it is out of sight and out of mind. Why worry of even a potential for brain injury ? (We have enough potential as it is !!)You can also very often just manage with a sucker inside for less complex cases. Prasanna On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: You can cannulate via the coronary sinus and if you need to open the right atrium, with an endotracheal tube. I have not done it. John Flege On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: For the 3rd or 4th time in a span of two years, I've been confronted with/ identified at the time of surgery, patients with a persistent Lt SVC. For the routine CAB, it's not really a problem, but 2 of them have been for mitral surgery. If I remember correctly, one had a diminutive SVC and no innominate vein. The other and most recent, had no SVC at all and a giant retro-cardiac vessel. For future reference, I'll be accepting any and all tips, pearls, and general knowledge. Thanks, 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 ----------------------------------------- -- 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 ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! ( http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62 ) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From tacuff at swbell.net Mon May 4 11:42:06 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon May 4 13:42:33 2009 Subject: [HSF] Persistent LSVC Message-ID: <273630.13223.qm@web81601.mail.mud.yahoo.com> And why most of us clamp the Lima on a redo if we use an arrested plegia technique. Even if all protections are better than nothing, it does not follow that more of all is better. anyway unpxygenated warm blood as we know from respirotpry collapse is not that useful. Tea Sent from my iPhone On May 4, 2009, at 11:21 AM, Prasanna Simha M wrote: Sorry. it is like telling that noncoronary collateral flow which washes out cardioplegia and rewarms the heart is good for myocardial protection. Prasanna On Mon, May 4, 2009 at 9:43 PM, Tea Acuff wrote: As i was trying to recreate your logic, for us duffers: Even with antegrade cardioplegia "alone" a PLSVC is like simulataneous retrograde warm unoxygenated blood "plegia" with a perfusion pressure inversely related the effectiveness of LSVC drainage, which in turn is an unmeasured variable. tea ________________________________ From: "ICHFNO@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Sunday, May 3, 2009 9:38:44 PM Subject: Re: [HSF] Persistent LSVC Interesting thread. We do not routinely use retrograde, rather antegrade and religiously give it every 15 minutes, however, if there is an LSVC we cannulate it if there is a chance the cross-clamp time is going to be greater than 30 minutes. The wash out that occurs is detrimental to protection. So, my simple answer is cannulate the LSVC, do so outside the heart, then you can give retrograde without any problems if that is what you would like to do. We see kids with an LSVC in about 15% of our cases, so it is a frequent issue for us, perhaps that is why we have a routine to deal with it and do not let it become an issue in terms of myocardial protection. WNovick In a message dated 5/3/2009 1:06:26 P.M. Central Daylight Time, prasannasimha@gmail.com writes: Not if you are opening the RA. If you don't open the RA you don't need to separately drain the left SVC.(Or if you need to snug the SVC and IVC with the RA unopened for whatever reason. Prasanna On Sun, May 3, 20' th a sucker inside for less complex cases. Prasanna Yes - we seem to be making a simple matter very complicated. I am sure the likes of Ed Raines will be wondering what all the mystery is about as they do all mitrals with a single two stage or long venous cannula and do not have problems with drainage. Why a need to drain the left cava separately - doesnt the blood all end up in the same place as the IVC blood? Ani From: prasannasimha@gmail.com Date: Sun, 3 May 2009 22:26:43 +0530 Subject: Re: [HSF] Persistent LSVC To: OpenHeart-L@lists.hsforum.com CC: I have done it in the past but today with vacuum its so easy - just plonk a straight cannula inside and connect it to the reservoir with a 1/4th tube and then it is out of sight and out of mind. Why worry of even a potential for brain injury ? (We have enough potential as it is !!)You can also very often just manage with a sucker inside for less complex cases. Prasanna On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: You can cannulate via the coronary sinus and if you need to open the right atrium, with an endotracheal tube. I have not done it. John Flege On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: For the 3rd or 4th time in a span of two years, I've been confronted with/ identified at the time of surgery, patients with a persistent Lt SVC. For the routine CAB, it's not really a problem, but 2 of them have been for mitral surgery. If I remember correctly, one had a diminutive SVC and no innominate vein. The other and most recent, had no SVC at all and a giant retro-cardiac vessel. For future reference, I'll be accepting any and all tips, pearls, and general knowledge. Thanks, 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 ----------------------------------------- -- 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 ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! ( http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62 ) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From msfirst at gmail.com Mon May 4 15:20:56 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Mon May 4 14:21:22 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <273630.13223.qm@web81601.mail.mud.yahoo.com> References: <273630.13223.qm@web81601.mail.mud.yahoo.com> Message-ID: so are you implying venous blood is better than no blood? -michael On Mon, May 4, 2009 at 1:42 PM, Tea Acuff wrote: > > And why most of us clamp the Lima on a redo if we use an arrested plegia > technique. Even if all protections are better than nothing, it does not > follow that more of all is better. anyway unpxygenated warm blood as we know > from respirotpry collapse is not that useful. > Tea > > Sent from my iPhone > > On May 4, 2009, at 11:21 AM, Prasanna Simha M > wrote: > > Sorry. it is like telling that noncoronary collateral flow which washes out > cardioplegia and rewarms the heart is good for myocardial protection. > Prasanna > > On Mon, May 4, 2009 at 9:43 PM, Tea Acuff wrote: > > As i was trying to recreate your logic, for us duffers: Even with antegrade > cardioplegia "alone" a PLSVC is like simulataneous retrograde warm > unoxygenated blood "plegia" with a perfusion pressure inversely related the > effectiveness of LSVC drainage, which in turn is an unmeasured variable. > > tea > > > > > ________________________________ > From: "ICHFNO@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Sunday, May 3, 2009 9:38:44 PM > Subject: Re: [HSF] Persistent LSVC > > Interesting thread. We do not routinely use retrograde, rather antegrade > and religiously give it every 15 minutes, however, if there is an LSVC we > cannulate it if there is a chance the cross-clamp time is going to be > greater > than 30 minutes. The wash out that occurs is detrimental to protection. So, > my simple answer is cannulate the LSVC, do so outside the heart, then you > can give retrograde without any problems if that is what you would like to > do. We see kids with an LSVC in about 15% of our cases, so it is a > frequent > issue for us, perhaps that is why we have a routine to deal with it and do > not let it become an issue in terms of myocardial protection. > > WNovick > > > In a message dated 5/3/2009 1:06:26 P.M. Central Daylight Time, > prasannasimha@gmail.com writes: > > Not if you are opening the RA. > If you don't open the RA you don't need to separately drain the left > SVC.(Or > if you need to snug the SVC and IVC with the RA unopened for whatever > reason. > > Prasanna > > On Sun, May 3, 20' > > th a sucker inside for less complex cases. > Prasanna > > > Yes - we seem to be making a simple matter very complicated. I am sure > the > likes of Ed Raines will be wondering what all the mystery is about as > they > do all mitrals with a single two stage or long venous cannula and do not > have problems with drainage. Why a need to drain the left cava > separately - > doesnt the blood all end up in the same place as the IVC blood? > > > > Ani > > > > > > From: prasannasimha@gmail.com > Date: Sun, 3 May 2009 22:26:43 +0530 > Subject: Re: [HSF] Persistent LSVC > To: OpenHeart-L@lists.hsforum.com > CC: > > I have done it in the past but today with vacuum its so easy - just > plonk > a > straight cannula inside and connect it to the reservoir with a 1/4th > tube > and then it is out of sight and out of mind. Why worry of even a > potential > for brain injury ? (We have enough potential as it is !!)You can also > very > often just manage with a sucker inside for less complex cases. > Prasanna > > On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: > > You can cannulate via the coronary sinus and if you need to open the > right > atrium, with an endotracheal tube. I have not done it. John Flege > > On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > > For the 3rd or 4th time in a span of two years, I've been confronted > with/ identified at the time of surgery, patients with a persistent > Lt > SVC. > For the routine CAB, it's not really a problem, but 2 of them have > been for > mitral surgery. If I remember correctly, one had a diminutive SVC > and > no > innominate vein. The other and most recent, had no SVC at all and > a > giant > retro-cardiac vessel. > > For future reference, I'll be accepting any and all tips, pearls, > and > general knowledge. > > Thanks, 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 > ----------------------------------------- > > > > > -- > 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 > ----------------------------------------- > > _________________________________________________________________ > View your Twitter and Flickr updates from one place ? Learn more! > > > > > http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > **************The Average US Credit Score is 692. See Yours in Just 2 Easy > Steps! > ( > > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > ay5309AvgfooterNO62< > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M%0Aay5309AvgfooterNO62 > > > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 robertobattellini at hotmail.com Mon May 4 22:09:04 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Mon May 4 15:09:27 2009 Subject: [HSF] Type II acute dissection + subacute hemorrhagic CVA In-Reply-To: References: <4B173E91-4C08-4727-A070-1D9B36FA8D3F@bigpond.com> Message-ID: May be terrible, but you must operate on him...he is too young for leaving him alone. Aorta ascendens replacement + LAD revascularization and may be Aortic valve resuspension/replacement. Take care of the myocardial protection!! retrograde and also through the RCA graft. Roberto > From: enaseri@hotmail.com.tr > To: openheart-l@lists.hsforum.com > Date: Mon, 4 May 2009 11:47:49 +0000 > Subject: [HSF] Type II acute dissection + subacute hemorrhagic CVA > > > Urgent opinion requested: > > 42 Y/O male ,operated CABG X 3 ( 9 months ago) ,7 days ago acute hemorrhagic infarction with minimal sequalae.today admitted with severe chest pain and anterolateral AMI.CAG:3 vessel disease, RCA graft open ,Diagonal graft occluded ,lima occluded,Aortography:acute aortic dissection, CT:Type II dissection ( no involvement of arch is seen),TTE: EF moderate,AR +++ > > 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 robertobattellini at hotmail.com Mon May 4 22:17:44 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Mon May 4 15:18:27 2009 Subject: [HSF] Type II acute dissection + subacute hemorrhagic CVA In-Reply-To: References: <4B173E91-4C08-4727-A070-1D9B36FA8D3F@bigpond.com> Message-ID: Erdinc, When you talk about infarction, is it myocardial or cerebral??? Roberto > From: robertobattellini@hotmail.com > To: openheart-l@lists.hsforum.com > Subject: RE: [HSF] Type II acute dissection + subacute hemorrhagic CVA > Date: Mon, 4 May 2009 21:09:04 +0200 > > > May be terrible, but you must operate on him...he is too young for leaving him alone. > > Aorta ascendens replacement + LAD revascularization and may be Aortic valve resuspension/replacement. > > > > Take care of the myocardial protection!! retrograde and also through the RCA graft. > > Roberto > > > From: enaseri@hotmail.com.tr > > To: openheart-l@lists.hsforum.com > > Date: Mon, 4 May 2009 11:47:49 +0000 > > Subject: [HSF] Type II acute dissection + subacute hemorrhagic CVA > > > > > > Urgent opinion requested: > > > > 42 Y/O male ,operated CABG X 3 ( 9 months ago) ,7 days ago acute hemorrhagic infarction with minimal sequalae.today admitted with severe chest pain and anterolateral AMI.CAG:3 vessel disease, RCA graft open ,Diagonal graft occluded ,lima occluded,Aortography:acute aortic dissection, CT:Type II dissection ( no involvement of arch is seen),TTE: EF moderate,AR +++ > > > > erdinc > > > > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From tacuff at swbell.net Mon May 4 14:20:52 2009 From: tacuff at swbell.net (Tea Acuff) Date: Mon May 4 16:21:16 2009 Subject: [HSF] Persistent LSVC Message-ID: <585092.3296.qm@web81604.mail.mud.yahoo.com> I think that it might be. If you re label it flow or no flow, it has possiblities. It could be worse which is also useful information. Transport has two directions: in and out. Can anyone think of such a situation? Tea Sent from my iPhone On May 4, 2009, at 1:20 PM, Michael Firstenberg wrote: so are you implying venous blood is better than no blood? -michael On Mon, May 4, 2009 at 1:42 PM, Tea Acuff wrote: And why most of us clamp the Lima on a redo if we use an arrested plegia technique. Even if all protections are better than nothing, it does not follow that more of all is better. anyway unpxygenated warm blood as we know from respirotpry collapse is not that useful. Tea Sent from my iPhone On May 4, 2009, at 11:21 AM, Prasanna Simha M wrote: Sorry. it is like telling that noncoronary collateral flow which washes out cardioplegia and rewarms the heart is good for myocardial protection. Prasanna On Mon, May 4, 2009 at 9:43 PM, Tea Acuff wrote: As i was trying to recreate your logic, for us duffers: Even with antegrade cardioplegia "alone" a PLSVC is like simulataneous retrograde warm unoxygenated blood "plegia" with a perfusion pressure inversely related the effectiveness of LSVC drainage, which in turn is an unmeasured variable. tea ________________________________ From: "ICHFNO@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Sunday, May 3, 2009 9:38:44 PM Subject: Re: [HSF] Persistent LSVC Interesting thread. We do not routinely use retrograde, rather antegrade and religiously give it every 15 minutes, however, if there is an LSVC we cannulate it if there is a chance the cross-clamp time is going to be greater than 30 minutes. The wash out that occurs is detrimental to protection. So, my simple answer is cannulate the LSVC, do so outside the heart, then you can give retrograde without any problems if that is what you would like to do. We see kids with an LSVC in about 15% of our cases, so it is a frequent issue for us, perhaps that is why we have a routine to deal with it and do not let it become an issue in terms of myocardial protection. WNovick In a message dated 5/3/2009 1:06:26 P.M. Central Daylight Time, prasannasimha@gmail.com writes: Not if you are opening the RA. If you don't open the RA you don't need to separately drain the left SVC.