From hgrmd at aol.com Thu Oct 1 00:05:00 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Wed Sep 30 19:03:59 2009 Subject: [HSF] Aortic aneurysm gray area? In-Reply-To: References: <2062643119-1254350322-cardhu_decombobulator_blackberry.rim.net-442248320-@bda266.bisx.prod.on.blackberry> Message-ID: <1188516554-1254351811-cardhu_decombobulator_blackberry.rim.net-606419134-@bda266.bisx.prod.on.blackberry> TWljaGFlbCwgDQogIExldCB1cyBrbm93IHRoZSBzdHVkeSByZXN1bHRzLCBidXQgSSBoaWdobHkg ZG91YnQgaGVyIHN5bXB0b21zIGFyZSByZWxhdGVkIHRvIHRoZSBhb3J0YS4NCg0KSGFsDQpTZW50 IGZyb20gbXkgVmVyaXpvbiBXaXJlbGVzcyBCbGFja0JlcnJ5DQoNCi0tLS0tT3JpZ2luYWwgTWVz c2FnZS0tLS0tDQpGcm9tOiBNaWNoYWVsIEZpcnN0ZW5iZXJnIDxtc2ZpcnN0QGdtYWlsLmNvbT4N Cg0KRGF0ZTogV2VkLCAzMCBTZXAgMjAwOSAxODo0NToxMSANClRvOiA8T3BlbkhlYXJ0LUxAbGlz dHMuaHNmb3J1bS5jb20+DQpTdWJqZWN0OiBSZTogW0hTRl0gQW9ydGljIGFuZXVyeXNtIGdyYXkg YXJlYT8NCg0KDQpJLCBpbiBnZW5lcmFsIGFncmVlIC0gaW4gcGFydCBvZiBteSBjb25jZXJuIGlz IGhlciAidmFndWUgY2hlc3QgcGFpbg0Kc3ltcHRvbXMiIChzb3VuZGVkIHZlcnkgY2FyZGlhYykg LSBpcyBpdCByZWFsIG9yIGp1c3QgYW54aWV0eSwgbWFkZSB3b3JzZQ0Kbm93IHRoYXQgc2hlIGtu 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In-Reply-To: References: <2062643119-1254350322-cardhu_decombobulator_blackberry.rim.net-442248320-@bda266.bisx.prod.on.blackberry> Message-ID: <211281618-1254361865-cardhu_decombobulator_blackberry.rim.net-957264312-@bda916.bisx.prod.on.blackberry> TWljaGFlbA0KDQpJZiB0aGUgcGFpbiB3YXMgdHlwaWNhbCBvZiBhbmdpbmEsIHNoZSBzaG91bGQg aGF2ZSBhbm90aGVyIHN0dWR5IHRvIHNlZSBpZiBzaGUgaGFzIGlzY2hlbWlhLiBBIG5vcm1hbCBj YXRoIHR3byB5ZWFycyBhZ28gZG9lcyBub3QgcHJlY2x1ZGUgY29yb25hcnkgZGlzZWFzZS4gQSBu b24gaW52YXNpdmUgc3RyZXNzIHRlc3QgY291bGQgYmUgYSBzdGFydC4gDQoNCkkgYWdyZWUgd2l0 aCB0aGUgb3RoZXJzIHdobyB3b3VsZCBub3QgcmVjb21tZW5kIGFvcnRpYyBzdXJnZXJ5IGF0IHRo aXMgdGltZS4gDQoNCkpvaG4NClNlbnQgZnJvbSBteSBWZXJpem9uIFdpcmVsZXNzIEJsYWNrQmVy cnkNCg0KLS0tLS1PcmlnaW5hbCBNZXNzYWdlLS0tLS0NCkZyb206IE1pY2hhZWwgRmlyc3RlbmJl cmcgPG1zZmlyc3RAZ21haWwuY29tPg0KDQpEYXRlOiBXZWQsIDMwIFNlcCAyMDA5IDE4OjQ1OjEx IA0KVG86IDxPcGVuSGVhcnQtTEBsaXN0cy5oc2ZvcnVtLmNvbT4NClN1YmplY3Q6IFJlOiBbSFNG 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LS0tDQo= From prasannasimha at gmail.com Thu Oct 1 07:46:40 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Wed Sep 30 22:11:34 2009 Subject: [HSF] Aortic aneurysm gray area? In-Reply-To: References: Message-ID: <89c4ed2d0909301816r105d1aacl9e8c91aca881ce54@mail.gmail.com> What is the indication here for surgery ? If her stress test is normal then treat her anxiety disorder. Prasanna On Thu, Oct 1, 2009 at 1:21 AM, Michael Firstenberg wrote: > I know we discuss this all of the time: > 67 year/old, BSA=2, handful of medical problems (HTN, DM, anxiety disorder, > etc), reported to have a clean cath from a couple of years ago > Presented with "chest pain" (troponins neg) but CT scan shows max 4.3cm > ascending, normal arch and descending. > echo show normal LV function and mild AI (trileaflet valve)...... > > inclined to offer repair (based upon ?symptoms?, concern for worsening > AI)...... i.e. simple tube graft before she would need something more > complicated? > > thoughts? > > this is a new diagnosis for her - would anyone wait 6months for a repeat > study? > > -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 benjamin.bidstrup at bigpond.com Thu Oct 1 15:59:51 2009 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Thu Oct 1 01:00:32 2009 Subject: [HSF] Aortic aneurysm gray area? In-Reply-To: <546238.86625.qm@web81606.mail.mud.yahoo.com> References: <2062643119-1254350322-cardhu_decombobulator_blackberry.rim.net-442248320-@bda266.bisx.prod.on.blackberry> <546238.86625.qm@web81606.mail.mud.yahoo.com> Message-ID: <0AB0869B-AAE1-413C-87A0-94CA05C1041F@bigpond.com> What are we treating? Not Marfan's ? Which falls into a different category Symptoms ? None that I can see. Survival? What is the risk of rupture etc of a 4.3 cm aneurysm. V small by all accounts and based on earlier discussions we have had. If you want to do anything a stress echo might be in order. I would give a beta blocker if not contra-indicated. Repeat CT in 6-12 months. Primum non nocere! Ben Bidstrup FRACS FRCSEd FEBCTS Cardiothoracic Surgeon. On 01/10/2009, at 12:38 PM, Tea Acuff wrote: > Tom? > > tea > > > > > ________________________________ > From: "hgrmd@aol.com" > To: OpenHeart-L@lists.hsforum.com > Sent: Wednesday, September 30, 2009 5:40:13 PM > Subject: Re: [HSF] Aortic aneurysm gray area? > > Michael, > Risk of surgery is more than risk of rupture at 4.3 cm. Would > repeat the scan in 6 month. If the same, would put on yearly schedule. > > Hal > ------Original Message------ > From: Edward Bender > Sender: openheart-l-bounces@lists.hsforum.com > To: HSF List > ReplyTo: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Aortic aneurysm gray area? > Sent: Sep 30, 2009 5:06 PM > > All concerns aside, I see no indication for any surgery. Xanax and > altace go > along way. > > Ed Bender, MD > > > On 9/30/09 2:51 PM, "Michael Firstenberg" wrote: > >> I know we discuss this all of the time: >> 67 year/old, BSA=2, handful of medical problems (HTN, DM, anxiety >> disorder, >> etc), reported to have a clean cath from a couple of years ago >> Presented with "chest pain" (troponins neg) but CT scan shows max >> 4.3cm >> ascending, normal arch and descending. >> echo show normal LV function and mild AI (trileaflet valve)...... >> >> inclined to offer repair (based upon ?symptoms?, concern for >> worsening >> AI)...... i.e. simple tube graft before she would need something more >> complicated? >> >> thoughts? >> >> this is a new diagnosis for her - would anyone wait 6months for a >> repeat >> study? >> >> -michael >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > Sent from my Verizon Wireless BlackBerry > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From nkkejriwal at gmail.com Thu Oct 1 21:09:13 2009 From: nkkejriwal at gmail.com (nand kejriwal) Date: Thu Oct 1 03:09:33 2009 Subject: [HSF] Aortic aneurysm gray area? In-Reply-To: <89c4ed2d0909301816r105d1aacl9e8c91aca881ce54@mail.gmail.com> References: <89c4ed2d0909301816r105d1aacl9e8c91aca881ce54@mail.gmail.com> Message-ID: While on this topic; if someone has isolated dilated aortic sinuses with normal aortic valve, no regurg, and ascending aorta not significantly dilated, do we use the same criteria for the sinuses as we do for ascending aorta, as far as size is concerned? Any references on this? nand 2009/10/1 Prasanna Simha M > What is the indication here for surgery ? If her stress test is normal > then treat her anxiety disorder. > Prasanna > > On Thu, Oct 1, 2009 at 1:21 AM, Michael Firstenberg > wrote: > > I know we discuss this all of the time: > > 67 year/old, BSA=2, handful of medical problems (HTN, DM, anxiety > disorder, > > etc), reported to have a clean cath from a couple of years ago > > Presented with "chest pain" (troponins neg) but CT scan shows max 4.3cm > > ascending, normal arch and descending. > > echo show normal LV function and mild AI (trileaflet valve)...... > > > > inclined to offer repair (based upon ?symptoms?, concern for worsening > > AI)...... i.e. simple tube graft before she would need something more > > complicated? > > > > thoughts? > > > > this is a new diagnosis for her - would anyone wait 6months for a repeat > > study? > > > > -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 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 John.Howse at kp.org Thu Oct 1 05:01:01 2009 From: John.Howse at kp.org (John.Howse@kp.org) Date: Thu Oct 1 07:05:09 2009 Subject: [HSF] John Howse/CA/KAIPERM is out of the office. Message-ID: I will be out of the office starting 10/01/2009 and will not return until 10/05/2009. I will respond to your message when possible . From anianyanwu at hotmail.com Thu Oct 1 12:12:48 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Thu Oct 1 07:13:17 2009 Subject: [HSF] Aortic aneurysm gray area? In-Reply-To: References: <2062643119-1254350322-cardhu_decombobulator_blackberry.rim.net-442248320-@bda266.bisx.prod.on.blackberry> Message-ID: > getting a dedicate aneurysm study tomorrow to look specifically at the size > and shape Michael What is a dedicated aneurysm study? Is it just another scan to give you a measurement you like better? Remember that there is varaibility in any measurement technique. If you did hundred scans on her in the next few days you will get several with measurements reported as over 4.5 and maybe you might be lucky to get a 5cm measurement too - then you can operate (of course ignoring the 4cm or 3.8 cm measures you will probably also get). What has shape got to do with decision? Ani > Date: Wed, 30 Sep 2009 18:45:11 -0400 > Subject: Re: [HSF] Aortic aneurysm gray area? > From: msfirst@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > > I, in general agree - in part of my concern is her "vague chest pain > symptoms" (sounded very cardiac) - is it real or just anxiety, made worse > now that she know she has a problem. Not to mention the concept of "lost to > follow-up" which is very common...... would hate for her to come back in X > years with a huge problem, AI, and a bad LV. > > getting a dedicate aneurysm study tomorrow to look specifically at the size > and shape. > > > -michael > > > > On Wed, Sep 30, 2009 at 6:40 PM, wrote: > > > Michael, > > Risk of surgery is more than risk of rupture at 4.3 cm. Would repeat the > > scan in 6 month. If the same, would put on yearly schedule. > > > > Hal > > ------Original Message------ > > From: Edward Bender > > Sender: openheart-l-bounces@lists.hsforum.com > > To: HSF List > > ReplyTo: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Aortic aneurysm gray area? > > Sent: Sep 30, 2009 5:06 PM > > > > All concerns aside, I see no indication for any surgery. Xanax and altace > > go > > along way. > > > > Ed Bender, MD > > > > > > On 9/30/09 2:51 PM, "Michael Firstenberg" wrote: > > > > > I know we discuss this all of the time: > > > 67 year/old, BSA=2, handful of medical problems (HTN, DM, anxiety > > disorder, > > > etc), reported to have a clean cath from a couple of years ago > > > Presented with "chest pain" (troponins neg) but CT scan shows max 4.3cm > > > ascending, normal arch and descending. > > > echo show normal LV function and mild AI (trileaflet valve)...... > > > > > > inclined to offer repair (based upon ?symptoms?, concern for worsening > > > AI)...... i.e. simple tube graft before she would need something more > > > complicated? > > > > > > thoughts? > > > > > > this is a new diagnosis for her - would anyone wait 6months for a repeat > > > study? > > > > > > -michael > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > Sent from my Verizon Wireless BlackBerry > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 ramirezgil at une.net.co Thu Oct 1 12:17:44 2009 From: ramirezgil at une.net.co (Lucas Ramirez, MD) Date: Thu Oct 1 12:27:14 2009 Subject: [HSF] Chest tubes In-Reply-To: References: <2062643119-1254350322-cardhu_decombobulator_blackberry.rim.net-442248320-@bda266.bisx.prod.on.blackberry> Message-ID: Members: There are lots of different approaches to decide when to pull out chest tubes. Do you have any special protocols regarding chest tube removal in anticoagulated patients? do you know of any articles on the subject? Thanks, Lucas Lucas Ram?rez, MD Cirujano Cardiovascular Cl?nica Cardiovascular Santa Mar?a Medell?n, Colombia From prasannasimha at gmail.com Thu Oct 1 23:09:04 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Oct 1 12:39:53 2009 Subject: [HSF] Chest tubes In-Reply-To: References: <2062643119-1254350322-cardhu_decombobulator_blackberry.rim.net-442248320-@bda266.bisx.prod.on.blackberry> Message-ID: <89c4ed2d0910010939y4f6d1f15m20edf43eb5cea441@mail.gmail.com> Just pull it out based on drainage indications. We have patients with valves who have chest tubes pulled out fully anticoagulated. Prasanna On Thu, Oct 1, 2009 at 9:47 PM, Lucas Ramirez, MD wrote: > Members: > > There are lots of different approaches to decide when to pull out chest tubes. ?Do you have any special protocols regarding chest tube removal in anticoagulated patients? ?do you know of any articles on the subject? > > Thanks, > > > Lucas > > Lucas Ram?rez, MD > Cirujano Cardiovascular > Cl?nica Cardiovascular Santa Mar?a > Medell?n, Colombia > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From ecdouville at orclinic.com Thu Oct 1 10:40:27 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Thu Oct 1 12:43:53 2009 Subject: [HSF] Aortic aneurysm gray area? References: <89c4ed2d0909301816r105d1aacl9e8c91aca881ce54@mail.gmail.com> Message-ID: Michael I personally would not operate on her now, but rather repeat her ct in 6 months and follow her AI. chuck ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of nand kejriwal Sent: Thu 10/1/2009 12:09 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Aortic aneurysm gray area? While on this topic; if someone has isolated dilated aortic sinuses with normal aortic valve, no regurg, and ascending aorta not significantly dilated, do we use the same criteria for the sinuses as we do for ascending aorta, as far as size is concerned? Any references on this? nand 2009/10/1 Prasanna Simha M > What is the indication here for surgery ? If her stress test is normal > then treat her anxiety disorder. > Prasanna > > On Thu, Oct 1, 2009 at 1:21 AM, Michael Firstenberg > wrote: > > I know we discuss this all of the time: > > 67 year/old, BSA=2, handful of medical problems (HTN, DM, anxiety > disorder, > > etc), reported to have a clean cath from a couple of years ago > > Presented with "chest pain" (troponins neg) but CT scan shows max 4.3cm > > ascending, normal arch and descending. > > echo show normal LV function and mild AI (trileaflet valve)...... > > > > inclined to offer repair (based upon ?symptoms?, concern for worsening > > AI)...... i.e. simple tube graft before she would need something more > > complicated? > > > > thoughts? > > > > this is a new diagnosis for her - would anyone wait 6months for a repeat > > study? > > > > -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 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 pfvil at intramed.net Thu Oct 1 15:03:52 2009 From: pfvil at intramed.net (Dr Patricio Villanueva) Date: Thu Oct 1 13:05:20 2009 Subject: [HSF] Real World In-Reply-To: References: <89c4ed2d0909301816r105d1aacl9e8c91aca881ce54@mail.gmail.com> Message-ID: <019A5EAC2BBB46998120A983C61DAE53@villanuevaPC> I am surprising by the words, REAL WORLD, in this paper Why? Because I remember many stories, wich I had lived, for example, one day we were doing a cardiac surgery and from the hemodinamic room come Doctor to ask for us because a patient in that had a "Little problem" after PTCI, wen two of us, a staff and I ( I was doing my training in cardiovascular, thoracic and transpanting surgery) arrived to the hemodinamic laboratory, the patient was on cardiac arrest. I received only a Mayo scissor to take out a segment of saphenous vein to do a graft on the LADA, I felt into the MASH movie ( the book is funnier). The patient died, and obviously, enter into the CABG stadistic mortality, not the PTCI. I am happy for this paper, some true at the end. Patricio Eur J Cardiothorac Surg 2009;36:611-615. doi:10.1016/j.ejcts.2009.03.012 Copyright ? 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved. Coronary artery bypass grafting versus drug-eluting stents in multivessel coronary disease. A meta-analysis on 24,268 patients Umberto Benedetto*, Giovanni Melina, Emiliano Angeloni, Simone Refice, Antonino Roscitano, Brenno Fiorani, Gian Domenico Di Nucci, Riccardo Sinatra Cardiac Surgery Department, II School of Medicine, University of Rome "La Sapienza", Policlinico S. Andrea, Via di Grottarossa 1039, Rome, Italy Received 3 September 2008; received in revised form 23 February 2009; accepted 6 March 2009. * Corresponding author. Tel.: +39 06 33775311; fax: +39 06 33775481. (Email: u2benedetto@libero.it ). Objective: Coronary artery bypass grafting (CABG) has been shown to provide better results than percutaneous coronary intervention (PCI) in multivessel coronary disease. Drug-eluting stents (DES) have significantly improved results of PCI in terms of restenosis but the advantages of such a treatment compared to CABG remain uncertain. This meta-analysis summarizes available data from observational cohorts comparing DES-PCI versus CABG. Methods: We performed a systematic literature search for observational cohorts comparing CABG versus DES-PCI in patients with multivessel coronary disease. The mixed model method was used to obtain the pooled hazard ratio (HR) for outcomes of interest. Results: A total of nine observational nonrandomized studies were identified and analyzed including a total of 24,268 patients with multivessel coronary disease who underwent DES-PCI (n = 13,540) and CABG (n = 10,728). Mean follow-up time was 20 months. Pooled analysis showed that DES-PCI and CABG were comparable in terms of composite occurrence of death, acute myocardial infarction and cerebrovascular accidents (HR = 0.94; 95% CI = 0.72-1.22; p = 0.66). However, there was a significantly higher risk of repeat revascularization in the DES-PCI group (HR = 4.06; 95% CI = 2.64-6.24; p < 0.001). Overall major adverse cardiac and cerebrovascular events rate in the DES-PCI was higher compared to the CABG group (HR = 1.86; 95% CI = 1.36-2.54; p < 0.001). Conclusions: In the 'real world' clinical practice, overall major adverse cardiac and cerebrovascular events rate continues to be higher after DES-PCI due to an excess of redo revascularization compared with CABG. Key Words: Coronary artery bypass grafting . Drug-eluting stents . Percutaneous coronary intervention From robertobattellini at hotmail.com Thu Oct 1 20:10:43 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Thu Oct 1 13:11:10 2009 Subject: [HSF] Aortic aneurysm gray area?-for Nand In-Reply-To: References: <89c4ed2d0909301816r105d1aacl9e8c91aca881ce54@mail.gmail.com> Message-ID: Read the last number of EJCTS in "how to do it", the problem is commented there. Roberto > Date: Thu, 1 Oct 2009 20:09:13 +1300 > Subject: Re: [HSF] Aortic aneurysm gray area? > From: nkkejriwal@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > > While on this topic; if someone has isolated dilated aortic sinuses with > normal aortic valve, no regurg, and ascending aorta not significantly > dilated, do we use the same criteria for the sinuses as we do for ascending > aorta, as far as size is concerned? Any references on this? > nand > > 2009/10/1 Prasanna Simha M > > > What is the indication here for surgery ? If her stress test is normal > > then treat her anxiety disorder. > > Prasanna > > > > On Thu, Oct 1, 2009 at 1:21 AM, Michael Firstenberg > > wrote: > > > I know we discuss this all of the time: > > > 67 year/old, BSA=2, handful of medical problems (HTN, DM, anxiety > > disorder, > > > etc), reported to have a clean cath from a couple of years ago > > > Presented with "chest pain" (troponins neg) but CT scan shows max 4.3cm > > > ascending, normal arch and descending. > > > echo show normal LV function and mild AI (trileaflet valve)...... > > > > > > inclined to offer repair (based upon ?symptoms?, concern for worsening > > > AI)...... i.e. simple tube graft before she would need something more > > > complicated? > > > > > > thoughts? > > > > > > this is a new diagnosis for her - would anyone wait 6months for a repeat > > > study? > > > > > > -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 > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From tacuff at swbell.net Thu Oct 1 11:45:12 2009 From: tacuff at swbell.net (Tea Acuff) Date: Thu Oct 1 13:46:45 2009 Subject: [HSF] Aortic aneurysm gray area? Message-ID: <389089.2561.qm@web81604.mail.mud.yahoo.com> I was thinking it was "delicate" study. Which I assumed was like Hal doing the case instead of me...? Tea Sent from my iPhone On Oct 1, 2009, at 6:12 AM, Ani Anyanwu wrote: getting a dedicate aneurysm study tomorrow to look specifically at the size and shape Michael What is a dedicated aneurysm study? Is it just another scan to give you a measurement you like better? Remember that there is varaibility in any measurement technique. If you did hundred scans on her in the next few days you will get several with measurements reported as over 4.5 and maybe you might be lucky to get a 5cm measurement too - then you can operate (of course ignoring the 4cm or 3.8 cm measures you will probably also get). What has shape got to do with decision? Ani Date: Wed, 30 Sep 2009 18:45:11 -0400 Subject: Re: [HSF] Aortic aneurysm gray area? From: msfirst@gmail.com To: OpenHeart-L@lists.hsforum.com CC: I, in general agree - in part of my concern is her "vague chest pain symptoms" (sounded very cardiac) - is it real or just anxiety, made worse now that she know she has a problem. Not to mention the concept of "lost to follow-up" which is very common...... would hate for her to come back in X years with a huge problem, AI, and a bad LV. getting a dedicate aneurysm study tomorrow to look specifically at the size and shape. -michael On Wed, Sep 30, 2009 at 6:40 PM, wrote: Michael, Risk of surgery is more than risk of rupture at 4.3 cm. Would repeat the scan in 6 month. If the same, would put on yearly schedule. Hal ------Original Message------ From: Edward Bender Sender: openheart-l-bounces@lists.hsforum.com To: HSF List ReplyTo: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Aortic aneurysm gray area? Sent: Sep 30, 2009 5:06 PM All concerns aside, I see no indication for any surgery. Xanax and altace go along way. Ed Bender, MD On 9/30/09 2:51 PM, "Michael Firstenberg" wrote: I know we discuss this all of the time: 67 year/old, BSA=2, handful of medical problems (HTN, DM, anxiety disorder, etc), reported to have a clean cath from a couple of years ago Presented with "chest pain" (troponins neg) but CT scan shows max 4.3cm ascending, normal arch and descending. echo show normal LV function and mild AI (trileaflet valve)...... inclined to offer repair (based upon ?symptoms?, concern for worsening AI)...... i.e. simple tube graft before she would need something more complicated? thoughts? this is a new diagnosis for her - would anyone wait 6months for a repeat study? -michael _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- Sent from my Verizon Wireless BlackBerry _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 prasannasimha at gmail.com Fri Oct 2 01:48:59 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Oct 1 15:25:57 2009 Subject: [HSF] Subclavian stenosis case follow up Message-ID: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> Did the subclavian stenosis case today (Postponed due to some non medical reasons) Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a mistake in my original post and there was no RCA disease on reviewing the angiogram). My logic was RIMA and LIMA have identical patencies to the LAD. Steneted subclavian has a good patency but not the same as virgin LIMA so I placed it to the OM as the patencies seemed to match that. Used a radial to the diagonal which was big as he is young. Incidentally used the right radial as he still complained of some tingling etc in the left fingers and did not want to worsen anything (or give an opportunity to have long term complaints ascribed to radial artery harvest in the stented side !!). I just harvested the radial and closed the arm by the time the Neck lines and Swan were floated and tucked the arm in and proceeded to harvest the IMA's so did not have to do the turn towards the head LIMA harvest as was advocated in the discussion. Despite skeletonization etc the RIMA could not be made to course superiorly under the innominate vein and required a straighter course to the LAD crossing the aorta under the covering RA appendage. I mobilized both mediastinal fat pads and covered the RIMA and LIMA to protect itfor a future redo and if at any time the RCA/PD requires a graft I will approach it basally by dividing the diaphragm and use an RGEA (or so I wishfully think !!) I was considering doing it OPCAB as the targets were good and he initially had excellent hemodynamics but he started developing hypotension and ST's during the final stages of LIMA harvest (which I had harvested last) so I did it beating supported (I had an alternate choice of a balloon pump but was worried about the very tight Left main). He came off with NTG and Diltiazem infusions that were prophylactically started. Comments ? -- Prasanna Simha M From ecdouville at orclinic.com Thu Oct 1 14:53:57 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Thu Oct 1 17:09:57 2009 Subject: [HSF] TMR with recent MI Message-ID: Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few days ago with Class 4 angina; she was admitted to a nearby hospital with an MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, closed RCA. She is living off that LIMA. There is an open ramus that is bypassable and a functional lateral wall. EF is 45%. Inferior wall is only scar on thallium I am planning Left thoracotomy radial graft to this Ramus from the Subclavian artery; initially had planned CO2 TMR to the lateral wall. Would anyone rule out adding TMR in the face of the recent infarct and abnormal EF? thx chuckdouville From drdharris at yahoo.co.uk Thu Oct 1 15:17:05 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Thu Oct 1 17:17:36 2009 Subject: [HSF] Aortic aneurysm gray area? In-Reply-To: Message-ID: <506148.98330.qm@web24714.mail.ird.yahoo.com> I would get cardiologists to recath her. A normal stress ECG does not exclude lesions, and she has significant? risk factors. We have seen patients with N stress ECG`s with severe disease such as mainstem. Also N cath becoming grossly abN in a few years - esp diabetics. During cath they can also do aortic measurements. ? Another option; if there is a good quality cardiac CT nearby, do combined coronary and aortic scan. can first do calcium score of coronaries to get idea. I would not be too concerned about aorta at this stage (unless you are missing a dissection), but rather undiagnosed coronary disease. ? Dave --- On Thu, 1/10/09, Ani Anyanwu wrote: From: Ani Anyanwu Subject: RE: [HSF] Aortic aneurysm gray area? To: "open heart list" Date: Thursday, 1 October, 2009, 2:12 PM > getting a dedicate aneurysm study tomorrow to look specifically at the size > and shape Michael What is a dedicated aneurysm study? Is it just another scan to give you a measurement you like better? Remember that there is varaibility in any measurement technique. If you did hundred scans on her in the next few days you will get several with measurements reported as over 4.5 and maybe you might be lucky to get a 5cm measurement too - then you can operate (of course ignoring the 4cm or 3.8 cm measures you will probably also get). What has shape got to do with decision? Ani > Date: Wed, 30 Sep 2009 18:45:11 -0400 > Subject: Re: [HSF] Aortic aneurysm gray area? > From: msfirst@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > > I, in general agree - in part of my concern is her "vague chest pain > symptoms" (sounded very cardiac) - is it real or just anxiety, made worse > now that she know she has a problem. Not to mention the concept of "lost to > follow-up" which is very common...... would hate for her to come back in X > years with a huge problem, AI, and a bad LV. > > getting a dedicate aneurysm study tomorrow to look specifically at the size > and shape. > > > -michael > > > > On Wed, Sep 30, 2009 at 6:40 PM, wrote: > > > Michael, > > Risk of surgery is more than risk of rupture at 4.3 cm. Would repeat the > > scan in 6 month. If the same, would put on yearly schedule. > > > > Hal > > ------Original Message------ > > From: Edward Bender > > Sender: openheart-l-bounces@lists.hsforum.com > > To: HSF List > > ReplyTo: OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Aortic aneurysm gray area? > > Sent: Sep 30, 2009 5:06 PM > > > > All concerns aside, I see no indication for any surgery. Xanax and altace > > go > > along way. > > > > Ed Bender, MD > > > > > > On 9/30/09 2:51 PM, "Michael Firstenberg" wrote: > > > > > I know we discuss this all of the time: > > > 67 year/old, BSA=2, handful of medical problems (HTN, DM, anxiety > > disorder, > > > etc), reported to have a clean cath from a couple of years ago > > > Presented with "chest pain" (troponins neg) but CT scan shows max 4.3cm > > > ascending, normal arch and descending. > > > echo show normal LV function and mild AI (trileaflet valve)...... > > > > > > inclined to offer repair (based upon ?symptoms?, concern for worsening > > > AI)...... i.e. simple tube graft before she would need something more > > > complicated? > > > > > > thoughts? > > > > > > this is a new diagnosis for her - would anyone wait 6months for a repeat > > > study? > > > > > > -michael > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > Sent from my Verizon Wireless BlackBerry > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Thu Oct 1 18:40:48 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Thu Oct 1 19:17:57 2009 Subject: [HSF] Aortic aneurysm gray area? In-Reply-To: <506148.98330.qm@web24714.mail.ird.yahoo.com> References: <506148.98330.qm@web24714.mail.ird.yahoo.com> Message-ID: The aneurysm CT showed the ascending aneurysm, greatest size ~4.3cm at the level of the PA. The coronary CT showed a little more than average calcium in the prox LAD - not huge amount, other than this distal LAD and the rest of her cors looked small - so she is getting a cath tomorrow..... -michael On Thu, Oct 1, 2009 at 5:17 PM, David Harris wrote: > I would get cardiologists to recath her. A normal stress ECG does not > exclude lesions, and she has significant risk factors. We have seen > patients with N stress ECG`s with severe disease such as mainstem. Also N > cath becoming grossly abN in a few years - esp diabetics. > During cath they can also do aortic measurements. > > Another option; if there is a good quality cardiac CT nearby, do combined > coronary and aortic scan. can first do calcium score of coronaries to get > idea. > I would not be too concerned about aorta at this stage (unless you are > missing a dissection), but rather undiagnosed coronary disease. > > Dave > > --- On Thu, 1/10/09, Ani Anyanwu wrote: > > > From: Ani Anyanwu > Subject: RE: [HSF] Aortic aneurysm gray area? > To: "open heart list" > Date: Thursday, 1 October, 2009, 2:12 PM > > > > > getting a dedicate aneurysm study tomorrow to look specifically at the > size > > and shape > > > > Michael > > > > What is a dedicated aneurysm study? > > > > Is it just another scan to give you a measurement you like better? Remember > that there is varaibility in any measurement technique. If you did hundred > scans on her in the next few days you will get several with measurements > reported as over 4.5 and maybe you might be lucky to get a 5cm measurement > too - then you can operate (of course ignoring the 4cm or 3.8 cm measures > you will probably also get). > > > > What has shape got to do with decision? > > > > Ani > > > Date: Wed, 30 Sep 2009 18:45:11 -0400 > > Subject: Re: [HSF] Aortic aneurysm gray area? > > From: msfirst@gmail.com > > To: OpenHeart-L@lists.hsforum.com > > CC: > > > > I, in general agree - in part of my concern is her "vague chest pain > > symptoms" (sounded very cardiac) - is it real or just anxiety, made worse > > now that she know she has a problem. Not to mention the concept of "lost > to > > follow-up" which is very common...... would hate for her to come back in > X > > years with a huge problem, AI, and a bad LV. > > > > getting a dedicate aneurysm study tomorrow to look specifically at the > size > > and shape. > > > > > > -michael > > > > > > > > On Wed, Sep 30, 2009 at 6:40 PM, wrote: > > > > > Michael, > > > Risk of surgery is more than risk of rupture at 4.3 cm. Would repeat > the > > > scan in 6 month. If the same, would put on yearly schedule. > > > > > > Hal > > > ------Original Message------ > > > From: Edward Bender > > > Sender: openheart-l-bounces@lists.hsforum.com > > > To: HSF List > > > ReplyTo: OpenHeart-L@lists.hsforum.com > > > Subject: Re: [HSF] Aortic aneurysm gray area? > > > Sent: Sep 30, 2009 5:06 PM > > > > > > All concerns aside, I see no indication for any surgery. Xanax and > altace > > > go > > > along way. > > > > > > Ed Bender, MD > > > > > > > > > On 9/30/09 2:51 PM, "Michael Firstenberg" wrote: > > > > > > > I know we discuss this all of the time: > > > > 67 year/old, BSA=2, handful of medical problems (HTN, DM, anxiety > > > disorder, > > > > etc), reported to have a clean cath from a couple of years ago > > > > Presented with "chest pain" (troponins neg) but CT scan shows max > 4.3cm > > > > ascending, normal arch and descending. > > > > echo show normal LV function and mild AI (trileaflet valve)...... > > > > > > > > inclined to offer repair (based upon ?symptoms?, concern for > worsening > > > > AI)...... i.e. simple tube graft before she would need something more > > > > complicated? > > > > > > > > thoughts? > > > > > > > > this is a new diagnosis for her - would anyone wait 6months for a > repeat > > > > study? > > > > > > > > -michael > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > policies > > > and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > > > > Sent from my Verizon Wireless BlackBerry > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 donross at bigpond.com Fri Oct 2 10:19:33 2009 From: donross at bigpond.com (Donald Ross) Date: Thu Oct 1 19:22:04 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> Message-ID: <92EDBC0C-AF95-4ECC-B65E-BFB4F6CCEB3C@bigpond.com> Goodness, Prasanna, that sounds like one of my operations. Yesterday I had a critical LM patient with 50% L subclavian stenosis. ( pre-op ima dopplers: both imas 25ml/ min) Did the lad with the rima and took the T-radial off the rima to graft the pda ( around L side as usual) The lima was used for the om and the whole shebang covered with mobilised pericardial fat. ( lima 40ml/min, rima 95 ml/min ) My second case an even worse unstable LM with 30%EF and recent stemi infarct, started to sag while I was trying to sneak the rima onto the lad so I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on pump. ( It is very satisfying to see an anterior wall contractility recover the instant it's graft is opened.) Don On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: > Did the subclavian stenosis case today (Postponed due to some non > medical reasons) > Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a > mistake in my original post and there was no RCA disease on reviewing > the angiogram). > My logic was > RIMA and LIMA have identical patencies to the LAD. > Steneted subclavian has a good patency but not the same as virgin LIMA > so I placed it to the OM as the patencies seemed to match that. > Used a radial to the diagonal which was big as he is young. > Incidentally used the right radial as he still complained of some > tingling etc in the left fingers and did not want to worsen anything > (or give an opportunity to have long term complaints ascribed to > radial artery harvest in the stented side !!). I just harvested the > radial and closed the arm by the time the Neck lines and Swan were > floated and tucked the arm in and proceeded to harvest the IMA's so > did not have to do the turn towards the head LIMA harvest as was > advocated in the discussion. > > > Despite skeletonization etc the RIMA could not be made to course > superiorly under the innominate vein and required a straighter course > to the LAD crossing the aorta under the covering RA appendage. I > mobilized both mediastinal fat pads and covered the RIMA and LIMA to > protect itfor a future redo and if at any time the RCA/PD requires a > graft I will approach it basally by dividing the diaphragm and use an > RGEA (or so I wishfully think !!) > > I was considering doing it OPCAB as the targets were good and he > initially had excellent hemodynamics but he started developing > hypotension and ST's during the final stages of LIMA harvest (which I > had harvested last) so I did it beating supported (I had an alternate > choice of a balloon pump but was worried about the very tight Left > main). He came off with NTG and Diltiazem infusions that were > prophylactically started. > > Comments ? > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From donross at bigpond.com Fri Oct 2 10:34:28 2009 From: donross at bigpond.com (Donald Ross) Date: Thu Oct 1 19:35:59 2009 Subject: [HSF] TMR with recent MI In-Reply-To: References: Message-ID: <6FAE9202-9C3D-4B9B-B1F8-6025C421FCE2@bigpond.com> Chuck, I have done several lateral wall salvages using the radial but do it through a postero lateral thoracotomy, putting the radial on the descending aorta, sweeping it inferiorly under the pulmonary vein and skipping it to the Cx vessels. The ramus ( ? high OM ) can be grafted as well, and all is facilitated by heavy traction on various bits of pericardium. Don PS Don't you wish you had used a T-radial at the first operation? On 02/10/2009, at 6:53 AM, Douville, Chuck wrote: > Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her > a few days ago with Class 4 