[HSF] Persistent LSVC

Michael Firstenberg msfirst at gmail.com
Sun May 3 18:52:52 EDT 2009 

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 at 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 at 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 at hotmail.com> wrote:
>
>>
>> the  problem is when you have no preop diagnosis...
>>
>> Roberto
>>
>>> From: gabuin at intramed.net
>>> To:  OpenHeart-L at 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" <robertobattellini at hotmail.com>
>>> To:  "lists HSF" <openheart-l at lists.hsforum.com>
>
>>> 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 at gmail.com
>>>> Date: Sun, 3 May 2009 07:12:35  +0530
>>>> Subject: Re: [HSF] Persistent LSVC
>>>> To: OpenHeart-L at 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 <drmitch at cox.net>
>> 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
>>>>>
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>>>>
>>>>
>>>> --
>>>> Prasanna Simha M
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