(Or if you need to snug the SVC and IVC with the RA unopened for whatever reason. Prasanna On Sun, May 3, 20' th a sucker inside for less complex cases. Prasanna Yes - we seem to be making a simple matter very complicated. I am sure the likes of Ed Raines will be wondering what all the mystery is about as they do all mitrals with a single two stage or long venous cannula and do not have problems with drainage. Why a need to drain the left cava separately - doesnt the blood all end up in the same place as the IVC blood? Ani From: prasannasimha@gmail.com Date: Sun, 3 May 2009 22:26:43 +0530 Subject: Re: [HSF] Persistent LSVC To: OpenHeart-L@lists.hsforum.com CC: I have done it in the past but today with vacuum its so easy - just plonk a straight cannula inside and connect it to the reservoir with a 1/4th tube and then it is out of sight and out of mind. Why worry of even a potential for brain injury ? (We have enough potential as it is !!)You can also very often just manage with a sucker inside for less complex cases. Prasanna On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: You can cannulate via the coronary sinus and if you need to open the right atrium, with an endotracheal tube. I have not done it. John Flege On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: For the 3rd or 4th time in a span of two years, I've been confronted with/ identified at the time of surgery, patients with a persistent Lt SVC. For the routine CAB, it's not really a problem, but 2 of them have been for mitral surgery. If I remember correctly, one had a diminutive SVC and no innominate vein. The other and most recent, had no SVC at all and a giant retro-cardiac vessel. For future reference, I'll be accepting any and all tips, pearls, and general knowledge. Thanks, 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 ----------------------------------------- -- 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 ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************The Average US Credit Score is 692. See Yours in Just 2 Easy Steps! ( http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M ay5309AvgfooterNO62< http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M%0Aay5309AvgfooterNO62 ) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Mon May 4 21:24:37 2009 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Mon May 4 16:25:19 2009 Subject: [HSF] Type II acute dissection + subacute hemorrhagic CVA In-Reply-To: References: <4B173E91-4C08-4727-A070-1D9B36FA8D3F@bigpond.com> Message-ID: Robertto, Cerebral infarction 1 week ago and AMI today. I operated him. ?ntraop finding: dissection in the LMCA and epicardial echo showed huge concentric LVH. Bentall +CABG X 4. RCA graft reattached to ascending aorta .Out of operation room on IABP and high inotrope. Cardioplegia thru all possible routes . erdinc > From: robertobattellini@hotmail.com > To: openheart-l@lists.hsforum.com > Subject: RE: [HSF] Type II acute dissection + subacute hemorrhagic CVA > Date: Mon, 4 May 2009 21:17:44 +0200 > > > Erdinc, > > > > When you talk about infarction, is it myocardial or cerebral??? > > Roberto > > > From: robertobattellini@hotmail.com > > To: openheart-l@lists.hsforum.com > > Subject: RE: [HSF] Type II acute dissection + subacute hemorrhagic CVA > > Date: Mon, 4 May 2009 21:09:04 +0200 > > > > > > May be terrible, but you must operate on him...he is too young for leaving him alone. > > > > Aorta ascendens replacement + LAD revascularization and may be Aortic valve resuspension/replacement. > > > > > > > > Take care of the myocardial protection!! retrograde and also through the RCA graft. > > > > Roberto > > > > > From: enaseri@hotmail.com.tr > > > To: openheart-l@lists.hsforum.com > > > Date: Mon, 4 May 2009 11:47:49 +0000 > > > Subject: [HSF] Type II acute dissection + subacute hemorrhagic CVA > > > > > > > > > Urgent opinion requested: > > > > > > 42 Y/O male ,operated CABG X 3 ( 9 months ago) ,7 days ago acute hemorrhagic infarction with minimal sequalae.today admitted with severe chest pain and anterolateral AMI.CAG:3 vessel disease, RCA graft open ,Diagonal graft occluded ,lima occluded,Aortography:acute aortic dissection, CT:Type II dissection ( no involvement of arch is seen),TTE: EF moderate,AR +++ > > > > > > erdinc > > > > > > > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 May 5 07:40:56 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon May 4 21:16:40 2009 Subject: [HSF] Persistent LSVC In-Reply-To: <585092.3296.qm@web81604.mail.mud.yahoo.com> References: <585092.3296.qm@web81604.mail.mud.yahoo.com> Message-ID: <89c4ed2d0905041810k177364b1p11a890af885ac0a3@mail.gmail.com> There may be an argument for deoxygenated blood as the intial reperfusate for the first couple of minutes after a period of anoxia as low oxygen tensions may attenuate the oxidative burst that occurs immediately post reperfusion. At least "Hyperoxygenated" blood is definitely not good. We do "Normoxic" induction and normoxic reperfusion in cyanotics on initiation of CPB and post cross clamp release and also on initiation of ventilation. Supposed to attenuate lung and cardiac damage. Prasanna On Tue, May 5, 2009 at 1:50 AM, Tea Acuff wrote: > > I think that it might be. If you re label it flow or no flow, it has > possiblities. It could be worse which is also useful information. Transport > has two directions: in and out. > Can anyone think of such a situation? > > Tea > Sent from my iPhone > > On May 4, 2009, at 1:20 PM, Michael Firstenberg wrote: > > so are you implying venous blood is better than no blood? > > -michael > > On Mon, May 4, 2009 at 1:42 PM, Tea Acuff wrote: > > > And why most of us clamp the Lima on a redo if we use an arrested plegia > technique. Even if all protections are better than nothing, it does not > follow that more of all is better. anyway unpxygenated warm blood as we > know > from respirotpry collapse is not that useful. > Tea > > Sent from my iPhone > > On May 4, 2009, at 11:21 AM, Prasanna Simha M > wrote: > > Sorry. it is like telling that noncoronary collateral flow which washes out > cardioplegia and rewarms the heart is good for myocardial protection. > Prasanna > > On Mon, May 4, 2009 at 9:43 PM, Tea Acuff wrote: > > As i was trying to recreate your logic, for us duffers: Even with antegrade > cardioplegia "alone" a PLSVC is like simulataneous retrograde warm > unoxygenated blood "plegia" with a perfusion pressure inversely related the > effectiveness of LSVC drainage, which in turn is an unmeasured variable. > > tea > > > > > ________________________________ > From: "ICHFNO@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Sunday, May 3, 2009 9:38:44 PM > Subject: Re: [HSF] Persistent LSVC > > Interesting thread. We do not routinely use retrograde, rather antegrade > and religiously give it every 15 minutes, however, if there is an LSVC we > cannulate it if there is a chance the cross-clamp time is going to be > greater > than 30 minutes. The wash out that occurs is detrimental to protection. So, > my simple answer is cannulate the LSVC, do so outside the heart, then you > can give retrograde without any problems if that is what you would like to > do. We see kids with an LSVC in about 15% of our cases, so it is a > frequent > issue for us, perhaps that is why we have a routine to deal with it and do > not let it become an issue in terms of myocardial protection. > > WNovick > > > In a message dated 5/3/2009 1:06:26 P.M. Central Daylight Time, > prasannasimha@gmail.com writes: > > Not if you are opening the RA. > If you don't open the RA you don't need to separately drain the left > SVC.(Or > if you need to snug the SVC and IVC with the RA unopened for whatever > reason. > > Prasanna > > On Sun, May 3, 20' > > th a sucker inside for less complex cases. > Prasanna > > > Yes - we seem to be making a simple matter very complicated. I am sure > the > likes of Ed Raines will be wondering what all the mystery is about as > they > do all mitrals with a single two stage or long venous cannula and do not > have problems with drainage. Why a need to drain the left cava > separately - > doesnt the blood all end up in the same place as the IVC blood? > > > > Ani > > > > > > From: prasannasimha@gmail.com > Date: Sun, 3 May 2009 22:26:43 +0530 > Subject: Re: [HSF] Persistent LSVC > To: OpenHeart-L@lists.hsforum.com > CC: > > I have done it in the past but today with vacuum its so easy - just > plonk > a > straight cannula inside and connect it to the reservoir with a 1/4th > tube > and then it is out of sight and out of mind. Why worry of even a > potential > for brain injury ? (We have enough potential as it is !!)You can also > very > often just manage with a sucker inside for less complex cases. > Prasanna > > On Sun, May 3, 2009 at 9:18 PM, John Flege wrote: > > You can cannulate via the coronary sinus and if you need to open the > right > atrium, with an endotracheal tube. I have not done it. John Flege > > On May 2, 2009, at 4:59 PM, Mitch Lirtzman wrote: > > For the 3rd or 4th time in a span of two years, I've been confronted > with/ identified at the time of surgery, patients with a persistent > Lt > SVC. > For the routine CAB, it's not really a problem, but 2 of them have > been for > mitral surgery. If I remember correctly, one had a diminutive SVC > and > no > innominate vein. The other and most recent, had no SVC at all and > a > giant > retro-cardiac vessel. > > For future reference, I'll be accepting any and all tips, pearls, > and > general knowledge. > > Thanks, 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 > ----------------------------------------- > > > > > -- > 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 > ----------------------------------------- > > _________________________________________________________________ > View your Twitter and Flickr updates from one place ? Learn more! > > > > > > http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ > OpenHeart-Lmailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 > ----------------------------------------- > > **************The Average US Credit Score is 692. See Yours in Just 2 Easy > Steps! > ( > > > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M > ay5309AvgfooterNO62 > < > > http://pr.atwola.com/promoclk/100126575x1222376998x1201454298/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=62&bcd=M%0Aay5309AvgfooterNO62 > > ) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 > ----------------------------------------- > -- Prasanna Simha M From robertobattellini at hotmail.com Tue May 5 14:54:43 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Tue May 5 07:55:07 2009 Subject: [HSF] Type II acute dissection + subacute hemorrhagic CVA-For Erdinc In-Reply-To: References: <4B173E91-4C08-4727-A070-1D9B36FA8D3F@bigpond.com> Message-ID: Good work! I wish you good luck. Roberto > From: enaseri@hotmail.com.tr > To: openheart-l@lists.hsforum.com > Subject: RE: [HSF] Type II acute dissection + subacute hemorrhagic CVA > Date: Mon, 4 May 2009 20:24:37 +0000 > > > Robertto, > > Cerebral infarction 1 week ago and AMI today. I operated him. ?ntraop finding: dissection in the LMCA and epicardial echo showed huge concentric LVH. > > Bentall +CABG X 4. RCA graft reattached to ascending aorta .Out of operation room on IABP and high inotrope. > > Cardioplegia thru all possible routes . > > erdinc > > > From: robertobattellini@hotmail.com > > To: openheart-l@lists.hsforum.com > > Subject: RE: [HSF] Type II acute dissection + subacute hemorrhagic CVA > > Date: Mon, 4 May 2009 21:17:44 +0200 > > > > > > Erdinc, > > > > > > > > When you talk about infarction, is it myocardial or cerebral??? > > > > Roberto > > > > > From: robertobattellini@hotmail.com > > > To: openheart-l@lists.hsforum.com > > > Subject: RE: [HSF] Type II acute dissection + subacute hemorrhagic CVA > > > Date: Mon, 4 May 2009 21:09:04 +0200 > > > > > > > > > May be terrible, but you must operate on him...he is too young for leaving him alone. > > > > > > Aorta ascendens replacement + LAD revascularization and may be Aortic valve resuspension/replacement. > > > > > > > > > > > > Take care of the myocardial protection!! retrograde and also through the RCA graft. > > > > > > Roberto > > > > > > > From: enaseri@hotmail.com.tr > > > > To: openheart-l@lists.hsforum.com > > > > Date: Mon, 4 May 2009 11:47:49 +0000 > > > > Subject: [HSF] Type II acute dissection + subacute hemorrhagic CVA > > > > > > > > > > > > Urgent opinion requested: > > > > > > > > 42 Y/O male ,operated CABG X 3 ( 9 months ago) ,7 days ago acute hemorrhagic infarction with minimal sequalae.today admitted with severe chest pain and anterolateral AMI.CAG:3 vessel disease, RCA graft open ,Diagonal graft occluded ,lima occluded,Aortography:acute aortic dissection, CT:Type II dissection ( no involvement of arch is seen),TTE: EF moderate,AR +++ > > > > > > > > erdinc > > > > > > > > > > > > > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 May 5 15:19:39 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Tue May 5 10:19:41 2009 Subject: [HSF] HIT and valve degenration? In-Reply-To: References: Message-ID: dear colleagues, i have to work on a report about a pt, who died after reoperation for a valve-replacement for another biological valve implanted just 2 months before. this pt also suffered from a confirmed diagnosis of HIT. the question came up, if HIT can influence dengeneration of biological valves, and if so, in which time? i could not find relevant literatur; therefore i kindly ask the forum, if anybody has knowledge or ideas relating to the problem. thx in advance, axel laczkovics, bochum From Rwmfglycar at aol.com Tue May 5 12:03:14 2009 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Tue May 5 11:04:40 2009 Subject: [HSF] HIT and valve degenration? Message-ID: I have experienced Heparin Induced Thrombocytopenia/Thrombosis in a few patients. I have followed many patients with bioprostheses. I have never seen any suggestion of degeneration of a bioprosthesis being related to an episode of HIT/T Bob In a message dated 5/5/2009 4:21:45 P.M. South Africa Standard Time, axel.m.laczkovics@ruhr-uni-bochum.de writes: dear colleagues, i have to work on a report about a pt, who died after reoperation for a valve-replacement for another biological valve implanted just 2 months before. this pt also suffered from a confirmed diagnosis of HIT. the question came up, if HIT can influence dengeneration of biological valves, and if so, in which time? i could not find relevant literatur; therefore i kindly ask the forum, if anybody has knowledge or ideas relating to the problem. thx in advance, 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 ----------------------------------------- **************A Good Credit Score is 700 or Above. See yours in just 2 easy steps! (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd =May5509AvgfooterNO115) From axel.m.laczkovics at ruhr-uni-bochum.de Tue May 5 16:33:05 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Tue May 5 11:33:05 2009 Subject: [HSF] HIT and valve degenration? In-Reply-To: References: Message-ID: <6fa2994efc5f578461ce14f7bc9db726@ruhr-uni-bochum.de> many thx for your quick and sound answer. axel > I have experienced Heparin Induced Thrombocytopenia/Thrombosis in a > few > patients. I have followed many patients with bioprostheses. I have > never > seen any suggestion of degeneration of a bioprosthesis being related > to an > episode of HIT/T > Bob > > > In a message dated 5/5/2009 4:21:45 P.M. South Africa Standard Time, > axel.m.laczkovics@ruhr-uni-bochum.de