angina; she was admitted to a nearby > hospital with an MI yesterday, troponin peaks at 5. Anatomy is a > nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, > closed RCA. She is living off that LIMA. There is an open ramus that > is bypassable and a functional lateral wall. EF is 45%. Inferior > wall is only scar on thallium I am planning Left thoracotomy radial > graft to this Ramus from the Subclavian artery; initially had > planned CO2 TMR to the lateral wall. Would anyone rule out adding > TMR in the face of the recent infarct and abnormal EF? > thx chuckdouville > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From tacuff at swbell.net Thu Oct 1 18:39:57 2009 From: tacuff at swbell.net (Tea Acuff) Date: Thu Oct 1 20:41:29 2009 Subject: [HSF] TMR with recent MI Message-ID: <915497.12280.qm@web81606.mail.mud.yahoo.com> Clearly: maybe. Tea my iPhone On Oct 1, 2009, at 6:34 PM, Donald Ross wrote: Chuck, I have done several lateral wall salvages using the radial but do it through a postero lateral thoracotomy, putting the radial on the descending aorta, sweeping it inferiorly under the pulmonary vein and skipping it to the Cx vessels. The ramus ( ? high OM ) can be grafted as well, and all is facilitated by heavy traction on various bits of pericardium. Don PS Don't you wish you had used a T-radial at the first operation? On 02/10/2009, at 6:53 AM, Douville, Chuck wrote: Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few days ago with Class 4 angina; she was admitted to a nearby hospital with an MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, closed RCA. She is living off that LIMA. There is an open ramus that is bypassable and a functional lateral wall. EF is 45%. Inferior wall is only scar on thallium I am planning Left thoracotomy radial graft to this Ramus from the Subclavian artery; initially had planned CO2 TMR to the lateral wall. Would anyone rule out adding TMR in the face of the recent infarct and abnormal EF? thx chuckdouville _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From tacuff at swbell.net Thu Oct 1 18:41:59 2009 From: tacuff at swbell.net (Tea Acuff) Date: Thu Oct 1 20:43:28 2009 Subject: [HSF] TMR with recent MI Message-ID: <994018.68144.qm@web81601.mail.mud.yahoo.com> I would be okay with both, but Tony is the silent CO2 expert. Tea Sent from my iPhone On Oct 1, 2009, at 3:53 PM, "Douville, Chuck" wrote: Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few days ago with Class 4 angina; she was admitted to a nearby hospital with an MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, closed RCA. She is living off that LIMA. There is an open ramus that is bypassable and a functional lateral wall. EF is 45%. Inferior wall is only scar on thallium I am planning Left thoracotomy radial graft to this Ramus from the Subclavian artery; initially had planned CO2 TMR to the lateral wall. Would anyone rule out adding TMR in the face of the recent infarct and abnormal EF? thx chuckdouville _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 Oct 2 02:05:35 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Thu Oct 1 21:06:24 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> Message-ID: Prasanna Do you usually procure the radial artery while anesthesia are placing the lines? ani > From: prasannasimha@gmail.com > Date: Fri, 2 Oct 2009 00:48:59 +0530 > To: OpenHeart-L@lists.hsforum.com > CC: > Subject: [HSF] Subclavian stenosis case follow up > > Did the subclavian stenosis case today (Postponed due to some non > medical reasons) > Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a > mistake in my original post and there was no RCA disease on reviewing > the angiogram). > My logic was > RIMA and LIMA have identical patencies to the LAD. > Steneted subclavian has a good patency but not the same as virgin LIMA > so I placed it to the OM as the patencies seemed to match that. > Used a radial to the diagonal which was big as he is young. > Incidentally used the right radial as he still complained of some > tingling etc in the left fingers and did not want to worsen anything > (or give an opportunity to have long term complaints ascribed to > radial artery harvest in the stented side !!). I just harvested the > radial and closed the arm by the time the Neck lines and Swan were > floated and tucked the arm in and proceeded to harvest the IMA's so > did not have to do the turn towards the head LIMA harvest as was > advocated in the discussion. > > > Despite skeletonization etc the RIMA could not be made to course > superiorly under the innominate vein and required a straighter course > to the LAD crossing the aorta under the covering RA appendage. I > mobilized both mediastinal fat pads and covered the RIMA and LIMA to > protect itfor a future redo and if at any time the RCA/PD requires a > graft I will approach it basally by dividing the diaphragm and use an > RGEA (or so I wishfully think !!) > > I was considering doing it OPCAB as the targets were good and he > initially had excellent hemodynamics but he started developing > hypotension and ST's during the final stages of LIMA harvest (which I > had harvested last) so I did it beating supported (I had an alternate > choice of a balloon pump but was worried about the very tight Left > main). He came off with NTG and Diltiazem infusions that were > prophylactically started. > > Comments ? > -- > 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 > ----------------------------------------- _________________________________________________________________ Get the best of MSN on your mobile http://clk.atdmt.com/UKM/go/147991039/direct/01/ From anianyanwu at hotmail.com Fri Oct 2 02:08:27 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Thu Oct 1 21:09:15 2009 Subject: [HSF] TMR with recent MI In-Reply-To: <994018.68144.qm@web81601.mail.mud.yahoo.com> References: <994018.68144.qm@web81601.mail.mud.yahoo.com> Message-ID: does anyone still use TMR? I know we have a machine somewhere but dont think it has been used for a few years. What is the consensus these days - does it work? What work does it do? How many actually believe it works? Ani > Date: Thu, 1 Oct 2009 17:41:59 -0700 > From: tacuff@swbell.net > Subject: Re: [HSF] TMR with recent MI > To: OpenHeart-L@lists.hsforum.com > CC: > > I would be okay with both, but Tony is the silent CO2 expert. > Tea > > Sent from my iPhone > > On Oct 1, 2009, at 3:53 PM, "Douville, Chuck" wrote: > > Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few days ago with Class 4 angina; she was admitted to a nearby hospital with an MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, closed RCA. She is living off that LIMA. There is an open ramus that is bypassable and a functional lateral wall. EF is 45%. Inferior wall is only scar on thallium I am planning Left thoracotomy radial graft to this Ramus from the Subclavian artery; initially had planned CO2 TMR to the lateral wall. Would anyone rule out adding TMR in the face of the recent infarct and abnormal EF? > thx chuckdouville > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ Get the best of MSN on your mobile http://clk.atdmt.com/UKM/go/147991039/direct/01/ From prasannasimha at gmail.com Fri Oct 2 08:06:14 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Oct 1 21:36:54 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> Message-ID: <89c4ed2d0910011836m5a1fd5ebt245b268b2d8b87fc@mail.gmail.com> Yes.Saves time. In fact we take out the grafts (be it saphenous vein or radial) while they place lines and generally tell the residents that when they procure grafts to time their efficiency in graft removal such that they finish with PA line placement.(Harvesting and closing the sites). In the beginning they are usually slower and as their efficiency builds up they get to harvest it quickly. I think a radial can easily be harvested by the time the neck lines are in place so that the hand is tucked back by the time sternotomy is to be done. Is there any reason not to do so ? When I came to the present hospital and at that time we had less hands , we used to harvest the peripheral conduits and close off the wounds for our HOD and then go to our cases in another OR by the time our case was being induced so it is sort of a habit. Prasanna On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu wrote: > > Prasanna > > > > Do you usually procure the radial artery while anesthesia are placing the lines? > > > > ani > > > > > >> From: prasannasimha@gmail.com >> Date: Fri, 2 Oct 2009 00:48:59 +0530 >> To: OpenHeart-L@lists.hsforum.com >> CC: >> Subject: [HSF] Subclavian stenosis case follow up >> >> Did the subclavian stenosis case today (Postponed due to some non >> medical reasons) >> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >> mistake in my original post and there was no RCA disease on reviewing >> the angiogram). >> My logic was >> RIMA and LIMA have identical patencies to the LAD. >> Steneted subclavian has a good patency but not the same as virgin LIMA >> so I placed it to the OM as the patencies seemed to match that. >> Used a radial to the diagonal which was big as he is young. >> Incidentally used the right radial as he still complained of some >> tingling etc in the left fingers and did not want to worsen anything >> (or give an opportunity to have long term complaints ascribed to >> radial artery harvest in the stented side !!). I just harvested the >> radial and closed the arm by the time the Neck lines and Swan were >> floated and tucked the arm in and proceeded to harvest the IMA's so >> did not have to do the turn towards the head LIMA harvest as was >> advocated in the discussion. >> >> >> Despite skeletonization etc the RIMA could not be made to course >> superiorly under the innominate vein and required a straighter course >> to the LAD crossing the aorta under the covering RA appendage. I >> mobilized both mediastinal fat pads and covered the RIMA and LIMA to >> protect itfor a future redo and if at any time the RCA/PD requires a >> graft I will approach it basally by dividing the diaphragm and use an >> RGEA (or so I wishfully think !!) >> >> I was considering doing it OPCAB as the targets were good and he >> initially had excellent hemodynamics but he started developing >> hypotension and ST's during the final stages of LIMA harvest (which I >> had harvested last) so I did it beating supported (I had an alternate >> choice of a balloon pump but was worried about the very tight Left >> main). He came off with NTG and Diltiazem infusions that were >> prophylactically started. >> >> Comments ? >> -- >> 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 >> ----------------------------------------- > > _________________________________________________________________ > Get the best of MSN on your mobile > http://clk.atdmt.com/UKM/go/147991039/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Fri Oct 2 08:13:17 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Thu Oct 1 21:50:47 2009 Subject: [HSF] TMR with recent MI In-Reply-To: References: Message-ID: <89c4ed2d0910011843r4f16155ud67eb75c7fc23c41@mail.gmail.com> Is TMR still used ? Prasanna On Fri, Oct 2, 2009 at 2:23 AM, Douville, Chuck wrote: > Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few days ago with Class 4 angina; she was admitted to a nearby hospital with an MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, closed RCA. She is living off that LIMA. There is an open ramus that is bypassable and a functional lateral wall. EF is 45%. Inferior wall is only scar on thallium I am planning Left thoracotomy radial graft to this Ramus from the Subclavian artery; initially had planned CO2 TMR to the lateral wall. Would anyone rule out adding TMR in the face of the recent infarct and abnormal EF? > thx chuckdouville > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From ecdouville at orclinic.com Thu Oct 1 20:49:14 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Thu Oct 1 22:52:44 2009 Subject: [HSF] TMR with recent MI In-Reply-To: <89c4ed2d0910011843r4f16155ud67eb75c7fc23c41@mail.gmail.com> References: <89c4ed2d0910011843r4f16155ud67eb75c7fc23c41@mail.gmail.com> Message-ID: <47A01664-CD8A-4E27-BD7D-967325A90E43@orclinic.com> Occasionally Prasanna, but perhaps only by Tea and I? Sent from my iPhone On Oct 1, 2009, at 6:51 PM, "Prasanna Simha M" wrote: > Is TMR still used ? > Prasanna > > On Fri, Oct 2, 2009 at 2:23 AM, Douville, Chuck > wrote: >> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw >> her a few days ago with Class 4 angina; she was admitted to a >> nearby hospital with an MI yesterday, troponin peaks at 5. Anatomy >> is a nice LIMA to LAD, all other (vein grafts) closed. 90% Left >> main, closed RCA. She is living off that LIMA. There is an open >> ramus that is bypassable and a functional lateral wall. EF is 45%. >> Inferior wall is only scar on thallium I am planning Left >> thoracotomy radial graft to this Ramus from the Subclavian artery; >> initially had planned CO2 TMR to the lateral wall. Would anyone >> rule out adding TMR in the face of the recent infarct and abnormal >> EF? >> thx chuckdouville >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 ramirezgil at une.net.co Thu Oct 1 23:40:21 2009 From: ramirezgil at une.net.co (Lucas Ramirez, MD) Date: Thu Oct 1 23:49:11 2009 Subject: [HSF] Chest tubes In-Reply-To: <89c4ed2d0910010939y4f6d1f15m20edf43eb5cea441@mail.gmail.com> References: <2062643119-1254350322-cardhu_decombobulator_blackberry.rim.net-442248320-@bda266.bisx.prod.on.blackberry> <89c4ed2d0910010939y4f6d1f15m20edf43eb5cea441@mail.gmail.com> Message-ID: Thanks, Prasanna. I'm asking because of an "urban legend" which goes from generation to generation in my hospital, and some of the surgeons of the team (including me) think that it's much more expensive to delay anticoagulation while waiting the chest tubes to come out. Regards, Lucas ----- Mensaje original ----- De: Prasanna Simha M Fecha: Jueves, 1 de Octubre de 2009, 7:22 pm Asunto: Re: [HSF] Chest tubes A: OpenHeart-L@lists.hsforum.com > Just pull it out based on drainage indications. We have patients with > valves who have chest tubes pulled out fully anticoagulated. > Prasanna > > On Thu, Oct 1, 2009 at 9:47 PM, Lucas Ramirez, MD > wrote: > > Members: > > > > There are lots of different approaches to decide when to pull > out chest tubes. Do you have any special protocols regarding > chest tube removal in anticoagulated patients? do you know of > any articles on the subject? > > > > Thanks, > > > > > > Lucas > > > > Lucas Ram?rez, MD > > Cirujano Cardiovascular > > Cl?nica Cardiovascular Santa Mar?a > > Medell?n, Colombia > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 > ----------------------------------------- Lucas Ram?rez, MD Cirujano Cardiovascular Cl?nica Cardiovascular Santa Mar?a Medell?n, Colombia From robertobattellini at hotmail.com Fri Oct 2 09:13:50 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri Oct 2 02:14:38 2009 Subject: [HSF] Chest tubes-old phantasy In-Reply-To: References: <2062643119-1254350322-cardhu_decombobulator_blackberry.rim.net-442248320-@bda266.bisx.prod.on.blackberry> Message-ID: There is an old phantasy: delay anticoagulation until drains are pulled out. We do it in Leipzig like in Bangalore. Roberto > Date: Thu, 1 Oct 2009 22:40:21 -0500 > From: ramirezgil@une.net.co > Subject: Re: [HSF] Chest tubes > To: OpenHeart-L@lists.hsforum.com > CC: > > Thanks, Prasanna. I'm asking because of an "urban legend" which goes from generation to generation in my hospital, and some of the surgeons of the team (including me) think that it's much more expensive to delay anticoagulation while waiting the chest tubes to come out. > > Regards, > > Lucas > > ----- Mensaje original ----- > De: Prasanna Simha M > Fecha: Jueves, 1 de Octubre de 2009, 7:22 pm > Asunto: Re: [HSF] Chest tubes > A: OpenHeart-L@lists.hsforum.com > > > Just pull it out based on drainage indications. We have patients with > > valves who have chest tubes pulled out fully anticoagulated. > > Prasanna > > > > On Thu, Oct 1, 2009 at 9:47 PM, Lucas Ramirez, MD > > wrote: > > > Members: > > > > > > There are lots of different approaches to decide when to pull > > out chest tubes. Do you have any special protocols regarding > > chest tube removal in anticoagulated patients? do you know of > > any articles on the subject? > > > > > > Thanks, > > > > > > > > > Lucas > > > > > > Lucas Ram?rez, MD > > > Cirujano Cardiovascular > > > Cl?nica Cardiovascular Santa Mar?a > > > Medell?n, Colombia > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/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 > > ----------------------------------------- > > Lucas Ram?rez, MD > Cirujano Cardiovascular > Cl?nica Cardiovascular Santa Mar?a > Medell?n, Colombia From otto at iafrica.com Fri Oct 2 09:35:00 2009 From: otto at iafrica.com (Otto Thaning) Date: Fri Oct 2 02:35:33 2009 Subject: [HSF] TMR with recent MI References: <994018.68144.qm@web81601.mail.mud.yahoo.com> Message-ID: <755C7C3720E04A5DBCF1B892CFA72AAC@private799f148> Ani - I am still occasionally doing TMLR. I have confined the indications to patients with coronaries that are unsuitable for further graft attempts, and that still have reasonable EF and LV function. Most of these patients are diabetic and have had previous foronary surgery. The results have been very gratifying in a series of approx 100 cases during the last 10 years. A few have had hybrid procedures with a single graft (usually to circumflex territory done off pump and the prox anastomosis to the descending aorta), and the TMLR to the usual areas. I note with some interest a clinical trial called INSTEM currently being conducted at four university medical center sites in Germany. The concept is combination therapy of Transmyocardial Revascularization (TMR) and autologous bone marrow derived stem cell (CD133+) injection into the myocardium for treatment of heart failure. The initial reports indicate improvement in LV function but it is still early days in my opinion. OTTO THANING Cape Town ----- Original Message ----- From: "Ani Anyanwu" To: "open heart list" Sent: Friday, October 02, 2009 3:08 AM Subject: RE: [HSF] TMR with recent MI does anyone still use TMR? I know we have a machine somewhere but dont think it has been used for a few years. What is the consensus these days - does it work? What work does it do? How many actually believe it works? Ani > Date: Thu, 1 Oct 2009 17:41:59 -0700 > From: tacuff@swbell.net > Subject: Re: [HSF] TMR with recent MI > To: OpenHeart-L@lists.hsforum.com > CC: > > I would be okay with both, but Tony is the silent CO2 expert. > Tea > > Sent from my iPhone > > On Oct 1, 2009, at 3:53 PM, "Douville, Chuck" > wrote: > > Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few > days ago with Class 4 angina; she was admitted to a nearby hospital with > an MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all > other (vein grafts) closed. 90% Left main, closed RCA. She is living off > that LIMA. There is an open ramus that is bypassable and a functional > lateral wall. EF is 45%. Inferior wall is only scar on thallium I am > planning Left thoracotomy radial graft to this Ramus from the Subclavian > artery; initially had planned CO2 TMR to the lateral wall. Would anyone > rule out adding TMR in the face of the recent infarct and abnormal EF? > thx chuckdouville > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ Get the best of MSN on your mobile http://clk.atdmt.com/UKM/go/147991039/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 robertobattellini at hotmail.com Fri Oct 2 14:36:17 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Fri Oct 2 07:36:47 2009 Subject: [HSF] Pulmonary endarterectomy in recidivating lungembolies In-Reply-To: References: Message-ID: > Has anyone experience with recidivating lung embolies, I mean Thromboendarterectomy in chronic cases? Literature? Prasanna, Ani, ? Roberto From prasannasimha at gmail.com Fri Oct 2 18:17:41 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 2 07:48:19 2009 Subject: [HSF] Pulmonary endarterectomy in recidivating lungembolies In-Reply-To: References: Message-ID: <89c4ed2d0910020447p4b4bb7a1sbe1eb1d6dd1601e1@mail.gmail.com> Yes. There is a whole body of literature of it with Jamieson being the pioneer. It needs low flow CPB and short periods of circulatory arrest to get a good plain to go down to the branch PA's.There have been cases done with alternative methods without TCA but the thing is that keeping the PA dry becomes an issue unless flows are lowered or stopped in the deep branches. You need to do an IVC weave with 6/0 prolene of place an IVC filter with this operation. As usual we have discussed this some time back and here is the old conversation [HSF] Pulmonary thromboendarterectomy prasannasimha prasannasimha at gmail.com Fri May 19 23:07:13 EDT 2006 * Previous message: [HSF] Pulmonary thromboendarterectomy * Next message: [HSF] Pulmonary thromboendarterectomy * Messages sorted by: [ date ] [ thread ] [ subject ] [ author ] This must be the reference that Tea was referring to. Jamieson of San Diego was the pioneer in extensive pulmonary thromboendartrectomy using TCA to enable extensive delamellation to be done. Prasanna 1: J Thorac Cardiovasc Surg. 1993 Jul;106(1):116-26; discussion 126-7. Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period. Jamieson SW, Auger WR, Fedullo PF, Channick RN, Kriett JM, Tarazi RY, Moser KM. Division of Cardiothoracic Surgery, University of California, School of Medicine, San Diego 92103-8892. A program to alleviate chronic, major vessel thromboembolic pulmonary hypertension by pulmonary thromboendarterectomy was initiated at this institution in 1970. Multiple evolutionary changes in the diagnostic evaluation, surgical approach, and postoperative management have been implemented over the series of 323 thromboendarterectomies performed through March 1992. A sequence of five surgeons at the University of California at San Diego have performed these procedures, with the last 150 having been performed by one surgeon. We report here the changes in surgical approach developed over the last 150 cases and the results obtained. The operation involves a median sternotomy incision, the institution of cardiopulmonary bypass, and deep hypothermia with circulatory arrest periods. Incisions are made in both pulmonary arteries into the lower lobe branches. Pulmonary thromboendarterectomy is always bilateral, with removal of both organized thrombus and an endarterectomy plane from all involved vessels. The right atrium is routinely explored for atrial septal defects. Current techniques appear to allow more thorough revascularization and shorter circulatory arrest times. The surgical mortality of 8.7% over this span is below that previously reported from this and other institutions. Among survivors, the hemodynamic and functional results have been excellent. Surgically correctable chronic thromboembolic pulmonary hypertension likely remains underdiagnosed. The diagnostic, surgical, and postoperative management evolution provided by the coordinated team involved at this institution has established that pulmonary thromboendarterectomy can be performed with an acceptable risk and good hemodynamic and symptomatic results. PMID: 8320990 [PubMed - indexed for MEDLINE] 2: Semin Cardiothorac Vasc Anesth. 2005 Sep;9(3):189-204. Chronic thromboembolic pulmonary hypertension and pulmonary thromboendarterectomy. Manecke GR Jr, Wilson WC, Auger WR, Jamieson SW. Department of Anesthesiology, University of California San Diego, San Diego, CA, USA. gmanecke at UCSD.edu Chronic thromboembolic pulmonary hypertension results from incomplete resolution of a pulmonary embolus or from recurrent pulmonary emboli. Its incidence is underappreciated, and it is currently an undertreated phenomenon. Pulmonary thromboendarterectomy is currently the safest and most effective treatment for this condition. The surgery involves midline sternotomy, profound hypothermic circulatory arrest, and complete endarterectomy of the pulmonary vascular tree. Success depends on effective coordination of multiple medical teams, including pulmonary medicine, anesthesiology, and surgery. This review, based on the past 30 years of experience at University of California San Diego Medical Center, includes information about the clinical history, diagnostic workup, anesthesia, surgical approach, and postoperative care. Outcome data are discussed, as are avenues for future research. Publication Types: Review PMID: 16151552 [PubMed - indexed for MEDLINE] Tea Acuff wrote: > The University of California at San Diego has a large experience with chronic PE. As usual I can't remember any names or specific papers, but you should be able to tract the information down. > Tea Acuff > > rashid akther wrote: > We had a patient referred for pulmonary embolectomy for acute PE. CT angio showed RPA and LPA emboli. > > Pulmonary embolectomy through MPA revealed a small amount of clots and we could not come off CPB. > Exploration of RPA at hilum revealed total chronic occlusion. We attempted thromboendarterectomy. Patient came of CPB with low pressures and then arrested and could not be revived. > > > How can we distinguish preoperatively?chronic occlusions and fresh ones? > > Any suggestions about the techniques of Pulmonary thromboendarterectomy > > --------------------------------- > Do you have a question on a topic you cant find an Answer to. Try Yahoo! Answers India > Get the all new Yahoo! Messenger Beta Now > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L at lists.hsforum.com > > To unsubscribe, change email address, or view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L at lists.hsforum.com > > To unsubscribe, change email address, or view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > * Previous message: [HSF] Pulmonary thromboendarterectomy * Next message: [HSF] Pulmonary thromboendarterectomy * Messages sorted by: [ date ] [ thread ] [ subject ] [ author ] More information about the OpenHeart-L mailing list Prasanna On Fri, Oct 2, 2009 at 5:06 PM, Roberto Battellini wrote: > > > > >> Has anyone experience with recidivating lung embolies, I mean Thromboendarterectomy in chronic cases? > > Literature? Prasanna, Ani, ? > > > > Roberto > ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Fri Oct 2 18:22:35 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 2 07:53:11 2009 Subject: [HSF] Pulmonary endarterectomy in recidivating lungembolies In-Reply-To: <89c4ed2d0910020447p4b4bb7a1sbe1eb1d6dd1601e1@mail.gmail.com> References: <89c4ed2d0910020447p4b4bb7a1sbe1eb1d6dd1601e1@mail.gmail.com> Message-ID: <89c4ed2d0910020452s767ce99cp46314c02d6205e12@mail.gmail.com> Our Jean Bachet is also one of the pioneers and he can also comment with sage advice. Arch Mal Coeur Vaiss. 1989 Oct;82(10):1719-25. [Surgical treatment of chronic pulmonary embolism using thromboembolectomy under extracorporeal circulation and deep hypothermia--a new approach route. 3 cases] [Article in ] Guilmet D, Arnaud-Crozat E, Bachet J, Goudot B, Dubois C, Brodaty D, de Lentdecker P, Diaz F, Teodori G, Caubarrere I, et al. Service de chirurgie cardio-vasculaire, CMC Foch, Suresnes. The authors, who have successfully performed thrombectomy of the pulmonary artery under extracorporeal circulation and deep hypothermia in three patients, wish to draw attention to the principal factors of success. The decision to operate, as accepted by most surgeons, rests on the patient's functional status (stage III or IV) and on the presence of a systolic pulmonary arterial pressure exceeding 50 mmHg. Deep hypothermia combined with circulatory arrest seems to be the best method, as it improves visual control, thereby avoiding damage to the endothelium or fracture of the distal thrombi during thrombectomy. Finally, a new approach route (severing of the superior pulmonary vein, opening of the pulmonary artery and use of Volmar-Sisteron strippers) makes it possible to remove the entire thrombus, thus obtaining an almost normal pressure in the pulmonary artery. In all three patients, the complications that are mostly due to intrabronchial haemorrhage by disruption of the endothelium, fracture of the distal thrombus or pulmonary artery contusion were avoided. PMID: 2512873 [PubMed - indexed for MEDLINE] On Fri, Oct 2, 2009 at 5:17 PM, Prasanna Simha M wrote: > Yes. > There is a whole body of literature ? of it with Jamieson being the > pioneer. It needs low flow CPB and short periods of circulatory arrest > to get a good plain to go down to the branch PA's.There have been > cases done with alternative methods without TCA but the thing is that > keeping the PA dry becomes an issue unless flows are lowered or > stopped in the deep branches. > You need to do an IVC weave with 6/0 prolene of place an IVC filter > with this operation. > As usual we have discussed this some time back and here is the old conversation > [HSF] Pulmonary thromboendarterectomy > > prasannasimha prasannasimha at gmail.com > Fri May 19 23:07:13 EDT 2006 > > ? ?* Previous message: [HSF] Pulmonary thromboendarterectomy > ? ?* Next message: [HSF] Pulmonary thromboendarterectomy > ? ?* Messages sorted by: [ date ] [ thread ] [ subject ] [ author ] > > This must be the reference that Tea was referring to. > Jamieson of San Diego was the pioneer > in extensive pulmonary thromboendartrectomy using TCA to enable > extensive delamellation to > be done. > Prasanna > > 1: J Thorac Cardiovasc Surg. 1993 Jul;106(1):116-26; discussion 126-7. > > Experience and results with 150 pulmonary thromboendarterectomy operations over > a 29-month period. > > Jamieson SW, Auger WR, Fedullo PF, Channick RN, Kriett JM, Tarazi RY, Moser KM. > > Division of Cardiothoracic Surgery, University of California, School of > Medicine, San Diego 92103-8892. > > A program to alleviate chronic, major vessel thromboembolic pulmonary > hypertension by pulmonary thromboendarterectomy was initiated at this > institution in 1970. Multiple evolutionary changes in the diagnostic evaluation, > surgical approach, and postoperative management have been implemented over the > series of 323 thromboendarterectomies performed through March 1992. A sequence > of five surgeons at the University of California at San Diego have performed > these procedures, with the last 150 having been performed by one surgeon. We > report here the changes in surgical approach developed over the last 150 cases > and the results obtained. The operation involves a median sternotomy incision, > the institution of cardiopulmonary bypass, and deep hypothermia with circulatory > arrest periods. Incisions are made in both pulmonary arteries into the lower > lobe branches. Pulmonary thromboendarterectomy is always bilateral, with removal > of both organized thrombus and an endarterectomy plane from all involved > vessels. The right atrium is routinely explored for atrial septal defects. > Current techniques appear to allow more thorough revascularization and shorter > circulatory arrest times. The surgical mortality of 8.7% over this span is below > that previously reported from this and other institutions. Among survivors, the > hemodynamic and functional results have been excellent. Surgically correctable > chronic thromboembolic pulmonary hypertension likely remains underdiagnosed. The > diagnostic, surgical, and postoperative management evolution provided by the > coordinated team involved at this institution has established that pulmonary > thromboendarterectomy can be performed with an acceptable risk and good > hemodynamic and symptomatic results. > > PMID: 8320990 [PubMed - indexed for MEDLINE] > > 2: Semin Cardiothorac Vasc Anesth. 2005 Sep;9(3):189-204. > > Chronic thromboembolic pulmonary hypertension and pulmonary > thromboendarterectomy. > > Manecke GR Jr, Wilson WC, Auger WR, Jamieson SW. > > Department of Anesthesiology, University of California San Diego, San Diego, CA, > USA. gmanecke at UCSD.edu > > Chronic thromboembolic pulmonary hypertension results from incomplete resolution > of a pulmonary embolus or from recurrent pulmonary emboli. Its incidence is > underappreciated, and it is currently an undertreated phenomenon. Pulmonary > thromboendarterectomy is currently the safest and most effective treatment for > this condition. The surgery involves midline sternotomy, profound hypothermic > circulatory arrest, and complete endarterectomy of the pulmonary vascular tree. > Success depends on effective coordination of multiple medical teams, including > pulmonary medicine, anesthesiology, and surgery. This review, based on the past > 30 years of experience at University of California San Diego Medical Center, > includes information about the clinical history, diagnostic workup, anesthesia, > surgical approach, and postoperative care. Outcome data are discussed, as are > avenues for future research. > > Publication Types: > ? ?Review > > PMID: 16151552 [PubMed - indexed for MEDLINE] > > > > > > Tea Acuff wrote: >> The University of California at San Diego has a large experience with chronic PE. As usual I can't remember any names or specific papers, but you should be able to tract the information down. >> ? Tea Acuff >> >> rashid akther wrote: >> ? We had a patient referred for pulmonary embolectomy for acute PE. CT angio showed RPA and LPA emboli. >> >> Pulmonary embolectomy through MPA revealed a small amount of clots and we could not come off CPB. >> Exploration of RPA at hilum revealed total chronic occlusion. We attempted thromboendarterectomy. Patient came of CPB with low pressures and then arrested and could not be revived. >> >> >> How can we distinguish preoperatively?chronic occlusions and fresh ones? >> >> Any suggestions about the techniques of Pulmonary thromboendarterectomy >> >> --------------------------------- >> Do you have a question on a topic you cant find an Answer to. Try Yahoo! Answers India >> Get the all new Yahoo! Messenger Beta Now >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L at lists.hsforum.com >> >> To unsubscribe, change email address, or view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L at lists.hsforum.com >> >> To unsubscribe, change email address, or view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> > > ? ?* Previous message: [HSF] Pulmonary thromboendarterectomy > ? ?* Next message: [HSF] Pulmonary thromboendarterectomy > ? ?* Messages sorted by: [ date ] [ thread ] [ subject ] [ author ] > > More information about the OpenHeart-L mailing list > > > Prasanna > > On Fri, Oct 2, 2009 at 5:06 PM, Roberto Battellini > wrote: >> >> >> >> >>> Has anyone experience with recidivating lung embolies, I mean Thromboendarterectomy in chronic cases? >> >> Literature? Prasanna, Ani, ? >> >> >> >> Roberto >> ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From prasannasimha at gmail.com Fri Oct 2 18:57:32 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 2 08:28:12 2009 Subject: [HSF] Query - Bigelow procedure Message-ID: <89c4ed2d0910020527ta024307p42836f5d8c3d13ad@mail.gmail.com> What is a "Bigelow procedure" ? Prasanna -- Prasanna Simha M From prasannasimha at gmail.com Fri Oct 2 18:32:51 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 2 08:32:09 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <92EDBC0C-AF95-4ECC-B65E-BFB4F6CCEB3C@bigpond.com> References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> <92EDBC0C-AF95-4ECC-B65E-BFB4F6CCEB3C@bigpond.com> Message-ID: <89c4ed2d0910020502q49188d90n73a558513c7c91dc@mail.gmail.com> What is your calcium channel protocol after surgery. I use intravenous Diltiazem followed with Amlodipine for a year. I have seen people not giving any periop calcium channel blockers (and giving a calcium channel blocker next day) to full coverage ?. Giving a calcium channel blocker can be a pain especially if the patient is vasoplegic. Prasanna On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: > Goodness, Prasanna, that sounds like one of my operations. > Yesterday I had ?a critical LM patient with 50% L subclavian stenosis.