writes: > > > dear colleagues, > > i have to work on a report about a pt, who died after reoperation for > a valve-replacement for another biological valve implanted just 2 > months before. > > this pt also suffered from a confirmed diagnosis of HIT. the question > came up, if HIT can influence dengeneration of biological valves, and > if so, in which time? > > i could not find relevant literatur; therefore i kindly ask the forum, > if anybody has knowledge or ideas relating to the problem. > > thx in advance, 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 > ----------------------------------------- > > > **************A Good Credit Score is 700 or Above. See yours in just 2 > easy > steps! > (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol? > redir=http://www.freecreditreport.com/pm/default.aspx? > sc=668072&hmpgID=115&bcd > =May5509AvgfooterNO115) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 May 5 10:38:12 2009 From: tacuff at swbell.net (Tea Acuff) Date: Tue May 5 12:39:36 2009 Subject: [HSF] HIT and valve degenration? Message-ID: <307605.2998.qm@web81602.mail.mud.yahoo.com> So it that a no, Bob? ; ) Tea Sent from my iPhone On May 5, 2009, at 10:03 AM, Rwmfglycar@aol.com wrote: I have experienced Heparin Induced Thrombocytopenia/Thrombosis in a few patients. I have followed many patients with bioprostheses. I have never seen any suggestion of degeneration of a bioprosthesis being related to an episode of HIT/T Bob In a message dated 5/5/2009 4:21:45 P.M. South Africa Standard Time, axel.m.laczkovics@ruhr-uni-bochum.de writes: dear colleagues, i have to work on a report about a pt, who died after reoperation for a valve-replacement for another biological valve implanted just 2 months before. this pt also suffered from a confirmed diagnosis of HIT. the question came up, if HIT can influence dengeneration of biological valves, and if so, in which time? i could not find relevant literatur; therefore i kindly ask the forum, if anybody has knowledge or ideas relating to the problem. thx in advance, 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 ----------------------------------------- **************A Good Credit Score is 700 or Above. See yours in just 2 easy steps! (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd =May5509AvgfooterNO115) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 May 5 11:20:18 2009 From: tacuff at swbell.net (Tea Acuff) Date: Tue May 5 13:21:44 2009 Subject: [HSF] HIT and valve degenration? Message-ID: <334488.77910.qm@web81603.mail.mud.yahoo.com> So it that a no, Bob? ; ) Tea Sent from my iPhone On May 5, 2009, at 10:03 AM, Rwmfglycar@aol.com wrote: > I have experienced Heparin Induced Thrombocytopenia/Thrombosis in > a few > patients. I have followed many patients with bioprostheses. I have > never > seen any suggestion of degeneration of a bioprosthesis being > related to an > episode of HIT/T > Bob > > > In a message dated 5/5/2009 4:21:45 P.M. South Africa Standard Time, > axel.m.laczkovics@ruhr-uni-bochum.de writes: > > > dear colleagues, > > i have to work on a report about a pt, who died after reoperation > for > a valve-replacement for another biological valve implanted just 2 > months before. > > this pt also suffered from a confirmed diagnosis of HIT. the question > came up, if HIT can influence dengeneration of biological valves, and > if so, in which time? > > i could not find relevant literatur; therefore i kindly ask the > forum, > if anybody has knowledge or ideas relating to the problem. > > thx in advance, 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 > ----------------------------------------- > > > **************A Good Credit Score is 700 or Above. See yours in just > 2 easy > steps! > (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd > =May5509AvgfooterNO115) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 May 5 15:50:04 2009 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Tue May 5 14:51:33 2009 Subject: [HSF] HIT and valve degenration? Message-ID: No. It is merely one small piece of experience without context in answer to a question with unknown context. There was a wonderful little book written about 20 years ago called "In the context of no context". I seem to be one of very few people who read it. But shall we say 10 or a hundred (pick a number) similar answers may allow the questioner to shed light on the circumstances that prompted the question. Or 10 or a hundred opposite answers may leave the questioner in a different position. Axel will perhaps digest such answers as he receives and tell us more Bob :) In a message dated 5/5/2009 7:23:58 P.M. South Africa Standard Time, tacuff@swbell.net writes: So it that a no, Bob? ; ) Tea Sent from my iPhone On May 5, 2009, at 10:03 AM, Rwmfglycar@aol.com wrote: > I have experienced Heparin Induced Thrombocytopenia/Thrombosis in > a few > patients. I have followed many patients with bioprostheses. I have > never > seen any suggestion of degeneration of a bioprosthesis being > related to an > episode of HIT/T > Bob > > > In a message dated 5/5/2009 4:21:45 P.M. South Africa Standard Time, > axel.m.laczkovics@ruhr-uni-bochum.de writes: > > > dear colleagues, > > i have to work on a report about a pt, who died after reoperation > for > a valve-replacement for another biological valve implanted just 2 > months before. > > this pt also suffered from a confirmed diagnosis of HIT. the question > came up, if HIT can influence dengeneration of biological valves, and > if so, in which time? > > i could not find relevant literatur; therefore i kindly ask the > forum, > if anybody has knowledge or ideas relating to the problem. > > thx in advance, 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 > ----------------------------------------- > > > **************A Good Credit Score is 700 or Above. See yours in just > 2 easy > steps! > (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd > =May5509AvgfooterNO115) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************A Good Credit Score is 700 or Above. See yours in just 2 easy steps! (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd =May5509AvgfooterNO115) From robertobattellini at hotmail.com Tue May 5 22:00:41 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Tue May 5 15:01:07 2009 Subject: [HSF] HIT and valve degenration? In-Reply-To: References: Message-ID: Bob, may be Tea is born with your way of thinking? If the book is wonderful and little, i want to read it. Can it be buyed in Amazon or so... Roberto > From: Rwmfglycar@aol.com > Date: Tue, 5 May 2009 14:50:04 -0400 > Subject: Re: [HSF] HIT and valve degenration? > To: OpenHeart-L@lists.hsforum.com > CC: > > No. It is merely one small piece of experience without context in answer > to a question with unknown context. There was a wonderful little book > written about 20 years ago called "In the context of no context". I seem to be > one of very few people who read it. > But shall we say 10 or a hundred (pick a number) similar answers may allow > the questioner to shed light on the circumstances that prompted the > question. Or 10 or a hundred opposite answers may leave the questioner in a > different position. > Axel will perhaps digest such answers as he receives and tell us more > > Bob > :) > > > In a message dated 5/5/2009 7:23:58 P.M. South Africa Standard Time, > tacuff@swbell.net writes: > > > So it that a no, Bob? > ; ) > > Tea > > Sent from my iPhone > > On May 5, 2009, at 10:03 AM, Rwmfglycar@aol.com wrote: > > > I have experienced Heparin Induced Thrombocytopenia/Thrombosis in > > a few > > patients. I have followed many patients with bioprostheses. I have > > never > > seen any suggestion of degeneration of a bioprosthesis being > > related to an > > episode of HIT/T > > Bob > > > > > > In a message dated 5/5/2009 4:21:45 P.M. South Africa Standard Time, > > axel.m.laczkovics@ruhr-uni-bochum.de writes: > > > > > > dear colleagues, > > > > i have to work on a report about a pt, who died after reoperation > > for > > a valve-replacement for another biological valve implanted just 2 > > months before. > > > > this pt also suffered from a confirmed diagnosis of HIT. the question > > came up, if HIT can influence dengeneration of biological valves, and > > if so, in which time? > > > > i could not find relevant literatur; therefore i kindly ask the > > forum, > > if anybody has knowledge or ideas relating to the problem. > > > > thx in advance, 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 > > ----------------------------------------- > > > > > > **************A Good Credit Score is 700 or Above. See yours in just > > 2 easy > > steps! > > > (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd > > =May5509AvgfooterNO115) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > **************A Good Credit Score is 700 or Above. See yours in just 2 easy > steps! > (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd > =May5509AvgfooterNO115) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Tue May 5 22:03:23 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Tue May 5 15:03:44 2009 Subject: [HSF] HIT and valve degenration? In-Reply-To: <6fa2994efc5f578461ce14f7bc9db726@ruhr-uni-bochum.de> References: <6fa2994efc5f578461ce14f7bc9db726@ruhr-uni-bochum.de> Message-ID: Axel, we have no knowledge. Do you have the second valve hystology? Nice to have seen you in Bad Oeynhausen. Roberto > Date: Tue, 5 May 2009 17:33:55 +0200 > From: axel.m.laczkovics@ruhr-uni-bochum.de > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] HIT and valve degenration? > CC: > > many thx for your quick and sound answer. > axel > > > > > I have experienced Heparin Induced Thrombocytopenia/Thrombosis in a > > few > > patients. I have followed many patients with bioprostheses. I have > > never > > seen any suggestion of degeneration of a bioprosthesis being related > > to an > > episode of HIT/T > > Bob > > > > > > In a message dated 5/5/2009 4:21:45 P.M. South Africa Standard Time, > > axel.m.laczkovics@ruhr-uni-bochum.de writes: > > > > > > dear colleagues, > > > > i have to work on a report about a pt, who died after reoperation for > > a valve-replacement for another biological valve implanted just 2 > > months before. > > > > this pt also suffered from a confirmed diagnosis of HIT. the question > > came up, if HIT can influence dengeneration of biological valves, and > > if so, in which time? > > > > i could not find relevant literatur; therefore i kindly ask the forum, > > if anybody has knowledge or ideas relating to the problem. > > > > thx in advance, 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 > > ----------------------------------------- > > > > > > **************A Good Credit Score is 700 or Above. See yours in just 2 > > easy > > steps! > > (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol? > > redir=http://www.freecreditreport.com/pm/default.aspx? > > sc=668072&hmpgID=115&bcd > > =May5509AvgfooterNO115) > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From gabuin at intramed.net Tue May 5 18:14:55 2009 From: gabuin at intramed.net (gustavo abuin) Date: Tue May 5 16:16:21 2009 Subject: [HSF] warfarin. acenocumarol and tricuspid insufficiency References: Message-ID: <000c01c9cdbe$286d45a0$6cfbe7c9@LIBERTAD> Members of the forum: What is the routine in your centers regarding the suspension of warfarin in patients with tricuspid insufficiency and hepatomegaly to achieve normal values of coagulation test? gustavo From prasannasimha at gmail.com Wed May 6 08:05:24 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Tue May 5 21:43:03 2009 Subject: [HSF] warfarin. acenocumarol and tricuspid insufficiency In-Reply-To: <000c01c9cdbe$286d45a0$6cfbe7c9@LIBERTAD> References: <000c01c9cdbe$286d45a0$6cfbe7c9@LIBERTAD> Message-ID: <89c4ed2d0905051835nbe77d49s1873e330b7fd06c8@mail.gmail.com> Why was the patient on warfarin in the first place ? For a mechanical valve or for Afib ? Prasanna On Wed, May 6, 2009 at 1:44 AM, gustavo abuin wrote: > Members of the forum: > What is the routine in your centers regarding the suspension of warfarin in > patients with tricuspid insufficiency and hepatomegaly to achieve normal > values of coagulation test? > gustavo > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Tue May 5 19:46:23 2009 From: tacuff at swbell.net (Tea Acuff) Date: Tue May 5 21:47:53 2009 Subject: [HSF] HIT and valve degenration? In-Reply-To: References: Message-ID: <926718.44867.qm@web81607.mail.mud.yahoo.com> This is related to multiple choice questions where one has no clue as to the real answer, that is, what is the question looking for?(perhaps even if one is an "expert" in that area), but by the form of the answers given one can pick an answer that is better than random. As to your specific example of the lack of context (category?) most us are more than happy to provide one. If for example we are presented a question about a patient with an (near?) endstage heart some?answer a LVAD, some a pacing device, some a CABG, some a mitral repair, etc.?We are all like card sharks looking at an imperfect hand. We thrown out the ace or one eyed jack tucked in our sleeve so we can be seen a "winner" and grab the adoration of the local ladies. tea ________________________________ From: "Rwmfglycar@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Tuesday, May 5, 2009 1:50:04 PM Subject: Re: [HSF] HIT and valve degenration? No. It is merely one small piece of experience without context in? answer to a question with unknown context. There was a wonderful little? book written about 20 years ago called "In the context of no context". I seem to? be one of very few people who read it. But shall we say 10 or a hundred (pick a number) similar answers? may allow the questioner to? shed light on the circumstances that? prompted the question. Or 10 or a hundred opposite answers may leave the? questioner in a different position. Axel will perhaps digest such answers as he receives and tell us more Bob :) In a message dated 5/5/2009 7:23:58 P.M. South Africa Standard Time,? tacuff@swbell.net writes: So? it that a no, Bob? ; ) Tea Sent from my iPhone On May? 5, 2009, at 10:03 AM, Rwmfglycar@aol.com wrote: > I have experienced? Heparin Induced Thrombocytopenia/Thrombosis? in? > a? few > patients. I have followed many patients with bioprostheses. I? have? > never > seen any suggestion of? degeneration of a bioprosthesis being? > related? to? an > episode? of HIT/T > Bob > > > In a? message dated 5/5/2009 4:21:45 P.M. South Africa Standard Time, >? axel.m.laczkovics@ruhr-uni-bochum.de writes: > > >? dear? colleagues, > > i have to work on a report about a? pt,? who died after? reoperation? > for > a? valve-replacement for another biological valve implanted? just 2 >? months before. > > this pt also suffered from a confirmed? diagnosis of HIT. the question > came up, if HIT can influence? dengeneration? of biological valves, and > if so, in which? time? > > i could not find? relevant literatur; therefore i? kindly ask the? > forum, > if? anybody? has? knowledge or ideas relating to the problem. > > thx in? advance, 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 >? ----------------------------------------- > > >? **************A Good Credit Score is 700 or Above. See yours in just? > 2 easy > steps! >? (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd >? =May5509AvgfooterNO115) >? _______________________________________________ > OpenHeart-L mailing? list > > Send postings to: >? OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email? address, or to view archives: >? http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages? transmitted by the OpenHeart-L are subject to the? > policies? and > disclaimers posted at: >? http://www.hsforum.com/listdisclaim >? ----------------------------------------- _______________________________________________ OpenHeart-L? mailing list Send postings? to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email? address, or to view? archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All? messages transmitted by the OpenHeart-L are subject to the policies and? disclaimers posted? at: http://www.hsforum.com/listdisclaim ----------------------------------------- **************A Good Credit Score is 700 or Above. See yours in just 2 easy steps! (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd =May5509AvgfooterNO115) _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 GoldmanS at MLHS.ORG Tue May 5 23:21:44 2009 From: GoldmanS at MLHS.ORG (Goldman, Scott) Date: Tue May 5 22:22:44 2009 Subject: [HSF] warfarin. acenocumarol and tricuspid insufficiency In-Reply-To: <89c4ed2d0905051835nbe77d49s1873e330b7fd06c8@mail.gmail.com> References: <000c01c9cdbe$286d45a0$6cfbe7c9@LIBERTAD>, <89c4ed2d0905051835nbe77d49s1873e330b7fd06c8@mail.gmail.com> Message-ID: <6FF71BF92ACC044F80A522679DCF11857BCC0E90@MLHMB2.ad.mlhs.org> Rat Poison Scott Goldman MD Chairman Department of Surgery Main Line Health ________________________________________ From: openheart-l-bounces@lists.hsforum.com [openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M [prasannasimha@gmail.com] Sent: Tuesday, May 05, 2009 9:35 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] warfarin. acenocumarol and tricuspid insufficiency Why was the patient on warfarin in the first place ? For a mechanical valve or for Afib ? Prasanna On Wed, May 6, 2009 at 1:44 AM, gustavo abuin wrote: > Members of the forum: > What is the routine in your centers regarding the suspension of warfarin in > patients with tricuspid insufficiency and hepatomegaly to achieve normal > values of coagulation test? > gustavo > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 axel.m.laczkovics at ruhr-uni-bochum.de Wed May 6 05:56:52 2009 From: axel.m.laczkovics at ruhr-uni-bochum.de (prof. dr. axel laczkovics) Date: Wed May 6 00:56:54 2009 Subject: [HSF] HIT and valve degenration? In-Reply-To: References: Message-ID: bob and roberto, in the time being there is only one answer (your answer!) to digest! concerning robertos q: the surgeons sent the vlave back to the company and received no answer sofar (a frequent experience). i will urge on that and come back if i have at least an answer (which might not be a solution!) axel > No. It is merely one small piece of experience without context in > answer > to a question with unknown context. There was a wonderful little book > written about 20 years ago called "In the context of no context". I > seem to be > one of very few people who read it. > But shall we say 10 or a hundred (pick a number) similar answers may > allow > the questioner to shed light on the circumstances that prompted the > question. Or 10 or a hundred opposite answers may leave the > questioner in a > different position. > Axel will perhaps digest such answers as he receives and tell us more > > Bob > :) > > > In a message dated 5/5/2009 7:23:58 P.M. South Africa Standard Time, > tacuff@swbell.net writes: > > > So it that a no, Bob? > ; ) > > Tea > > Sent from my iPhone > > On May 5, 2009, at 10:03 AM, Rwmfglycar@aol.com wrote: > >> I have experienced Heparin Induced Thrombocytopenia/Thrombosis in >> a few >> patients. I have followed many patients with bioprostheses. I have >> never >> seen any suggestion of degeneration of a bioprosthesis being >> related to an >> episode of HIT/T >> Bob >> >> >> In a message dated 5/5/2009 4:21:45 P.M. South Africa Standard Time, >> axel.m.laczkovics@ruhr-uni-bochum.de writes: >> >> >> dear colleagues, >> >> i have to work on a report about a pt, who died after reoperation >> for >> a valve-replacement for another biological valve implanted just 2 >> months before. >> >> this pt also suffered from a confirmed diagnosis of HIT. the >> question >> came up, if HIT can influence dengeneration of biological valves, >> and >> if so, in which time? >> >> i could not find relevant literatur; therefore i kindly ask the >> forum, >> if anybody has knowledge or ideas relating to the problem. >> >> thx in advance, 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 >> ----------------------------------------- >> >> >> **************A Good Credit Score is 700 or Above. See yours in just >> 2 easy >> steps! >> > (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol? > redir=http://www.freecreditreport.com/pm/default.aspx? > sc=668072&hmpgID=115&bcd >> =May5509AvgfooterNO115) >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > **************A Good Credit Score is 700 or Above. See yours in just 2 > easy > steps! > (http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol? > redir=http://www.freecreditreport.com/pm/default.aspx? > sc=668072&hmpgID=115&bcd > =May5509AvgfooterNO115) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From benjamin.bidstrup at bigpond.com Wed May 6 16:39:11 2009 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Wed May 6 01:39:51 2009 Subject: [HSF] HIT and valve degenration? In-Reply-To: References: Message-ID: Axel, Was this thrombocytopenia or the thrombotic state of HIT? What was the mode of death - related to HIT or HITTS? What was the mode of degeneration - ie was there a thrombotic aggregation on the valve leaflets? I suspect that given the nature of HIT, a PF4/heparin reactive antibody related to heparin exposure , it is unlikely there would be an association let alone a cause/effect relationship with rapid degeneration of a tissue prosthesis. This is only my opinion, based on my understanding of HIT. Ben Bidstrup FRACS FRCSEd FEBCTS Cardiothoracic Surgeon On 06/05/2009, at 12:21 AM, prof. dr. axel laczkovics wrote: > > dear colleagues, > > i have to work on a report about a pt, who died after reoperation > for a valve-replacement for another biological valve implanted just > 2 months before. > > this pt also suffered from a confirmed diagnosis of HIT. the > question came up, if HIT can influence dengeneration of biological > valves, and if so, in which time? > > i could not find relevant literatur; therefore i kindly ask the > forum, if anybody has knowledge or ideas relating to the problem. > > thx in advance, 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 friedrich-christian.riess at albertinen.de Wed May 6 15:47:29 2009 From: friedrich-christian.riess at albertinen.de (friedrich-christian.riess@albertinen.de) Date: Wed May 6 08:49:01 2009 Subject: Antwort: Re: [HSF] HIT and valve degenration? In-Reply-To: Message-ID: Lieber Herr Kollege Laczkovics, wir haben bei einem Patienten nach Mosaic-Klappenimplantation in Ministernotomie-Technik ca. 1 Jahr sp?ter eine Re-AKE vornehmen m?ssen bei Klappenthrombose (Stenose der Aortenklappenprothese). Wir fanden intraoperativ alle drei Taschen mit einem Fibrinbelag bedeckt ("white Clots"?). Dieser Patient hatte nach der ersten Klappen-OP eine HIT II gehabt und war mit Refludan behandelt worden. Viele Gr??e aus Hamburg Friedrich-Christian Rie? Albertinen-Krankenhaus Priv.Doz. Dr. med. Friedrich-Christian Rie? Chefarzt der Abteilung f?r Herzchirurgie Albertinen-Krankenhaus/Albertinen-Haus gemeinn?tzige GmbH Ein Haus der Albertinen-Gruppe S?ntelstra?e 11 a, 22457 Hamburg Tel.: (0 40) 5588 2445, Fax: 040 5588 2421 E-Mail: Friedrich-Christian.Riess@albertinen.de www.albertinen.de www.albertinen-herzzentrum.de Sitz der Gesellschaft: S?ntelstra?e 11a, 22457 Hamburg Handelsregister: HRB 102934, Amtsgericht Hamburg Ust.-Nr. 17/423/04759 Gesch?ftsf?hrer: Cord Meyer, Tobias Schwarz, Ralf Zastrau Diese E-Mail enth?lt vertrauliche und/oder rechtlich gesch?tzte Informationen. Wenn Sie nicht der richtige Adressat sind oder diese E-Mail irrt?mlich erhalten haben, informieren Sie bitte sofort den Absender und vernichten Sie diese Mail. Das unerlaubte Kopieren sowie die unbefugte Weitergabe dieser E-Mail ist nicht gestattet. From gabuin at intramed.net Wed May 6 15:45:38 2009 From: gabuin at intramed.net (gustavo abuin) Date: Wed May 6 19:56:58 2009 Subject: [HSF] warfarin. acenocumarol and tricuspid insufficiency References: <000c01c9cdbe$286d45a0$6cfbe7c9@LIBERTAD> <89c4ed2d0905051835nbe77d49s1873e330b7fd06c8@mail.gmail.com> Message-ID: <000001c9cea6$464c0550$539e12be@LIBERTAD> For a mechanical valve. ----- Original Message ----- From: "Prasanna Simha M" To: Sent: Tuesday, May 05, 2009 10:35 PM Subject: Re: [HSF] warfarin. acenocumarol and tricuspid insufficiency > Why was the patient on warfarin in the first place ? For a mechanical > valve > or for Afib ? > Prasanna > > On Wed, May 6, 2009 at 1:44 AM, gustavo abuin wrote: > >> Members of the forum: >> What is the routine in your centers regarding the suspension of warfarin >> in >> patients with tricuspid insufficiency and hepatomegaly to achieve normal >> values of coagulation test? >> gustavo >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 > ----------------------------------------- -------------------------------------------------------------------------------- No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.325 / Virus Database: 270.12.19/2099 - Release Date: 05/05/09 13:07:00 From prasannasimha at gmail.com Thu May 7 08:00:02 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed May 6 21:37:20 2009 Subject: [HSF] warfarin. acenocumarol and tricuspid insufficiency In-Reply-To: <000001c9cea6$464c0550$539e12be@LIBERTAD> References: <000c01c9cdbe$286d45a0$6cfbe7c9@LIBERTAD> <89c4ed2d0905051835nbe77d49s1873e330b7fd06c8@mail.gmail.com> <000001c9cea6$464c0550$539e12be@LIBERTAD> Message-ID: <89c4ed2d0905061830l634137f1q8f8155a89bc4c399@mail.gmail.com> With a mechanical valve why do you want to achieve "Normalcy". If you wan to stop Warfarin convert to Heparin or Bivaluridin if the patient has HIT. Prasanna On Wed, May 6, 2009 at 11:15 PM, gustavo abuin wrote: > For a mechanical valve. > ----- Original Message ----- From: "Prasanna Simha M" < > prasannasimha@gmail.com> > To: > Sent: Tuesday, May 05, 2009 10:35 PM > Subject: Re: [HSF] warfarin. acenocumarol and tricuspid insufficiency > > > Why was the patient on warfarin in the first place ? For a mechanical >> valve >> or for Afib ? >> Prasanna >> >> On Wed, May 6, 2009 at 1:44 AM, gustavo abuin >> wrote: >> >> Members of the forum: >>> What is the routine in your centers regarding the suspension of warfarin >>> in >>> patients with tricuspid insufficiency and hepatomegaly to achieve normal >>> values of coagulation test? >>> gustavo >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/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 >> ----------------------------------------- >> > > > > -------------------------------------------------------------------------------- > > > > No virus found in this incoming message. > Checked by AVG - www.avg.com > Version: 8.5.325 / Virus Database: 270.12.19/2099 - Release Date: 05/05/09 > 13:07:00 > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From drmitch at cox.net Wed May 6 21:57:39 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Wed May 6 21:58:02 2009 Subject: [HSF] Post operative anorexia Message-ID: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Looking at the pot I stirred with LSCV, I hesitate to ask, but here goes: We've talked a lot about PONV in the past, but recently we've encountered a spate of patients who have lost their appetite after surgery. I've seen it many times over the years. It is self-limited, but I was wondering if any of the group has a favorite bit of voo-doo to make my patients feel better and make me look like a genius. Thanks, Mitch From prasannasimha at gmail.com Thu May 7 08:30:57 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed May 6 22:08:40 2009 Subject: [HSF] Post operative anorexia In-Reply-To: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: <89c4ed2d0905061900w65fd4f22kfd6f8443c00d5b72@mail.gmail.com> No stirring the pot is always interesting. I have one kid who is just now refusing to eat and is actually requiring tube feeding to just stay hydrated !!. Prasanna On Thu, May 7, 2009 at 7:27 AM, Mitch Lirtzman wrote: > Looking at the pot I stirred with LSCV, I hesitate to ask, but here goes: > > We've talked a lot about PONV in the past, but recently we've encountered a > spate of patients who have lost their appetite after surgery. I've seen it > many times over the years. It is self-limited, but I was wondering if any of > the group has a favorite bit of voo-doo to make my patients feel better and > make me look like a genius. > > Thanks, 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 > ----------------------------------------- > -- Prasanna Simha M From grescigno at mac.com Thu May 7 09:40:46 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Thu May 7 02:50:20 2009 Subject: [HSF] Post operative anorexia In-Reply-To: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: Mitch, considering the rates of obese pts we deal, some starvation is not so bad! I noticed that going back to home improve significantly their appetite. Giuseppe Il giorno 07/mag/09, alle ore 03:57, Mitch Lirtzman ha scritto: > Looking at the pot I stirred with LSCV, I hesitate to ask, but here > goes: > > We've talked a lot about PONV in the past, but recently we've > encountered a spate of patients who have lost their appetite after > surgery. I've seen it many times over the years. It is self- > limited, but I was wondering if any of the group has a favorite bit > of voo-doo to make my patients feel better and make me look like a > genius. > > Thanks, 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 anianyanwu at hotmail.com Thu May 7 21:41:57 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Thu May 7 16:42:24 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: Patient 41 years old, previous multivessel PCI in 2007 now instent occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned up for his LAD stent - maybe fortunately; four stents placed in Cx first week, four in RCA two weeks after and then was to have LAD staged two weeks later and never came back till now). For full revascularization would need bypass to LAD, OM and PDA +/-PLV. EF 45%. Patient has diabetes since age 10 with multiple end-organ complications. Renal failure on dialysis for 2 years, retinopathy with laser treatment, arteriopathy with severe peripheral vascular disease. Has had below knee amputation on right side and toe amputations on left. No distal pulses in left leg. Used to smoke but stopped few years ago. He is being considered for pancreatic and kidney transplant but needs heart fixed first. Has AV fistula in left forearm which failed. Right arm untouched so far. Being dialysed via catheter while awaiting plan for new fistula (they wont do that either till heart fixed). He is terrified about losing his left leg or needing more amputated off his right or having a chronic ulcer due to non-healing of surgical incision and says he does not want his legs cut. As amputee very dependent on upper torso to mobilize. What conduits would you use and in what configuration? Thanks Ani _________________________________________________________________ Share your photos with Windows Live Photos ? Free. http://clk.atdmt.com/UKM/go/134665338/direct/01/ From donross at bigpond.com Fri May 8 10:20:01 2009 From: donross at bigpond.com (Donald Ross) Date: Thu May 7 19:20:44 