( > pre-op ima dopplers: both imas 25ml/ min) > Did the lad with the rima ?and took the T-radial off the rima to graft the > pda ( ?around L side as usual) > The lima was used for the om and the whole shebang covered with mobilised > pericardial fat. ( lima 40ml/min, rima 95 ml/min ) > > My second case an even worse unstable LM with 30%EF and recent stemi > infarct, started to sag while I was trying to sneak the rima onto the lad so > I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on > pump. ( It is very ?satisfying ?to see an anterior wall contractility > recover the instant it's ?graft is opened.) > Don > > On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: > >> Did the subclavian stenosis case today (Postponed due to some non >> medical reasons) >> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >> mistake in my original post and there was no RCA disease on reviewing >> the angiogram). >> My logic was >> RIMA and LIMA have identical patencies to the LAD. >> Steneted subclavian has a good patency but not the same as virgin LIMA >> so I placed it to the OM as the patencies seemed to match that. >> Used a radial to the diagonal which was big as he is young. >> Incidentally used the right radial as he still complained of some >> tingling ?etc in the left fingers and did not want to worsen anything >> (or give an opportunity to have long term complaints ?ascribed to >> radial artery harvest in the stented side !!). I just harvested the >> radial and closed the arm by the time the Neck lines and Swan were >> floated and tucked the arm in and proceeded to harvest the IMA's so >> did not have to do the turn towards the head LIMA harvest as was >> advocated ?in the discussion. >> >> >> Despite skeletonization etc the RIMA could not be made to course >> superiorly under the innominate vein and required a straighter course >> to the LAD crossing the aorta under the covering RA appendage. I >> mobilized both mediastinal fat pads and covered the RIMA and LIMA ?to >> protect itfor a future redo and if at any time the RCA/PD requires a >> graft I will approach it basally by dividing the diaphragm ?and use an >> RGEA (or so I wishfully think !!) >> >> I was considering doing it OPCAB as the targets were good and he >> initially had excellent hemodynamics but he started developing >> hypotension and ST's ?during the final stages of LIMA harvest (which I >> had harvested last) so I did it beating supported (I had an alternate >> choice of a balloon pump ?but was worried about the very tight ?Left >> main). He came off with NTG and Diltiazem infusions that were >> prophylactically started. >> >> Comments ? >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From Rwmfglycar at aol.com Fri Oct 2 10:11:58 2009 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Fri Oct 2 09:12:30 2009 Subject: [HSF] Query - Bigelow procedure Message-ID: Could be a desc thoracic aorta homograft conduit for aortic insufficiency but he was involved in many things. He even tried reestablishing spinal cord function in paraplegics Bob In a message dated 10/2/2009 2:29:51 P.M. South Africa Standard Time, prasannasimha@gmail.com writes: What is a "Bigelow procedure" ? Prasanna -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From prasannasimha at gmail.com Fri Oct 2 19:47:17 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 2 09:17:38 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: References: Message-ID: <89c4ed2d0910020617o2abe43eaud432a2b6ce67f5f5@mail.gmail.com> There is a mention in the Carpentier Acar radial artery paper as well as in another French paper so I was wondering what they were referring to. Prasanna On Fri, Oct 2, 2009 at 6:41 PM, wrote: > Could be a desc thoracic aorta homograft conduit for aortic insufficiency > but he was involved in many things. He even tried reestablishing spinal cord > ?function in paraplegics > Bob > > > > In a message dated 10/2/2009 2:29:51 P.M. South Africa Standard Time, > prasannasimha@gmail.com writes: > > What is ?a "Bigelow procedure" ? > Prasanna > > -- > Prasanna Simha ?M > _______________________________________________ > OpenHeart-L mailing ?list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To ?UNSUBSCRIBE, to CHANGE email address, or to view ?archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All ?messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted ?at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Fri Oct 2 22:54:34 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 2 12:30:29 2009 Subject: [HSF] RGEA Message-ID: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> For those who have used Right gastroepiploic routinely what intraabdominal and periop complications have you observed ? Prasanna -- Prasanna Simha M From ecdouville at orclinic.com Fri Oct 2 10:30:58 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Fri Oct 2 12:53:07 2009 Subject: [HSF] TMR with recent MI References: <6FAE9202-9C3D-4B9B-B1F8-6025C421FCE2@bigpond.com> Message-ID: Thanks Don. You think that the ramus is best approached from a pure lateral incision rather than a 30%, in between anterior thoracotomy and lateral, it sounds like. will do; I can always extend it anteriorly if needed. The ramus is the only real lateral target. Yes, it makes the tgraft look good. ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Donald Ross Sent: Thu 10/1/2009 4:34 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] TMR with recent MI Chuck, I have done several lateral wall salvages using the radial but do it through a postero lateral thoracotomy, putting the radial on the descending aorta, sweeping it inferiorly under the pulmonary vein and skipping it to the Cx vessels. The ramus ( ? high OM ) can be grafted as well, and all is facilitated by heavy traction on various bits of pericardium. Don PS Don't you wish you had used a T-radial at the first operation? On 02/10/2009, at 6:53 AM, Douville, Chuck wrote: > Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her > a few days ago with Class 4 angina; she was admitted to a nearby > hospital with an MI yesterday, troponin peaks at 5. Anatomy is a > nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, > closed RCA. She is living off that LIMA. There is an open ramus that > is bypassable and a functional lateral wall. EF is 45%. Inferior > wall is only scar on thallium I am planning Left thoracotomy radial > graft to this Ramus from the Subclavian artery; initially had > planned CO2 TMR to the lateral wall. Would anyone rule out adding > TMR in the face of the recent infarct and abnormal EF? > thx chuckdouville > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 jrodriguezcampos at yahoo.com Fri Oct 2 11:47:07 2009 From: jrodriguezcampos at yahoo.com (Jorge Rodriguez Campos) Date: Fri Oct 2 13:47:36 2009 Subject: [HSF] RGEA In-Reply-To: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> Message-ID: <465290.8655.qm@web51407.mail.re2.yahoo.com> Dear Prasanna: ? ? ? ? ? ? ? ? ? ? ? Only transitory intestinal paralysis, that yields spontaneously, to be careful in the tie or cauterization of the collaterals is the main thing, to leave releases it, nontense, and the orifice of the sufficient diaphragm. ?????????????????????????????????????????????????????????????? Best regards. Dr. Jorge F. Rodriguez Campos --- El vie 2-oct-09, Prasanna Simha M escribi?: De: Prasanna Simha M Asunto: [HSF] RGEA A: "OpenHeart-L" Fecha: viernes, 2 octubre, 2009, 8:24 pm For those who have used Right gastroepiploic routinely what intraabdominal and periop complications have you observed ? Prasanna -- 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 ----------------------------------------- ____________________________________________________________________________________ ?Obt?n la mejor experiencia en la web! Descarga gratis el nuevo Internet Explorer 8. http://downloads.yahoo.com/ieak8/?l=e1 From jrodriguezcampos at yahoo.com Fri Oct 2 13:27:00 2009 From: jrodriguezcampos at yahoo.com (Jorge Rodriguez Campos) Date: Fri Oct 2 15:27:32 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910020502q49188d90n73a558513c7c91dc@mail.gmail.com> Message-ID: <312786.43954.qm@web51412.mail.re2.yahoo.com> Dear Prasanna: ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?? I don' t? use intravenous Diltiazem at? periop time,. I give? a calcium channel blocker next day and for a six month.- Jorge F. Rodriguez Campos --- El vie 2-oct-09, Prasanna Simha M escribi?: De: Prasanna Simha M Asunto: Re: [HSF] Subclavian stenosis case follow up A: OpenHeart-L@lists.hsforum.com Fecha: viernes, 2 octubre, 2009, 4:02 pm What is your? calcium channel protocol after surgery. I use intravenous Diltiazem followed with Amlodipine for a year. I have seen people not giving any periop calcium channel blockers (and giving a calcium channel blocker next day) to full coverage ?. Giving a calcium channel blocker can be a pain especially if the patient is vasoplegic. Prasanna On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: > Goodness, Prasanna, that sounds like one of my operations. > Yesterday I had ?a critical LM patient with 50% L subclavian stenosis.( > pre-op ima dopplers: both imas 25ml/ min) > Did the lad with the rima ?and took the T-radial off the rima to graft the > pda ( ?around L side as usual) > The lima was used for the om and the whole shebang covered with mobilised > pericardial fat. ( lima 40ml/min, rima 95 ml/min ) > > My second case an even worse unstable LM with 30%EF and recent stemi > infarct, started to sag while I was trying to sneak the rima onto the lad so > I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on > pump. ( It is very ?satisfying ?to see an anterior wall contractility > recover the instant it's ?graft is opened.) > Don > > On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: > >> Did the subclavian stenosis case today (Postponed due to some non >> medical reasons) >> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >> mistake in my original post and there was no RCA disease on reviewing >> the angiogram). >> My logic was >> RIMA and LIMA have identical patencies to the LAD. >> Steneted subclavian has a good patency but not the same as virgin LIMA >> so I placed it to the OM as the patencies seemed to match that. >> Used a radial to the diagonal which was big as he is young. >> Incidentally used the right radial as he still complained of some >> tingling ?etc in the left fingers and did not want to worsen anything >> (or give an opportunity to have long term complaints ?ascribed to >> radial artery harvest in the stented side !!). I just harvested the >> radial and closed the arm by the time the Neck lines and Swan were >> floated and tucked the arm in and proceeded to harvest the IMA's so >> did not have to do the turn towards the head LIMA harvest as was >> advocated ?in the discussion. >> >> >> Despite skeletonization etc the RIMA could not be made to course >> superiorly under the innominate vein and required a straighter course >> to the LAD crossing the aorta under the covering RA appendage. I >> mobilized both mediastinal fat pads and covered the RIMA and LIMA ?to >> protect itfor a future redo and if at any time the RCA/PD requires a >> graft I will approach it basally by dividing the diaphragm ?and use an >> RGEA (or so I wishfully think !!) >> >> I was considering doing it OPCAB as the targets were good and he >> initially had excellent hemodynamics but he started developing >> hypotension and ST's ?during the final stages of LIMA harvest (which I >> had harvested last) so I did it beating supported (I had an alternate >> choice of a balloon pump ?but was worried about the very tight ?Left >> main). He came off with NTG and Diltiazem infusions that were >> prophylactically started. >> >> Comments ? >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- ____________________________________________________________________________________ ?Obt?n la mejor experiencia en la web! Descarga gratis el nuevo Internet Explorer 8. http://downloads.yahoo.com/ieak8/?l=e1 From donross at bigpond.com Sat Oct 3 07:30:31 2009 From: donross at bigpond.com (Donald Ross) Date: Fri Oct 2 16:33:10 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910020502q49188d90n73a558513c7c91dc@mail.gmail.com> References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> <92EDBC0C-AF95-4ECC-B65E-BFB4F6CCEB3C@bigpond.com> <89c4ed2d0910020502q49188d90n73a558513c7c91dc@mail.gmail.com> Message-ID: Nil, There is no evidence for it's use and we have never used it apart from the the local application of verapamil. Don On 02/10/2009, at 10:02 PM, Prasanna Simha M wrote: > What is your calcium channel protocol after surgery. I use > intravenous Diltiazem followed with Amlodipine for a year. I have seen > people not giving any periop calcium channel blockers (and giving a > calcium channel blocker next day) to full coverage ?. > Giving a calcium channel blocker can be a pain especially if the > patient is vasoplegic. > Prasanna > > On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross > wrote: >> Goodness, Prasanna, that sounds like one of my operations. >> Yesterday I had a critical LM patient with 50% L subclavian >> stenosis.( >> pre-op ima dopplers: both imas 25ml/ min) >> Did the lad with the rima and took the T-radial off the rima to >> graft the >> pda ( around L side as usual) >> The lima was used for the om and the whole shebang covered with >> mobilised >> pericardial fat. ( lima 40ml/min, rima 95 ml/min ) >> >> My second case an even worse unstable LM with 30%EF and recent stemi >> infarct, started to sag while I was trying to sneak the rima onto >> the lad so >> I went on pump and did the bilateral ima, T-radial cabgX4 beating >> heart on >> pump. ( It is very satisfying to see an anterior wall contractility >> recover the instant it's graft is opened.) >> Don >> >> On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: >> >>> Did the subclavian stenosis case today (Postponed due to some non >>> medical reasons) >>> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >>> mistake in my original post and there was no RCA disease on >>> reviewing >>> the angiogram). >>> My logic was >>> RIMA and LIMA have identical patencies to the LAD. >>> Steneted subclavian has a good patency but not the same as virgin >>> LIMA >>> so I placed it to the OM as the patencies seemed to match that. >>> Used a radial to the diagonal which was big as he is young. >>> Incidentally used the right radial as he still complained of some >>> tingling etc in the left fingers and did not want to worsen >>> anything >>> (or give an opportunity to have long term complaints ascribed to >>> radial artery harvest in the stented side !!). I just harvested the >>> radial and closed the arm by the time the Neck lines and Swan were >>> floated and tucked the arm in and proceeded to harvest the IMA's so >>> did not have to do the turn towards the head LIMA harvest as was >>> advocated in the discussion. >>> >>> >>> Despite skeletonization etc the RIMA could not be made to course >>> superiorly under the innominate vein and required a straighter >>> course >>> to the LAD crossing the aorta under the covering RA appendage. I >>> mobilized both mediastinal fat pads and covered the RIMA and LIMA >>> to >>> protect itfor a future redo and if at any time the RCA/PD requires a >>> graft I will approach it basally by dividing the diaphragm and >>> use an >>> RGEA (or so I wishfully think !!) >>> >>> I was considering doing it OPCAB as the targets were good and he >>> initially had excellent hemodynamics but he started developing >>> hypotension and ST's during the final stages of LIMA harvest >>> (which I >>> had harvested last) so I did it beating supported (I had an >>> alternate >>> choice of a balloon pump but was worried about the very tight Left >>> main). He came off with NTG and Diltiazem infusions that were >>> prophylactically started. >>> >>> Comments ? >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies >> anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From tacuff at swbell.net Fri Oct 2 14:35:44 2009 From: tacuff at swbell.net (Tea Acuff) Date: Fri Oct 2 16:36:15 2009 Subject: [HSF] Subclavian stenosis case follow up Message-ID: <384379.97304.qm@web81604.mail.mud.yahoo.com> Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. Tea Sent from my iPhone On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: What is your calcium channel protocol after surgery. I use intravenous Diltiazem followed with Amlodipine for a year. I have seen people not giving any periop calcium channel blockers (and giving a calcium channel blocker next day) to full coverage ?. Giving a calcium channel blocker can be a pain especially if the patient is vasoplegic. Prasanna On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: Goodness, Prasanna, that sounds like one of my operations. Yesterday I had a critical LM patient with 50% L subclavian stenosis.( pre-op ima dopplers: both imas 25ml/ min) Did the lad with the rima and took the T-radial off the rima to graft the pda ( around L side as usual) The lima was used for the om and the whole shebang covered with mobilised pericardial fat. ( lima 40ml/min, rima 95 ml/min ) My second case an even worse unstable LM with 30%EF and recent stemi infarct, started to sag while I was trying to sneak the rima onto the lad so I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on pump. ( It is very satisfying to see an anterior wall contractility recover the instant it's graft is opened.) Don On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: Did the subclavian stenosis case today (Postponed due to some non medical reasons) Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a mistake in my original post and there was no RCA disease on reviewing the angiogram). My logic was RIMA and LIMA have identical patencies to the LAD. Steneted subclavian has a good patency but not the same as virgin LIMA so I placed it to the OM as the patencies seemed to match that. Used a radial to the diagonal which was big as he is young. Incidentally used the right radial as he still complained of some tingling etc in the left fingers and did not want to worsen anything (or give an opportunity to have long term complaints ascribed to radial artery harvest in the stented side !!). I just harvested the radial and closed the arm by the time the Neck lines and Swan were floated and tucked the arm in and proceeded to harvest the IMA's so did not have to do the turn towards the head LIMA harvest as was advocated in the discussion. Despite skeletonization etc the RIMA could not be made to course superiorly under the innominate vein and required a straighter course to the LAD crossing the aorta under the covering RA appendage. I mobilized both mediastinal fat pads and covered the RIMA and LIMA to protect itfor a future redo and if at any time the RCA/PD requires a graft I will approach it basally by dividing the diaphragm and use an RGEA (or so I wishfully think !!) I was considering doing it OPCAB as the targets were good and he initially had excellent hemodynamics but he started developing hypotension and ST's during the final stages of LIMA harvest (which I had harvested last) so I did it beating supported (I had an alternate choice of a balloon pump but was worried about the very tight Left main). He came off with NTG and Diltiazem infusions that were prophylactically started. Comments ? -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From donross at bigpond.com Sat Oct 3 07:37:04 2009 From: donross at bigpond.com (Donald Ross) Date: Fri Oct 2 16:38:15 2009 Subject: [HSF] TMR with recent MI In-Reply-To: References: <6FAE9202-9C3D-4B9B-B1F8-6025C421FCE2@bigpond.com> Message-ID: <443FC5BB-0E10-4167-A155-0CB45766DFBB@bigpond.com> Chuck, I am not sure which artery you are calling "ramus" I presume it is the highest lateral wall branch which emerges from the middle of the La appendage region. This artery can sometimes be a little more difficult to reach from the lateral approach than the regular Cx branches from the a/v groove. Don On 03/10/2009, at 2:30 AM, Douville, Chuck wrote: > Thanks Don. You think that the ramus is best approached from a pure > lateral incision rather than a 30%, in between anterior thoracotomy > and lateral, it sounds like. will do; I can always extend it > anteriorly if needed. The ramus is the only real lateral target. > Yes, it makes the tgraft look good. > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Donald Ross > Sent: Thu 10/1/2009 4:34 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] TMR with recent MI > > > > Chuck, > I have done several lateral wall salvages using the radial but do it > through a postero lateral thoracotomy, putting the radial on the > descending aorta, sweeping it inferiorly under the pulmonary vein and > skipping it to the Cx vessels. The ramus ( ? high OM ) can be grafted > as well, and all is facilitated by heavy traction on various bits of > pericardium. > Don > PS Don't you wish you had used a T-radial at the first operation? > > On 02/10/2009, at 6:53 AM, Douville, Chuck wrote: > >> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her >> a few days ago with Class 4 angina; she was admitted to a nearby >> hospital with an MI yesterday, troponin peaks at 5. Anatomy is a >> nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, >> closed RCA. She is living off that LIMA. There is an open ramus that >> is bypassable and a functional lateral wall. EF is 45%. Inferior >> wall is only scar on thallium I am planning Left thoracotomy radial >> graft to this Ramus from the Subclavian artery; initially had >> planned CO2 TMR to the lateral wall. Would anyone rule out adding >> TMR in the face of the recent infarct and abnormal EF? >> thx chuckdouville >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From jbflegejr at aol.com Fri Oct 2 18:01:35 2009 From: jbflegejr at aol.com (John Flege) Date: Fri Oct 2 17:03:14 2009 Subject: [HSF] RGEA In-Reply-To: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> References: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> Message-ID: <1C4FD5C3-34C9-4E28-90B2-104151B1ACD1@aol.com> I did 25 to 30 cases and none recently (last 15 years) and there were no intraabdominal complications other than ileus for a day or two. Because of concern that a vital coronary graft might be injured during an upper abdominal operation some day, I routed the graft posterior to the stomach and the left lobe of the liver in most cases. John Flege On Oct 2, 2009, at 12:24 PM, Prasanna Simha M wrote: > For those who have used Right gastroepiploic routinely what > intraabdominal and periop complications have you observed ? > Prasanna > > -- > 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 toruasai at belle.shiga-med.ac.jp Sat Oct 3 08:10:52 2009 From: toruasai at belle.shiga-med.ac.jp (Tohru Asai) Date: Fri Oct 2 18:11:26 2009 Subject: [HSF] RGEA In-Reply-To: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> References: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> Message-ID: <20091002221052.00001FEF.0355@belle.shiga-med.ac.jp> Prassanna I have used 200 cases and no complication at all. I incise diaphragm vertically deep and limit the abdominal incision very small. The skeletonized GEA is harvested by Harmonic Scalpel in 10 minutes or so. Patients start PO intake in POD #1 routinely, I have not change postop protocol at all in 10 years. Tohru ----- Original Message ----- > For those who have used Right gastroepiploic routinely what > intraabdominal and periop complications have you observed ? > Prasanna > > -- > 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 > ----------------------------------------- > Tohru Asai Professor and Director,Cardiovascular Surgery Department of Surgery Shiga University of Medical Science Otsu Japan From nfaabouseada at gmail.com Fri Oct 2 18:40:59 2009 From: nfaabouseada at gmail.com (Nasser F Abou'Seada) Date: Fri Oct 2 20:51:01 2009 Subject: [HSF] RGEA In-Reply-To: <20091002221052.00001FEF.0355@belle.shiga-med.ac.jp> References: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> <20091002221052.00001FEF.0355@belle.shiga-med.ac.jp> Message-ID: <4906FD1076364102A177D0BB8FC109BF@AbouSeadaN> Tohru I guess you mean an antero-posterior dimension by Vertical incision of the diaphragm ! if so, - where exactly do you place your incision ? WHERE do you "START" your diaphragmatic incision ? where do you START cutting ? - what length " how DEEP" is your incision ? - how would you GRADE the exposure ? NFA -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Tohru Asai Sent: Friday, October 02, 2009 5:11 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] RGEA Prassanna I have used 200 cases and no complication at all. I incise diaphragm vertically deep and limit the abdominal incision very small. The skeletonized GEA is harvested by Harmonic Scalpel in 10 minutes or so. Patients start PO intake in POD #1 routinely, I have not change postop protocol at all in 10 years. Tohru ----- Original Message ----- > For those who have used Right gastroepiploic routinely what > intraabdominal and periop complications have you observed ? > Prasanna > > -- > 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 > ----------------------------------------- > Tohru Asai Professor and Director,Cardiovascular Surgery Department of Surgery Shiga University of Medical Science Otsu Japan _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From prasannasimha at gmail.com Sat Oct 3 08:34:54 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 2 22:11:33 2009 Subject: [HSF] RGEA In-Reply-To: <1C4FD5C3-34C9-4E28-90B2-104151B1ACD1@aol.com> References: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> <1C4FD5C3-34C9-4E28-90B2-104151B1ACD1@aol.com> Message-ID: <89c4ed2d0910021904p1768ab63p95f8ec0e74ac6159@mail.gmail.com> What made you stop John ? Prasanna On Sat, Oct 3, 2009 at 2:31 AM, John Flege wrote: > I did 25 to 30 cases and none recently (last 15 years) and there were no > intraabdominal complications other than ileus for a day or two. Because of > concern that a vital coronary graft might be injured during an upper > abdominal operation some day, I routed the graft posterior to the stomach > and the left lobe of the liver in most cases. John Flege > On Oct 2, 2009, at 12:24 PM, Prasanna Simha M wrote: > >> For those who have used Right gastroepiploic routinely what >> intraabdominal and periop complications have you observed ? >> Prasanna >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sat Oct 3 08:57:19 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Oct 2 22:28:02 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <384379.97304.qm@web81604.mail.mud.yahoo.com> References: <384379.97304.qm@web81604.mail.mud.yahoo.com> Message-ID: <89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> I am in a bit of conflict here - one of the reasons for revival of the radial was the supposed antispasmodic therapy protocols that were inititated that was supposed to be the ameliorating factor for spasm - read improved current patency. On the other hand use of calcium channel blockers was not found to be useful in some studies. How is this dichotomy in thinking resolved by those who would not give long term CCB's. Incidentally I have used He's solution with the addition of Phenoxybenzamine after doing some literature search and it does produce an elegant pipe with the hopeful advantage that adding phenoxy blocks the receptors for at leastthe first 5 days !! Prasanna On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: > Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. > Tea > > Sent from my iPhone > > On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: > > What is your ?calcium channel protocol after surgery. I use > intravenous Diltiazem followed with Amlodipine for a year. I have seen > people not giving any periop calcium channel blockers (and giving a > calcium channel blocker next day) to full coverage ?. > Giving a calcium channel blocker can be a pain especially if the > patient is vasoplegic. > Prasanna > > On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: > Goodness, Prasanna, that sounds like one of my operations. > Yesterday I had ?a critical LM patient with 50% L subclavian stenosis.( > pre-op ima dopplers: both imas 25ml/ min) > Did the lad with the rima ?and took the T-radial off the rima to graft the > pda ( ?around L side as usual) > The lima was used for the om and the whole shebang covered with mobilised > pericardial fat. ( lima 40ml/min, rima 95 ml/min ) > > My second case an even worse unstable LM with 30%EF and recent stemi > infarct, started to sag while I was trying to sneak the rima onto the lad so > I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on > pump. ( It is very ?satisfying ?to see an anterior wall contractility > recover the instant it's ?graft is opened.) > Don > > On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: > > Did the subclavian stenosis case today (Postponed due to some non > medical reasons) > Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a > mistake in my original post and there was no RCA disease on reviewing > the angiogram). > My logic was > RIMA and LIMA have identical patencies to the LAD. > Steneted subclavian has a good patency but not the same as virgin LIMA > so I placed it to the OM as the patencies seemed to match that. > Used a radial to the diagonal which was big as he is young. > Incidentally used the right radial as he still complained of some > tingling ?etc in the left fingers and did not want to worsen anything > (or give an opportunity to have long term complaints ?ascribed to > radial artery harvest in the stented side !!). I just harvested the > radial and closed the arm by the time the Neck lines and Swan were > floated and tucked the arm in and proceeded to harvest the IMA's so > did not have to do the turn towards the head LIMA harvest as was > advocated ?in the discussion. > > > Despite skeletonization etc the RIMA could not be made to course > superiorly under the innominate vein and required a straighter course > to the LAD crossing the aorta under the covering RA appendage. I > mobilized both mediastinal fat pads and covered the RIMA and LIMA ?to > protect itfor a future redo and if at any time the RCA/PD requires a > graft I will approach it basally by dividing the diaphragm ?and use an > RGEA (or so I wishfully think !!) > > I was considering doing it OPCAB as the targets were good and he > initially had excellent hemodynamics but he started developing > hypotension and ST's ?during the final stages of LIMA harvest (which I > had harvested last) so I did it beating supported (I had an alternate > choice of a balloon pump ?but was worried about the very tight ?Left > main). He came off with NTG and Diltiazem infusions that were > prophylactically started. > > Comments ? > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 anianyanwu at hotmail.com Sat Oct 3 04:23:29 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Fri Oct 2 23:24:21 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> References: <384379.97304.qm@web81604.mail.mud.yahoo.com> Message-ID: I don't think antispasmodic pharmacology was behind revival of the radial - there are no data, previous or present, supporting efficacy of such drugs. I think the key change was with surgical technique avoiding handling and manipulation that can precipitate spasm. Harvesting as pedicle rather than skeletonized was one such maneuver thought we have gone full circle and now skeletonize again. Ani > From: prasannasimha@gmail.com > Date: Sat, 3 Oct 2009 07:57:19 +0530 > Subject: Re: [HSF] Subclavian stenosis case follow up > To: OpenHeart-L@lists.hsforum.com > CC: > > I am in a bit of conflict here - one of the reasons for revival of the > radial was the supposed antispasmodic therapy protocols that were > inititated that was supposed to be the ameliorating factor for spasm - > read improved current patency. On the other hand use of calcium > channel blockers was not found to be useful in some studies. > How is this dichotomy in thinking resolved by those who would not give > long term CCB's. > Incidentally I have used He's solution with the addition of > Phenoxybenzamine after doing some literature search and it does > produce an elegant pipe with the hopeful advantage that adding phenoxy > blocks the receptors for at leastthe first 5 days !! > Prasanna > > On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: > > Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. > > Tea > > > > Sent from my iPhone > > > > On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: > > > > What is your calcium channel protocol after surgery. I use > > intravenous Diltiazem followed with Amlodipine for a year. I have seen > > people not giving any periop calcium channel blockers (and giving a > > calcium channel blocker next day) to full coverage ?. > > Giving a calcium channel blocker can be a pain especially if the > > patient is vasoplegic. > > Prasanna > > > > On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: > > Goodness, Prasanna, that sounds like one of my operations. > > Yesterday I had a critical LM patient with 50% L subclavian stenosis.( > > pre-op ima dopplers: both imas 25ml/ min) > > Did the lad with the rima and took the T-radial off the rima to graft the > > pda ( around L side as usual) > > The lima was used for the om and the whole shebang covered with mobilised > > pericardial fat. ( lima 40ml/min, rima 95 ml/min ) > > > > My second case an even worse unstable LM with 30%EF and recent stemi > > infarct, started to sag while I was trying to sneak the rima onto the lad so > > I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on > > pump. ( It is very satisfying to see an anterior wall contractility > > recover the instant it's graft is opened.) > > Don > > > > On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: > > > > Did the subclavian stenosis case today (Postponed due to some non > > medical reasons) > > Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a > > mistake in my original post and there was no RCA disease on reviewing > > the angiogram). > > My logic was > > RIMA and LIMA have identical patencies to the LAD. > > Steneted subclavian has a good patency but not the same as virgin LIMA > > so I placed it to the OM as the patencies seemed to match that. > > Used a radial to the diagonal which was big as he is young. > > Incidentally used the right radial as he still complained of some > > tingling etc in the left fingers and did not want to worsen anything > > (or give an opportunity to have long term complaints ascribed to > > radial artery harvest in the stented side !!). I just harvested the > > radial and closed the arm by the time the Neck lines and Swan were > > floated and tucked the arm in and proceeded to harvest the IMA's so > > did not have to do the turn towards the head LIMA harvest as was > > advocated in the discussion. > > > > > > Despite skeletonization etc the RIMA could not be made to course > > superiorly under the innominate vein and required a straighter course > > to the LAD crossing the aorta under the covering RA appendage. I > > mobilized both mediastinal fat pads and covered the RIMA and LIMA to > > protect itfor a future redo and if at any time the RCA/PD requires a > > graft I will approach it basally by dividing the diaphragm and use an > > RGEA (or so I wishfully think !!) > > > > I was considering doing it OPCAB as the targets were good and he > > initially had excellent hemodynamics but he started developing > > hypotension and ST's during the final stages of LIMA harvest (which I > > had harvested last) so I did it beating supported (I had an alternate > > choice of a balloon pump but was worried about the very tight Left > > main). He came off with NTG and Diltiazem infusions that were > > prophylactically started. > > > > Comments ? > > -- > > Prasanna Simha M > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > anddisclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > > > > > -- > > Prasanna Simha M > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/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 > ----------------------------------------- _________________________________________________________________ Learn how to add other email accounts to Hotmail in 3 easy steps. http://clk.atdmt.com/UKM/go/167688463/direct/01/ From donross at bigpond.com Sat Oct 3 15:22:40 2009 From: donross at bigpond.com (Donald Ross) Date: Sat Oct 3 00:24:13 2009 Subject: [HSF] reason for historic radial failure In-Reply-To: References: <384379.97304.qm@web81604.mail.mud.yahoo.com> Message-ID: It remains a mystery but is probably related to a number of factors one of which is not the absence of systemic calcium antagonists. 1. Inadequate local drug induced spasm relief. ( which increases oxygen consumption as well as causing early no flow) 2. Ischaemic injury from spasm and spending too long out of body or away from some form of oxygenation. 3. Used for lesions which were not significant. Any others? Don On 03/10/2009, at 1:23 PM, Ani Anyanwu wrote: > I don't think antispasmodic pharmacology was behind revival of the > radial - there are no data, previous or present, supporting efficacy > of such drugs. > > I think the key change was with surgical technique avoiding handling > and manipulation that can precipitate spasm. Harvesting as pedicle > rather than skeletonized was one such maneuver thought we have gone > full circle and now skeletonize again. > > Ani > > >> From: prasannasimha@gmail.com >> Date: Sat, 3 Oct 2009 07:57:19 +0530 >> Subject: Re: [HSF] Subclavian stenosis case follow up >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> I am in a bit of conflict here - one of the reasons for revival of >> the >> radial was the supposed antispasmodic therapy protocols that were >> inititated that was supposed to be the ameliorating factor for >> spasm - >> read improved current patency. On the other hand use of calcium >> channel blockers was not found to be useful in some studies. >> How is this dichotomy in thinking resolved by those who would not >> give >> long term CCB's. >> Incidentally I have used He's solution with the addition of >> Phenoxybenzamine after doing some literature search and it does >> produce an elegant pipe with the hopeful advantage that adding >> phenoxy >> blocks the receptors for at leastthe first 5 days !! >> Prasanna >> >> On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: >>> Liberal use of nitro periop. I useHe solution, which is TNG, >>> verapamil, and bicarbonate to block intraop and then nothing at >>> discharge. >>> Tea >>> >>> Sent from my iPhone >>> >>> On Oct 2, 2009, at 7:02 AM, Prasanna Simha M >> > wrote: >>> >>> What is your calcium channel protocol after surgery. I use >>> intravenous Diltiazem followed with Amlodipine for a year. I have >>> seen >>> people not giving any periop calcium channel blockers (and giving a >>> calcium channel blocker next day) to full coverage ?. >>> Giving a calcium channel blocker can be a pain especially if the >>> patient is vasoplegic. >>> Prasanna >>> >>> On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross >>> wrote: >>> Goodness, Prasanna, that sounds like one of my operations. >>> Yesterday I had a critical LM patient with 50% L subclavian >>> stenosis.