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: Ani. Providing the renal guys will let you have the R radial and you can verify the safe harvesting of the lima (CT angio??) then he will should have no problems with my routine graft choice... Lima T-radial for all distals. Don On 08/05/2009, at 6:41 AM, Ani Anyanwu wrote: > > Patient 41 years old, previous multivessel PCI in 2007 now instent > occlusion of RCA and Cx, also severe proximal LAD lesion (he never > turned up for his LAD stent - maybe fortunately; four stents placed > in Cx first week, four in RCA two weeks after and then was to have > LAD staged two weeks later and never came back till now). For full > revascularization would need bypass to LAD, OM and PDA +/-PLV. EF 45%. > > > > Patient has diabetes since age 10 with multiple end-organ > complications. Renal failure on dialysis for 2 years, retinopathy > with laser treatment, arteriopathy with severe peripheral vascular > disease. Has had below knee amputation on right side and toe > amputations on left. No distal pulses in left leg. Used to smoke but > stopped few years ago. He is being considered for pancreatic and > kidney transplant but needs heart fixed first. Has AV fistula in > left forearm which failed. Right arm untouched so far. Being > dialysed via catheter while awaiting plan for new fistula (they wont > do that either till heart fixed). He is terrified about losing his > left leg or needing more amputated off his right or having a chronic > ulcer due to non-healing of surgical incision and says he does not > want his legs cut. As amputee very dependent on upper torso to > mobilize. > > > > What conduits would you use and in what configuration? > > > > Thanks > > > > Ani > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From drmitch at cox.net Thu May 7 19:41:11 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Thu May 7 19:42:41 2009 Subject: [HSF] Post operative anorexia In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: <6.2.1.2.2.20090507184000.01df9128@pop.east.cox.net> Very true! For many of my pts, I'll just encourage them to stay hydrated as "you're not going to waste away".At 01:40 AM 5/7/2009, you wrote: >Mitch, > >considering the rates of obese pts we deal, some starvation is not so >bad! I noticed that going back to home improve significantly their >appetite. > >Giuseppe > > >Il giorno 07/mag/09, alle ore 03:57, Mitch Lirtzman ha scritto: > >>Looking at the pot I stirred with LSCV, I hesitate to ask, but here >>goes: >> >>We've talked a lot about PONV in the past, but recently we've >>encountered a spate of patients who have lost their appetite after >>surgery. I've seen it many times over the years. It is self- limited, but >>I was wondering if any of the group has a favorite bit >>of voo-doo to make my patients feel better and make me look like a >>genius. >> >>Thanks, 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 anianyanwu at hotmail.com Fri May 8 00:52:45 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Thu May 7 19:53:34 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: CTA shows both IMAs look okay. Off course renal worried about arm. Where do you want them to site next fistula? The other problem is whether his severe small vessel disease (the reason for his amputations) could also involve his arm and threaten the limb if radial harvested. Ani > From: donross@bigpond.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Conduit choice > Date: Fri, 8 May 2009 09:20:01 +1000 > CC: > > Ani. > Providing the renal guys will let you have the R radial and you can > verify the safe harvesting of the lima (CT angio??) then he will > should have no problems with my routine graft choice... Lima T-radial > for all distals. > Don > On 08/05/2009, at 6:41 AM, Ani Anyanwu wrote: > > > > > Patient 41 years old, previous multivessel PCI in 2007 now instent > > occlusion of RCA and Cx, also severe proximal LAD lesion (he never > > turned up for his LAD stent - maybe fortunately; four stents placed > > in Cx first week, four in RCA two weeks after and then was to have > > LAD staged two weeks later and never came back till now). For full > > revascularization would need bypass to LAD, OM and PDA +/-PLV. EF 45%. > > > > > > > > Patient has diabetes since age 10 with multiple end-organ > > complications. Renal failure on dialysis for 2 years, retinopathy > > with laser treatment, arteriopathy with severe peripheral vascular > > disease. Has had below knee amputation on right side and toe > > amputations on left. No distal pulses in left leg. Used to smoke but > > stopped few years ago. He is being considered for pancreatic and > > kidney transplant but needs heart fixed first. Has AV fistula in > > left forearm which failed. Right arm untouched so far. Being > > dialysed via catheter while awaiting plan for new fistula (they wont > > do that either till heart fixed). He is terrified about losing his > > left leg or needing more amputated off his right or having a chronic > > ulcer due to non-healing of surgical incision and says he does not > > want his legs cut. As amputee very dependent on upper torso to > > mobilize. > > > > > > > > What conduits would you use and in what configuration? > > > > > > > > Thanks > > > > > > > > Ani > > > > _________________________________________________________________ > > Share your photos with Windows Live Photos ? Free. > > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ Share your photos with Windows Live Photos ? Free. http://clk.atdmt.com/UKM/go/134665338/direct/01/ From donross at bigpond.com Fri May 8 11:38:43 2009 From: donross at bigpond.com (Donald Ross) Date: Thu May 7 20:38:02 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: <548C0E88-91D2-44FC-9958-5F9068961790@bigpond.com> I have not heard of that problem with diabetic arterial disease, it probably happens like most things but if the palmar arch is intact I doubt there would be a problem. You say the imas look okay but what are you looking for to predict inadequate intercostal co-lateral supply to the sternum? Can't they redo the L arm fistula? If not, the L radial might be a great conduit because if its high flow when supplying the fistula. Don On 08/05/2009, at 9:52 AM, Ani Anyanwu wrote: > > CTA shows both IMAs look okay. Off course renal worried about arm. > Where do you want them to site next fistula? The other problem is > whether his severe small vessel disease (the reason for his > amputations) could also involve his arm and threaten the limb if > radial harvested. > > > > Ani > >> From: donross@bigpond.com >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Conduit choice >> Date: Fri, 8 May 2009 09:20:01 +1000 >> CC: >> >> Ani. >> Providing the renal guys will let you have the R radial and you can >> verify the safe harvesting of the lima (CT angio??) then he will >> should have no problems with my routine graft choice... Lima T-radial >> for all distals. >> Don >> On 08/05/2009, at 6:41 AM, Ani Anyanwu wrote: >> >>> >>> Patient 41 years old, previous multivessel PCI in 2007 now instent >>> occlusion of RCA and Cx, also severe proximal LAD lesion (he never >>> turned up for his LAD stent - maybe fortunately; four stents placed >>> in Cx first week, four in RCA two weeks after and then was to have >>> LAD staged two weeks later and never came back till now). For full >>> revascularization would need bypass to LAD, OM and PDA +/-PLV. EF >>> 45%. >>> >>> >>> >>> Patient has diabetes since age 10 with multiple end-organ >>> complications. Renal failure on dialysis for 2 years, retinopathy >>> with laser treatment, arteriopathy with severe peripheral vascular >>> disease. Has had below knee amputation on right side and toe >>> amputations on left. No distal pulses in left leg. Used to smoke but >>> stopped few years ago. He is being considered for pancreatic and >>> kidney transplant but needs heart fixed first. Has AV fistula in >>> left forearm which failed. Right arm untouched so far. Being >>> dialysed via catheter while awaiting plan for new fistula (they wont >>> do that either till heart fixed). He is terrified about losing his >>> left leg or needing more amputated off his right or having a chronic >>> ulcer due to non-healing of surgical incision and says he does not >>> want his legs cut. As amputee very dependent on upper torso to >>> mobilize. >>> >>> >>> >>> What conduits would you use and in what configuration? >>> >>> >>> >>> Thanks >>> >>> >>> >>> Ani >>> >>> _________________________________________________________________ >>> Share your photos with Windows Live Photos ? Free. >>> http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From drmitch at cox.net Thu May 7 20:49:07 2009 From: drmitch at cox.net (Mitch Lirtzman) Date: Thu May 7 20:49:36 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: <6.2.1.2.2.20090507192738.01e99440@pop.east.cox.net> At the outset, they should do the AVF now!!! It takes 45mins under local. Don't be weenies. All he needs is a shot of pyrogen in that #*!#* catheter and that's all she wrote. How is the Lt cephalic v. at the elbow? If it's a decent vessel, use it for a brachial-cephalic fistula and leave the Rt to use another day. Next get a CTA of the subclavians. As we have discussed, the IMA's can and do provide huge collateral to the femorals. Need I say more about that before you harvest his arteries. Examine the LRA if the Lt cephalic isn't to be used for HD access. Next, try to preserve his saphenous veins...in BOTH legs. He may need them for distal bypass sooner or later. Next, go LIMA to LAD w/ "T" RIMA to Cx to PDA. On or off pump, doesn't matter. Next, shoot the cardiologist. MitchAt 03:41 PM 5/7/2009, you wrote: >Patient 41 years old, previous multivessel PCI in 2007 now instent >occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned >up for his LAD stent - maybe fortunately; four stents placed in Cx first >week, four in RCA two weeks after and then was to have LAD staged two >weeks later and never came back till now). For full revascularization >would need bypass to LAD, OM and PDA +/-PLV. EF 45%. > > > >Patient has diabetes since age 10 with multiple end-organ complications. >Renal failure on dialysis for 2 years, retinopathy with laser treatment, >arteriopathy with severe peripheral vascular disease. Has had below knee >amputation on right side and toe amputations on left. No distal pulses in >left leg. Used to smoke but stopped few years ago. He is being considered >for pancreatic and kidney transplant but needs heart fixed first. Has AV >fistula in left forearm which failed. Right arm untouched so far. Being >dialysed via catheter while awaiting plan for new fistula (they wont do >that either till heart fixed). He is terrified about losing his left leg >or needing more amputated off his right or having a chronic ulcer due to >non-healing of surgical incision and says he does not want his legs cut. >As amputee very dependent on upper torso to mobilize. > > > >What conduits would you use and in what configuration? > > > >Thanks > > > >Ani > >_________________________________________________________________ >Share your photos with Windows Live Photos ? Free. >http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- From tacuff at swbell.net Thu May 7 20:55:45 2009 From: tacuff at swbell.net (Tea Acuff) Date: Thu May 7 22:56:13 2009 Subject: [HSF] Conduit choice In-Reply-To: <6.2.1.2.2.20090507192738.01e99440@pop.east.cox.net> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <6.2.1.2.2.20090507192738.01e99440@pop.east.cox.net> Message-ID: <774294.89240.qm@web81605.mail.mud.yahoo.com> I would bet that a LIMA to the LAD and thigh vein from right side for other two distals will give him the same five year survival (<50%, perhaps much less) as any other combination. Surely no one is planning a R fempop to save the BKA. If there are problems with sternal infection or upper arm ischemia, he is DED (southern spellling) dead. Heart disease is NOT this guys problem. But we are heart surgeons (the poker player with a card up his sleeve) so he gets?"winning" surgery. But what do any of us know on a case like this? This is a good a place as any to mention a science TV?show I just saw. It was about "network biology". The short? (teas Cliff Note version) story is that everything is connected and that behavior (phenotype)?is not in the cell or protein as in the DNA or RNA?but the connections, relations,?or networks?of these proteins(in and among the cell) which are huge and vary from "system" (eg individual) to system whether subcellular, cellular, ecosystem, global, etc. This would suggest?that meaning (behavioral prediction) is not hierarchical but associative. Heard this anywhere before? Is this related to this case? Does anyone have a clue? tea ________________________________ From: Mitch Lirtzman To: OpenHeart-L@lists.hsforum.com Sent: Thursday, May 7, 2009 7:49:07 PM Subject: RE: [HSF] Conduit choice At the outset, they should do the AVF now!!! It takes 45mins under local.? Don't be weenies. All he needs is a shot of pyrogen in that #*!#* catheter and that's all she wrote. How is the Lt cephalic v. at the elbow? If it's a decent vessel, use it for a brachial-cephalic fistula and leave the Rt to use another day. Next get a CTA of the subclavians. As we have discussed, the IMA's can and do provide huge collateral to the femorals. Need I say more about that before you harvest his arteries. Examine the LRA if the Lt cephalic isn't to be used for HD access. Next, try to preserve his saphenous veins...in BOTH legs. He may need them for distal bypass sooner or later. Next, go LIMA to LAD w/ "T" RIMA to Cx to PDA. On or off pump, doesn't matter. Next, shoot the cardiologist. MitchAt 03:41 PM 5/7/2009, you wrote: > Patient 41 years old, previous multivessel PCI in 2007 now instent occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned up for his LAD stent - maybe fortunately; four stents placed in Cx first week, four in RCA two weeks after and then was to have LAD staged two weeks later and never came back till now). For full revascularization would need bypass to LAD, OM and PDA +/-PLV. EF 45%. > > > > Patient has diabetes since age 10 with multiple end-organ complications. Renal failure on dialysis for 2 years, retinopathy with laser treatment, arteriopathy with severe peripheral vascular disease. Has had below knee amputation on right side and toe amputations on left. No distal pulses in left leg. Used to smoke but stopped few years ago. He is being considered for pancreatic and kidney transplant but needs heart fixed first. Has AV fistula in left forearm which failed. Right arm untouched so far. Being dialysed via catheter while awaiting plan for new fistula (they wont do that either till heart fixed). He is terrified about losing his left leg or needing more amputated off his right or having a chronic ulcer due to non-healing of surgical incision and says he does not want his legs cut. As amputee very dependent on upper torso to mobilize. > > > > What conduits would you use and in what configuration? > > > > Thanks > > > > Ani > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: >? OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 tfurnary at starrwood.com Thu May 7 22:42:21 2009 From: tfurnary at starrwood.com (Anthony P Furnary MD) Date: Fri May 8 00:42:55 2009 Subject: [HSF] Post operative anorexia In-Reply-To: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: <4B7623D2-DF26-4EEF-971E-E689EE578A73@starrwood.com> Megase ES 625 mg q day or Megase susp 800 mg q day 400 - 800 mg q day in some form On May 6, 2009, at 6:57 PM, Mitch Lirtzman wrote: > Looking at the pot I stirred with LSCV, I hesitate to ask, but here > goes: > > We've talked a lot about PONV in the past, but recently we've > encountered a spate of patients who have lost their appetite after > surgery. I've seen it many times over the years. It is self-limited, > but I was wondering if any of the group has a favorite bit of voo- > doo to make my patients feel better and make me look like a genius. > > Thanks, 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 grescigno at mac.com Fri May 8 09:12:50 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Fri May 8 02:17:04 2009 Subject: [HSF] Conduit choice In-Reply-To: References: Message-ID: <91874447580916105777560392264982806161-Webmail@me.com> Ani, is this guy obese? Why do you hesitate in using both IMAs? The fate of saphenous veins in dialysis is very bad, I guess. I would avoid to touch the limbs. Giuseppe Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Thursday, May 07, 2009, at 10:41PM, "Ani Anyanwu" wrote: > >Patient 41 years old, previous multivessel PCI in 2007 now instent occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned up for his LAD stent - maybe fortunately; four stents placed in Cx first week, four in RCA two weeks after and then was to have LAD staged two weeks later and never came back till now). For full revascularization would need bypass to LAD, OM and PDA +/-PLV. EF 45%. > > > >Patient has diabetes since age 10 with multiple end-organ complications. Renal failure on dialysis for 2 years, retinopathy with laser treatment, arteriopathy with severe peripheral vascular disease. Has had below knee amputation on right side and toe amputations on left. No distal pulses in left leg. Used to smoke but stopped few years ago. He is being considered for pancreatic and kidney transplant but needs heart fixed first. Has AV fistula in left forearm which failed. Right arm untouched so far. Being dialysed via catheter while awaiting plan for new fistula (they wont do that either till heart fixed). He is terrified about losing his left leg or needing more amputated off his right or having a chronic ulcer due to non-healing of surgical incision and says he does not want his legs cut. As amputee very dependent on upper torso to mobilize. > > > >What conduits would you use and in what configuration? > > > >Thanks > > > >Ani > >_________________________________________________________________ >Share your photos with Windows Live Photos ? Free. >http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- > > From anianyanwu at hotmail.com Fri May 8 10:52:13 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Fri May 8 05:52:41 2009 Subject: [HSF] Conduit choice In-Reply-To: <91874447580916105777560392264982806161-Webmail@me.com> References: <91874447580916105777560392264982806161-Webmail@me.com> Message-ID: He is not obese. Concern about the IMAs is the consequence of wound infection and whether the necessary strain on an amputee's sternum post-operatively as he mobilizes will increase risk of sternal disruption. I am not though convinced that this risk, or the consequences, are necessarily different from if one took a single IMA. I have also not yet seen primary sternal necrosis with skeltonized IMA tehnique so am not as convinced of this phenomenon. Ani > Date: Fri, 8 May 2009 08:12:50 +0200 > From: grescigno@mac.com > To: OpenHeart-L@lists.hsforum.com > Subject: RE: [HSF] Conduit choice > CC: > > Ani, > > is this guy obese? Why do you hesitate in using both IMAs? The fate of saphenous veins in dialysis is very bad, I guess. I would avoid to touch the limbs. > > Giuseppe > > Giuseppe Rescigno M.D. > Cardiothoracic Surgeon > > Lancisi Hospital > Torrette - Ancona > Italy > > > > On Thursday, May 07, 2009, at 10:41PM, "Ani Anyanwu" wrote: > > > >Patient 41 years old, previous multivessel PCI in 2007 now instent occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned up for his LAD stent - maybe fortunately; four stents placed in Cx first week, four in RCA two weeks after and then was to have LAD staged two weeks later and never came back till now). For full revascularization would need bypass to LAD, OM and PDA +/-PLV. EF 45%. > > > > > > > >Patient has diabetes since age 10 with multiple end-organ complications. Renal failure on dialysis for 2 years, retinopathy with laser treatment, arteriopathy with severe peripheral vascular disease. Has had below knee amputation on right side and toe amputations on left. No distal pulses in left leg. Used to smoke but stopped few years ago. He is being considered for pancreatic and kidney transplant but needs heart fixed first. Has AV fistula in left forearm which failed. Right arm untouched so far. Being dialysed via catheter while awaiting plan for new fistula (they wont do that either till heart fixed). He is terrified about losing his left leg or needing more amputated off his right or having a chronic ulcer due to non-healing of surgical incision and says he does not want his legs cut. As amputee very dependent on upper torso to mobilize. > > > > > > > >What conduits would you use and in what configuration? > > > > > > > >Thanks > > > > > > > >Ani > > > >_________________________________________________________________ > >Share your photos with Windows Live Photos ? Free. > >http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > >OpenHeart-L mailing list > > > >Send postings to: > > OpenHeart-L@lists.hsforum.com > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >All messages transmitted by the OpenHeart-L are subject to the policies and > >disclaimers posted at: > >http://www.hsforum.com/listdisclaim > >----------------------------------------- > > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/ From anianyanwu at hotmail.com Fri May 8 11:04:38 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Fri May 8 06:05:26 2009 Subject: [HSF] Conduit choice In-Reply-To: <6.2.1.2.2.20090507192738.01e99440@pop.east.cox.net> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <6.2.1.2.2.20090507192738.01e99440@pop.east.cox.net> Message-ID: Mitch Yes the plan is to use the upper left arm for the next fistula but as he has working permcath they feel not immediate priority. Would anybody (aside from Don) ignore all the renal stuff and procure either radial artery? His femorals and major aortic branch vessels are not actually stenosed - all small vessel disease. This disease is very aggresive as ended up losing his leg from what started as a tiny wound in his ankle. I am tilting towards your revascularization option using the IMAs in Y/T configuration as, provided he survives surgery without wound morbidity, this maybe the choice least likely to interfere with his future. Ani > Date: Thu, 7 May 2009 19:49:07 -0500 > To: OpenHeart-L@lists.hsforum.com > From: drmitch@cox.net > Subject: RE: [HSF] Conduit choice > CC: > > At the outset, they should do the AVF now!!! It takes 45mins under > local. Don't be weenies. All he needs is a shot of pyrogen in that #*!#* > catheter and that's all she wrote. How is the Lt cephalic v. at the elbow? > If it's a decent vessel, use it for a brachial-cephalic fistula and leave > the Rt to use another day. > > Next get a CTA of the subclavians. As we have discussed, the IMA's can and > do provide huge collateral to the femorals. Need I say more about that > before you harvest his arteries. Examine the LRA if the Lt cephalic isn't > to be used for HD access. > > Next, try to preserve his saphenous veins...in BOTH legs. He may need them > for distal bypass sooner or later. > > Next, go LIMA to LAD w/ "T" RIMA to Cx to PDA. On or off pump, doesn't matter. > > Next, shoot the cardiologist. > > MitchAt 03:41 PM 5/7/2009, you wrote: > > >Patient 41 years old, previous multivessel PCI in 2007 now instent > >occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned > >up for his LAD stent - maybe fortunately; four stents placed in Cx first > >week, four in RCA two weeks after and then was to have LAD staged two > >weeks later and never came back till now). For full revascularization > >would need bypass to LAD, OM and PDA +/-PLV. EF 45%. > > > > > > > >Patient has diabetes since age 10 with multiple end-organ complications. > >Renal failure on dialysis for 2 years, retinopathy with laser treatment, > >arteriopathy with severe peripheral vascular disease. Has had below knee > >amputation on right side and toe amputations on left. No distal pulses in > >left leg. Used to smoke but stopped few years ago. He is being considered > >for pancreatic and kidney transplant but needs heart fixed first. Has AV > >fistula in left forearm which failed. Right arm untouched so far. Being > >dialysed via catheter while awaiting plan for new fistula (they wont do > >that either till heart fixed). He is terrified about losing his left leg > >or needing more amputated off his right or having a chronic ulcer due to > >non-healing of surgical incision and says he does not want his legs cut. > >As amputee very dependent on upper torso to mobilize. > > > > > > > >What conduits would you use and in what configuration? > > > > > > > >Thanks > > > > > > > >Ani > > > >_________________________________________________________________ > >Share your photos with Windows Live Photos ? Free. > >http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > >OpenHeart-L mailing list > > > >Send postings to: > > OpenHeart-L@lists.hsforum.com > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >All messages transmitted by the OpenHeart-L are subject to the policies and > >disclaimers posted at: > >http://www.hsforum.com/listdisclaim > >----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/ From gabuin at intramed.net Fri May 8 09:09:54 2009 From: gabuin at intramed.net (gustavo abuin) Date: Fri May 8 07:11:27 2009 Subject: [HSF] Conduit choice References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: <002a01c9cfcd$83f35f20$6400a8c0@LIBERTAD> peritoneal dyalisis must be a solution or the patient have any contraindication? If so almost one radial could be used ----- Original Message ----- From: "Ani Anyanwu" To: "open heart list" Sent: Thursday, May 07, 2009 8:52 PM Subject: RE: [HSF] Conduit choice CTA shows both IMAs look okay. Off course renal worried about arm. Where do you want them to site next fistula? The other problem is whether his severe small vessel disease (the reason for his amputations) could also involve his arm and threaten the limb if radial harvested. Ani > From: donross@bigpond.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Conduit choice > Date: Fri, 8 May 2009 09:20:01 +1000 > CC: > > Ani. > Providing the renal guys will let you have the R radial and you can > verify the safe harvesting of the lima (CT angio??) then he will > should have no problems with my routine graft choice... Lima T-radial > for all distals. > Don > On 08/05/2009, at 6:41 AM, Ani Anyanwu wrote: > > > > > Patient 41 years old, previous multivessel PCI in 2007 now instent > > occlusion of RCA and Cx, also severe proximal LAD lesion (he never > > turned up for his LAD stent - maybe fortunately; four stents placed > > in Cx first week, four in RCA two weeks after and then was to have > > LAD staged two weeks later and never came back till now). For full > > revascularization would need bypass to LAD, OM and PDA +/-PLV. EF 45%. > > > > > > > > Patient has diabetes since age 10 with multiple end-organ > > complications. Renal failure on dialysis for 2 years, retinopathy > > with laser treatment, arteriopathy with severe peripheral vascular > > disease. Has had below knee amputation on right side and toe > > amputations on left. No distal pulses in left leg. Used to smoke but > > stopped few years ago. He is being considered for pancreatic and > > kidney transplant but needs heart fixed first. Has AV fistula in > > left forearm which failed. Right arm untouched so far. Being > > dialysed via catheter while awaiting plan for new fistula (they wont > > do that either till heart fixed). He is terrified about losing his > > left leg or needing more amputated off his right or having a chronic > > ulcer due to non-healing of surgical incision and says he does not > > want his legs cut. As amputee very dependent on upper torso to > > mobilize. > > > > > > > > What conduits would you use and in what configuration? > > > > > > > > Thanks > > > > > > > > Ani > > > > _________________________________________________________________ > > Share your photos with Windows Live Photos ? Free. > > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ Share your photos with Windows Live Photos ? Free. http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -------------------------------------------------------------------------------- No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.325 / Virus Database: 270.12.19/2099 - Release Date: 05/05/09 13:07:00 From prasannasimha at gmail.com Fri May 8 18:21:49 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri May 8 07:59:53 2009 Subject: [HSF] Post operative anorexia In-Reply-To: <4B7623D2-DF26-4EEF-971E-E689EE578A73@starrwood.com> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <4B7623D2-DF26-4EEF-971E-E689EE578A73@starrwood.com> Message-ID: <89c4ed2d0905080451g407bd42cg9dd8935d58e99a9e@mail.gmail.com> What is Megase. I know Megace which is Medroxyprogesterone !1 Prasanna On Fri, May 8, 2009 at 10:12 AM, Anthony P Furnary MD < tfurnary@starrwood.com> wrote: > Megase ES 625 mg q day > or > Megase susp 800 mg q day > > 400 - 800 mg q day in some form > On May 6, 2009, at 6:57 PM, Mitch Lirtzman wrote: > > Looking at the pot I stirred with LSCV, I hesitate to ask, but here goes: >> >> We've talked a lot about PONV in the past, but recently we've encountered >> a spate of patients who have lost their appetite after surgery. I've seen it >> many times over the years. It is self-limited, but I was wondering if any of >> the group has a favorite bit of voo-doo to make my patients feel better and >> make me look like a genius. >> >> Thanks, 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 > ----------------------------------------- > -- Prasanna Simha M From chand.ramaiah at uky.edu Fri May 8 09:02:06 2009 From: chand.ramaiah at uky.edu (Ramaiah, Chandrashekar) Date: Fri May 8 08:03:35 2009 Subject: [HSF] Conduit choice Message-ID: <3ACC54310BF13645A0D12496D7CA94E5011EA249F0@EX7FM04.ad.uky.edu> Ani, I would use Lima and right thigh Svg. Chand -----Original Message----- From: Ani Anyanwu Sent: Friday, May 08, 2009 6:06 AM To: open heart list Subject: RE: [HSF] Conduit choice Mitch Yes the plan is to use the upper left arm for the next fistula but as he has working permcath they feel not immediate priority. Would anybody (aside from Don) ignore all the renal stuff and procure either radial artery? His femorals and major aortic branch vessels are not actually stenosed - all small vessel disease. This disease is very aggresive as ended up losing his leg from what started as a tiny wound in his ankle. I am tilting towards your revascularization option using the IMAs in Y/T configuration as, provided he survives surgery without wound morbidity, this maybe the choice least likely to interfere with his future. Ani > Date: Thu, 7 May 2009 19:49:07 -0500 > To: OpenHeart-L@lists.hsforum.com > From: drmitch@cox.net > Subject: RE: [HSF] Conduit choice > CC: > > At the outset, they should do the AVF now!!! It takes 45mins under > local. Don't be weenies. All he needs is a shot of pyrogen in that #*!