( >>> pre-op ima dopplers: both imas 25ml/ min) >>> Did the lad with the rima and took the T-radial off the rima to >>> graft the >>> pda ( around L side as usual) >>> The lima was used for the om and the whole shebang covered with >>> mobilised >>> pericardial fat. ( lima 40ml/min, rima 95 ml/min ) >>> >>> My second case an even worse unstable LM with 30%EF and recent stemi >>> infarct, started to sag while I was trying to sneak the rima onto >>> the lad so >>> I went on pump and did the bilateral ima, T-radial cabgX4 beating >>> heart on >>> pump. ( It is very satisfying to see an anterior wall >>> contractility >>> recover the instant it's graft is opened.) >>> Don >>> >>> On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: >>> >>> Did the subclavian stenosis case today (Postponed due to some non >>> medical reasons) >>> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >>> mistake in my original post and there was no RCA disease on >>> reviewing >>> the angiogram). >>> My logic was >>> RIMA and LIMA have identical patencies to the LAD. >>> Steneted subclavian has a good patency but not the same as virgin >>> LIMA >>> so I placed it to the OM as the patencies seemed to match that. >>> Used a radial to the diagonal which was big as he is young. >>> Incidentally used the right radial as he still complained of some >>> tingling etc in the left fingers and did not want to worsen >>> anything >>> (or give an opportunity to have long term complaints ascribed to >>> radial artery harvest in the stented side !!). I just harvested the >>> radial and closed the arm by the time the Neck lines and Swan were >>> floated and tucked the arm in and proceeded to harvest the IMA's so >>> did not have to do the turn towards the head LIMA harvest as was >>> advocated in the discussion. >>> >>> >>> Despite skeletonization etc the RIMA could not be made to course >>> superiorly under the innominate vein and required a straighter >>> course >>> to the LAD crossing the aorta under the covering RA appendage. I >>> mobilized both mediastinal fat pads and covered the RIMA and LIMA >>> to >>> protect itfor a future redo and if at any time the RCA/PD requires a >>> graft I will approach it basally by dividing the diaphragm and >>> use an >>> RGEA (or so I wishfully think !!) >>> >>> I was considering doing it OPCAB as the targets were good and he >>> initially had excellent hemodynamics but he started developing >>> hypotension and ST's during the final stages of LIMA harvest >>> (which I >>> had harvested last) so I did it beating supported (I had an >>> alternate >>> choice of a balloon pump but was worried about the very tight Left >>> main). He came off with NTG and Diltiazem infusions that were >>> prophylactically started. >>> >>> Comments ? >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/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 >> ----------------------------------------- > > _________________________________________________________________ > Learn how to add other email accounts to Hotmail in 3 easy steps. > http://clk.atdmt.com/UKM/go/167688463/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 Fri Oct 2 23:11:21 2009 From: tacuff at swbell.net (Tea Acuff) Date: Sat Oct 3 01:12:52 2009 Subject: [HSF] reason for historic radial failure Message-ID: <243090.83515.qm@web81606.mail.mud.yahoo.com> Probably the trend away from pressors and blood pressure focus in post op management . Tea Sent from my iPhone On Oct 2, 2009, at 11:22 PM, Donald Ross wrote: It remains a mystery but is probably related to a number of factors one of which is not the absence of systemic calcium antagonists. 1. Inadequate local drug induced spasm relief. ( which increases oxygen consumption as well as causing early no flow) 2. Ischaemic injury from spasm and spending too long out of body or away from some form of oxygenation. 3. Used for lesions which were not significant. Any others? Don On 03/10/2009, at 1:23 PM, Ani Anyanwu wrote: I don't think antispasmodic pharmacology was behind revival of the radial - there are no data, previous or present, supporting efficacy of such drugs. I think the key change was with surgical technique avoiding handling and manipulation that can precipitate spasm. Harvesting as pedicle rather than skeletonized was one such maneuver thought we have gone full circle and now skeletonize again. Ani From: prasannasimha@gmail.com Date: Sat, 3 Oct 2009 07:57:19 +0530 Subject: Re: [HSF] Subclavian stenosis case follow up To: OpenHeart-L@lists.hsforum.com CC: I am in a bit of conflict here - one of the reasons for revival of the radial was the supposed antispasmodic therapy protocols that were inititated that was supposed to be the ameliorating factor for spasm - read improved current patency. On the other hand use of calcium channel blockers was not found to be useful in some studies. How is this dichotomy in thinking resolved by those who would not give long term CCB's. Incidentally I have used He's solution with the addition of Phenoxybenzamine after doing some literature search and it does produce an elegant pipe with the hopeful advantage that adding phenoxy blocks the receptors for at leastthe first 5 days !! Prasanna On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. Tea Sent from my iPhone On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: What is your calcium channel protocol after surgery. I use intravenous Diltiazem followed with Amlodipine for a year. I have seen people not giving any periop calcium channel blockers (and giving a calcium channel blocker next day) to full coverage ?. Giving a calcium channel blocker can be a pain especially if the patient is vasoplegic. Prasanna On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: Goodness, Prasanna, that sounds like one of my operations. Yesterday I had a critical LM patient with 50% L subclavian stenosis.( pre-op ima dopplers: both imas 25ml/ min) Did the lad with the rima and took the T-radial off the rima to graft the pda ( around L side as usual) The lima was used for the om and the whole shebang covered with mobilised pericardial fat. ( lima 40ml/min, rima 95 ml/min ) My second case an even worse unstable LM with 30%EF and recent stemi infarct, started to sag while I was trying to sneak the rima onto the lad so I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on pump. ( It is very satisfying to see an anterior wall contractility recover the instant it's graft is opened.) Don On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: Did the subclavian stenosis case today (Postponed due to some non medical reasons) Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a mistake in my original post and there was no RCA disease on reviewing the angiogram). My logic was RIMA and LIMA have identical patencies to the LAD. Steneted subclavian has a good patency but not the same as virgin LIMA so I placed it to the OM as the patencies seemed to match that. Used a radial to the diagonal which was big as he is young. Incidentally used the right radial as he still complained of some tingling etc in the left fingers and did not want to worsen anything (or give an opportunity to have long term complaints ascribed to radial artery harvest in the stented side !!). I just harvested the radial and closed the arm by the time the Neck lines and Swan were floated and tucked the arm in and proceeded to harvest the IMA's so did not have to do the turn towards the head LIMA harvest as was advocated in the discussion. Despite skeletonization etc the RIMA could not be made to course superiorly under the innominate vein and required a straighter course to the LAD crossing the aorta under the covering RA appendage. I mobilized both mediastinal fat pads and covered the RIMA and LIMA to protect itfor a future redo and if at any time the RCA/PD requires a graft I will approach it basally by dividing the diaphragm and use an RGEA (or so I wishfully think !!) I was considering doing it OPCAB as the targets were good and he initially had excellent hemodynamics but he started developing hypotension and ST's during the final stages of LIMA harvest (which I had harvested last) so I did it beating supported (I had an alternate choice of a balloon pump but was worried about the very tight Left main). He came off with NTG and Diltiazem infusions that were prophylactically started. Comments ? -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 ----------------------------------------- _________________________________________________________________ Learn how to add other email accounts to Hotmail in 3 easy steps. http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From valdretemd at shaw.ca Fri Oct 2 23:51:31 2009 From: valdretemd at shaw.ca (V. Aldrete, M.D.) Date: Sat Oct 3 01:53:03 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: References: Message-ID: The descending thoracic aortic homograft inclusion. The same principle as the first Hufnagel valve implant was in fact an operation started by Dr. Gordon Murray, also from Toronto and the person that introduced the use of heparin in vascular surgery before Bigelow's time. I will call one of Bigelow's early residents and see if I can find out what the Bigelow Procedure might be. He definitely started the use of hypothermia in direct open heart surgery in the animal lab, although the first such operation was done by Dr. Lewis. Victor On 2009-10-02, at 6:11 AM, Rwmfglycar@aol.com wrote: > Could be a desc thoracic aorta homograft conduit for aortic > insufficiency > but he was involved in many things. He even tried reestablishing > spinal cord > function in paraplegics > Bob > > > > In a message dated 10/2/2009 2:29:51 P.M. South Africa Standard Time, > prasannasimha@gmail.com writes: > > What is a "Bigelow procedure" ? > Prasanna > > -- > 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 rowlesjohn at aol.com Sat Oct 3 07:03:29 2009 From: rowlesjohn at aol.com (rowlesjohn@aol.com) Date: Sat Oct 3 02:04:35 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> References: <384379.97304.qm@web81604.mail.mud.yahoo.com><89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> Message-ID: <2089991517-1254549776-cardhu_decombobulator_blackberry.rim.net-310660041-@bda916.bisx.prod.on.blackberry> Makes sense Prasanna. I like the way you think. John Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Prasanna Simha M Date: Sat, 3 Oct 2009 07:57:19 To: Subject: Re: [HSF] Subclavian stenosis case follow up I am in a bit of conflict here - one of the reasons for revival of the radial was the supposed antispasmodic therapy protocols that were inititated that was supposed to be the ameliorating factor for spasm - read improved current patency. On the other hand use of calcium channel blockers was not found to be useful in some studies. How is this dichotomy in thinking resolved by those who would not give long term CCB's. Incidentally I have used He's solution with the addition of Phenoxybenzamine after doing some literature search and it does produce an elegant pipe with the hopeful advantage that adding phenoxy blocks the receptors for at leastthe first 5 days !! Prasanna On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: > Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. > Tea > > Sent from my iPhone > > On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: > > What is your ?calcium channel protocol after surgery. I use > intravenous Diltiazem followed with Amlodipine for a year. I have seen > people not giving any periop calcium channel blockers (and giving a > calcium channel blocker next day) to full coverage ?. > Giving a calcium channel blocker can be a pain especially if the > patient is vasoplegic. > Prasanna > > On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: > Goodness, Prasanna, that sounds like one of my operations. > Yesterday I had ?a critical LM patient with 50% L subclavian stenosis.( > pre-op ima dopplers: both imas 25ml/ min) > Did the lad with the rima ?and took the T-radial off the rima to graft the > pda ( ?around L side as usual) > The lima was used for the om and the whole shebang covered with mobilised > pericardial fat. ( lima 40ml/min, rima 95 ml/min ) > > My second case an even worse unstable LM with 30%EF and recent stemi > infarct, started to sag while I was trying to sneak the rima onto the lad so > I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on > pump. ( It is very ?satisfying ?to see an anterior wall contractility > recover the instant it's ?graft is opened.) > Don > > On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: > > Did the subclavian stenosis case today (Postponed due to some non > medical reasons) > Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a > mistake in my original post and there was no RCA disease on reviewing > the angiogram). > My logic was > RIMA and LIMA have identical patencies to the LAD. > Steneted subclavian has a good patency but not the same as virgin LIMA > so I placed it to the OM as the patencies seemed to match that. > Used a radial to the diagonal which was big as he is young. > Incidentally used the right radial as he still complained of some > tingling ?etc in the left fingers and did not want to worsen anything > (or give an opportunity to have long term complaints ?ascribed to > radial artery harvest in the stented side !!). I just harvested the > radial and closed the arm by the time the Neck lines and Swan were > floated and tucked the arm in and proceeded to harvest the IMA's so > did not have to do the turn towards the head LIMA harvest as was > advocated ?in the discussion. > > > Despite skeletonization etc the RIMA could not be made to course > superiorly under the innominate vein and required a straighter course > to the LAD crossing the aorta under the covering RA appendage. I > mobilized both mediastinal fat pads and covered the RIMA and LIMA ?to > protect itfor a future redo and if at any time the RCA/PD requires a > graft I will approach it basally by dividing the diaphragm ?and use an > RGEA (or so I wishfully think !!) > > I was considering doing it OPCAB as the targets were good and he > initially had excellent hemodynamics but he started developing > hypotension and ST's ?during the final stages of LIMA harvest (which I > had harvested last) so I did it beating supported (I had an alternate > choice of a balloon pump ?but was worried about the very tight ?Left > main). He came off with NTG and Diltiazem infusions that were > prophylactically started. > > Comments ? > -- > Prasanna Simha M >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > > > -- > Prasanna Simha M >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 jdpigott at tulane.edu Sat Oct 3 08:06:50 2009 From: jdpigott at tulane.edu (Pigott, John D III) Date: Sat Oct 3 08:09:14 2009 Subject: [HSF] He solution References: <384379.97304.qm@web81604.mail.mud.yahoo.com><89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> <2089991517-1254549776-cardhu_decombobulator_blackberry.rim.net-310660041-@bda916.bisx.prod.on.blackberry> Message-ID: <93F431B4ABF11C43BDB776B643B691BC014538F5@EX04.ad.tulane.edu> Prasanna, So you use verapamil, NTG and phenoxybenzamine? Do you add blood? John John Pigott -----Original Message----- From: rowlesjohn@aol.com [mailto:rowlesjohn@aol.com] Sent: Sat 10/3/2009 1:03 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Subclavian stenosis case follow up Makes sense Prasanna. I like the way you think. John Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Prasanna Simha M Date: Sat, 3 Oct 2009 07:57:19 To: Subject: Re: [HSF] Subclavian stenosis case follow up I am in a bit of conflict here - one of the reasons for revival of the radial was the supposed antispasmodic therapy protocols that were inititated that was supposed to be the ameliorating factor for spasm - read improved current patency. On the other hand use of calcium channel blockers was not found to be useful in some studies. How is this dichotomy in thinking resolved by those who would not give long term CCB's. Incidentally I have used He's solution with the addition of Phenoxybenzamine after doing some literature search and it does produce an elegant pipe with the hopeful advantage that adding phenoxy blocks the receptors for at leastthe first 5 days !! Prasanna On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: > Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. > Tea > > Sent from my iPhone > > On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: > > What is your ?calcium channel protocol after surgery. I use > intravenous Diltiazem followed with Amlodipine for a year. I have seen > people not giving any periop calcium channel blockers (and giving a > calcium channel blocker next day) to full coverage ?. > Giving a calcium channel blocker can be a pain especially if the > patient is vasoplegic. > Prasanna > > On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: > Goodness, Prasanna, that sounds like one of my operations. > Yesterday I had ?a critical LM patient with 50% L subclavian stenosis.( > pre-op ima dopplers: both imas 25ml/ min) > Did the lad with the rima ?and took the T-radial off the rima to graft the > pda ( ?around L side as usual) > The lima was used for the om and the whole shebang covered with mobilised > pericardial fat. ( lima 40ml/min, rima 95 ml/min ) > > My second case an even worse unstable LM with 30%EF and recent stemi > infarct, started to sag while I was trying to sneak the rima onto the lad so > I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on > pump. ( It is very ?satisfying ?to see an anterior wall contractility > recover the instant it's ?graft is opened.) > Don > > On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: > > Did the subclavian stenosis case today (Postponed due to some non > medical reasons) > Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a > mistake in my original post and there was no RCA disease on reviewing > the angiogram). > My logic was > RIMA and LIMA have identical patencies to the LAD. > Steneted subclavian has a good patency but not the same as virgin LIMA > so I placed it to the OM as the patencies seemed to match that. > Used a radial to the diagonal which was big as he is young. > Incidentally used the right radial as he still complained of some > tingling ?etc in the left fingers and did not want to worsen anything > (or give an opportunity to have long term complaints ?ascribed to > radial artery harvest in the stented side !!). I just harvested the > radial and closed the arm by the time the Neck lines and Swan were > floated and tucked the arm in and proceeded to harvest the IMA's so > did not have to do the turn towards the head LIMA harvest as was > advocated ?in the discussion. > > > Despite skeletonization etc the RIMA could not be made to course > superiorly under the innominate vein and required a straighter course > to the LAD crossing the aorta under the covering RA appendage. I > mobilized both mediastinal fat pads and covered the RIMA and LIMA ?to > protect itfor a future redo and if at any time the RCA/PD requires a > graft I will approach it basally by dividing the diaphragm ?and use an > RGEA (or so I wishfully think !!) > > I was considering doing it OPCAB as the targets were good and he > initially had excellent hemodynamics but he started developing > hypotension and ST's ?during the final stages of LIMA harvest (which I > had harvested last) so I did it beating supported (I had an alternate > choice of a balloon pump ?but was worried about the very tight ?Left > main). He came off with NTG and Diltiazem infusions that were > prophylactically started. > > Comments ? > -- > Prasanna Simha M >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > > > -- > Prasanna Simha M >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From Rwmfglycar at aol.com Sat Oct 3 09:49:35 2009 From: Rwmfglycar at aol.com (Rwmfglycar@aol.com) Date: Sat Oct 3 08:50:42 2009 Subject: [HSF] Query - Bigelow procedure Message-ID: Apologies. Victor has the right story Bob In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard Time, valdretemd@shaw.ca writes: The descending thoracic aortic homograft inclusion. The same principle as the first Hufnagel valve implant was in fact an operation started by Dr. Gordon Murray, also from Toronto and the person that introduced the use of heparin in vascular surgery before Bigelow's time. I will call one of Bigelow's early residents and see if I can find out what the Bigelow Procedure might be. He definitely started the use of hypothermia in direct open heart surgery in the animal lab, although the first such operation was done by Dr. Lewis. Victor On 2009-10-02, at 6:11 AM, Rwmfglycar@aol.com wrote: > Could be a desc thoracic aorta homograft conduit for aortic > insufficiency > but he was involved in many things. He even tried reestablishing > spinal cord > function in paraplegics > Bob > > > > In a message dated 10/2/2009 2:29:51 P.M. South Africa Standard Time, > prasannasimha@gmail.com writes: > > What is a "Bigelow procedure" ? > Prasanna > > -- > 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 jpym at erols.com Sat Oct 3 10:18:59 2009 From: jpym at erols.com (John Pym) Date: Sat Oct 3 09:26:22 2009 Subject: [HSF] reason for historic radial failure In-Reply-To: References: <384379.97304.qm@web81604.mail.mud.yahoo.com> Message-ID: Christoph Acar once told me that the major reason for radial artery failure during its initial use in the late 60s and early 70s was endothelial damage. They used to mechanically dilate the radial with 5 mm olive-tipped bougies, resulting in severe endothelial trauma. (After all, the role of the endothelium was not described until the late 80s by Furchgott who received the Nobel prize for this work). The radials were also harvested with a lot of electrocautery, hence the severe spasm requiring dilatation. John Pym On Sat, Oct 3, 2009 at 12:22 AM, Donald Ross wrote: > It remains a mystery but is probably related to a number of factors one of > which is not the absence of systemic calcium antagonists. > > 1. Inadequate local drug induced spasm relief. ( which increases oxygen > consumption as well as causing early no flow) > 2. Ischaemic injury from spasm and spending too long out of body or away > from some form of oxygenation. > 3. Used for lesions which were not significant. > Any others? > Don > On 03/10/2009, at 1:23 PM, Ani Anyanwu wrote: > > I don't think antispasmodic pharmacology was behind revival of the radial >> - there are no data, previous or present, supporting efficacy of such drugs. >> >> I think the key change was with surgical technique avoiding handling and >> manipulation that can precipitate spasm. Harvesting as pedicle rather than >> skeletonized was one such maneuver thought we have gone full circle and now >> skeletonize again. >> >> Ani >> >> >> From: prasannasimha@gmail.com >>> Date: Sat, 3 Oct 2009 07:57:19 +0530 >>> Subject: Re: [HSF] Subclavian stenosis case follow up >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> I am in a bit of conflict here - one of the reasons for revival of the >>> radial was the supposed antispasmodic therapy protocols that were >>> inititated that was supposed to be the ameliorating factor for spasm - >>> read improved current patency. On the other hand use of calcium >>> channel blockers was not found to be useful in some studies. >>> How is this dichotomy in thinking resolved by those who would not give >>> long term CCB's. >>> Incidentally I have used He's solution with the addition of >>> Phenoxybenzamine after doing some literature search and it does >>> produce an elegant pipe with the hopeful advantage that adding phenoxy >>> blocks the receptors for at leastthe first 5 days !! >>> Prasanna >>> >>> On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: >>> >>>> Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, >>>> and bicarbonate to block intraop and then nothing at discharge. >>>> Tea >>>> >>>> Sent from my iPhone >>>> >>>> On Oct 2, 2009, at 7:02 AM, Prasanna Simha M >>>> wrote: >>>> >>>> What is your calcium channel protocol after surgery. I use >>>> intravenous Diltiazem followed with Amlodipine for a year. I have seen >>>> people not giving any periop calcium channel blockers (and giving a >>>> calcium channel blocker next day) to full coverage ?. >>>> Giving a calcium channel blocker can be a pain especially if the >>>> patient is vasoplegic. >>>> Prasanna >>>> >>>> On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross >>>> wrote: >>>> Goodness, Prasanna, that sounds like one of my operations. >>>> Yesterday I had a critical LM patient with 50% L subclavian stenosis.( >>>> pre-op ima dopplers: both imas 25ml/ min) >>>> Did the lad with the rima and took the T-radial off the rima to graft >>>> the >>>> pda ( around L side as usual) >>>> The lima was used for the om and the whole shebang covered with >>>> mobilised >>>> pericardial fat. ( lima 40ml/min, rima 95 ml/min ) >>>> >>>> My second case an even worse unstable LM with 30%EF and recent stemi >>>> infarct, started to sag while I was trying to sneak the rima onto the >>>> lad so >>>> I went on pump and did the bilateral ima, T-radial cabgX4 beating heart >>>> on >>>> pump. ( It is very satisfying to see an anterior wall contractility >>>> recover the instant it's graft is opened.) >>>> Don >>>> >>>> On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: >>>> >>>> Did the subclavian stenosis case today (Postponed due to some non >>>> medical reasons) >>>> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >>>> mistake in my original post and there was no RCA disease on reviewing >>>> the angiogram). >>>> My logic was >>>> RIMA and LIMA have identical patencies to the LAD. >>>> Steneted subclavian has a good patency but not the same as virgin LIMA >>>> so I placed it to the OM as the patencies seemed to match that. >>>> Used a radial to the diagonal which was big as he is young. >>>> Incidentally used the right radial as he still complained of some >>>> tingling etc in the left fingers and did not want to worsen anything >>>> (or give an opportunity to have long term complaints ascribed to >>>> radial artery harvest in the stented side !!). I just harvested the >>>> radial and closed the arm by the time the Neck lines and Swan were >>>> floated and tucked the arm in and proceeded to harvest the IMA's so >>>> did not have to do the turn towards the head LIMA harvest as was >>>> advocated in the discussion. >>>> >>>> >>>> Despite skeletonization etc the RIMA could not be made to course >>>> superiorly under the innominate vein and required a straighter course >>>> to the LAD crossing the aorta under the covering RA appendage. I >>>> mobilized both mediastinal fat pads and covered the RIMA and LIMA to >>>> protect itfor a future redo and if at any time the RCA/PD requires a >>>> graft I will approach it basally by dividing the diaphragm and use an >>>> RGEA (or so I wishfully think !!) >>>> >>>> I was considering doing it OPCAB as the targets were good and he >>>> initially had excellent hemodynamics but he started developing >>>> hypotension and ST's during the final stages of LIMA harvest (which I >>>> had harvested last) so I did it beating supported (I had an alternate >>>> choice of a balloon pump but was worried about the very tight Left >>>> main). He came off with NTG and Diltiazem infusions that were >>>> prophylactically started. >>>> >>>> Comments ? >>>> -- >>>> Prasanna Simha M >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>> anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>>> >>>> >>>> >>>> >>>> -- >>>> Prasanna Simha M >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/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 >>> ----------------------------------------- >>> >> >> _________________________________________________________________ >> Learn how to add other email accounts to Hotmail in 3 easy steps. >> >> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- John Pym MB, BS, FRACS, FRCSC, FACS Professor of Surgery From flege19 at gmail.com Sat Oct 3 10:29:50 2009 From: flege19 at gmail.com (Flege John) Date: Sat Oct 3 09:30:22 2009 Subject: [HSF] RGEA In-Reply-To: <89c4ed2d0910021904p1768ab63p95f8ec0e74ac6159@mail.gmail.com> References: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> <1C4FD5C3-34C9-4E28-90B2-104151B1ACD1@aol.com> <89c4ed2d0910021904p1768ab63p95f8ec0e74ac6159@mail.gmail.com> Message-ID: <950062BE-706F-4384-886D-A71AE69CE21E@gmail.com> Prasanna, Several factors. Most of my cases were in the 1980s and were reoperations with shortage of SVG and I had not progressed to using both IMAs. Radial arteries were reintroduced about 1990 and they were a little easier to get at. Then in 1989 I went back to the university to study law and during those years reduced my cardiac surgical activity. I still did an occassional RGEA graft in cases where conduit was scarce. I found nothing wrong with the GEA grafts and in fact of my first 19 cases angiography was done before discharge in 17 and demonstrated good function of the grafts. The other two had renal dysfunction and were excused from the angiography. One patient had recurrent exertional angina a few years later and inferior reversible ischemia. Angiogram showed severe stenosis of the celiac axis. I did a SVG from the superior mesenteric to the right hepatic artery which relieved his angina. I would encourage the use of the RGEA by those surgeons comfortable with operating in the abdomen. Unfortunately their number is shrinking. John Flege On Oct 2, 2009, at 10:04 PM, Prasanna Simha M wrote: > What made you stop John ? > Prasanna > > On Sat, Oct 3, 2009 at 2:31 AM, John Flege wrote: >> I did 25 to 30 cases and none recently (last 15 years) and there >> were no >> intraabdominal complications other than ileus for a day or two. >> Because of >> concern that a vital coronary graft might be injured during an upper >> abdominal operation some day, I routed the graft posterior to the >> stomach >> and the left lobe of the liver in most cases. John Flege >> On Oct 2, 2009, at 12:24 PM, Prasanna Simha M wrote: >> >>> For those who have used Right gastroepiploic routinely what >>> intraabdominal and periop complications have you observed ? >>> Prasanna >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies >> anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From flege19 at gmail.com Sat Oct 3 10:35:43 2009 From: flege19 at gmail.com (Flege John) Date: Sat Oct 3 09:36:19 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> References: <384379.97304.qm@web81604.mail.mud.yahoo.com> <89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> Message-ID: I saw a recent paper reporting the experimental use of Botox to prevent spasm in arterial grafts and it worked in the model used. This approach may be worth further investigation since the blocking effect of Botox persists for months. I there anyone out there with a laboratory and eager young assistants looking for a way of making a name for themselves? John Flege On Oct 2, 2009, at 10:27 PM, Prasanna Simha M wrote: > I am in a bit of conflict here - one of the reasons for revival of the > radial was the supposed antispasmodic therapy protocols that were > inititated that was supposed to be the ameliorating factor for spasm - > read improved current patency. On the other hand use of calcium > channel blockers was not found to be useful in some studies. > How is this dichotomy in thinking resolved by those who would not give > long term CCB's. > Incidentally I have used He's solution with the addition of > Phenoxybenzamine after doing some literature search and it does > produce an elegant pipe with the hopeful advantage that adding phenoxy > blocks the receptors for at leastthe first 5 days !! > Prasanna > > On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: >> Liberal use of nitro periop. I useHe solution, which is TNG, >> verapamil, and bicarbonate to block intraop and then nothing at >> discharge. >> Tea >> >> Sent from my iPhone >> >> On Oct 2, 2009, at 7:02 AM, Prasanna Simha M >> wrote: >> >> What is your calcium channel protocol after surgery. I use >> intravenous Diltiazem followed with Amlodipine for a year. I have >> seen >> people not giving any periop calcium channel blockers (and giving a >> calcium channel blocker next day) to full coverage ?. >> Giving a calcium channel blocker can be a pain especially if the >> patient is vasoplegic. >> Prasanna >> >> On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross >> wrote: >> Goodness, Prasanna, that sounds like one of my operations. >> Yesterday I had a critical LM patient with 50% L subclavian >> stenosis.( >> pre-op ima dopplers: both imas 25ml/ min) >> Did the lad with the rima and took the T-radial off the rima to >> graft the >> pda ( around L side as usual) >> The lima was used for the om and the whole shebang covered with >> mobilised >> pericardial fat. ( lima 40ml/min, rima 95 ml/min ) >> >> My second case an even worse unstable LM with 30%EF and recent stemi >> infarct, started to sag while I was trying to sneak the rima onto >> the lad so >> I went on pump and did the bilateral ima, T-radial cabgX4 beating >> heart on >> pump. ( It is very satisfying to see an anterior wall contractility >> recover the instant it's graft is opened.) >> Don >> >> On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: >> >> Did the subclavian stenosis case today (Postponed due to some non >> medical reasons) >> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >> mistake in my original post and there was no RCA disease on reviewing >> the angiogram). >> My logic was >> RIMA and LIMA have identical patencies to the LAD. >> Steneted subclavian has a good patency but not the same as virgin >> LIMA >> so I placed it to the OM as the patencies seemed to match that. >> Used a radial to the diagonal which was big as he is young. >> Incidentally used the right radial as he still complained of some >> tingling etc in the left fingers and did not want to worsen anything >> (or give an opportunity to have long term complaints ascribed to >> radial artery harvest in the stented side !!). I just harvested the >> radial and closed the arm by the time the Neck lines and Swan were >> floated and tucked the arm in and proceeded to harvest the IMA's so >> did not have to do the turn towards the head LIMA harvest as was >> advocated in the discussion. >> >> >> Despite skeletonization etc the RIMA could not be made to course >> superiorly under the innominate vein and required a straighter course >> to the LAD crossing the aorta under the covering RA appendage. I >> mobilized both mediastinal fat pads and covered the RIMA and LIMA to >> protect itfor a future redo and if at any time the RCA/PD requires a >> graft I will approach it basally by dividing the diaphragm and use >> an >> RGEA (or so I wishfully think !!) >> >> I was considering doing it OPCAB as the targets were good and he >> initially had excellent hemodynamics but he started developing >> hypotension and ST's during the final stages of LIMA harvest >> (which I >> had harvested last) so I did it beating supported (I had an alternate >> choice of a balloon pump but was worried about the very tight Left >> main). He came off with NTG and Diltiazem infusions that were >> prophylactically started. >> >> Comments ? >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies >> anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From grescigno at mac.com Sat Oct 3 16:43:08 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Sat Oct 3 09:45:42 2009 Subject: [HSF] RGEA In-Reply-To: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> References: <89c4ed2d0910020924s10f45a66hfe29ca743d66e98c@mail.gmail.com> Message-ID: Prasanna, I have done several a few years ago with no abdominal problems. However, I actually hesitate in using it as we have several other grafts available (I am now much more confortable with 2 ITA Y grafts and radials). Moreover, at least in 2 occasions I was called by general surgeons having problems with RGEA going up to PD. In one case they were removing hepatic metastases and completely transected the graft (I was unable to restore it). In fact younger patients that may mostly benefit from RGEA are really exposed to the risk of subsequent abdominal operations and in these cases even a video cholecistectomy becomes a mess. Giuseppe Il giorno 02/ott/09, alle ore 18:24, Prasanna Simha M ha scritto: > For those who have used Right gastroepiploic routinely what > intraabdominal and periop complications have you observed ? > Prasanna > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From prasannasimha at gmail.com Sat Oct 3 20:42:40 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 10:13:30 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: References: <384379.97304.qm@web81604.mail.mud.yahoo.com> <89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> Message-ID: <89c4ed2d0910030712od3f8590ide22cc69ed1d9d54@mail.gmail.com> I had thought of this and also injecting into the RVOT to prevent dynamic RVOTO and suicide RV !! Prasanna On Sat, Oct 3, 2009 at 7:05 PM, Flege John wrote: > I saw a recent paper reporting the experimental use of Botox to prevent > spasm in arterial grafts and it worked in the model used. This approach may > be worth further investigation since the blocking effect of Botox persists > for months. I there anyone out there with a laboratory and eager young > assistants looking for a way of making a name for themselves? John Flege > On Oct 2, 2009, at 10:27 PM, Prasanna Simha M wrote: > >> I am in a bit of conflict here - one of the reasons for revival of the >> radial was the supposed antispasmodic therapy protocols that were >> inititated that was supposed to be the ameliorating factor for spasm - >> read improved current patency. On the other hand use of calcium >> channel blockers was not found to be useful in some studies. >> How is this dichotomy in thinking resolved by those who would not give >> long term CCB's. >> Incidentally I have used He's solution with the addition of >> Phenoxybenzamine after doing some literature search and it does >> produce an elegant pipe with the hopeful advantage that adding phenoxy >> blocks the receptors for at leastthe first 5 days !! >> Prasanna >> >> On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: >>> >>> Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, >>> and bicarbonate to block intraop and then nothing at discharge. >>> Tea >>> >>> Sent from my iPhone >>> >>> On Oct 2, 2009, at 7:02 AM, Prasanna Simha M >>> wrote: >>> >>> What is your ?calcium channel protocol after surgery. I use >>> intravenous Diltiazem followed with Amlodipine for a year. I have seen >>> people not giving any periop calcium channel blockers (and giving a >>> calcium channel blocker next day) to full coverage ?. >>> Giving a calcium channel blocker can be a pain especially if the >>> patient is vasoplegic. >>> Prasanna >>> >>> On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: >>> Goodness, Prasanna, that sounds like one of my operations. >>> Yesterday I had ?a critical LM patient with 50% L subclavian stenosis.