#* > catheter and that's all she wrote. How is the Lt cephalic v. at the elbow? > If it's a decent vessel, use it for a brachial-cephalic fistula and leave > the Rt to use another day. > > Next get a CTA of the subclavians. As we have discussed, the IMA's can and > do provide huge collateral to the femorals. Need I say more about that > before you harvest his arteries. Examine the LRA if the Lt cephalic isn't > to be used for HD access. > > Next, try to preserve his saphenous veins...in BOTH legs. He may need them > for distal bypass sooner or later. > > Next, go LIMA to LAD w/ "T" RIMA to Cx to PDA. On or off pump, doesn't matter. > > Next, shoot the cardiologist. > > MitchAt 03:41 PM 5/7/2009, you wrote: > > >Patient 41 years old, previous multivessel PCI in 2007 now instent > >occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned > >up for his LAD stent - maybe fortunately; four stents placed in Cx first > >week, four in RCA two weeks after and then was to have LAD staged two > >weeks later and never came back till now). For full revascularization > >would need bypass to LAD, OM and PDA +/-PLV. EF 45%. > > > > > > > >Patient has diabetes since age 10 with multiple end-organ complications. > >Renal failure on dialysis for 2 years, retinopathy with laser treatment, > >arteriopathy with severe peripheral vascular disease. Has had below knee > >amputation on right side and toe amputations on left. No distal pulses in > >left leg. Used to smoke but stopped few years ago. He is being considered > >for pancreatic and kidney transplant but needs heart fixed first. Has AV > >fistula in left forearm which failed. Right arm untouched so far. Being > >dialysed via catheter while awaiting plan for new fistula (they wont do > >that either till heart fixed). He is terrified about losing his left leg > >or needing more amputated off his right or having a chronic ulcer due to > >non-healing of surgical incision and says he does not want his legs cut. > >As amputee very dependent on upper torso to mobilize. > > > > > > > >What conduits would you use and in what configuration? > > > > > > > >Thanks > > > > > > > >Ani > > > >_________________________________________________________________ > >Share your photos with Windows Live Photos ? Free. > >http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > >OpenHeart-L mailing list > > > >Send postings to: > > OpenHeart-L@lists.hsforum.com > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >All messages transmitted by the OpenHeart-L are subject to the policies and > >disclaimers posted at: > >http://www.hsforum.com/listdisclaim > >----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ View your Twitter and Flickr updates from one place ? Learn more! http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From prasannasimha at gmail.com Fri May 8 18:31:04 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri May 8 08:09:26 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> Message-ID: <89c4ed2d0905080501m1bb71e9dn4c5cf12c11a65f53@mail.gmail.com> As Ani is wont to ask - Why CABG ? (and in the first place with such end organ disease why kidney pancreas transplant ?) If the answer is cnvincing , does he have a vein in his right 9ampuated teg that can be harvested ?) then if there is one - use an IMA + vein. Other conduit choices could be considered are inferior epigastric or gastroepiploic etc etc Why will they not do an AV fistula till his heart is fixed. A distal fistula will not really "overload him". Funny - he seems too sick for an AV fistula but Ok for a cardiac surgery and a double transplant !! Prasanna On Fri, May 8, 2009 at 2:11 AM, Ani Anyanwu wrote: > > Patient 41 years old, previous multivessel PCI in 2007 now instent > occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned up > for his LAD stent - maybe fortunately; four stents placed in Cx first week, > four in RCA two weeks after and then was to have LAD staged two weeks later > and never came back till now). For full revascularization would need bypass > to LAD, OM and PDA +/-PLV. EF 45%. > > > > Patient has diabetes since age 10 with multiple end-organ complications. > Renal failure on dialysis for 2 years, retinopathy with laser treatment, > arteriopathy with severe peripheral vascular disease. Has had below knee > amputation on right side and toe amputations on left. No distal pulses in > left leg. Used to smoke but stopped few years ago. He is being considered > for pancreatic and kidney transplant but needs heart fixed first. Has AV > fistula in left forearm which failed. Right arm untouched so far. Being > dialysed via catheter while awaiting plan for new fistula (they wont do that > either till heart fixed). He is terrified about losing his left leg or > needing more amputated off his right or having a chronic ulcer due to > non-healing of surgical incision and says he does not want his legs cut. As > amputee very dependent on upper torso to mobilize. > > > > What conduits would you use and in what configuration? > > > > Thanks > > > > Ani > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > OpenHeart-Lmailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Fri May 8 06:41:06 2009 From: tacuff at swbell.net (Tea Acuff) Date: Fri May 8 08:42:36 2009 Subject: [HSF] Conduit choice In-Reply-To: <89c4ed2d0905080501m1bb71e9dn4c5cf12c11a65f53@mail.gmail.com> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <89c4ed2d0905080501m1bb71e9dn4c5cf12c11a65f53@mail.gmail.com> Message-ID: <884412.77395.qm@web81601.mail.mud.yahoo.com> This is a very interesting perspective or hierarchy. UNOS, the united organ sharing group, perhaps rightly so, sees itself as advocate for the rare donated organ. The question is not what is best for the patient, but rather what is best for the organ since there are many more patients than organs. This (oversite) goes on at different levels by ALL groups that have control or picked by those in control as experts for those that are in control. It is just much harder to see in a government or insurance company. This is why I favor control of the process, which necessarily means responsibility for also, as close to the patient as possible. tea ________________________________ From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Friday, May 8, 2009 7:01:04 AM Subject: Re: [HSF] Conduit choice As Ani is wont to ask - Why CABG ? (and in the first place with such end organ disease? why kidney pancreas transplant ?) If the answer is cnvincing , does he have a vein in his right 9ampuated teg that can be harvested ?) then if there is one - use an IMA + vein. Other conduit choices could be considered are inferior epigastric or gastroepiploic etc etc Why will they not do an AV fistula till his heart is fixed. A distal fistula will not really "overload him". Funny - he seems too sick for an AV fistula but Ok for? a cardiac surgery and a double transplant !! Prasanna On Fri, May 8, 2009 at 2:11 AM, Ani Anyanwu wrote: > > Patient 41 years old, previous multivessel PCI in 2007 now instent > occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned up > for his LAD stent - maybe fortunately; four stents placed in Cx first week, > four in RCA two weeks after and then was to have LAD staged two weeks later > and never came back till now). For full revascularization would need bypass > to LAD, OM and PDA +/-PLV. EF 45%. > > > > Patient has diabetes since age 10 with multiple end-organ complications. > Renal failure on dialysis for 2 years, retinopathy with laser treatment, > arteriopathy with severe peripheral vascular disease. Has had below knee > amputation on right side and toe amputations on left. No distal pulses in > left leg. Used to smoke but stopped few years ago. He is being considered > for pancreatic and kidney transplant but needs heart fixed first. Has AV > fistula in left forearm which failed. Right arm untouched so far. Being > dialysed via catheter while awaiting plan for new fistula (they wont do that > either till heart fixed). He is terrified about losing his left leg or > needing more amputated off his right or having a chronic ulcer due to > non-healing of surgical incision and says he does not want his legs cut. As > amputee very dependent on upper torso to mobilize. > > > > What conduits would you use and in what configuration? > > > > Thanks > > > > Ani > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > OpenHeart-Lmailing list > > Send postings to: >? OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 anianyanwu at hotmail.com Fri May 8 14:21:41 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Fri May 8 09:22:09 2009 Subject: [HSF] Conduit choice In-Reply-To: <89c4ed2d0905080501m1bb71e9dn4c5cf12c11a65f53@mail.gmail.com> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <89c4ed2d0905080501m1bb71e9dn4c5cf12c11a65f53@mail.gmail.com> Message-ID: Prasanna Lots of questions so will answer individually! >Why CABG ? Class 3 symptoms >and in the first place with such end organ disease why kidney pancreas transplant This is the very indication and ideal case for pancreatic and kidney transplantation - patients with secondary diabetic complications refractory to medical management. These are typically unfortunate young patients as the one I describe. There is no evidence that pancreatic transplant is beneficial before advent of end-organ complications and then it becomes a quality of life issue which would be debatable for such a drastic 'solution'. In patients with endorgan dysfunction and no contraindications, kidney-pancreas transplant can prolong life substantially. > does he have a vein in his right 9ampuated leg that can be harvested ? Yes. But had severe wound healing problems post amputation so he is convcerned about further incisions there causing him to need higher level amputation. Maybe the concerns are not valid though. > Why will they not do an AV fistula till his heart is fixed. Just because there is no priority to do so. He is being dialysed via cathther. At the present time is coronary symptoms override all others (fistula, transplant etc) which can be dealt with electively. He is not 'too sick' for a fistula just no immediate indication for one. Ani > From: prasannasimha@gmail.com > Date: Fri, 8 May 2009 17:31:04 +0530 > Subject: Re: [HSF] Conduit choice > To: OpenHeart-L@lists.hsforum.com > CC: > > As Ani is wont to ask - Why CABG ? (and in the first place with such end > organ disease why kidney pancreas transplant ?) > If the answer is cnvincing , does he have a vein in his right 9ampuated teg > that can be harvested ?) > then if there is one - use an IMA + vein. Other conduit choices could be > considered are inferior epigastric or gastroepiploic etc etc > Why will they not do an AV fistula till his heart is fixed. A distal fistula > will not really "overload him". > Funny - he seems too sick for an AV fistula but Ok for a cardiac surgery > and a double transplant !! > Prasanna > On Fri, May 8, 2009 at 2:11 AM, Ani Anyanwu wrote: > > > > > Patient 41 years old, previous multivessel PCI in 2007 now instent > > occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned up > > for his LAD stent - maybe fortunately; four stents placed in Cx first week, > > four in RCA two weeks after and then was to have LAD staged two weeks later > > and never came back till now). For full revascularization would need bypass > > to LAD, OM and PDA +/-PLV. EF 45%. > > > > > > > > Patient has diabetes since age 10 with multiple end-organ complications. > > Renal failure on dialysis for 2 years, retinopathy with laser treatment, > > arteriopathy with severe peripheral vascular disease. Has had below knee > > amputation on right side and toe amputations on left. No distal pulses in > > left leg. Used to smoke but stopped few years ago. He is being considered > > for pancreatic and kidney transplant but needs heart fixed first. Has AV > > fistula in left forearm which failed. Right arm untouched so far. Being > > dialysed via catheter while awaiting plan for new fistula (they wont do that > > either till heart fixed). He is terrified about losing his left leg or > > needing more amputated off his right or having a chronic ulcer due to > > non-healing of surgical incision and says he does not want his legs cut. As > > amputee very dependent on upper torso to mobilize. > > > > > > > > What conduits would you use and in what configuration? > > > > > > > > Thanks > > > > > > > > Ani > > > > _________________________________________________________________ > > Share your photos with Windows Live Photos ? Free. > > > > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > > OpenHeart-Lmailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 > ----------------------------------------- _________________________________________________________________ Share your photos with Windows Live Photos ? Free. http://clk.atdmt.com/UKM/go/134665338/direct/01/ From prasannasimha at gmail.com Fri May 8 20:07:24 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri May 8 10:36:24 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <89c4ed2d0905080501m1bb71e9dn4c5cf12c11a65f53@mail.gmail.com> Message-ID: <89c4ed2d0905080637g261bbccbx13cb37e9e50803a3@mail.gmail.com> In patients with endorgan dysfunction and no contraindications, kidney-pancreas transplant can prolong life substantially. OK so with such dense vasculopathy what is the perceived benefit of kidney pancreas transplant ? (His 5 year survival would be poor by virtue of his extracardiac vasculopathy) ie would he benefit with his established bad vasculopathic status ? In this case one IMA would still be required (In the last few months back we did 2 Polio patients t with similar concerns ie upper torso integrity is important so I elected to do it with a hemisternotomy without any lateral sternal split to keep the manubrial appendicualr sketetal chain intact.The patients did very well.In fact both were on crutches in 4 days !! Prasanna On Fri, May 8, 2009 at 6:51 PM, Ani Anyanwu wrote: > > Prasanna > > > > Lots of questions so will answer individually! > > > > >Why CABG ? > > > > Class 3 symptoms > > > > > > >and in the first place with such end organ disease why kidney pancreas > transplant > > > > This is the very indication and ideal case for pancreatic and kidney > transplantation - patients with secondary diabetic complications refractory > to medical management. These are typically unfortunate young patients as the > one I describe. There is no evidence that pancreatic transplant is > beneficial before advent of end-organ complications and then it becomes a > quality of life issue which would be debatable for such a drastic > 'solution'. In patients with endorgan dysfunction and no contraindications, > kidney-pancreas transplant can prolong life substantially. > > > > > does he have a vein in his right 9ampuated leg that can be harvested ? > > > > Yes. But had severe wound healing problems post amputation so he is > convcerned about further incisions there causing him to need higher level > amputation. Maybe the concerns are not valid though. > > > > > Why will they not do an AV fistula till his heart is fixed. > > > > Just because there is no priority to do so. He is being dialysed via > cathther. At the present time is coronary symptoms override all others > (fistula, transplant etc) which can be dealt with electively. He is not 'too > sick' for a fistula just no immediate indication for one. > > > > Ani > > > > > > > > > > > > From: prasannasimha@gmail.com > > Date: Fri, 8 May 2009 17:31:04 +0530 > > Subject: Re: [HSF] Conduit choice > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > As Ani is wont to ask - Why CABG ? (and in the first place with such end > > organ disease why kidney pancreas transplant ?) > > If the answer is cnvincing , does he have a vein in his right 9ampuated > teg > > that can be harvested ?) > > then if there is one - use an IMA + vein. Other conduit choices could be > > considered are inferior epigastric or gastroepiploic etc etc > > Why will they not do an AV fistula till his heart is fixed. A distal > fistula > > will not really "overload him". > > Funny - he seems too sick for an AV fistula but Ok for a cardiac surgery > > and a double transplant !! > > Prasanna > > On Fri, May 8, 2009 at 2:11 AM, Ani Anyanwu > wrote: > > > > > > > > Patient 41 years old, previous multivessel PCI in 2007 now instent > > > occlusion of RCA and Cx, also severe proximal LAD lesion (he never > turned up > > > for his LAD stent - maybe fortunately; four stents placed in Cx first > week, > > > four in RCA two weeks after and then was to have LAD staged two weeks > later > > > and never came back till now). For full revascularization would need > bypass > > > to LAD, OM and PDA +/-PLV. EF 45%. > > > > > > > > > > > > Patient has diabetes since age 10 with multiple end-organ > complications. > > > Renal failure on dialysis for 2 years, retinopathy with laser > treatment, > > > arteriopathy with severe peripheral vascular disease. Has had below > knee > > > amputation on right side and toe amputations on left. No distal pulses > in > > > left leg. Used to smoke but stopped few years ago. He is being > considered > > > for pancreatic and kidney transplant but needs heart fixed first. Has > AV > > > fistula in left forearm which failed. Right arm untouched so far. Being > > > dialysed via catheter while awaiting plan for new fistula (they wont do > that > > > either till heart fixed). He is terrified about losing his left leg or > > > needing more amputated off his right or having a chronic ulcer due to > > > non-healing of surgical incision and says he does not want his legs > cut. As > > > amputee very dependent on upper torso to mobilize. > > > > > > > > > > > > What conduits would you use and in what configuration? > > > > > > > > > > > > Thanks > > > > > > > > > > > > Ani > > > > > > _________________________________________________________________ > > > Share your photos with Windows Live Photos ? Free. > > > > > > > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > > > OpenHeart-L< > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________%0AOpenHeart-L>mailing > list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/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 > > ----------------------------------------- > > _________________________________________________________________ > Share your photos with Windows Live Photos ? Free. > > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > OpenHeart-Lmailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Fri May 8 10:05:16 2009 From: tacuff at swbell.net (Tea Acuff) Date: Fri May 8 12:07:00 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <89c4ed2d0905080501m1bb71e9dn4c5cf12c11a65f53@mail.gmail.com> Message-ID: <300593.69261.qm@web81606.mail.mud.yahoo.com> Ani said : "Just because there is no priority to do so. He is being dialysed via cathther. At the present time is coronary symptoms override all others (fistula, transplant etc) which can be dealt with electively. He is not 'too sick' for a fistula just no immediate indication for one." Of course nothing is straight forward. The CABG is not an emergency either. As per Mitch's comment the catheter may also be a source of problems. Ani is doubtlessly not asked about the vascular access. But the advent of easy PIC lines "just for access" undoubtedly has caused many more upper extermity thrombosis than before. Unlikewise I?fought?for decades?to get out the foley (and other lines) in post op patients left in for convenience. Now with the failure to pay for hospital "acquired"?urosepsis the hospital is mobilizing all their forces for the same effect. tea ________________________________ From: Ani Anyanwu To: open heart list Sent: Friday, May 8, 2009 8:21:41 AM Subject: RE: [HSF] Conduit choice Prasanna Lots of questions so will answer individually! >Why CABG ? Class 3 symptoms >and in the first place with such end? organ disease why kidney pancreas transplant This is the very indication and ideal case for pancreatic and kidney transplantation -? patients with secondary diabetic complications refractory to medical management. These are typically unfortunate young patients as the one I describe. There is no evidence that pancreatic transplant is beneficial before advent of end-organ complications and then it becomes a quality of life issue which would be debatable for such a drastic 'solution'. In patients with endorgan dysfunction and no contraindications, kidney-pancreas transplant can prolong life substantially. > does he have a vein in his right 9ampuated leg that can be harvested ? Yes. But had severe wound healing problems post amputation so he is convcerned about further incisions there causing him to need higher level amputation. Maybe the concerns are not valid though. > Why will they not do an AV fistula till his heart is fixed. Just because there is no priority to do so. He is being dialysed via cathther. At the present time is coronary symptoms override all others (fistula, transplant etc) which can be dealt with electively. He is not 'too sick' for a fistula just no immediate indication for one. Ani > From: prasannasimha@gmail.com > Date: Fri, 8 May 2009 17:31:04 +0530 > Subject: Re: [HSF] Conduit choice > To: OpenHeart-L@lists.hsforum.com > CC: > > As Ani is wont to ask - Why CABG ? (and in the first place with such end > organ disease why kidney pancreas transplant ?) > If the answer is cnvincing , does he have a vein in his right 9ampuated teg > that can be harvested ?) > then if there is one - use an IMA + vein. Other conduit choices could be > considered are inferior epigastric or gastroepiploic etc etc > Why will they not do an AV fistula till his heart is fixed. A distal fistula > will not really "overload him". > Funny - he seems too sick for an AV fistula but Ok for a cardiac surgery > and a double transplant !! > Prasanna > On Fri, May 8, 2009 at 2:11 AM, Ani Anyanwu wrote: > > > > > Patient 41 years old, previous multivessel PCI in 2007 now instent > > occlusion of RCA and Cx, also severe proximal LAD lesion (he never turned up > > for his LAD stent - maybe fortunately; four stents placed in Cx first week, > > four in RCA two weeks after and then was to have LAD staged two weeks later > > and never came back till now). For full revascularization would need bypass > > to LAD, OM and PDA +/-PLV. EF 45%. > > > > > > > > Patient has diabetes since age 10 with multiple end-organ complications. > > Renal failure on dialysis for 2 years, retinopathy with laser treatment, > > arteriopathy with severe peripheral vascular disease. Has had below knee > > amputation on right side and toe amputations on left. No distal pulses in > > left leg. Used to smoke but stopped few years ago. He is being considered > > for pancreatic and kidney transplant but needs heart fixed first. Has AV > > fistula in left forearm which failed. Right arm untouched so far. Being > > dialysed via catheter while awaiting plan for new fistula (they wont do that > > either till heart fixed). He is terrified about losing his left leg or > > needing more amputated off his right or having a chronic ulcer due to > > non-healing of surgical incision and says he does not want his legs cut. As > > amputee very dependent on upper torso to mobilize. > > > > > > > > What conduits would you use and in what configuration? > > > > > > > > Thanks > > > > > > > > Ani > > > > _________________________________________________________________ > > Share your photos with Windows Live Photos ? Free. > > > > http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ > > OpenHeart-Lmailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 > ----------------------------------------- _________________________________________________________________ Share your photos with Windows Live Photos ? Free. http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From msfirst at gmail.com Fri May 8 13:50:43 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Fri May 8 12:59:40 2009 Subject: [HSF] Post operative anorexia In-Reply-To: <89c4ed2d0905080451g407bd42cg9dd8935d58e99a9e@mail.gmail.com> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <4B7623D2-DF26-4EEF-971E-E689EE578A73@starrwood.com> <89c4ed2d0905080451g407bd42cg9dd8935d58e99a9e@mail.gmail.com> Message-ID: I thought Megace can induce a hypercoagulable condition - hence I rarely, if ever, use it - especially in patients with bypass grafts. -m On May 8, 2009, at 7:51 AM, Prasanna Simha M wrote: > What is Megase. I know Megace which is Medroxyprogesterone !1 > Prasanna > > On Fri, May 8, 2009 at 10:12 AM, Anthony P Furnary MD < > tfurnary@starrwood.com> wrote: > >> Megase ES 625 mg q day >> or >> Megase susp 800 mg q day >> >> 400 - 800 mg q day in some form >> On May 6, 2009, at 6:57 PM, Mitch Lirtzman wrote: >> >> Looking at the pot I stirred with LSCV, I hesitate to ask, but here >> goes: >>> >>> We've talked a lot about PONV in the past, but recently we've >>> encountered >>> a spate of patients who have lost their appetite after surgery. >>> I've seen it >>> many times over the years. It is self-limited, but I was wondering >>> if any of >>> the group has a favorite bit of voo-doo to make my patients feel >>> better and >>> make me look like a genius. >>> >>> Thanks, 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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From msfirst at gmail.com Fri May 8 13:54:09 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Fri May 8 12:59:50 2009 Subject: [HSF] Conduit choice In-Reply-To: References: <91874447580916105777560392264982806161-Webmail@me.com> Message-ID: <8CE8011D-EB84-43E1-90ED-895016DE712A@gmail.com> I would not compromise your operation for the "benefit" of what may get done in the future...... how much do you want to bet, regardless of your outcome, he never gets transplanted. I have done a bunch of "pre-transplant" CABGs on similar train wrecks on somehow none of them (to my knowledge) ever have gotten listed..... On May 8, 2009, at 5:52 AM, Ani Anyanwu wrote: > > He is not obese. Concern about the IMAs is the consequence of wound > infection and whether the necessary strain on an amputee's sternum > post-operatively as he mobilizes will increase risk of sternal > disruption. I am not though convinced that this risk, or the > consequences, are necessarily different from if one took a single > IMA. I have also not yet seen primary sternal necrosis with > skeltonized IMA tehnique so am not as convinced of this phenomenon. > > > > Ani > > > >> Date: Fri, 8 May 2009 08:12:50 +0200 >> From: grescigno@mac.com >> To: OpenHeart-L@lists.hsforum.com >> Subject: RE: [HSF] Conduit choice >> CC: >> >> Ani, >> >> is this guy obese? Why do you hesitate in using both IMAs? The fate >> of saphenous veins in dialysis is very bad, I guess. I would avoid >> to touch the limbs. >> >> Giuseppe >> >> Giuseppe Rescigno M.D. >> Cardiothoracic Surgeon >> >> Lancisi Hospital >> Torrette - Ancona >> Italy >> >> >> >> On Thursday, May 07, 2009, at 10:41PM, "Ani Anyanwu" > > wrote: >>> >>> Patient 41 years old, previous multivessel PCI in 2007 now instent >>> occlusion of RCA and Cx, also severe proximal LAD lesion (he never >>> turned up for his LAD stent - maybe fortunately; four stents >>> placed in Cx first week, four in RCA two weeks after and then was >>> to have LAD staged two weeks later and never came back till now). >>> For full revascularization would need bypass to LAD, OM and PDA +/- >>> PLV. EF 45%. >>> >>> >>> >>> Patient has diabetes since age 10 with multiple end-organ >>> complications. Renal failure on dialysis for 2 years, retinopathy >>> with laser treatment, arteriopathy with severe peripheral vascular >>> disease. Has had below knee amputation on right side and toe >>> amputations on left. No distal pulses in left leg. Used to smoke >>> but stopped few years ago. He is being considered for pancreatic >>> and kidney transplant but needs heart fixed first. Has AV fistula >>> in left forearm which failed. Right arm untouched so far. Being >>> dialysed via catheter while awaiting plan for new fistula (they >>> wont do that either till heart fixed). He is terrified about >>> losing his left leg or needing more amputated off his right or >>> having a chronic ulcer due to non-healing of surgical incision and >>> says he does not want his legs cut. As amputee very dependent on >>> upper torso to mobilize. >>> >>> >>> >>> What conduits would you use and in what configuration? >>> >>> >>> >>> Thanks >>> >>> >>> >>> Ani >>> >>> _________________________________________________________________ >>> Share your photos with Windows Live Photos ? Free. >>> http://clk.atdmt.com/UKM/go/134665338/direct/01/_______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > View your Twitter and Flickr updates from one place ? Learn more! > http://clk.atdmt.com/UKM/go/137984870/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From msfirst at gmail.com Fri May 8 13:54:49 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Fri May 8 13:06:44 2009 Subject: [HSF] Conduit choice In-Reply-To: <89c4ed2d0905080501m1bb71e9dn4c5cf12c11a65f53@mail.gmail.com> References: <6.2.1.2.2.20090506204841.01eb9018@pop.east.cox.net> <89c4ed2d0905080501m1bb71e9dn4c5cf12c11a65f53@mail.gmail.com> Message-ID: <07CDEE8B-C9C2-4E1D-9CA5-889A903C47D5@gmail.com> Per my previous notes - these are all excuses to do or not do something. If he has such diabetic disease - is there anything left appropriate to graft? How about a off-pump LIMA-LAD? What are his symptoms? Inducible ischemia? I would avoid BIMAs - he would die after any sternal wound issues and for what? A 10 year survival benefit over vein? Please, what do you think his 10 year survival is even if he had no CAD? On May 8, 2009, at 8:01 AM, Prasanna Simha M wrote: > As Ani is wont to ask - Why CABG ? (and in the first place with such > end > organ disease why kidney pancreas transplant ?) > If the answer is cnvincing , does he have a vein in his right > 9ampuated teg > that can be harvested ?) > then if there is one - use an IMA + vein. Other conduit choices > could be > considered are inferior epigastric or gastroepiploic etc etc > Why will they not do an AV fistula till his heart is fixed. A distal > fistula > will not really "overload him". > Funny - he seems too sick for an AV fistula but Ok for a cardiac > surgery > and a double transplant !! > Prasanna > On Fri, May 8, 2009 at 2:11 AM, Ani Anyanwu > wrote: > >> >> Patient 41 years old, previous multivessel PCI in 2007 now instent >> occlusion of RCA and Cx, also severe proximal LAD lesion (he never >> turned up >> for his LAD stent - maybe fortunately; four stents placed in Cx >> first week, >> four in RCA two weeks after and then was to have LAD staged two >> weeks later >> and never came back till now). For full revascularization would >> need bypass >> to LAD, OM and PDA +/-PLV. EF 45%. >> >> >> >> Patient has diabetes since age 10 with multiple end-organ >> complications. >> Renal failure on dialysis for 2 years, retinopathy with laser >> treatment, >> arteriopathy with severe peripheral vascular disease. Has had below >> knee >> amputation on right side and toe amputations on left. No distal >> pulses in >> left leg. Used to smoke but stopped few years ago. He is being >> considered >> for pancreatic and kidney transplant but needs heart fixed first. >> Has A