( >>> pre-op ima dopplers: both imas 25ml/ min) >>> Did the lad with the rima ?and took the T-radial off the rima to graft >>> the >>> pda ( ?around L side as usual) >>> The lima was used for the om and the whole shebang covered with mobilised >>> pericardial fat. ( lima 40ml/min, rima 95 ml/min ) >>> >>> My second case an even worse unstable LM with 30%EF and recent stemi >>> infarct, started to sag while I was trying to sneak the rima onto the lad >>> so >>> I went on pump and did the bilateral ima, T-radial cabgX4 beating heart >>> on >>> pump. ( It is very ?satisfying ?to see an anterior wall contractility >>> recover the instant it's ?graft is opened.) >>> Don >>> >>> On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: >>> >>> Did the subclavian stenosis case today (Postponed due to some non >>> medical reasons) >>> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >>> mistake in my original post and there was no RCA disease on reviewing >>> the angiogram). >>> My logic was >>> RIMA and LIMA have identical patencies to the LAD. >>> Steneted subclavian has a good patency but not the same as virgin LIMA >>> so I placed it to the OM as the patencies seemed to match that. >>> Used a radial to the diagonal which was big as he is young. >>> Incidentally used the right radial as he still complained of some >>> tingling ?etc in the left fingers and did not want to worsen anything >>> (or give an opportunity to have long term complaints ?ascribed to >>> radial artery harvest in the stented side !!). I just harvested the >>> radial and closed the arm by the time the Neck lines and Swan were >>> floated and tucked the arm in and proceeded to harvest the IMA's so >>> did not have to do the turn towards the head LIMA harvest as was >>> advocated ?in the discussion. >>> >>> >>> Despite skeletonization etc the RIMA could not be made to course >>> superiorly under the innominate vein and required a straighter course >>> to the LAD crossing the aorta under the covering RA appendage. I >>> mobilized both mediastinal fat pads and covered the RIMA and LIMA ?to >>> protect itfor a future redo and if at any time the RCA/PD requires a >>> graft I will approach it basally by dividing the diaphragm ?and use an >>> RGEA (or so I wishfully think !!) >>> >>> I was considering doing it OPCAB as the targets were good and he >>> initially had excellent hemodynamics but he started developing >>> hypotension and ST's ?during the final stages of LIMA harvest (which I >>> had harvested last) so I did it beating supported (I had an alternate >>> choice of a balloon pump ?but was worried about the very tight ?Left >>> main). He came off with NTG and Diltiazem infusions that were >>> prophylactically started. >>> >>> Comments ? >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the policies >>> anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sat Oct 3 20:39:11 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 10:17:09 2009 Subject: [HSF] He solution In-Reply-To: <93F431B4ABF11C43BDB776B643B691BC014538F5@EX04.ad.tulane.edu> References: <384379.97304.qm@web81604.mail.mud.yahoo.com> <89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> <2089991517-1254549776-cardhu_decombobulator_blackberry.rim.net-310660041-@bda916.bisx.prod.on.blackberry> <93F431B4ABF11C43BDB776B643B691BC014538F5@EX04.ad.tulane.edu> Message-ID: <89c4ed2d0910030709w1ae968fbhdbd2ef038b45c9ce@mail.gmail.com> No I used it to just flush the radial and then I kept a moist gauze soaked in this and covered the IMA's beforetransection. Blood got added on into the solution incidentally but not with any intent - probably would be a good buffer bu the solution is already alkaline due to the 0.3 ml NaHCO3 (7.4 %) or 0.2 ml 8.4 % bicarb that is added. Papaverine is highly acidic and would benefit with blood buffer. Prasanna On Sat, Oct 3, 2009 at 5:36 PM, Pigott, John D III wrote: > Prasanna, > So you use verapamil, NTG and phenoxybenzamine? ?Do you add blood? > > John > John Pigott > > > -----Original Message----- > From: rowlesjohn@aol.com [mailto:rowlesjohn@aol.com] > Sent: Sat 10/3/2009 1:03 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Subclavian stenosis case follow up > > Makes sense Prasanna. I like the way you think. > > John > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Prasanna Simha M > > Date: Sat, 3 Oct 2009 07:57:19 > To: > Subject: Re: [HSF] Subclavian stenosis case follow up > > > I am in a bit of conflict here - one of the reasons for revival of the > radial was the supposed antispasmodic therapy protocols that were > inititated that was supposed to be the ameliorating factor for spasm - > read improved current patency. On the other hand use of calcium > channel blockers was not found to be useful in some studies. > How is this dichotomy in thinking resolved by those who would not give > long term CCB's. > Incidentally I have used He's solution with the addition of > Phenoxybenzamine after doing some literature search and it does > produce an elegant pipe with the hopeful advantage that adding phenoxy > blocks the receptors for at leastthe first 5 days !! > Prasanna > > On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: >> Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. >> Tea >> >> Sent from my iPhone >> >> On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: >> >> What is your ?calcium channel protocol after surgery. I use >> intravenous Diltiazem followed with Amlodipine for a year. I have seen >> people not giving any periop calcium channel blockers (and giving a >> calcium channel blocker next day) to full coverage ?. >> Giving a calcium channel blocker can be a pain especially if the >> patient is vasoplegic. >> Prasanna >> >> On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: >> Goodness, Prasanna, that sounds like one of my operations. >> Yesterday I had ?a critical LM patient with 50% L subclavian stenosis.( >> pre-op ima dopplers: both imas 25ml/ min) >> Did the lad with the rima ?and took the T-radial off the rima to graft the >> pda ( ?around L side as usual) >> The lima was used for the om and the whole shebang covered with mobilised >> pericardial fat. ( lima 40ml/min, rima 95 ml/min ) >> >> My second case an even worse unstable LM with 30%EF and recent stemi >> infarct, started to sag while I was trying to sneak the rima onto the lad so >> I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on >> pump. ( It is very ?satisfying ?to see an anterior wall contractility >> recover the instant it's ?graft is opened.) >> Don >> >> On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: >> >> Did the subclavian stenosis case today (Postponed due to some non >> medical reasons) >> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >> mistake in my original post and there was no RCA disease on reviewing >> the angiogram). >> My logic was >> RIMA and LIMA have identical patencies to the LAD. >> Steneted subclavian has a good patency but not the same as virgin LIMA >> so I placed it to the OM as the patencies seemed to match that. >> Used a radial to the diagonal which was big as he is young. >> Incidentally used the right radial as he still complained of some >> tingling ?etc in the left fingers and did not want to worsen anything >> (or give an opportunity to have long term complaints ?ascribed to >> radial artery harvest in the stented side !!). I just harvested the >> radial and closed the arm by the time the Neck lines and Swan were >> floated and tucked the arm in and proceeded to harvest the IMA's so >> did not have to do the turn towards the head LIMA harvest as was >> advocated ?in the discussion. >> >> >> Despite skeletonization etc the RIMA could not be made to course >> superiorly under the innominate vein and required a straighter course >> to the LAD crossing the aorta under the covering RA appendage. I >> mobilized both mediastinal fat pads and covered the RIMA and LIMA ?to >> protect itfor a future redo and if at any time the RCA/PD requires a >> graft I will approach it basally by dividing the diaphragm ?and use an >> RGEA (or so I wishfully think !!) >> >> I was considering doing it OPCAB as the targets were good and he >> initially had excellent hemodynamics but he started developing >> hypotension and ST's ?during the final stages of LIMA harvest (which I >> had harvested last) so I did it beating supported (I had an alternate >> choice of a balloon pump ?but was worried about the very tight ?Left >> main). He came off with NTG and Diltiazem infusions that were >> prophylactically started. >> >> Comments ? >> -- >> Prasanna Simha M >>_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >>_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >> >> >> >> -- >> Prasanna Simha M >>_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> >>_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sat Oct 3 20:51:03 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 10:29:31 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: References: Message-ID: <89c4ed2d0910030721h255f5289j8f162380fec31873@mail.gmail.com> Thanks but I wonder why Carpentier and QAcar would do that surgery with a radial grafting in the 19 70's and 80's - I am sure AVR was established by that time. Incidentally Bigelow was very well known for orthopedics apart from hypothermia - (Remember the Y shaped ligament of Bigelow in the anterior surface of the hip joint !!) What was it with Toronto/Canadians being cardiac surgeons and Orthopods - like Mustard of the Mustard operation !! Prasanna On Sat, Oct 3, 2009 at 6:19 PM, wrote: > Apologies. Victor has the right story > Bob > > > In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard Time, > valdretemd@shaw.ca writes: > > The ?descending thoracic aortic homograft inclusion. ?The same > principle as the first Hufnagel valve implant was in fact an ?operation > started by Dr. Gordon Murray, also from Toronto and the ?person that > introduced the use of heparin in vascular surgery before ?Bigelow's time. > > I will call one of Bigelow's early residents and see if ?I can find out > what the Bigelow Procedure might be. ?He ?definitely started the use of > hypothermia in direct open heart ?surgery in the animal lab, although > the first such operation was ?done by Dr. Lewis. > > Victor > > On 2009-10-02, at 6:11 AM, ?Rwmfglycar@aol.com wrote: > >> Could be a desc thoracic aorta homograft ?conduit for aortic >> insufficiency >> but he was involved in ?many things. He even tried reestablishing >> spinal cord >> ?function in paraplegics >> Bob >> >> >> >> In a ?message dated 10/2/2009 2:29:51 P.M. South Africa Standard Time, >> ?prasannasimha@gmail.com writes: >> >> What is ?a "Bigelow ?procedure" ? >> Prasanna >> >> -- >> 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 prasannasimha at gmail.com Sat Oct 3 21:51:03 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 11:27:22 2009 Subject: [HSF] reason for historic radial failure In-Reply-To: References: <384379.97304.qm@web81604.mail.mud.yahoo.com> Message-ID: <89c4ed2d0910030821s654ecf95o765a885666e5a0f5@mail.gmail.com> Interesting . Also how legendary myths get perpetuated !! Incidentally I think you (John Pym) have one of the largest experiences with RGEA. What problems did you encounter ? Prasanna On Sat, Oct 3, 2009 at 6:48 PM, John Pym wrote: > Christoph Acar once told me that the major reason for radial artery failure > during its initial use in the late 60s and early 70s was endothelial damage. > They used to mechanically dilate the radial with 5 mm olive-tipped bougies, > resulting in severe endothelial trauma. (After all, the role of the > endothelium was not described until the late 80s by Furchgott who received > the Nobel prize for this work). The radials were also harvested with a lot > of electrocautery, hence the severe spasm requiring dilatation. > John Pym > > On Sat, Oct 3, 2009 at 12:22 AM, Donald Ross wrote: > >> It remains a mystery but is probably related to a number of factors one of >> which is not the absence of systemic calcium antagonists. >> >> 1. Inadequate ?local drug induced spasm relief. ( which increases oxygen >> consumption as well as causing early no flow) >> 2. Ischaemic injury from spasm and spending too long out of body or away >> from some form of oxygenation. >> 3. Used for lesions which were not significant. >> Any others? >> Don >> On 03/10/2009, at 1:23 PM, Ani Anyanwu wrote: >> >> ?I don't think antispasmodic pharmacology was behind revival of the radial >>> - there are no data, previous or present, supporting efficacy of such drugs. >>> >>> I think the key change was with surgical technique avoiding handling and >>> manipulation that can precipitate spasm. Harvesting as pedicle rather than >>> skeletonized was one such maneuver thought we have gone full circle and now >>> skeletonize again. >>> >>> Ani >>> >>> >>> ?From: prasannasimha@gmail.com >>>> Date: Sat, 3 Oct 2009 07:57:19 +0530 >>>> Subject: Re: [HSF] Subclavian stenosis case follow up >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> >>>> I am in a bit of conflict here - one of the reasons for revival of the >>>> radial was the supposed antispasmodic therapy protocols that were >>>> inititated that was supposed to be the ameliorating factor for spasm - >>>> read improved current patency. On the other hand use of calcium >>>> channel blockers was not found to be useful in some studies. >>>> How is this dichotomy in thinking resolved by those who would not give >>>> long term CCB's. >>>> Incidentally I have used He's solution with the addition of >>>> Phenoxybenzamine after doing some literature search and it does >>>> produce an elegant pipe with the hopeful advantage that adding phenoxy >>>> blocks the receptors for at leastthe first 5 days !! >>>> Prasanna >>>> >>>> On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: >>>> >>>>> Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, >>>>> and bicarbonate to block intraop and then nothing at discharge. >>>>> Tea >>>>> >>>>> Sent from my iPhone >>>>> >>>>> On Oct 2, 2009, at 7:02 AM, Prasanna Simha M >>>>> wrote: >>>>> >>>>> What is your ?calcium channel protocol after surgery. I use >>>>> intravenous Diltiazem followed with Amlodipine for a year. I have seen >>>>> people not giving any periop calcium channel blockers (and giving a >>>>> calcium channel blocker next day) to full coverage ?. >>>>> Giving a calcium channel blocker can be a pain especially if the >>>>> patient is vasoplegic. >>>>> Prasanna >>>>> >>>>> On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross >>>>> wrote: >>>>> Goodness, Prasanna, that sounds like one of my operations. >>>>> Yesterday I had ?a critical LM patient with 50% L subclavian stenosis.( >>>>> pre-op ima dopplers: both imas 25ml/ min) >>>>> Did the lad with the rima ?and took the T-radial off the rima to graft >>>>> the >>>>> pda ( ?around L side as usual) >>>>> The lima was used for the om and the whole shebang covered with >>>>> mobilised >>>>> pericardial fat. ( lima 40ml/min, rima 95 ml/min ) >>>>> >>>>> My second case an even worse unstable LM with 30%EF and recent stemi >>>>> infarct, started to sag while I was trying to sneak the rima onto the >>>>> lad so >>>>> I went on pump and did the bilateral ima, T-radial cabgX4 beating heart >>>>> on >>>>> pump. ( It is very ?satisfying ?to see an anterior wall contractility >>>>> recover the instant it's ?graft is opened.) >>>>> Don >>>>> >>>>> On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: >>>>> >>>>> Did the subclavian stenosis case today (Postponed due to some non >>>>> medical reasons) >>>>> Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >>>>> mistake in my original post and there was no RCA disease on reviewing >>>>> the angiogram). >>>>> My logic was >>>>> RIMA and LIMA have identical patencies to the LAD. >>>>> Steneted subclavian has a good patency but not the same as virgin LIMA >>>>> so I placed it to the OM as the patencies seemed to match that. >>>>> Used a radial to the diagonal which was big as he is young. >>>>> Incidentally used the right radial as he still complained of some >>>>> tingling ?etc in the left fingers and did not want to worsen anything >>>>> (or give an opportunity to have long term complaints ?ascribed to >>>>> radial artery harvest in the stented side !!). I just harvested the >>>>> radial and closed the arm by the time the Neck lines and Swan were >>>>> floated and tucked the arm in and proceeded to harvest the IMA's so >>>>> did not have to do the turn towards the head LIMA harvest as was >>>>> advocated ?in the discussion. >>>>> >>>>> >>>>> Despite skeletonization etc the RIMA could not be made to course >>>>> superiorly under the innominate vein and required a straighter course >>>>> to the LAD crossing the aorta under the covering RA appendage. I >>>>> mobilized both mediastinal fat pads and covered the RIMA and LIMA ?to >>>>> protect itfor a future redo and if at any time the RCA/PD requires a >>>>> graft I will approach it basally by dividing the diaphragm ?and use an >>>>> RGEA (or so I wishfully think !!) >>>>> >>>>> I was considering doing it OPCAB as the targets were good and he >>>>> initially had excellent hemodynamics but he started developing >>>>> hypotension and ST's ?during the final stages of LIMA harvest (which I >>>>> had harvested last) so I did it beating supported (I had an alternate >>>>> choice of a balloon pump ?but was worried about the very tight ?Left >>>>> main). He came off with NTG and Diltiazem infusions that were >>>>> prophylactically started. >>>>> >>>>> Comments ? >>>>> -- >>>>> Prasanna Simha M >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> >>>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>>> and >>>>> disclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> >>>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>>> anddisclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>>> >>>>> >>>>> >>>>> >>>>> -- >>>>> Prasanna Simha M >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> >>>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>>> and >>>>> disclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> http://mmp.cjp.com/mailman/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 >>>> ----------------------------------------- >>>> >>> >>> _________________________________________________________________ >>> Learn how to add other email accounts to Hotmail in 3 easy steps. >>> >>> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > John Pym > MB, BS, FRACS, FRCSC, FACS > Professor of Surgery > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 anianyanwu at hotmail.com Sat Oct 3 17:04:55 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sat Oct 3 12:05:47 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: <89c4ed2d0910030721h255f5289j8f162380fec31873@mail.gmail.com> References: Message-ID: I decided to do some reading about this and it appears the operation carpentier called 'Bigelow's' was a modification of the Vineberg. Looking through the literature Bigelow seemed to be a geat proponent of Vineberg for coronary revasularization in the late 1960s and early 1970s which was when carpentier did his early work on the radial artery (published in 1973). An article Bigelow wrote in 1971 "surgical treatment of coronary artery disease" is very informing (Can Med Assoc J. 1971 Mar 20;104(6):501-6). He describes his modification of the Vineberg procedure: "In our modification of his single implant operation through a left anterior incision a large pedicle of pericardial omentum is dissected free, leaving a superior attachment. After implanting the artery, an epicardectomy is carried out over the left ventricular and adjacent right ventricular surfaces. The omentum is fixed to the anterior chest wall and wrapped around the artery as it passes between the chest wall and the heart; it is then spread out over the epicardectomized ventricular surface as an omentopexy. As a routine a left cervicodorsal sympathectomy is carried out through the same incision." He also stated reservations about the aortocornary bypass operation (CABG) which was that performed by Carpentier at the time: "I personally confess to some reservations about employing an aortocoronary bypass alone in patients disabled with coronary heart disease in the third or early in the fourth decade of life. Our follow-up studies show such a rapid and progressive occlusion of their vessels that there is anxiety about the long-term results of bypass grafting. The concept of having two new arteries implanted (vineberg with bilateral ITAs) is more appealing than shunting blood into a young patient with a diseased, rapidly occluding arterial system. Perhaps a combined procedure would be best in the young age group." Ani > From: prasannasimha@gmail.com > Date: Sat, 3 Oct 2009 19:51:03 +0530 > Subject: Re: [HSF] Query - Bigelow procedure > To: OpenHeart-L@lists.hsforum.com > CC: > > Thanks but I wonder why Carpentier and QAcar would do that surgery > with a radial grafting in the 19 70's and 80's - I am sure AVR was > established by that time. > Incidentally Bigelow was very well known for orthopedics apart from > hypothermia - (Remember the Y shaped ligament of Bigelow in the > anterior surface of the hip joint !!) What was it with > Toronto/Canadians being cardiac surgeons and Orthopods - like Mustard > of the Mustard operation !! > Prasanna > > On Sat, Oct 3, 2009 at 6:19 PM, wrote: > > Apologies. Victor has the right story > > Bob > > > > > > In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard Time, > > valdretemd@shaw.ca writes: > > > > The descending thoracic aortic homograft inclusion. The same > > principle as the first Hufnagel valve implant was in fact an operation > > started by Dr. Gordon Murray, also from Toronto and the person that > > introduced the use of heparin in vascular surgery before Bigelow's time. > > > > I will call one of Bigelow's early residents and see if I can find out > > what the Bigelow Procedure might be. He definitely started the use of > > hypothermia in direct open heart surgery in the animal lab, although > > the first such operation was done by Dr. Lewis. > > > > Victor > > > > On 2009-10-02, at 6:11 AM, Rwmfglycar@aol.com wrote: > > > >> Could be a desc thoracic aorta homograft conduit for aortic > >> insufficiency > >> but he was involved in many things. He even tried reestablishing > >> spinal cord > >> function in paraplegics > >> Bob > >> > >> > >> > >> In a message dated 10/2/2009 2:29:51 P.M. South Africa Standard Time, > >> prasannasimha@gmail.com writes: > >> > >> What is a "Bigelow procedure" ? > >> Prasanna > >> > >> -- > >> 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 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ Save time by using Hotmail to access your other email accounts. http://clk.atdmt.com/UKM/go/167688463/direct/01/ From valdretemd at shaw.ca Sat Oct 3 10:08:12 2009 From: valdretemd at shaw.ca (V. Aldrete, M.D.) Date: Sat Oct 3 12:09:43 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: <89c4ed2d0910030721h255f5289j8f162380fec31873@mail.gmail.com> References: <89c4ed2d0910030721h255f5289j8f162380fec31873@mail.gmail.com> Message-ID: I have heard that Dr. Mustard, indeed originally an orthopaedic surgeon, said that he chose to move on to heart surgery because that way he did not have to do repeat operations, which are not as much fun as operating on a non scarred tissue. It was, of course, said partially I assume in jest. Victor On 2009-10-03, at 7:21 AM, Prasanna Simha M wrote: > Thanks but I wonder why Carpentier and QAcar would do that surgery > with a radial grafting in the 19 70's and 80's - I am sure AVR was > established by that time. > Incidentally Bigelow was very well known for orthopedics apart from > hypothermia - (Remember the Y shaped ligament of Bigelow in the > anterior surface of the hip joint !!) What was it with > Toronto/Canadians being cardiac surgeons and Orthopods - like Mustard > of the Mustard operation !! > Prasanna > > On Sat, Oct 3, 2009 at 6:19 PM, wrote: >> Apologies. Victor has the right story >> Bob >> >> >> In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard Time, >> valdretemd@shaw.ca writes: >> >> The descending thoracic aortic homograft inclusion. The same >> principle as the first Hufnagel valve implant was in fact an >> operation >> started by Dr. Gordon Murray, also from Toronto and the person that >> introduced the use of heparin in vascular surgery before Bigelow's >> time. >> >> I will call one of Bigelow's early residents and see if I can find >> out >> what the Bigelow Procedure might be. He definitely started the >> use of >> hypothermia in direct open heart surgery in the animal lab, although >> the first such operation was done by Dr. Lewis. >> >> Victor >> >> On 2009-10-02, at 6:11 AM, Rwmfglycar@aol.com wrote: >> >>> Could be a desc thoracic aorta homograft conduit for aortic >>> insufficiency >>> but he was involved in many things. He even tried reestablishing >>> spinal cord >>> function in paraplegics >>> Bob >>> >>> >>> >>> In a message dated 10/2/2009 2:29:51 P.M. South Africa Standard >>> Time, >>> prasannasimha@gmail.com writes: >>> >>> What is a "Bigelow procedure" ? >>> Prasanna >>> >>> -- >>> 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 > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 Sat Oct 3 13:30:59 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sat Oct 3 12:31:54 2009 Subject: [HSF] TMR with recent MI Message-ID: Otto, From what little I've read and heard, injecting cells into the heart doesn't work. The lack of a matrix is apparently the problem. If the cells are tracked, a lot of them end up in the spleen and other useless places. As for TMLR, though I did the first cases in South Florida, beginning in 1998, I gradually became a skeptic many years ago and eventually abandoned it. Parenthetically, the referring cardiologists also thought it was B.S. For one thing, if drilling holes in the heart was so helpful, why not just use a large bore needle? Certainly, it would have been a heck of a lot cheaper. You've done 100 cases in 10 years. That's 10 per year. Is the number of cases per year, growing, declining, or the same? Also, if you remain convinced of its efficacy, could you share some recent publications on the subject that might make me reconsider? Hal In a message dated 10/2/2009 2:37:03 A.M. Eastern Daylight Time, otto@iafrica.com writes: Ani - I am still occasionally doing TMLR. I have confined the indications to patients with coronaries that are unsuitable for further graft attempts, and that still have reasonable EF and LV function. Most of these patients are diabetic and have had previous foronary surgery. The results have been very gratifying in a series of approx 100 cases during the last 10 years. A few have had hybrid procedures with a single graft (usually to circumflex territory done off pump and the prox anastomosis to the descending aorta), and the TMLR to the usual areas. I note with some interest a clinical trial called INSTEM currently being conducted at four university medical center sites in Germany. The concept is combination therapy of Transmyocardial Revascularization (TMR) and autologous bone marrow derived stem cell (CD133+) injection into the myocardium for treatment of heart failure. The initial reports indicate improvement in LV function but it is still early days in my opinion. OTTO THANING Cape Town ----- Original Message ----- From: "Ani Anyanwu" To: "open heart list" Sent: Friday, October 02, 2009 3:08 AM Subject: RE: [HSF] TMR with recent MI does anyone still use TMR? I know we have a machine somewhere but dont think it has been used for a few years. What is the consensus these days - does it work? What work does it do? How many actually believe it works? Ani > Date: Thu, 1 Oct 2009 17:41:59 -0700 > From: tacuff@swbell.net > Subject: Re: [HSF] TMR with recent MI > To: OpenHeart-L@lists.hsforum.com > CC: > > I would be okay with both, but Tony is the silent CO2 expert. > Tea > > Sent from my iPhone > > On Oct 1, 2009, at 3:53 PM, "Douville, Chuck" > wrote: > > Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few > days ago with Class 4 angina; she was admitted to a nearby hospital with > an MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all > other (vein grafts) closed. 90% Left main, closed RCA. She is living off > that LIMA. There is an open ramus that is bypassable and a functional > lateral wall. EF is 45%. Inferior wall is only scar on thallium I am > planning Left thoracotomy radial graft to this Ramus from the Subclavian > artery; initially had planned CO2 TMR to the lateral wall. Would anyone > rule out adding TMR in the face of the recent infarct and abnormal EF? > thx chuckdouville > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _________________________________________________________________ Get the best of MSN on your mobile http://clk.atdmt.com/UKM/go/147991039/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 valdretemd at shaw.ca Sat Oct 3 10:42:58 2009 From: valdretemd at shaw.ca (V. Aldrete, M.D.) Date: Sat Oct 3 12:44:21 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: References: Message-ID: <3E3B0C65-78A7-4040-83A4-65E2F1AA83D7@shaw.ca> Ani, That was great detective work. I think you are correct, though I have not yet been able to reach my possible source. Thank you, Victor On 2009-10-03, at 9:04 AM, Ani Anyanwu wrote: > > I decided to do some reading about this and it appears the operation > carpentier called 'Bigelow's' was a modification of the Vineberg. > > > > Looking through the literature Bigelow seemed to be a geat proponent > of Vineberg for coronary revasularization in the late 1960s and > early 1970s which was when carpentier did his early work on the > radial artery (published in 1973). > > > > An article Bigelow wrote in 1971 "surgical treatment of coronary > artery disease" is very informing (Can Med Assoc J. 1971 Mar 20;104 > (6):501-6). He describes his modification of the Vineberg procedure: > > > > "In our modification of his single implant operation through a left > anterior incision a large pedicle of pericardial omentum is > dissected free, leaving a superior attachment. After implanting the > artery, an epicardectomy is carried out over the left ventricular > and adjacent right ventricular surfaces. The omentum is fixed to the > anterior chest wall and wrapped around the artery as it passes > between the chest wall and the heart; it is then spread out over the > epicardectomized ventricular surface as an omentopexy. As a routine > a left cervicodorsal sympathectomy is carried out through the same > incision." > > > > He also stated reservations about the aortocornary bypass operation > (CABG) which was that performed by Carpentier at the time: > > > > "I personally confess to some reservations about employing an > aortocoronary bypass alone in patients disabled with coronary heart > disease in the third or early in the fourth decade of life. Our > follow-up studies show such a rapid and progressive occlusion of > their vessels that there is anxiety about the long-term results of > bypass grafting. The concept of having two new arteries implanted > (vineberg with bilateral ITAs) is more appealing than shunting blood > into a young patient with a diseased, rapidly occluding arterial > system. Perhaps a combined procedure would be best in the young age > group." > > Ani > > > > >> From: prasannasimha@gmail.com >> Date: Sat, 3 Oct 2009 19:51:03 +0530 >> Subject: Re: [HSF] Query - Bigelow procedure >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Thanks but I wonder why Carpentier and QAcar would do that surgery >> with a radial grafting in the 19 70's and 80's - I am sure AVR was >> established by that time. >> Incidentally Bigelow was very well known for orthopedics apart from >> hypothermia - (Remember the Y shaped ligament of Bigelow in the >> anterior surface of the hip joint !!) What was it with >> Toronto/Canadians being cardiac surgeons and Orthopods - like Mustard >> of the Mustard operation !! >> Prasanna >> >> On Sat, Oct 3, 2009 at 6:19 PM, wrote: >>> Apologies. Victor has the right story >>> Bob >>> >>> >>> In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard >>> Time, >>> valdretemd@shaw.ca writes: >>> >>> The descending thoracic aortic homograft inclusion. The same >>> principle as the first Hufnagel valve implant was in fact an >>> operation >>> started by Dr. Gordon Murray, also from Toronto and the person that >>> introduced the use of heparin in vascular surgery before >>> Bigelow's time. >>> >>> I will call one of Bigelow's early residents and see if I can >>> find out >>> what the Bigelow Procedure might be. He definitely started the >>> use of >>> hypothermia in direct open heart surgery in the animal lab, >>> although >>> the first such operation was done by Dr. Lewis. >>> >>> Victor >>> >>> On 2009-10-02, at 6:11 AM, Rwmfglycar@aol.com wrote: >>> >>>> Could be a desc thoracic aorta homograft conduit for aortic >>>> insufficiency >>>> but he was involved in many things. He even tried reestablishing >>>> spinal cord >>>> function in paraplegics >>>> Bob >>>> >>>> >>>> >>>> In a message dated 10/2/2009 2:29:51 P.M. South Africa Standard >>>> Time, >>>> prasannasimha@gmail.com writes: >>>> >>>> What is a "Bigelow procedure" ? >>>> Prasanna >>>> >>>> -- >>>> 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 >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > Save time by using Hotmail to access your other email accounts. > http://clk.atdmt.com/UKM/go/167688463/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 Oct 4 00:39:51 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 14:10:33 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: References: <89c4ed2d0910030721h255f5289j8f162380fec31873@mail.gmail.com> Message-ID: <89c4ed2d0910031109t1014234cu8200a5b1edc1cba6@mail.gmail.com> http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=4927501 Prasanna On Sat, Oct 3, 2009 at 9:34 PM, Ani Anyanwu wrote: > > I decided to do some reading about this and it appears the operation carpentier called 'Bigelow's' was a modification of the Vineberg. > > > > Looking through the literature Bigelow seemed to be a geat proponent of Vineberg for coronary revasularization in the late 1960s and early 1970s which was when carpentier did his early work on the radial artery (published in 1973). > > > > An article Bigelow wrote in 1971 "surgical treatment of coronary artery disease" is very informing (Can Med Assoc J. 1971 Mar 20;104(6):501-6). He describes his modification of the Vineberg procedure: > > > > "In our modification of his single implant operation through a left anterior incision a large pedicle of pericardial omentum is dissected free, leaving a superior attachment. After implanting the artery, an epicardectomy is carried out over the left ventricular and adjacent right ventricular surfaces. The omentum is fixed to the anterior chest wall and wrapped around the artery as it passes between the chest wall and the heart; it is then spread out over the epicardectomized ventricular surface as an omentopexy. As a routine a left cervicodorsal sympathectomy is carried out through the same incision." > > > > He also stated reservations about the aortocornary bypass operation (CABG) which was that performed by Carpentier at the time: > > > > "I personally confess to some reservations about employing an aortocoronary bypass alone in patients disabled with coronary heart disease in the third or early in the fourth decade of life. Our follow-up studies show such a rapid and progressive occlusion of their vessels that there is anxiety about the long-term results of bypass grafting. The concept of having two new arteries implanted (vineberg with bilateral ITAs) is more appealing than shunting blood into a young patient with a diseased, rapidly occluding arterial system. Perhaps a combined procedure would be best in the young age group." > > Ani > > > > >> From: prasannasimha@gmail.com >> Date: Sat, 3 Oct 2009 19:51:03 +0530 >> Subject: Re: [HSF] Query - Bigelow procedure >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Thanks but I wonder why Carpentier and QAcar would do that surgery >> with a radial grafting in the 19 70's and 80's - I am sure AVR was >> established by that time. >> Incidentally Bigelow was very well known for orthopedics apart from >> hypothermia - (Remember the Y shaped ligament of Bigelow in the >> anterior surface of the hip joint !!) What was it with >> Toronto/Canadians being cardiac surgeons and Orthopods - like Mustard >> of the Mustard operation !! >> Prasanna >> >> On Sat, Oct 3, 2009 at 6:19 PM, wrote: >> > Apologies. Victor has the right story >> > Bob >> > >> > >> > In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard Time, >> > valdretemd@shaw.ca writes: >> > >> > The ?descending thoracic aortic homograft inclusion. ?The same >> > principle as the first Hufnagel valve implant was in fact an ?operation >> > started by Dr. Gordon Murray, also from Toronto and the ?person that >> > introduced the use of heparin in vascular surgery before ?Bigelow's time. >> > >> > I will call one of Bigelow's early residents and see if ?I can find out >> > what the Bigelow Procedure might be. ?He ?definitely started the use of >> > hypothermia in direct open heart ?surgery in the animal lab, although >> > the first such operation was ?done by Dr. Lewis. >> > >> > Victor >> > >> > On 2009-10-02, at 6:11 AM, ?Rwmfglycar@aol.com wrote: >> > >> >> Could be a desc thoracic aorta homograft ?conduit for aortic >> >> insufficiency >> >> but he was involved in ?many things. He even tried reestablishing >> >> spinal cord >> >> ?function in paraplegics >> >> Bob >> >> >> >> >> >> >> >> In a ?message dated 10/2/2009 2:29:51 P.M. South Africa Standard Time, >> >> ?prasannasimha@gmail.com writes: >> >> >> >> What is ?a "Bigelow ?procedure" ? >> >> Prasanna >> >> >> >> -- >> >> 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 >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _________________________________________________________________ > Save time by using Hotmail to access your other email accounts. > http://clk.atdmt.com/UKM/go/167688463/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 Oct 4 00:49:11 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 14:19:51 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: <89c4ed2d0910031109t1014234cu8200a5b1edc1cba6@mail.gmail.com> References: <89c4ed2d0910030721h255f5289j8f162380fec31873@mail.gmail.com> <89c4ed2d0910031109t1014234cu8200a5b1edc1cba6@mail.gmail.com> Message-ID: <89c4ed2d0910031119l6356afb9h5f650b835dd7887d@mail.gmail.com> And just for fun and worth reading http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3051&itool=AbstractPlus-def&uid=4642307&nlmid=0147763&db=pubmed&url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=4642307 Prasanna On Sat, Oct 3, 2009 at 11:39 PM, Prasanna Simha M wrote: > http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=4927501 > Prasanna > > On Sat, Oct 3, 2009 at 9:34 PM, Ani Anyanwu wrote: >> >> I decided to do some reading about this and it appears the operation carpentier called 'Bigelow's' was a modification of the Vineberg. >> >> >> >> Looking through the literature Bigelow seemed to be a geat proponent of Vineberg for coronary revasularization in the late 1960s and early 1970s which was when carpentier did his early work on the radial artery (published in 1973). >> >> >> >> An article Bigelow wrote in 1971 "surgical treatment of coronary artery disease" is very informing (Can Med Assoc J. 1971 Mar 20;104(6):501-6). He describes his modification of the Vineberg procedure: >> >> >> >> "In our modification of his single implant operation through a left anterior incision a large pedicle of pericardial omentum is dissected free, leaving a superior attachment. After implanting the artery, an epicardectomy is carried out over the left ventricular and adjacent right ventricular surfaces. The omentum is fixed to the anterior chest wall and wrapped around the artery as it passes between the chest wall and the heart; it is then spread out over the epicardectomized ventricular surface as an omentopexy. As a routine a left cervicodorsal sympathectomy is carried out through the same incision." >> >> >> >> He also stated reservations about the aortocornary bypass operation (CABG) which was that performed by Carpentier at the time: >> >> >> >> "I personally confess to some reservations about employing an aortocoronary bypass alone in patients disabled with coronary heart disease in the third or early in the fourth decade of life. Our follow-up studies show such a rapid and progressive occlusion of their vessels that there is anxiety about the long-term results of bypass grafting. The concept of having two new arteries implanted (vineberg with bilateral ITAs) is more appealing than shunting blood into a young patient with a diseased, rapidly occluding arterial system. Perhaps a combined procedure would be best in the young age group." >> >> Ani >> >> >> >> >>> From: prasannasimha@gmail.com >>> Date: Sat, 3 Oct 2009 19:51:03 +0530 >>> Subject: Re: [HSF] Query - Bigelow procedure >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> Thanks but I wonder why Carpentier and QAcar would do that surgery >>> with a radial grafting in the 19 70's and 80's - I am sure AVR was >>> established by that time. >>> Incidentally Bigelow was very well known for orthopedics apart from >>> hypothermia - (Remember the Y shaped ligament of Bigelow in the >>> anterior surface of the hip joint !!) What was it with >>> Toronto/Canadians being cardiac surgeons and Orthopods - like Mustard >>> of the Mustard operation !! >>> Prasanna >>> >>> On Sat, Oct 3, 2009 at 6:19 PM, wrote: >>> > Apologies. Victor has the right story >>> > Bob >>> > >>> > >>> > In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard Time, >>> > valdretemd@shaw.ca writes: >>> > >>> > The ?descending thoracic aortic homograft inclusion. ?The same >>> > principle as the first Hufnagel valve implant was in fact an ?operation >>> > started by Dr. Gordon Murray, also from Toronto and the ?person that >>> > introduced the use of heparin in vascular surgery before ?Bigelow's time. >>> > >>> > I will call one of Bigelow's early residents and see if ?I can find out >>> > what the Bigelow Procedure might be. ?He ?definitely started the use of >>> > hypothermia in direct open heart ?surgery in the animal lab, although >>> > the first such operation was ?done by Dr. Lewis. >>> > >>> > Victor >>> > >>> > On 2009-10-02, at 6:11 AM, ?Rwmfglycar@aol.com wrote: >>> > >>> >> Could be a desc thoracic aorta homograft ?conduit for aortic >>> >> insufficiency >>> >> but he was involved in ?many things. He even tried reestablishing >>> >> spinal cord >>> >> ?function in paraplegics >>> >> Bob >>> >> >>> >> >>> >> >>> >> In a ?message dated 10/2/2009 2:29:51 P.M. South Africa Standard Time, >>> >> ?prasannasimha@gmail.com writes: >>> >> >>> >> What is ?a "Bigelow ?procedure" ? >>> >> Prasanna >>> >> >>> >> -- >>> >> 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 >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _________________________________________________________________ >> Save time by using Hotmail to access your other email accounts. >> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From prasannasimha at gmail.com Sun Oct 4 01:03:15 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 14:41:09 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> Message-ID: <89c4ed2d0910031133r6b14379x6300d5408b0a4bc6@mail.gmail.com> How do you harvest Ani ? After everything is ready ? What do the others on the list do ? On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu wrote: > > Prasanna > Do you usually procure the radial artery while anesthesia are placing the lines? > ani From prasannasimha at gmail.com Sun Oct 4 01:06:52 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 14:43:20 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: References: <384379.97304.qm@web81604.mail.mud.yahoo.com> <89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> Message-ID: <89c4ed2d0910031136rdba4e39qa66772fb7c73ff4f@mail.gmail.com> When the radial was revived , people were screaming the use of calcium channel blockers !! It was described then at every conference as 'The difference" and people used to swear by it !! Having said that removing it enmasse helped I find it conflicting that a skeletonized artery would be better - conflicting thinking. I do take the radial with the veins with a non touch technique still. Worried about skeletonizing though Don swears by it. Prasanna On Sat, Oct 3, 2009 at 8:53 AM, Ani Anyanwu wrote: > I don't think antispasmodic pharmacology was behind revival of the radial - there are no data, previous or present, supporting efficacy of such drugs. > > I think the key change was with surgical technique avoiding handling and manipulation that can precipitate spasm. Harvesting as pedicle rather than skeletonized was one such maneuver thought we have gone full circle and now skeletonize again. > > Ani > > >> From: prasannasimha@gmail.com >> Date: Sat, 3 Oct 2009 07:57:19 +0530 >> Subject: Re: [HSF] Subclavian stenosis case follow up >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> I am in a bit of conflict here - one of the reasons for revival of the >> radial was the supposed antispasmodic therapy protocols that were >> inititated that was supposed to be the ameliorating factor for spasm - >> read improved current patency. On the other hand use of calcium >> channel blockers was not found to be useful in some studies. >> How is this dichotomy in thinking resolved by those who would not give >> long term CCB's. >> Incidentally I have used He's solution with the addition of >> Phenoxybenzamine after doing some literature search and it does >> produce an elegant pipe with the hopeful advantage that adding phenoxy >> blocks the receptors for at leastthe first 5 days !! >> Prasanna >> >> On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: >> > Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. >> > Tea >> > >> > Sent from my iPhone >> > >> > On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: >> > >> > What is your ?calcium channel protocol after surgery. I use >> > intravenous Diltiazem followed with Amlodipine for a year. I have seen >> > people not giving any periop calcium channel blockers (and giving a >> > calcium channel blocker next day) to full coverage ?. >> > Giving a calcium channel blocker can be a pain especially if the >> > patient is vasoplegic. >> > Prasanna >> > >> > On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: >> > Goodness, Prasanna, that sounds like one of my operations. >> > Yesterday I had ?a critical LM patient with 50% L subclavian stenosis.( >> > pre-op ima dopplers: both imas 25ml/ min) >> > Did the lad with the rima ?and took the T-radial off the rima to graft the >> > pda ( ?around L side as usual) >> > The lima was used for the om and the whole shebang covered with mobilised >> > pericardial fat. ( lima 40ml/min, rima 95 ml/min ) >> > >> > My second case an even worse unstable LM with 30%EF and recent stemi >> > infarct, started to sag while I was trying to sneak the rima onto the lad so >> > I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on >> > pump. ( It is very ?satisfying ?to see an anterior wall contractility >> > recover the instant it's ?graft is opened.) >> > Don >> > >> > On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: >> > >> > Did the subclavian stenosis case today (Postponed due to some non >> > medical reasons) >> > Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a >> > mistake in my original post and there was no RCA disease on reviewing >> > the angiogram). >> > My logic was >> > RIMA and LIMA have identical patencies to the LAD. >> > Steneted subclavian has a good patency but not the same as virgin LIMA >> > so I placed it to the OM as the patencies seemed to match that. >> > Used a radial to the diagonal which was big as he is young. >> > Incidentally used the right radial as he still complained of some >> > tingling ?etc in the left fingers and did not want to worsen anything >> > (or give an opportunity to have long term complaints ?ascribed to >> > radial artery harvest in the stented side !!). I just harvested the >> > radial and closed the arm by the time the Neck lines and Swan were >> > floated and tucked the arm in and proceeded to harvest the IMA's so >> > did not have to do the turn towards the head LIMA harvest as was >> > advocated ?in the discussion. >> > >> > >> > Despite skeletonization etc the RIMA could not be made to course >> > superiorly under the innominate vein and required a straighter course >> > to the LAD crossing the aorta under the covering RA appendage. I >> > mobilized both mediastinal fat pads and covered the RIMA and LIMA ?to >> > protect itfor a future redo and if at any time the RCA/PD requires a >> > graft I will approach it basally by dividing the diaphragm ?and use an >> > RGEA (or so I wishfully think !!) >> > >> > I was considering doing it OPCAB as the targets were good and he >> > initially had excellent hemodynamics but he started developing >> > hypotension and ST's ?during the final stages of LIMA harvest (which I >> > had harvested last) so I did it beating supported (I had an alternate >> > choice of a balloon pump ?but was worried about the very tight ?Left >> > main). He came off with NTG and Diltiazem infusions that were >> > prophylactically started. >> > >> > Comments ? >> > -- >> > Prasanna Simha M >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > >> > All messages transmitted by the OpenHeart-L are subject to the policies >> > and >> > disclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> > >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > >> > All messages transmitted by the OpenHeart-L are subject to the policies >> > anddisclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> > >> > >> > >> > >> > -- >> > Prasanna Simha M >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > >> > All messages transmitted by the OpenHeart-L are subject to the policies and >> > disclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> > >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > ?OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/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 >> ----------------------------------------- > > _________________________________________________________________ > Learn how to add other email accounts to Hotmail in 3 easy steps. > http://clk.atdmt.com/UKM/go/167688463/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 tacuff at swbell.net Sat Oct 3 12:52:29 2009 From: tacuff at swbell.net (Tea Acuff) Date: Sat Oct 3 14:54:01 2009 Subject: [HSF] Subclavian stenosis case follow up Message-ID: <558209.87682.qm@web81604.mail.mud.yahoo.com> Interesting perspective, John Tea Sent from my iPhone On Oct 3, 2009, at 8:35 AM, Flege John wrote: I saw a recent paper reporting the experimental use of Botox to prevent spasm in arterial grafts and it worked in the model used. This approach may be worth further investigation since the blocking effect of Botox persists for months. I there anyone out there with a laboratory and eager young assistants looking for a way of making a name for themselves? John Flege On Oct 2, 2009, at 10:27 PM, Prasanna Simha M wrote: I am in a bit of conflict here - one of the reasons for revival of the radial was the supposed antispasmodic therapy protocols that were inititated that was supposed to be the ameliorating factor for spasm - read improved current patency. On the other hand use of calcium channel blockers was not found to be useful in some studies. How is this dichotomy in thinking resolved by those who would not give long term CCB's. Incidentally I have used He's solution with the addition of Phenoxybenzamine after doing some literature search and it does produce an elegant pipe with the hopeful advantage that adding phenoxy blocks the receptors for at leastthe first 5 days !! Prasanna On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. Tea Sent from my iPhone On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: What is your calcium channel protocol after surgery. I use intravenous Diltiazem followed with Amlodipine for a year. I have seen people not giving any periop calcium channel blockers (and giving a calcium channel blocker next day) to full coverage ?. Giving a calcium channel blocker can be a pain especially if the patient is vasoplegic. Prasanna On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: Goodness, Prasanna, that sounds like one of my operations. Yesterday I had a critical LM patient with 50% L subclavian stenosis.( pre-op ima dopplers: both imas 25ml/ min) Did the lad with the rima and took the T-radial off the rima to graft the pda ( around L side as usual) The lima was used for the om and the whole shebang covered with mobilised pericardial fat. ( lima 40ml/min, rima 95 ml/min ) My second case an even worse unstable LM with 30%EF and recent stemi infarct, started to sag while I was trying to sneak the rima onto the lad so I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on pump. ( It is very satisfying to see an anterior wall contractility recover the instant it's graft is opened.) Don On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: Did the subclavian stenosis case today (Postponed due to some non medical reasons) Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a mistake in my original post and there was no RCA disease on reviewing the angiogram). My logic was RIMA and LIMA have identical patencies to the LAD. Steneted subclavian has a good patency but not the same as virgin LIMA so I placed it to the OM as the patencies seemed to match that. Used a radial to the diagonal which was big as he is young. Incidentally used the right radial as he still complained of some tingling etc in the left fingers and did not want to worsen anything (or give an opportunity to have long term complaints ascribed to radial artery harvest in the stented side !!). I just harvested the radial and closed the arm by the time the Neck lines and Swan were floated and tucked the arm in and proceeded to harvest the IMA's so did not have to do the turn towards the head LIMA harvest as was advocated in the discussion. Despite skeletonization etc the RIMA could not be made to course superiorly under the innominate vein and required a straighter course to the LAD crossing the aorta under the covering RA appendage. I mobilized both mediastinal fat pads and covered the RIMA and LIMA to protect itfor a future redo and if at any time the RCA/PD requires a graft I will approach it basally by dividing the diaphragm and use an RGEA (or so I wishfully think !!) I was considering doing it OPCAB as the targets were good and he initially had excellent hemodynamics but he started developing hypotension and ST's during the final stages of LIMA harvest (which I had harvested last) so I did it beating supported (I had an alternate choice of a balloon pump but was worried about the very tight Left main). He came off with NTG and Diltiazem infusions that were prophylactically started. Comments ? -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From msfirst at gmail.com Sat Oct 3 14:16:11 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sat Oct 3 15:00:04 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: <3E3B0C65-78A7-4040-83A4-65E2F1AA83D7@shaw.ca> References: <3E3B0C65-78A7-4040-83A4-65E2F1AA83D7@shaw.ca> Message-ID: I seem to do many modified veinbergs in my practice. -michael/iPhone On Oct 3, 2009, at 12:42 PM, "V. Aldrete, M.D." wrote: > Ani, > > That was great detective work. I think you are correct, though I > have not yet been able to reach my possible source. > > Thank you, > > Victor > > On 2009-10-03, at 9:04 AM, Ani Anyanwu wrote: > >> >> I decided to do some reading about this and it appears the >> operation carpentier called 'Bigelow's' was a modification of the >> Vineberg. >> >> >> >> Looking through the literature Bigelow seemed to be a geat >> proponent of Vineberg for coronary revasularization in the late >> 1960s and early 1970s which was when carpentier did his early work >> on the radial artery (published in 1973). >> >> >> >> An article Bigelow wrote in 1971 "surgical treatment of coronary >> artery disease" is very informing (Can Med Assoc J. 1971 Mar 20;104 >> (6):501-6). He describes his modification of the Vineberg procedure: >> >> >> >> "In our modification of his single implant operation through a left >> anterior incision a large pedicle of pericardial omentum is >> dissected free, leaving a superior attachment. After implanting the >> artery, an epicardectomy is carried out over the left ventricular >> and adjacent right ventricular surfaces. The omentum is fixed to >> the anterior chest wall and wrapped around the artery as it passes >> between the chest wall and the heart; it is then spread out over >> the epicardectomized ventricular surface as an omentopexy. As a >> routine a left cervicodorsal sympathectomy is carried out through >> the same incision." >> >> >> >> He also stated reservations about the aortocornary bypass operation >> (CABG) which was that performed by Carpentier at the time: >> >> >> >> "I personally confess to some reservations about employing an >> aortocoronary bypass alone in patients disabled with coronary heart >> disease in the third or early in the fourth decade of life. Our >> follow-up studies show such a rapid and progressive occlusion of >> their vessels that there is anxiety about the long-term results of >> bypass grafting. The concept of having two new arteries implanted >> (vineberg with bilateral ITAs) is more appealing than shunting >> blood into a young patient with a diseased, rapidly occluding >> arterial system. Perhaps a combined procedure would be best in the >> young age group." >> >> Ani >> >> >> >> >>> From: prasannasimha@gmail.com >>> Date: Sat, 3 Oct 2009 19:51:03 +0530 >>> Subject: Re: [HSF] Query - Bigelow procedure >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> Thanks but I wonder why Carpentier and QAcar would do that surgery >>> with a radial grafting in the 19 70's and 80's - I am sure AVR was >>> established by that time. >>> Incidentally Bigelow was very well known for orthopedics apart from >>> hypothermia - (Remember the Y shaped ligament of Bigelow in the >>> anterior surface of the hip joint !!) What was it with >>> Toronto/Canadians being cardiac surgeons and Orthopods - like >>> Mustard >>> of the Mustard operation !! >>> Prasanna >>> >>> On Sat, Oct 3, 2009 at 6:19 PM, wrote: >>>> Apologies. Victor has the right story >>>> Bob >>>> >>>> >>>> In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard >>>> Time, >>>> valdretemd@shaw.ca writes: >>>> >>>> The descending thoracic aortic homograft inclusion. The same >>>> principle as the first Hufnagel valve implant was in fact an >>>> operation >>>> started by Dr. Gordon Murray, also from Toronto and the person >>>> that >>>> introduced the use of heparin in vascular surgery before >>>> Bigelow's time. >>>> >>>> I will call one of Bigelow's early residents and see if I can >>>> find out >>>> what the Bigelow Procedure might be. He definitely started the >>>> use of >>>> hypothermia in direct open heart surgery in the animal lab, >>>> although >>>> the first such operation was done by Dr. Lewis. >>>> >>>> Victor >>>> >>>> On 2009-10-02, at 6:11 AM, Rwmfglycar@aol.com wrote: >>>> >>>>> Could be a desc thoracic aorta homograft conduit for aortic >>>>> insufficiency >>>>> but he was involved in many things. He even tried reestablishing >>>>> spinal cord >>>>> function in paraplegics >>>>> Bob >>>>> >>>>> >>>>> >>>>> In a message dated 10/2/2009 2:29:51 P.M. South Africa Standard >>>>> Time, >>>>> prasannasimha@gmail.com writes: >>>>> >>>>> What is a "Bigelow procedure" ? >>>>> Prasanna >>>>> >>>>> -- >>>>> 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 >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _________________________________________________________________ >> Save time by using Hotmail to access your other email accounts. >> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From robertobattellini at hotmail.com Sat Oct 3 23:06:23 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sat Oct 3 16:06:55 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910031136rdba4e39qa66772fb7c73ff4f@mail.gmail.com> References: <384379.97304.qm@web81604.mail.mud.yahoo.com> <89c4ed2d0910021927v68d9f755ud807d9cb9375c618@mail.gmail.com> Message-ID: We take all radials with Harmonic scalpel, no spasm.We believe if the graft closes is because of bad technique or less than subtotal occlusion on the coronary. Roberto > From: prasannasimha@gmail.com > Date: Sun, 4 Oct 2009 00:06:52 +0530 > Subject: Re: [HSF] Subclavian stenosis case follow up > To: OpenHeart-L@lists.hsforum.com > CC: > > When the radial was revived , people were screaming the use of calcium > channel blockers !! It was described then at every conference as 'The > difference" and people used to swear by it !! > Having said that removing it enmasse helped I find it conflicting that > a skeletonized artery would be better - conflicting thinking. > I do take the radial with the veins with a non touch technique still. > Worried about skeletonizing though Don swears by it. > Prasanna > > On Sat, Oct 3, 2009 at 8:53 AM, Ani Anyanwu wrote: > > I don't think antispasmodic pharmacology was behind revival of the radial - there are no data, previous or present, supporting efficacy of such drugs. > > > > I think the key change was with surgical technique avoiding handling and manipulation that can precipitate spasm. Harvesting as pedicle rather than skeletonized was one such maneuver thought we have gone full circle and now skeletonize again. > > > > Ani > > > > > >> From: prasannasimha@gmail.com > >> Date: Sat, 3 Oct 2009 07:57:19 +0530 > >> Subject: Re: [HSF] Subclavian stenosis case follow up > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> > >> I am in a bit of conflict here - one of the reasons for revival of the > >> radial was the supposed antispasmodic therapy protocols that were > >> inititated that was supposed to be the ameliorating factor for spasm - > >> read improved current patency. On the other hand use of calcium > >> channel blockers was not found to be useful in some studies. > >> How is this dichotomy in thinking resolved by those who would not give > >> long term CCB's. > >> Incidentally I have used He's solution with the addition of > >> Phenoxybenzamine after doing some literature search and it does > >> produce an elegant pipe with the hopeful advantage that adding phenoxy > >> blocks the receptors for at leastthe first 5 days !! > >> Prasanna > >> > >> On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: > >> > Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. > >> > Tea > >> > > >> > Sent from my iPhone > >> > > >> > On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: > >> > > >> > What is your calcium channel protocol after surgery. I use > >> > intravenous Diltiazem followed with Amlodipine for a year. I have seen > >> > people not giving any periop calcium channel blockers (and giving a > >> > calcium channel blocker next day) to full coverage ?. > >> > Giving a calcium channel blocker can be a pain especially if the > >> > patient is vasoplegic. > >> > Prasanna > >> > > >> > On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: > >> > Goodness, Prasanna, that sounds like one of my operations. > >> > Yesterday I had a critical LM patient with 50% L subclavian stenosis.( > >> > pre-op ima dopplers: both imas 25ml/ min) > >> > Did the lad with the rima and took the T-radial off the rima to graft the > >> > pda ( around L side as usual) > >> > The lima was used for the om and the whole shebang covered with mobilised > >> > pericardial fat. ( lima 40ml/min, rima 95 ml/min ) > >> > > >> > My second case an even worse unstable LM with 30%EF and recent stemi > >> > infarct, started to sag while I was trying to sneak the rima onto the lad so > >> > I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on > >> > pump. ( It is very satisfying to see an anterior wall contractility > >> > recover the instant it's graft is opened.) > >> > Don > >> > > >> > On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: > >> > > >> > Did the subclavian stenosis case today (Postponed due to some non > >> > medical reasons) > >> > Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a > >> > mistake in my original post and there was no RCA disease on reviewing > >> > the angiogram). > >> > My logic was > >> > RIMA and LIMA have identical patencies to the LAD. > >> > Steneted subclavian has a good patency but not the same as virgin LIMA > >> > so I placed it to the OM as the patencies seemed to match that. > >> > Used a radial to the diagonal which was big as he is young. > >> > Incidentally used the right radial as he still complained of some > >> > tingling etc in the left fingers and did not want to worsen anything > >> > (or give an opportunity to have long term complaints ascribed to > >> > radial artery harvest in the stented side !!). I just harvested the > >> > radial and closed the arm by the time the Neck lines and Swan were > >> > floated and tucked the arm in and proceeded to harvest the IMA's so > >> > did not have to do the turn towards the head LIMA harvest as was > >> > advocated in the discussion. > >> > > >> > > >> > Despite skeletonization etc the RIMA could not be made to course > >> > superiorly under the innominate vein and required a straighter course > >> > to the LAD crossing the aorta under the covering RA appendage. I > >> > mobilized both mediastinal fat pads and covered the RIMA and LIMA to > >> > protect itfor a future redo and if at any time the RCA/PD requires a > >> > graft I will approach it basally by dividing the diaphragm and use an > >> > RGEA (or so I wishfully think !!) > >> > > >> > I was considering doing it OPCAB as the targets were good and he > >> > initially had excellent hemodynamics but he started developing > >> > hypotension and ST's during the final stages of LIMA harvest (which I > >> > had harvested last) so I did it beating supported (I had an alternate > >> > choice of a balloon pump but was worried about the very tight Left > >> > main). He came off with NTG and Diltiazem infusions that were > >> > prophylactically started. > >> > > >> > Comments ? > >> > -- > >> > Prasanna Simha M > >> > _______________________________________________ > >> > OpenHeart-L mailing list > >> > > >> > Send postings to: > >> > OpenHeart-L@lists.hsforum.com > >> > > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> > http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > > >> > All messages transmitted by the OpenHeart-L are subject to the policies > >> > and > >> > disclaimers posted at: > >> > http://www.hsforum.com/listdisclaim > >> > ----------------------------------------- > >> > > >> > _______________________________________________ > >> > OpenHeart-L mailing list > >> > > >> > Send postings to: > >> > OpenHeart-L@lists.hsforum.com > >> > > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> > http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > > >> > All messages transmitted by the OpenHeart-L are subject to the policies > >> > anddisclaimers posted at: > >> > http://www.hsforum.com/listdisclaim > >> > ----------------------------------------- > >> > > >> > > >> > > >> > > >> > -- > >> > Prasanna Simha M > >> > _______________________________________________ > >> > OpenHeart-L mailing list > >> > > >> > Send postings to: > >> > OpenHeart-L@lists.hsforum.com > >> > > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> > http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > > >> > All messages transmitted by the OpenHeart-L are subject to the policies and > >> > disclaimers posted at: > >> > http://www.hsforum.com/listdisclaim > >> > ----------------------------------------- > >> > > >> > _______________________________________________ > >> > OpenHeart-L mailing list > >> > > >> > Send postings to: > >> > OpenHeart-L@lists.hsforum.com > >> > > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> > http://mmp.cjp.com/mailman/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 > >> ----------------------------------------- > > > > _________________________________________________________________ > > Learn how to add other email accounts to Hotmail in 3 easy steps. > > http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From anianyanwu at hotmail.com Sat Oct 3 23:50:41 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sat Oct 3 18:51:11 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910031133r6b14379x6300d5408b0a4bc6@mail.gmail.com> References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> Message-ID: Yes we harvest at same time as ready for sternotomy. Never before - I think our OR police would shreik if i suggested taking out radial while lines and foley being placed. I use a skeletonized procurement technique after several online and off-line discussions with Don. The last two I have also used verapamil as per don. i dont routinely use calcium blockers after surgery. Ani > From: prasannasimha@gmail.com > Date: Sun, 4 Oct 2009 00:03:15 +0530 > Subject: Re: [HSF] Subclavian stenosis case follow up > To: OpenHeart-L@lists.hsforum.com > CC: > > How do you harvest Ani ? After everything is ready ? What do the > others on the list do ? > > On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu wrote: > > > > Prasanna > > > Do you usually procure the radial artery while anesthesia are placing the lines? > > > ani > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/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 other email accounts from your Hotmail inbox. Add them now. http://clk.atdmt.com/UKM/go/167688463/direct/01/ From valdretemd at shaw.ca Sat Oct 3 16:59:11 2009 From: valdretemd at shaw.ca (V. Aldrete, M.D.) Date: Sat Oct 3 19:00:41 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: <89c4ed2d0910031119l6356afb9h5f650b835dd7887d@mail.gmail.com> References: <89c4ed2d0910030721h255f5289j8f162380fec31873@mail.gmail.com> <89c4ed2d0910031109t1014234cu8200a5b1edc1cba6@mail.gmail.com> <89c4ed2d0910031119l6356afb9h5f650b835dd7887d@mail.gmail.com> Message-ID: Thank you Prasanna. These articles are most interesting and fun to read. I have just talked to one of Dr. Bigelow's early residents and he confirmed that he is not aware of a "Bigelow's Procedure", thus this must be a name given to one of his descriptions of techniques used, and I assume it has to do with the section I am transcribing below. -------------- next part -------------- Victor On 2009-10-03, at 11:19 AM, Prasanna Simha M wrote: > And just for fun and worth reading > http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3051&itool=AbstractPlus-def&uid=4642307&nlmid=0147763&db=pubmed&url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=4642307 > Prasanna > On Sat, Oct 3, 2009 at 11:39 PM, Prasanna Simha M > wrote: >> http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=4927501 >> Prasanna >> >> On Sat, Oct 3, 2009 at 9:34 PM, Ani Anyanwu >> wrote: >>> >>> I decided to do some reading about this and it appears the >>> operation carpentier called 'Bigelow's' was a modification of the >>> Vineberg. >>> >>> >>> >>> Looking through the literature Bigelow seemed to be a geat >>> proponent of Vineberg for coronary revasularization in the late >>> 1960s and early 1970s which was when carpentier did his early work >>> on the radial artery (published in 1973). >>> >>> >>> >>> An article Bigelow wrote in 1971 "surgical treatment of coronary >>> artery disease" is very informing (Can Med Assoc J. 1971 Mar 20;104 >>> (6):501-6). He describes his modification of the Vineberg procedure: >>> >>> >>> >>> "In our modification of his single implant operation through a >>> left anterior incision a large pedicle of pericardial omentum is >>> dissected free, leaving a superior attachment. After implanting >>> the artery, an epicardectomy is carried out over the left >>> ventricular and adjacent right ventricular surfaces. The omentum >>> is fixed to the anterior chest wall and wrapped around the artery >>> as it passes between the chest wall and the heart; it is then >>> spread out over the epicardectomized ventricular surface as an >>> omentopexy. As a routine a left cervicodorsal sympathectomy is >>> carried out through the same incision." >>> >>> >>> >>> He also stated reservations about the aortocornary bypass >>> operation (CABG) which was that performed by Carpentier at the time: >>> >>> >>> >>> "I personally confess to some reservations about employing an >>> aortocoronary bypass alone in patients disabled with coronary >>> heart disease in the third or early in the fourth decade of life. >>> Our follow-up studies show such a rapid and progressive occlusion >>> of their vessels that there is anxiety about the long-term results >>> of bypass grafting. The concept of having two new arteries >>> implanted (vineberg with bilateral ITAs) is more appealing than >>> shunting blood into a young patient with a diseased, rapidly >>> occluding arterial system. Perhaps a combined procedure would be >>> best in the young age group." >>> >>> Ani >>> >>> >>> >>> >>>> From: prasannasimha@gmail.com >>>> Date: Sat, 3 Oct 2009 19:51:03 +0530 >>>> Subject: Re: [HSF] Query - Bigelow procedure >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> >>>> Thanks but I wonder why Carpentier and QAcar would do that surgery >>>> with a radial grafting in the 19 70's and 80's - I am sure AVR was >>>> established by that time. >>>> Incidentally Bigelow was very well known for orthopedics apart from >>>> hypothermia - (Remember the Y shaped ligament of Bigelow in the >>>> anterior surface of the hip joint !!) What was it with >>>> Toronto/Canadians being cardiac surgeons and Orthopods - like >>>> Mustard >>>> of the Mustard operation !! >>>> Prasanna >>>> >>>> On Sat, Oct 3, 2009 at 6:19 PM, wrote: >>>>> Apologies. Victor has the right story >>>>> Bob >>>>> >>>>> >>>>> In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard >>>>> Time, >>>>> valdretemd@shaw.ca writes: >>>>> >>>>> The descending thoracic aortic homograft inclusion. The same >>>>> principle as the first Hufnagel valve implant was in fact an >>>>> operation >>>>> started by Dr. Gordon Murray, also from Toronto and the person >>>>> that >>>>> introduced the use of heparin in vascular surgery before >>>>> Bigelow's time. >>>>> >>>>> I will call one of Bigelow's early residents and see if I can >>>>> find out >>>>> what the Bigelow Procedure might be. He definitely started the >>>>> use of >>>>> hypothermia in direct open heart surgery in the animal lab, >>>>> although >>>>> the first such operation was done by Dr. Lewis. >>>>> >>>>> Victor >>>>> >>>>> On 2009-10-02, at 6:11 AM, Rwmfglycar@aol.com wrote: >>>>> >>>>>> Could be a desc thoracic aorta homograft conduit for aortic >>>>>> insufficiency >>>>>> but he was involved in many things. He even tried reestablishing >>>>>> spinal cord >>>>>> function in paraplegics >>>>>> Bob >>>>>> >>>>>> >>>>>> >>>>>> In a message dated 10/2/2009 2:29:51 P.M. South Africa >>>>>> Standard Time, >>>>>> prasannasimha@gmail.com writes: >>>>>> >>>>>> What is a "Bigelow procedure" ? >>>>>> Prasanna >>>>>> >>>>>> -- >>>>>> 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 >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the >>>> policies and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> >>> _________________________________________________________________ >>> Save time by using Hotmail to access your other email accounts. >>> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From tfurnary at starrwood.com Sat Oct 3 17:00:03 2009 From: tfurnary at starrwood.com (Anthony P Furnary MD) Date: Sat Oct 3 19:01:06 2009 Subject: [HSF] TMR with recent MI In-Reply-To: References: Message-ID: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> Chuck, Tea, Ani, Hal If you think she would benefit from TMR, and she dopes not have ongoing chest pain, not requiring NTG or heparin drips -- would be safest to stabilize her with oral meds, let her "cool down" and do her in 4 weeks -- CABG / TMR. I would go midline. Lateral approach OK , but limits future redo IMO. If she can not be "stabilized" in this fashion, continues to have rest pain and needs to be done now -- TMR increases risk of post-op death following MI. Risk is 4X for the first two weeks and 2X for the ensuing 2 weeks, whence it drops to "normal" (1X) [x being baseline STS risk of redo CABG. This is the basis of the STS guidelines on TMR as they relate to doing it Post-MI... and why medicare will sometimes not reimburse for post-MI TMR... and the basis of several lawsuits regarding poor outcomes following CABG / TMR following MI. Hal -- Dense perusal of the literature results seem to show benefit depending on which laser was used. CO2 adn HoYAG although both called "TMR" may actually be different procedures. Ani / Prasanna -- Yes -- still doing it. Did a redo CABG / TMR yesterday. have an isolated TMR Monday. Another Redo CABG / TMR schedled in two weeks. and Yes... it works....CO2 that is -- stimulates formation of collaterals - that's how Ani. Tea -- there I said it. 'nuff said. Don't want the Cardiogenesis lawyers chasing me down again and attempting to sue me for my thoughts on HSF, like they did before. over and out, (silent) Tony PS -- Sorry Ani... I hereby refuse, in advance, argue with your response to this post.... Just don't have the time (can't type fast enough) to get into it. Search the archives. Thnx On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: > Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her > a few days ago with Class 4 angina; she was admitted to a nearby > hospital with an MI yesterday, troponin peaks at 5. Anatomy is a > nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, > closed RCA. She is living off that LIMA. There is an open ramus that > is bypassable and a functional lateral wall. EF is 45%. Inferior > wall is only scar on thallium I am planning Left thoracotomy radial > graft to this Ramus from the Subclavian artery; initially had > planned CO2 TMR to the lateral wall. Would anyone rule out adding > TMR in the face of the recent infarct and abnormal EF? > thx chuckdouville > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From donross at bigpond.com Sun Oct 4 11:16:46 2009 From: donross at bigpond.com (Donald Ross) Date: Sat Oct 3 19:18:21 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> Message-ID: <313C0596-BBD0-4592-B603-CB6DD311D16D@bigpond.com> For my standard cabg X 3-4 the radial is taken while the chest is opened and the LIMA harvested. The T graft is constructed, usually, while the arm incision is closed. With the arm back in place the distals are done, the usual total OR time is 4 hours. Don On 04/10/2009, at 9:50 AM, Ani Anyanwu wrote: > > Yes we harvest at same time as ready for sternotomy. Never before - > I think our OR police would shreik if i suggested taking out radial > while lines and foley being placed. > > > > I use a skeletonized procurement technique after several online and > off-line discussions with Don. The last two I have also used > verapamil as per don. i dont routinely use calcium blockers after > surgery. > > > > Ani > >> From: prasannasimha@gmail.com >> Date: Sun, 4 Oct 2009 00:03:15 +0530 >> Subject: Re: [HSF] Subclavian stenosis case follow up >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> How do you harvest Ani ? After everything is ready ? What do the >> others on the list do ? >> >> On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu >> wrote: >>> >>> Prasanna >> >>> Do you usually procure the radial artery while anesthesia are >>> placing the lines? >> >>> ani >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 other email accounts from your Hotmail inbox. Add them now. > http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From Hgrmd at aol.com Sat Oct 3 20:32:24 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sat Oct 3 19:33:37 2009 Subject: [HSF] TMR with recent MI Message-ID: Tony, Thanks for mustering the courage to post your thoughts on TMR. Those nasty lawyers are really stifling free discourse on HSF. Like you, the few TMR cases I did were with TMR. They seemed to work pretty well, though I did knock off a patient with a starting EF of 30% (I apologize in advance to any potential scumsuckers. The statutes on that case ran over 10 years ago.). When I took the training course, the mechanism in which TMR supposedly worked was by stimulating angiogenesis. Why is it that holes with CO2 seem to work, while Holmium/YAG and simple needle punctures aren't as effective? Also, do you think denervation of the heart contributes to the relief of symptoms? I've seen precious little to no data that TMR objectively decreases ischemic areas on Thallium. Hal In a message dated 10/3/2009 7:03:22 P.M. Eastern Daylight Time, tfurnary@starrwood.com writes: Chuck, Tea, Ani, Hal If you think she would benefit from TMR, and she dopes not have ongoing chest pain, not requiring NTG or heparin drips -- would be safest to stabilize her with oral meds, let her "cool down" and do her in 4 weeks -- CABG / TMR. I would go midline. Lateral approach OK , but limits future redo IMO. If she can not be "stabilized" in this fashion, continues to have rest pain and needs to be done now -- TMR increases risk of post-op death following MI. Risk is 4X for the first two weeks and 2X for the ensuing 2 weeks, whence it drops to "normal" (1X) [x being baseline STS risk of redo CABG. This is the basis of the STS guidelines on TMR as they relate to doing it Post-MI... and why medicare will sometimes not reimburse for post-MI TMR... and the basis of several lawsuits regarding poor outcomes following CABG / TMR following MI. Hal -- Dense perusal of the literature results seem to show benefit depending on which laser was used. CO2 adn HoYAG although both called "TMR" may actually be different procedures. Ani / Prasanna -- Yes -- still doing it. Did a redo CABG / TMR yesterday. have an isolated TMR Monday. Another Redo CABG / TMR schedled in two weeks. and Yes... it works....CO2 that is -- stimulates formation of collaterals - that's how Ani. Tea -- there I said it. 'nuff said. Don't want the Cardiogenesis lawyers chasing me down again and attempting to sue me for my thoughts on HSF, like they did before. over and out, (silent) Tony PS -- Sorry Ani... I hereby refuse, in advance, argue with your response to this post.... Just don't have the time (can't type fast enough) to get into it. Search the archives. Thnx On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: > Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her > a few days ago with Class 4 angina; she was admitted to a nearby > hospital with an MI yesterday, troponin peaks at 5. Anatomy is a > nice LIMA to LAD, all other (vein grafts) closed. 90% Left main, > closed RCA. She is living off that LIMA. There is an open ramus that > is bypassable and a functional lateral wall. EF is 45%. Inferior > wall is only scar on thallium I am planning Left thoracotomy radial > graft to this Ramus from the Subclavian artery; initially had > planned CO2 TMR to the lateral wall. Would anyone rule out adding > TMR in the face of the recent infarct and abnormal EF? > thx chuckdouville > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From prasannasimha at gmail.com Sun Oct 4 08:32:16 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 22:03:07 2009 Subject: [HSF] Query - Bigelow procedure In-Reply-To: References: <89c4ed2d0910030721h255f5289j8f162380fec31873@mail.gmail.com> <89c4ed2d0910031109t1014234cu8200a5b1edc1cba6@mail.gmail.com> <89c4ed2d0910031119l6356afb9h5f650b835dd7887d@mail.gmail.com> Message-ID: <89c4ed2d0910031902i6b035710g1528e345517b4174@mail.gmail.com> Any French surgeons around ? I think Bigelow may not have had his unit calling it the "Bigelow" procedure in his own unit !! Also Ani why would a bilateral Vineberg be combined with a radial ? (If that was the procedure). Not so sure what this procedure is still !! Prasanna On Sun, Oct 4, 2009 at 4:29 AM, V. Aldrete, M.D. wrote: > Thank you Prasanna. ?These articles are most interesting and fun to read. > > I have just talked to one of Dr. Bigelow's early residents and he confirmed > that he is not aware of a "Bigelow's Procedure", thus this must be a name > given to one of his descriptions of techniques used, and I assume it has to > do with the section I am transcribing below. > > > > Victor > > > On 2009-10-03, at 11:19 AM, Prasanna Simha M wrote: > >> And just for fun and worth reading >> >> http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3051&itool=AbstractPlus-def&uid=4642307&nlmid=0147763&db=pubmed&url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=4642307 >> Prasanna >> On Sat, Oct 3, 2009 at 11:39 PM, Prasanna Simha M >> wrote: >>> >>> >>> http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=4927501 >>> Prasanna >>> >>> On Sat, Oct 3, 2009 at 9:34 PM, Ani Anyanwu >>> wrote: >>>> >>>> I decided to do some reading about this and it appears the operation >>>> carpentier called 'Bigelow's' was a modification of the Vineberg. >>>> >>>> >>>> >>>> Looking through the literature Bigelow seemed to be a geat proponent of >>>> Vineberg for coronary revasularization in the late 1960s and early 1970s >>>> which was when carpentier did his early work on the radial artery (published >>>> in 1973). >>>> >>>> >>>> >>>> An article Bigelow wrote in 1971 "surgical treatment of coronary artery >>>> disease" is very informing (Can Med Assoc J. 1971 Mar 20;104(6):501-6). He >>>> describes his modification of the Vineberg procedure: >>>> >>>> >>>> >>>> "In our modification of his single implant operation through a left >>>> anterior incision a large pedicle of pericardial omentum is dissected free, >>>> leaving a superior attachment. After implanting the artery, an epicardectomy >>>> is carried out over the left ventricular and adjacent right ventricular >>>> surfaces. The omentum is fixed to the anterior chest wall and wrapped around >>>> the artery as it passes between the chest wall and the heart; it is then >>>> spread out over the epicardectomized ventricular surface as an omentopexy. >>>> As a routine a left cervicodorsal sympathectomy is carried out through the >>>> same incision." >>>> >>>> >>>> >>>> He also stated reservations about the aortocornary bypass operation >>>> (CABG) which was that performed by Carpentier at the time: >>>> >>>> >>>> >>>> "I personally confess to some reservations about employing an >>>> aortocoronary bypass alone in patients disabled with coronary heart disease >>>> in the third or early in the fourth decade of life. Our follow-up studies >>>> show such a rapid and progressive occlusion of their vessels that there is >>>> anxiety about the long-term results of bypass grafting. The concept of >>>> having two new arteries implanted (vineberg with bilateral ITAs) is more >>>> appealing than shunting blood into a young patient with a diseased, rapidly >>>> occluding arterial system. Perhaps a combined procedure would be best in the >>>> young age group." >>>> >>>> Ani >>>> >>>> >>>> >>>> >>>>> From: prasannasimha@gmail.com >>>>> Date: Sat, 3 Oct 2009 19:51:03 +0530 >>>>> Subject: Re: [HSF] Query - Bigelow procedure >>>>> To: OpenHeart-L@lists.hsforum.com >>>>> CC: >>>>> >>>>> Thanks but I wonder why Carpentier and QAcar would do that surgery >>>>> with a radial grafting in the 19 70's and 80's - I am sure AVR was >>>>> established by that time. >>>>> Incidentally Bigelow was very well known for orthopedics apart from >>>>> hypothermia - (Remember the Y shaped ligament of Bigelow in the >>>>> anterior surface of the hip joint !!) What was it with >>>>> Toronto/Canadians being cardiac surgeons and Orthopods - like Mustard >>>>> of the Mustard operation !! >>>>> Prasanna >>>>> >>>>> On Sat, Oct 3, 2009 at 6:19 PM, wrote: >>>>>> >>>>>> Apologies. Victor has the right story >>>>>> Bob >>>>>> >>>>>> >>>>>> In a message dated 10/3/2009 7:55:05 A.M. South Africa Standard Time, >>>>>> valdretemd@shaw.ca writes: >>>>>> >>>>>> The ?descending thoracic aortic homograft inclusion. ?The same >>>>>> principle as the first Hufnagel valve implant was in fact an >>>>>> ?operation >>>>>> started by Dr. Gordon Murray, also from Toronto and the ?person that >>>>>> introduced the use of heparin in vascular surgery before ?Bigelow's >>>>>> time. >>>>>> >>>>>> I will call one of Bigelow's early residents and see if ?I can find >>>>>> out >>>>>> what the Bigelow Procedure might be. ?He ?definitely started the use >>>>>> of >>>>>> hypothermia in direct open heart ?surgery in the animal lab, although >>>>>> the first such operation was ?done by Dr. Lewis. >>>>>> >>>>>> Victor >>>>>> >>>>>> On 2009-10-02, at 6:11 AM, ?Rwmfglycar@aol.com wrote: >>>>>> >>>>>>> Could be a desc thoracic aorta homograft ?conduit for aortic >>>>>>> insufficiency >>>>>>> but he was involved in ?many things. He even tried reestablishing >>>>>>> spinal cord >>>>>>> ?function in paraplegics >>>>>>> Bob >>>>>>> >>>>>>> >>>>>>> >>>>>>> In a ?message dated 10/2/2009 2:29:51 P.M. South Africa Standard >>>>>>> Time, >>>>>>> ?prasannasimha@gmail.com writes: >>>>>>> >>>>>>> What is ?a "Bigelow ?procedure" ? >>>>>>> Prasanna >>>>>>> >>>>>>> -- >>>>>>> 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 >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> >>>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>>> and >>>>> disclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>> >>>> _________________________________________________________________ >>>> Save time by using Hotmail to access your other email accounts. >>>> >>>> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> ?OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>> >>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>> and >>>> disclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Oct 4 08:39:24 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 22:10:04 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> <89c4ed2d0910031133r6b14379x6300d5408b0a4bc6@mail.gmail.com> Message-ID: <89c4ed2d0910031909m510b76e3t4b4ad830033f1f1b@mail.gmail.com> If draped and isolated why should they "shriek" (We put the Femoral arterial line and Foleys and then do the Vein but why would one need to worry if we surgically isolate the leg or arm ?. In fact if leg is prepped after the Foley and the femoral arterial line placer is scrubbed up then vein harvest can go ahead pronto. The arm and leg is far away from the neck line site and don't people do noncardiac vascular surgery without the chest prepared ? Its all in the isolation and drapes are a plenty in the OR.I would suggest you make your "OR Police" shriek ;) Prasanna On Sun, Oct 4, 2009 at 4:20 AM, Ani Anyanwu wrote: > > Yes we harvest at same time as ready for sternotomy. Never before - I think our OR police would shreik if I suggested taking out radial while lines and foley being placed. > > > > I use a skeletonized procurement technique after several online and off-line discussions with Don. The last two I have also used verapamil as per don. i dont routinely use calcium blockers after surgery. > > > > Ani > >> From: prasannasimha@gmail.com >> Date: Sun, 4 Oct 2009 00:03:15 +0530 >> Subject: Re: [HSF] Subclavian stenosis case follow up >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> How do you harvest Ani ? After everything is ready ? What do the >> others on the list do ? >> >> On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu wrote: >> > >> > Prasanna >> >> > Do you usually procure the radial artery while anesthesia are placing the lines? >> >> > ani >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/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 other email accounts from your Hotmail inbox. Add them now. > http://clk.atdmt.com/UKM/go/167688463/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 Oct 4 08:51:06 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 3 22:21:51 2009 Subject: [HSF] TMR with recent MI In-Reply-To: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> Message-ID: <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> Tony and all HSFers, If you want to post incognito forward them to me. All HSFers are repeatedly invited to post any problems via me. A friend can laways "post an question" stripped of all details.HSF is too precious to allow legal wranglers from destroying a free spritied exchange. Also I think that the emails are now removed from "public view" now from the HSF website Prasanna On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD wrote: > Chuck, Tea, Ani, Hal > > If you think she would benefit from TMR, and she dopes not have ongoing > chest pain, not requiring NTG or heparin drips -- would be safest to > stabilize her with oral meds, let her "cool down" and do her in 4 weeks -- > CABG / TMR. ?I would go midline. ?Lateral approach OK , but limits future > redo IMO. > > If she can not be "stabilized" in this fashion, continues to have rest pain > and needs to be done now -- TMR increases risk of post-op death following > MI. ?Risk is 4X for the first two weeks and 2X for the ensuing 2 weeks, > whence it drops to "normal" (1X) [x being baseline STS risk of redo CABG. > ?This is the basis of the STS guidelines on TMR as they relate to doing it > Post-MI... and why medicare will sometimes not reimburse for post-MI TMR... > and the basis of several lawsuits regarding poor outcomes following CABG / > TMR following MI. > > Hal -- Dense perusal of the literature results seem to show benefit > depending on which laser was used. CO2 adn HoYAG although both called "TMR" > may actually be different procedures. > > Ani / Prasanna -- Yes -- still doing it. ?Did a redo CABG ?/ TMR yesterday. > ?have an isolated TMR Monday. ?Another Redo CABG / TMR schedled in two > weeks. > > and Yes... it works....CO2 that is -- ?stimulates formation of collaterals - > that's how Ani. > > Tea -- there I said it. ?'nuff said. ?Don't want the Cardiogenesis lawyers > chasing me down again and attempting to sue me for my thoughts on HSF, like > they did before. > > over and out, > (silent) Tony > > PS -- Sorry Ani... I hereby refuse, in advance, argue with your response to > this post.... Just don't have the time (can't type fast enough) to get into > it. ?Search the archives. Thnx > > > On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: > >> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few >> days ago with Class 4 angina; she was admitted to a nearby hospital with an >> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all other >> (vein grafts) closed. 90% Left main, closed RCA. She is living off that >> LIMA. There is an open ramus that is bypassable and a functional lateral >> wall. EF is 45%. Inferior wall is only scar on thallium I am planning Left >> thoracotomy radial graft to this Ramus from the Subclavian artery; initially >> had planned CO2 TMR to the lateral wall. Would anyone rule out adding TMR in >> the face of the recent infarct and abnormal EF? >> thx chuckdouville >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, 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 msfirst at gmail.com Sat Oct 3 23:46:51 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sat Oct 3 22:53:49 2009 Subject: [HSF] TMR with recent MI In-Reply-To: <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> Message-ID: <38FAD97E-88E5-4CF9-9A82-299AC5F56ECB@gmail.com> Doesn't really matter how stripped of identity it is. We are kidding ourselves if we think concepts such as freedom of speach or thought really exist. The price of expressing ones self particularly if it is something that is unpopular regardless of how true is too great. Right tea? Not worth it. We stay silent. A common theme throughout history. -michael/iPhone On Oct 3, 2009, at 10:21 PM, Prasanna Simha M wrote: > Tony and all HSFers, If you want to post incognito forward them to > me. > All HSFers are repeatedly invited to post any problems via me. A > friend can laways "post an question" stripped of all details.HSF is > too precious to allow legal wranglers from destroying a free spritied > exchange. > Also I think that the emails are now removed from "public view" now > from the HSF website > Prasanna > > On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD > wrote: >> Chuck, Tea, Ani, Hal >> >> If you think she would benefit from TMR, and she dopes not have >> ongoing >> chest pain, not requiring NTG or heparin drips -- would be safest to >> stabilize her with oral meds, let her "cool down" and do her in 4 >> weeks -- >> CABG / TMR. I would go midline. Lateral approach OK , but limits >> future >> redo IMO. >> >> If she can not be "stabilized" in this fashion, continues to have >> rest pain >> and needs to be done now -- TMR increases risk of post-op death >> following >> MI. Risk is 4X for the first two weeks and 2X for the ensuing 2 >> weeks, >> whence it drops to "normal" (1X) [x being baseline STS risk of redo >> CABG. >> This is the basis of the STS guidelines on TMR as they relate to >> doing it >> Post-MI... and why medicare will sometimes not reimburse for post- >> MI TMR... >> and the basis of several lawsuits regarding poor outcomes following >> CABG / >> TMR following MI. >> >> Hal -- Dense perusal of the literature results seem to show benefit >> depending on which laser was used. CO2 adn HoYAG although both >> called "TMR" >> may actually be different procedures. >> >> Ani / Prasanna -- Yes -- still doing it. Did a redo CABG / TMR >> yesterday. >> have an isolated TMR Monday. Another Redo CABG / TMR schedled in >> two >> weeks. >> >> and Yes... it works....CO2 that is -- stimulates formation of >> collaterals - >> that's how Ani. >> >> Tea -- there I said it. 'nuff said. Don't want the Cardiogenesis >> lawyers >> chasing me down again and attempting to sue me for my thoughts on >> HSF, like >> they did before. >> >> over and out, >> (silent) Tony >> >> PS -- Sorry Ani... I hereby refuse, in advance, argue with your >> response to >> this post.... Just don't have the time (can't type fast enough) to >> get into >> it. Search the archives. Thnx >> >> >> On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: >> >>> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw >>> her a few >>> days ago with Class 4 angina; she was admitted to a nearby >>> hospital with an >>> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, >>> all other >>> (vein grafts) closed. 90% Left main, closed RCA. She is living off >>> that >>> LIMA. There is an open ramus that is bypassable and a functional >>> lateral >>> wall. EF is 45%. Inferior wall is only scar on thallium I am >>> planning Left >>> thoracotomy radial graft to this Ramus from the Subclavian artery; >>> initially >>> had planned CO2 TMR to the lateral wall. Would anyone rule out >>> adding TMR in >>> the face of the recent infarct and abnormal EF? >>> thx chuckdouville >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, 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 nfaabouseada at gmail.com Sun Oct 4 00:29:49 2009 From: nfaabouseada at gmail.com (Nasser F Abou'Seada) Date: Sun Oct 4 00:30:22 2009 Subject: [HSF] TMR with recent MI In-Reply-To: <38FAD97E-88E5-4CF9-9A82-299AC5F56ECB@gmail.com> References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com><89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> <38FAD97E-88E5-4CF9-9A82-299AC5F56ECB@gmail.com> Message-ID: Michael Can I express my RIGHT OF FREE SPEECH here ? I BELIEVE you are RIGHT NFA -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg Sent: Saturday, October 03, 2009 9:47 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] TMR with recent MI Doesn't really matter how stripped of identity it is. We are kidding ourselves if we think concepts such as freedom of speach or thought really exist. The price of expressing ones self particularly if it is something that is unpopular regardless of how true is too great. Right tea? Not worth it. We stay silent. A common theme throughout history. -michael/iPhone On Oct 3, 2009, at 10:21 PM, Prasanna Simha M wrote: > Tony and all HSFers, If you want to post incognito forward them to > me. > All HSFers are repeatedly invited to post any problems via me. A > friend can laways "post an question" stripped of all details.HSF is > too precious to allow legal wranglers from destroying a free spritied > exchange. > Also I think that the emails are now removed from "public view" now > from the HSF website > Prasanna > > On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD > wrote: >> Chuck, Tea, Ani, Hal >> >> If you think she would benefit from TMR, and she dopes not have >> ongoing >> chest pain, not requiring NTG or heparin drips -- would be safest to >> stabilize her with oral meds, let her "cool down" and do her in 4 >> weeks -- >> CABG / TMR. I would go midline. Lateral approach OK , but limits >> future >> redo IMO. >> >> If she can not be "stabilized" in this fashion, continues to have >> rest pain >> and needs to be done now -- TMR increases risk of post-op death >> following >> MI. Risk is 4X for the first two weeks and 2X for the ensuing 2 >> weeks, >> whence it drops to "normal" (1X) [x being baseline STS risk of redo >> CABG. >> This is the basis of the STS guidelines on TMR as they relate to >> doing it >> Post-MI... and why medicare will sometimes not reimburse for post- >> MI TMR... >> and the basis of several lawsuits regarding poor outcomes following >> CABG / >> TMR following MI. >> >> Hal -- Dense perusal of the literature results seem to show benefit >> depending on which laser was used. CO2 adn HoYAG although both >> called "TMR" >> may actually be different procedures. >> >> Ani / Prasanna -- Yes -- still doing it. Did a redo CABG / TMR >> yesterday. >> have an isolated TMR Monday. Another Redo CABG / TMR schedled in >> two >> weeks. >> >> and Yes... it works....CO2 that is -- stimulates formation of >> collaterals - >> that's how Ani. >> >> Tea -- there I said it. 'nuff said. Don't want the Cardiogenesis >> lawyers >> chasing me down again and attempting to sue me for my thoughts on >> HSF, like >> they did before. >> >> over and out, >> (silent) Tony >> >> PS -- Sorry Ani... I hereby refuse, in advance, argue with your >> response to >> this post.... Just don't have the time (can't type fast enough) to >> get into >> it. Search the archives. Thnx >> >> >> On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: >> >>> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw >>> her a few >>> days ago with Class 4 angina; she was admitted to a nearby >>> hospital with an >>> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, >>> all other >>> (vein grafts) closed. 90% Left main, closed RCA. She is living off >>> that >>> LIMA. There is an open ramus that is bypassable and a functional >>> lateral >>> wall. EF is 45%. Inferior wall is only scar on thallium I am >>> planning Left >>> thoracotomy radial graft to this Ramus from the Subclavian artery; >>> initially >>> had planned CO2 TMR to the lateral wall. Would anyone rule out >>> adding TMR in >>> the face of the recent infarct and abnormal EF? >>> thx chuckdouville >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies >>> and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies >> anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From grescigno at mac.com Sun Oct 4 08:49:55 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Sun Oct 4 01:54:12 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <89c4ed2d0910031909m510b76e3t4b4ad830033f1f1b@mail.gmail.com> References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> <89c4ed2d0910031133r6b14379x6300d5408b0a4bc6@mail.gmail.com> <89c4ed2d0910031909m510b76e3t4b4ad830033f1f1b@mail.gmail.com> Message-ID: <99114204098463684034147127729904934360-Webmail@me.com> Prasanna, a good anesthesist needs less than 5 min in putting a CVC. I have harvested conduits before standard draping in case of lesser saphenous vein only. Giuseppe Giuseppe Rescigno M.D. Cardiothoracic Surgeon Lancisi Hospital Torrette - Ancona Italy On Sunday, 04 October, 2009, at 04:09AM, "Prasanna Simha M" wrote: >If draped and isolated why should they "shriek" (We put the Femoral >arterial line and Foleys and then do the Vein but why would one need >to worry if we surgically isolate the leg or arm ?. In fact if leg is >prepped after the Foley and the femoral arterial line placer is >scrubbed up then vein harvest can go ahead pronto. The arm and leg is >far away from the neck line site and don't people do noncardiac >vascular surgery without the chest prepared ? Its all in the isolation >and drapes are a plenty in the OR.I would suggest you make your "OR >Police" shriek ;) >Prasanna > >On Sun, Oct 4, 2009 at 4:20 AM, Ani Anyanwu wrote: >> >> Yes we harvest at same time as ready for sternotomy. Never before - I think our OR police would shreik if I suggested taking out radial while lines and foley being placed. >> >> >> >> I use a skeletonized procurement technique after several online and off-line discussions with Don. The last two I have also used verapamil as per don. i dont routinely use calcium blockers after surgery. >> >> >> >> Ani >> >>> From: prasannasimha@gmail.com >>> Date: Sun, 4 Oct 2009 00:03:15 +0530 >>> Subject: Re: [HSF] Subclavian stenosis case follow up >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> How do you harvest Ani ? After everything is ready ? What do the >>> others on the list do ? >>> >>> On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu wrote: >>> > >>> > Prasanna >>> >>> > Do you usually procure the radial artery while anesthesia are placing the lines? >>> >>> > ani >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/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 other email accounts from your Hotmail inbox. Add them now. >> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > >-- >Prasanna Simha M >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- > > From prasannasimha at gmail.com Sun Oct 4 12:31:31 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Oct 4 03:03:39 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <99114204098463684034147127729904934360-Webmail@me.com> References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> <89c4ed2d0910031133r6b14379x6300d5408b0a4bc6@mail.gmail.com> <89c4ed2d0910031909m510b76e3t4b4ad830033f1f1b@mail.gmail.com> <99114204098463684034147127729904934360-Webmail@me.com> Message-ID: <89c4ed2d0910032301n29618cf2s183de078635b63e0@mail.gmail.com> We float a PA and a CVP line so it will take longer and if he is taking 5 minutes to put a line he is not painting allowing the drug to act and draping properly !! (Dabbing paint is not equal to painting !!). I really think you should time it as what you think looks like 5 minutes is not. While doing a coronary anastomosis it looks as if we took 2 minutes and I know only very few surgeons who can actually do one in 2 minutes, one being Denton Cooley reputedly (I havent seen it) and the Late Nithu Mandke (whom I actually saw and timed !!). He would do all coronary anstomosis in one cardioplegia !! Valavanur Subramaniam commented that he operates not like even a fast train but like a rocket !!) Prasanna On Sun, Oct 4, 2009 at 11:19 AM, Giuseppe Rescigno wrote: > Prasanna, > > a good anesthesist needs less than 5 min in putting a CVC. I have harvested conduits before standard draping in case of lesser saphenous vein only. > > Giuseppe > > Giuseppe Rescigno M.D. > Cardiothoracic Surgeon > > Lancisi Hospital > Torrette - Ancona > Italy > > > > On Sunday, 04 October, 2009, at 04:09AM, "Prasanna Simha M" wrote: >>If draped and isolated why should they "shriek" (We put the Femoral >>arterial line and Foleys and then do the Vein but why would one need >>to worry if we surgically isolate the leg or arm ?. In fact if leg is >>prepped after the Foley and the femoral arterial line placer is >>scrubbed up then vein harvest can go ahead pronto. The arm and leg is >>far away from the neck line site and don't people do noncardiac >>vascular surgery without the chest prepared ? Its all in the isolation >>and drapes are a plenty in the OR.I would suggest you make your "OR >>Police" shriek ;) >>Prasanna >> >>On Sun, Oct 4, 2009 at 4:20 AM, Ani Anyanwu wrote: >>> >>> Yes we harvest at same time as ready for sternotomy. Never before - I think our OR police would shreik if I suggested taking out radial while lines and foley being placed. >>> >>> >>> >>> I use a skeletonized procurement technique after several online and off-line discussions with Don. The last two I have also used verapamil as per don. i dont routinely use calcium blockers after surgery. >>> >>> >>> >>> Ani >>> >>>> From: prasannasimha@gmail.com >>>> Date: Sun, 4 Oct 2009 00:03:15 +0530 >>>> Subject: Re: [HSF] Subclavian stenosis case follow up >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> >>>> How do you harvest Ani ? After everything is ready ? What do the >>>> others on the list do ? >>>> >>>> On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu wrote: >>>> > >>>> > Prasanna >>>> >>>> > Do you usually procure the radial artery while anesthesia are placing the lines? >>>> >>>> > ani >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/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 other email accounts from your Hotmail inbox. Add them now. >>> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> >> >>-- >>Prasanna Simha M >>_______________________________________________ >>OpenHeart-L mailing list >> >>Send postings to: >> OpenHeart-L@lists.hsforum.com >> >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>http://mmp.cjp.com/mailman/listinfo/openheart-l >> >>All messages transmitted by the OpenHeart-L are subject to the policies and >>disclaimers posted at: >>http://www.hsforum.com/listdisclaim >>----------------------------------------- >> >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From robertobattellini at hotmail.com Sun Oct 4 12:53:35 2009 From: robertobattellini at hotmail.com (Roberto Battellini) Date: Sun Oct 4 05:54:07 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: <313C0596-BBD0-4592-B603-CB6DD311D16D@bigpond.com> References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> Message-ID: Leipzig technique is: Lines are put in an Anaesthesia room (Einleitung) continuous to the OR, while the scrub nurse prepares everything. Surgeon takes the LIMA while the assistant takes the radial with harmonic Scalpel, then surgeon takes RIMA. Never put arm back, is time consuming.(the assistants afterwards get of course some backpain...) OR time 3 hours for CABG x 3 Leipzig > From: donross@bigpond.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Subclavian stenosis case follow up > Date: Sun, 4 Oct 2009 10:16:46 +1100 > CC: > > For my standard cabg X 3-4 the radial is taken while the chest is > opened and the LIMA harvested. > The T graft is constructed, usually, while the arm incision is closed. > With the arm back in place the distals are done, the usual total OR > time is 4 hours. > Don > On 04/10/2009, at 9:50 AM, Ani Anyanwu wrote: > > > > > Yes we harvest at same time as ready for sternotomy. Never before - > > I think our OR police would shreik if i suggested taking out radial > > while lines and foley being placed. > > > > > > > > I use a skeletonized procurement technique after several online and > > off-line discussions with Don. The last two I have also used > > verapamil as per don. i dont routinely use calcium blockers after > > surgery. > > > > > > > > Ani > > > >> From: prasannasimha@gmail.com > >> Date: Sun, 4 Oct 2009 00:03:15 +0530 > >> Subject: Re: [HSF] Subclavian stenosis case follow up > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> > >> How do you harvest Ani ? After everything is ready ? What do the > >> others on the list do ? > >> > >> On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu > >> wrote: > >>> > >>> Prasanna > >> > >>> Do you usually procure the radial artery while anesthesia are > >>> placing the lines? > >> > >>> ani > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 other email accounts from your Hotmail inbox. Add them now. > > http://clk.atdmt.com/UKM/go/167688463/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 ichfno at aol.com Sun Oct 4 07:58:25 2009 From: ichfno at aol.com (ichfno@aol.com) Date: Sun Oct 4 06:59:13 2009 Subject: [HSF] OR Police In-Reply-To: References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> Message-ID: <8CC12F8BB62C6D8-292C-2F71A@webmail-m041.sysops.aol.com> As you all know, we are trying to improve pediatric cardiac surgery in a number of different institutions world-wide. We have been invited to start a program de novo, in a new Maquet constructed center, that has never, ever performed ANY cardiac surgery. We have been requested to build the program from zero, no policy and procedures yet, nor Quality Assurance Comm, no nothing is in place. Ani's allusion (perhaps illusion is a better term) to OR police of course started the synapses firing. Would everyone send me thoughts on what organizational committee's, check lists, overseer's and what nots they think are valuable to improve care, proficiency and standardization, additionally thoughts on what is a waste of time would be kindly welcomed as well. Should be an interesting thread. Bill -----Original Message----- From: Roberto Battellini To: lists HSF Sent: Sun, Oct 4, 2009 4:53 am Subject: RE: [HSF] Subclavian stenosis case follow up Leipzig technique is: Lines are put in an Anaesthesia room (Einleitung) continuous to the OR, while the scrub nurse prepares everything. Surgeon takes the LIMA while the assistant takes the radial with harmonic Scalpel, then surgeon takes RIMA. Never put arm back, is time consuming.(the assistants afterwards get of course some backpain...) OR time 3 hours for CABG x 3 Leipzig > From: donross@bigpond.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Subclavian stenosis case follow up > Date: Sun, 4 Oct 2009 10:16:46 +1100 > CC: > > For my standard cabg X 3-4 the radial is taken while the chest is > opened and the LIMA harvested. > The T graft is constructed, usually, while the arm incision is closed. > With the arm back in place the distals are done, the usual total OR > time is 4 hours. > Don > On 04/10/2009, at 9:50 AM, Ani Anyanwu wrote: > > > > > Yes we harvest at same time as ready for sternotomy. Never before - > > I think our OR police would shreik if i suggested taking out radial > > while lines and foley being placed. > > > > > > > > I use a skeletonized procurement technique after several online and > > off-line discussions with Don. The last two I have also used > > verapamil as per don. i dont routinely use calcium blockers after > > surgery. > > > > > > > > Ani > > > >> From: prasannasimha@gmail.com > >> Date: Sun, 4 Oct 2009 00:03:15 +0530 > >> Subject: Re: [HSF] Subclavian stenosis case follow up > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> > >> How do you harvest Ani ? After everything is ready ? What do the > >> others on the list do ? > >> > >> On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu > >> wrote: > >>> > >>> Prasanna > >> > >>> Do you usually procure the radial artery while anesthesia are > >>> placing the lines? > >> > >>> ani > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/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 other email accounts from your Hotmail inbox. Add them now. > > http://clk.atdmt.com/UKM/go/167688463/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 anianyanwu at hotmail.com Sun Oct 4 14:20:50 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun Oct 4 09:21:44 2009 Subject: [HSF] HSF and lawyers etc In-Reply-To: <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> Message-ID: Does not really matter this is a 'closed' list - there are numerous non-cardiac surgeons that subscribe to this list. All the big industry players all follow this list closely and it won't surprise me if some legal companies also do. I have on a few occasions been approached by industry regarding (extreme) views I expressed on HSF about their's or competitor's products. I have also always been one to criticize or ignore single theme posters (those who lurk and then suddenly post a question about a case and never provide further info or contribute to subsequent discussion) - I bet you some of these are not surgeons but are third parties (lawyers, relatives, insurance companies etc) looking to gather ammunition to make a case against a surgeon. Only 2 days ago my office got a call from attorney in florida wanting to enlist me as an 'expert' witness in a case - I refused to return the call as I do not deal with lawyers except when I am being sued and refuse to be part of this medicolegal machinery. I have a strange suspicion they tracked me through HSF and noticed I seem to be able to argue anything. That said I do feel somewhat guilty because the attorney calling may well have been defending a colleague and we probably should all make out time to help in cases brought up against colleagues. Else what you have is a pool of 'experts' usually made up of non-operating surgeons or even non-cardiac surgeons who are the ones that are supposed to fight our case. My experience in cases I have been involved in is that I have a far better understanding of the issues than the doctors advising either side and the lawyers are paying all these experts sums of money for nothing. I see that the real case that can be made against me is not being made, and that there are wide holes in the case being made against me that the experts my lawyers are paying have not observed. I could do a much much better job for either side. Unless this list is revamped and started afresh with strictly named surgeons verified off collaborative sources such as society records or CTSNET, lawyers, industry and other third parties will always be part of any discussions we have. This is anything but a closed list. Ani > From: prasannasimha@gmail.com > Date: Sun, 4 Oct 2009 07:51:06 +0530 > Subject: Re: [HSF] TMR with recent MI > To: OpenHeart-L@lists.hsforum.com > CC: > > Tony and all HSFers, If you want to post incognito forward them to me. > All HSFers are repeatedly invited to post any problems via me. A > friend can laways "post an question" stripped of all details.HSF is > too precious to allow legal wranglers from destroying a free spritied > exchange. > Also I think that the emails are now removed from "public view" now > from the HSF website > Prasanna > > On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD > wrote: > > Chuck, Tea, Ani, Hal > > > > If you think she would benefit from TMR, and she dopes not have ongoing > > chest pain, not requiring NTG or heparin drips -- would be safest to > > stabilize her with oral meds, let her "cool down" and do her in 4 weeks -- > > CABG / TMR. I would go midline. Lateral approach OK , but limits future > > redo IMO. > > > > If she can not be "stabilized" in this fashion, continues to have rest pain > > and needs to be done now -- TMR increases risk of post-op death following > > MI. Risk is 4X for the first two weeks and 2X for the ensuing 2 weeks, > > whence it drops to "normal" (1X) [x being baseline STS risk of redo CABG. > > This is the basis of the STS guidelines on TMR as they relate to doing it > > Post-MI... and why medicare will sometimes not reimburse for post-MI TMR... > > and the basis of several lawsuits regarding poor outcomes following CABG / > > TMR following MI. > > > > Hal -- Dense perusal of the literature results seem to show benefit > > depending on which laser was used. CO2 adn HoYAG although both called "TMR" > > may actually be different procedures. > > > > Ani / Prasanna -- Yes -- still doing it. Did a redo CABG / TMR yesterday. > > have an isolated TMR Monday. Another Redo CABG / TMR schedled in two > > weeks. > > > > and Yes... it works....CO2 that is -- stimulates formation of collaterals - > > that's how Ani. > > > > Tea -- there I said it. 'nuff said. Don't want the Cardiogenesis lawyers > > chasing me down again and attempting to sue me for my thoughts on HSF, like > > they did before. > > > > over and out, > > (silent) Tony > > > > PS -- Sorry Ani... I hereby refuse, in advance, argue with your response to > > this post.... Just don't have the time (can't type fast enough) to get into > > it. Search the archives. Thnx > > > > > > On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: > > > >> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few > >> days ago with Class 4 angina; she was admitted to a nearby hospital with an > >> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all other > >> (vein grafts) closed. 90% Left main, closed RCA. She is living off that > >> LIMA. There is an open ramus that is bypassable and a functional lateral > >> wall. EF is 45%. Inferior wall is only scar on thallium I am planning Left > >> thoracotomy radial graft to this Ramus from the Subclavian artery; initially > >> had planned CO2 TMR to the lateral wall. Would anyone rule out adding TMR in > >> the face of the recent infarct and abnormal EF? > >> thx chuckdouville > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >> All messages transmitted by the OpenHeart-L are subject to the policies > >> and > >> disclaimers posted at: > >> http://www.hsforum.com/listdisclaim > >> ----------------------------------------- > >> > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, 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 > ----------------------------------------- _________________________________________________________________ Save time by using Hotmail to access your other email accounts. http://clk.atdmt.com/UKM/go/167688463/direct/01/ From otto at iafrica.com Sun Oct 4 16:23:01 2009 From: otto at iafrica.com (Otto Thaning) Date: Sun Oct 4 09:24:07 2009 Subject: [HSF] Stented subclavian stenosis References: <89c4ed2d0909250452x471fa64dwbb4ff903382f5cb9@mail.gmail.com> Message-ID: <7CDCB99B05874722BEC436C8E66500BC@private799f148> Ani - somehow I seem to be missing something. The discussion seems to revolve around whether the LIMA should be used in the setting of inflow from a stented left subclavian artery. I can accept that the stenting in the left subclavian artery has been done for left arm symptomatology, but to additonally 'hang' the wellbeing of the additional myocardium on the future fo the stent in the subclavian seems illogical to me when we decry the concept of coronary stents and their longterm patency results, and advocate coronary surgical revascularisation in preference to PCI. If we are true to our beliefs then surely we should recommend a free graft LIMA to LAD, rather than a LIMA from a stented vessel?! OTTO THANING Cape Town ----- Original Message ----- From: "Ani Anyanwu" To: "open heart list" Sent: Friday, September 25, 2009 8:12 PM Subject: RE: [HSF] Stented subclavian stenosis > "If though he had symptomatic subclavian stenosis, may change things > somewhat." since now he has a stented sublcavian with good run off how > would things now differ ? > Prasanna Things differ because the questions are different, and so will be the answers. The question from the first scenario is: I have a patient with coronary disease and found a stenosed left subcalvian. I placed a stent in the vessel yesterday with a view to performing LIMA grafting next week - what do you think of my plan? The second scenario's question is: I have a patient who had a subclavian stent yesterday for arm ischemia and I plan to do CABG next week. Should I use the LIMA? And there is the third unasked question - probably the real question here - which has been overtaken by events (hence muting responses): I have a patient with coronary artery disease and a stenosed left subcalvian artery who needs CABG. How do I manage it? Although all looking at the same scenario the answers we get can be very divergent depending on which question we ask. As humans we are biased by the answers people asking the question already seem to have given to their question. Its like your friendly cardiologist calls you to the lab and says to you "i have this guy with short isolated mid left main disease, I already have a wire in the artery and looks like it is easy to balloon and stent - will take five minutes but I just wanted you to take a quick look at the film first?" (and as you look a tech is showing him various sizes of stents). Very different question from "I have this patient with left main disease - how should we manage it?". Ani > From: prasannasimha@gmail.com > Date: Fri, 25 Sep 2009 18:16:21 +0530 > Subject: Re: [HSF] Stented subclavian stenosis > To: OpenHeart-L@lists.hsforum.com > CC: > > He had confusing symptomatology with presentation with left arm pain > on exertion and weak pulses. A coronary angio + left subclavian shoot > was done was done showing the subclavian stenosis - short segment and > good for stenting.. The plan was/is to stent and use the LIMA if the > subclavian stenting gives a good result.(The result is good). I > discussed this with the cardiologist and also mentioned I would take > an opinion from the group and hence posed the question. > I did not understand what you meant with your statement > "If though he had symptomatic subclavian stenosis, may change things > somewhat." since now he has a stented sublcavian with good run off how > would things now differ ? > Prasanna > > On Fri, Sep 25, 2009 at 6:06 PM, Ani Anyanwu > wrote: > > > > I am confused as to why you ask this question. If he had a stent > > yesterday and CABG planned for next week was the whole intent of the > > stent not to allow LIMA grafting? Otherwise why was subclavian stented? > > If so is this not a fait accomplait or are you just asking us to > > validate a plan already being executed? Given that the subclavian is > > already stented - presumably successfully - there does not seem much > > grounds to not use the IMA (on this basis). If though he had symptomatic > > subclavian stenosis, may change things somewhat. > > > > > > > > How was the subcalvian stenosis diagnosed and why was a stent placed? > > > > > > > > Ani > > > >> From: prasannasimha@gmail.com > >> Date: Fri, 25 Sep 2009 17:22:18 +0530 > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> Subject: [HSF] Stented subclavian stenosis > >> > >> I have a case - Left main with left subclavian stenosis. Will require > >> CABG. The left subclavian was stented yesterday and a CABG is planned > >> for Tuesday (unless he gets symptoms). He is on Aspirin and Heparin. > >> Since this stenosis is now successfully stented I am debating about > >> going ahead with the LIMA. What is the opinion of the group ? or > >> should I use a RIMA to LAD ?.Plan is for a radial for OM and vein to > >> the PDA (70% stenosis). (I do want multiple inflows) > >> > >> 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 > >> ----------------------------------------- > > > > _________________________________________________________________ > > > > MSN straight to your mobile - news, entertainment, videos and more. > > > > http://clk.atdmt.com/UKM/go/147991039/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 > ----------------------------------------- _________________________________________________________________ With Windows Live, you can organise, edit, and share your photos. 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 prasannasimha at gmail.com Sun Oct 4 19:58:34 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Oct 4 09:36:21 2009 Subject: [HSF] HSF and lawyers etc In-Reply-To: References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> Message-ID: <89c4ed2d0910040628x67c0d6aflf508069d899dde9f@mail.gmail.com> When I joined Dr Levinson asked me to "Fax" my letter head !! I did not have access to a Fax or a scanner at that time!! I don't remember how I convinced him I was a cardiac surgeon. I do now at times that some people in the industry are on this list.Not really sure how they came on this list. There have been some legal issues in the past forcing Dr Levinson to remove public display of discussions One person asked me why I gave some adverse comment on some product and I "mildly" ticked him off and told him to mind his own business. That product never came to be popular !! Prasanna On Sun, Oct 4, 2009 at 6:50 PM, Ani Anyanwu wrote: > Does not really matter this is a 'closed' list - there are numerous non-cardiac surgeons that subscribe to this list. All the big industry players all follow this list closely and it won't surprise me if some legal companies also do. I have on a few occasions been approached ?by industry regarding (extreme) ?views I expressed on HSF about their's or competitor's products. > > I have also always been one to criticize or ignore single theme posters (those who lurk and then suddenly post a question about a case and never provide further info or contribute to subsequent discussion) - I bet you some of these are not surgeons but are third parties (lawyers, relatives, insurance companies etc) looking to gather ammunition to make a case against a surgeon. > > Only 2 days ago my office got a call from attorney in florida wanting to enlist me as an 'expert' witness in a case - I refused to return the call as I do not deal with lawyers except when I am being sued and refuse to be part of this medicolegal machinery. I have a strange suspicion they tracked me through HSF and noticed I seem to be able to argue anything. That said I do feel somewhat guilty because the attorney calling may well have been defending a colleague and we probably should all make out time to help in cases brought up against colleagues. Else what you have is a pool of 'experts' usually made up of non-operating surgeons or even non-cardiac surgeons who are the ones that are supposed to fight our case. My experience in cases I have been involved in is that I have a far better understanding of the issues than the doctors advising either side and the lawyers are paying all these experts sums of money for nothing. I see that the real case that can be made against me is not being made, and that there are wide holes in the case being made against me that the experts my lawyers are paying have not observed. I could do a much much better job for either side. > > Unless this list is revamped and started afresh with strictly named surgeons verified off collaborative sources such as society records or CTSNET, lawyers, industry and other third parties will always be part of any discussions we have. This is anything but a closed list. > > Ani > >> From: prasannasimha@gmail.com >> Date: Sun, 4 Oct 2009 07:51:06 +0530 >> Subject: Re: [HSF] TMR with recent MI >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Tony ?and all HSFers, If you want to post incognito forward them to me. >> All HSFers are repeatedly invited to post any problems via me. A >> friend can laways "post an question" stripped of all details.HSF is >> too precious to allow ?legal wranglers from destroying a free spritied >> exchange. >> Also I think that the emails are now removed from "public view" now >> from the HSF website >> Prasanna >> >> On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD >> wrote: >> > Chuck, Tea, Ani, Hal >> > >> > If you think she would benefit from TMR, and she dopes not have ongoing >> > chest pain, not requiring NTG or heparin drips -- would be safest to >> > stabilize her with oral meds, let her "cool down" and do her in 4 weeks -- >> > CABG / TMR. ?I would go midline. ?Lateral approach OK , but limits future >> > redo IMO. >> > >> > If she can not be "stabilized" in this fashion, continues to have rest pain >> > and needs to be done now -- TMR increases risk of post-op death following >> > MI. ?Risk is 4X for the first two weeks and 2X for the ensuing 2 weeks, >> > whence it drops to "normal" (1X) [x being baseline STS risk of redo CABG. >> > ?This is the basis of the STS guidelines on TMR as they relate to doing it >> > Post-MI... and why medicare will sometimes not reimburse for post-MI TMR... >> > and the basis of several lawsuits regarding poor outcomes following CABG / >> > TMR following MI. >> > >> > Hal -- Dense perusal of the literature results seem to show benefit >> > depending on which laser was used. CO2 adn HoYAG although both called "TMR" >> > may actually be different procedures. >> > >> > Ani / Prasanna -- Yes -- still doing it. ?Did a redo CABG ?/ TMR yesterday. >> > ?have an isolated TMR Monday. ?Another Redo CABG / TMR schedled in two >> > weeks. >> > >> > and Yes... it works....CO2 that is -- ?stimulates formation of collaterals - >> > that's how Ani. >> > >> > Tea -- there I said it. ?'nuff said. ?Don't want the Cardiogenesis lawyers >> > chasing me down again and attempting to sue me for my thoughts on HSF, like >> > they did before. >> > >> > over and out, >> > (silent) Tony >> > >> > PS -- Sorry Ani... I hereby refuse, in advance, argue with your response to >> > this post.... Just don't have the time (can't type fast enough) to get into >> > it. ?Search the archives. Thnx >> > >> > >> > On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: >> > >> >> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few >> >> days ago with Class 4 angina; she was admitted to a nearby hospital with an >> >> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all other >> >> (vein grafts) closed. 90% Left main, closed RCA. She is living off that >> >> LIMA. There is an open ramus that is bypassable and a functional lateral >> >> wall. EF is 45%. Inferior wall is only scar on thallium I am planning Left >> >> thoracotomy radial graft to this Ramus from the Subclavian artery; initially >> >> had planned CO2 TMR to the lateral wall. Would anyone rule out adding TMR in >> >> the face of the recent infarct and abnormal EF? >> >> thx chuckdouville >> >> _______________________________________________ >> >> OpenHeart-L mailing list >> >> >> >> Send postings to: >> >> OpenHeart-L@lists.hsforum.com >> >> >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> >> and >> >> disclaimers posted at: >> >> http://www.hsforum.com/listdisclaim >> >> ----------------------------------------- >> >> >> > >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, 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 >> ----------------------------------------- > > _________________________________________________________________ > Save time by using Hotmail to access your other email accounts. > http://clk.atdmt.com/UKM/go/167688463/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 Oct 4 20:00:03 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Oct 4 09:36:38 2009 Subject: [HSF] Stented subclavian stenosis In-Reply-To: <7CDCB99B05874722BEC436C8E66500BC@private799f148> References: <89c4ed2d0909250452x471fa64dwbb4ff903382f5cb9@mail.gmail.com> <7CDCB99B05874722BEC436C8E66500BC@private799f148> Message-ID: <89c4ed2d0910040630p1e9c82eevf22e31318030f52f@mail.gmail.com> Otto there is a difference between a stent for a short length stenosis for alarge vessel versus a stent in a coronary - the patencies and behaviour are different. Prasanna On Sun, Oct 4, 2009 at 6:53 PM, Otto Thaning wrote: > Ani - somehow I seem to be missing something. The discussion seems to > revolve around whether the LIMA should be used in the setting of inflow from > a stented left subclavian artery. I can accept that the stenting in the left > subclavian artery has been done for left arm symptomatology, but to > additonally 'hang' the wellbeing of the additional myocardium on the future > fo the stent in the subclavian seems illogical to me when we decry the > concept of coronary stents and their longterm patency results, and advocate > coronary surgical revascularisation in preference to PCI. > > If we are true to our beliefs then surely we should recommend a free graft > LIMA to LAD, rather than a LIMA from a stented vessel?! > > OTTO THANING > Cape Town > ----- Original Message ----- From: "Ani Anyanwu" > To: "open heart list" > Sent: Friday, September 25, 2009 8:12 PM > Subject: RE: [HSF] Stented subclavian stenosis > > > >> "If though he had symptomatic subclavian stenosis, may change things >> somewhat." since now he has a stented sublcavian with good run off how >> would things now differ ? >> Prasanna > > > > Things differ because the questions are different, and so will be the > answers. > > > > The question from the first scenario is: I have a patient with coronary > disease and found a stenosed left subcalvian. I placed a stent in the vessel > yesterday with a view to performing LIMA grafting next week - what do you > think of my plan? > > > > The second scenario's question is: I have a patient who had a subclavian > stent yesterday for arm ischemia and I plan to do CABG next week. Should I > use the LIMA? > > > > And there is the third unasked question - probably the real question here - > which has been overtaken by events (hence muting responses): I have a > patient with coronary artery disease and a stenosed left subcalvian artery > who needs CABG. How do I manage it? > > > > Although all looking at the same scenario the answers we get can be very > divergent depending on which question we ask. As humans we are biased by the > answers people asking the question already seem to have given to their > question. Its like your friendly cardiologist calls you to the lab and says > to you "i have this guy with short isolated mid left main disease, I already > have a wire in the artery and looks like it is easy to balloon and stent - > will take five minutes but I just wanted you to take a quick look at the > film first?" (and as you look a tech is showing him various sizes of > stents). Very different question from "I have this patient with left main > disease - how should we manage it?". > > > Ani > > >> From: prasannasimha@gmail.com >> Date: Fri, 25 Sep 2009 18:16:21 +0530 >> Subject: Re: [HSF] Stented subclavian stenosis >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> He had confusing symptomatology with presentation with left arm pain >> on exertion and weak pulses. A coronary angio + left subclavian shoot >> was done was done showing the subclavian stenosis - short segment and >> good for stenting.. The plan was/is to stent and use the LIMA if the >> subclavian stenting gives a good result.(The result is good). I >> discussed this with the cardiologist and also mentioned I would take >> an opinion from the group and hence posed the question. >> I did not understand what you meant with your statement >> "If though he had symptomatic subclavian stenosis, may change things >> somewhat." since now he has a stented sublcavian with good run off how >> would things now differ ? >> Prasanna >> >> On Fri, Sep 25, 2009 at 6:06 PM, Ani Anyanwu >> wrote: >> > >> > I am confused as to why you ask this question. If he had a stent > >> > yesterday and CABG planned for next week was the whole intent of the > stent >> > not to allow LIMA grafting? Otherwise why was subclavian stented? > If so is >> > this not a fait accomplait or are you just asking us to > validate a plan >> > already being executed? Given that the subclavian is > already stented - >> > presumably successfully - there does not seem much > grounds to not use the >> > IMA (on this basis). If though he had symptomatic > subclavian stenosis, may >> > change things somewhat. >> > >> > >> > >> > How was the subcalvian stenosis diagnosed and why was a stent placed? >> > >> > >> > >> > Ani >> > >> >> From: prasannasimha@gmail.com >> >> Date: Fri, 25 Sep 2009 17:22:18 +0530 >> >> To: OpenHeart-L@lists.hsforum.com >> >> CC: >> >> Subject: [HSF] Stented subclavian stenosis >> >> >> >> I have a case - Left main with left subclavian stenosis. Will require >> >> CABG. The left subclavian was stented yesterday and a CABG is planned >> >> for Tuesday (unless he gets symptoms). He is on Aspirin and Heparin. >> >> Since this stenosis is now successfully stented I am debating about >> >> going ahead with the LIMA. What is the opinion of the group ? or >> >> should I use a RIMA to LAD ?.Plan is for a radial for OM and vein to >> >> the PDA (70% stenosis). (I do want multiple inflows) >> >> >> >> 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 >> >> ----------------------------------------- >> > >> > _________________________________________________________________ >> > >> > MSN straight to your mobile - news, entertainment, videos and more. >> > >> > >> > http://clk.atdmt.com/UKM/go/147991039/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 >> ----------------------------------------- > > _________________________________________________________________ > With Windows Live, you can organise, edit, and share your photos. > 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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Oct 4 20:05:22 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Oct 4 10:06:45 2009 Subject: [HSF] HSF and lawyers etc In-Reply-To: References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> Message-ID: <89c4ed2d0910040635m27d3bef4p75826ffd4f9d2cc7@mail.gmail.com> Even with all of that I still keep an open offer that I will describe a problematic case to the list when advice is seeked. I have learnt a lot from this list by posing problems and have changed my practice many a time based on suggestions on this list. I consider it a precious resource and dont hesitate to share my experiences and my problems. Prasanna On Sun, Oct 4, 2009 at 6:50 PM, Ani Anyanwu wrote: > Does not really matter this is a 'closed' list - there are numerous non-cardiac surgeons that subscribe to this list. All the big industry players all follow this list closely and it won't surprise me if some legal companies also do. I have on a few occasions been approached ?by industry regarding (extreme) ?views I expressed on HSF about their's or competitor's products. > > I have also always been one to criticize or ignore single theme posters (those who lurk and then suddenly post a question about a case and never provide further info or contribute to subsequent discussion) - I bet you some of these are not surgeons but are third parties (lawyers, relatives, insurance companies etc) looking to gather ammunition to make a case against a surgeon. > > Only 2 days ago my office got a call from attorney in florida wanting to enlist me as an 'expert' witness in a case - I refused to return the call as I do not deal with lawyers except when I am being sued and refuse to be part of this medicolegal machinery. I have a strange suspicion they tracked me through HSF and noticed I seem to be able to argue anything. That said I do feel somewhat guilty because the attorney calling may well have been defending a colleague and we probably should all make out time to help in cases brought up against colleagues. Else what you have is a pool of 'experts' usually made up of non-operating surgeons or even non-cardiac surgeons who are the ones that are supposed to fight our case. My experience in cases I have been involved in is that I have a far better understanding of the issues than the doctors advising either side and the lawyers are paying all these experts sums of money for nothing. I see that the real case that can be made against me is not being made, and that there are wide holes in the case being made against me that the experts my lawyers are paying have not observed. I could do a much much better job for either side. > > Unless this list is revamped and started afresh with strictly named surgeons verified off collaborative sources such as society records or CTSNET, lawyers, industry and other third parties will always be part of any discussions we have. This is anything but a closed list. > > Ani > >> From: prasannasimha@gmail.com >> Date: Sun, 4 Oct 2009 07:51:06 +0530 >> Subject: Re: [HSF] TMR with recent MI >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> Tony ?and all HSFers, If you want to post incognito forward them to me. >> All HSFers are repeatedly invited to post any problems via me. A >> friend can laways "post an question" stripped of all details.HSF is >> too precious to allow ?legal wranglers from destroying a free spritied >> exchange. >> Also I think that the emails are now removed from "public view" now >> from the HSF website >> Prasanna >> >> On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD >> wrote: >> > Chuck, Tea, Ani, Hal >> > >> > If you think she would benefit from TMR, and she dopes not have ongoing >> > chest pain, not requiring NTG or heparin drips -- would be safest to >> > stabilize her with oral meds, let her "cool down" and do her in 4 weeks -- >> > CABG / TMR. ?I would go midline. ?Lateral approach OK , but limits future >> > redo IMO. >> > >> > If she can not be "stabilized" in this fashion, continues to have rest pain >> > and needs to be done now -- TMR increases risk of post-op death following >> > MI. ?Risk is 4X for the first two weeks and 2X for the ensuing 2 weeks, >> > whence it drops to "normal" (1X) [x being baseline STS risk of redo CABG. >> > ?This is the basis of the STS guidelines on TMR as they relate to doing it >> > Post-MI... and why medicare will sometimes not reimburse for post-MI TMR... >> > and the basis of several lawsuits regarding poor outcomes following CABG / >> > TMR following MI. >> > >> > Hal -- Dense perusal of the literature results seem to show benefit >> > depending on which laser was used. CO2 adn HoYAG although both called "TMR" >> > may actually be different procedures. >> > >> > Ani / Prasanna -- Yes -- still doing it. ?Did a redo CABG ?/ TMR yesterday. >> > ?have an isolated TMR Monday. ?Another Redo CABG / TMR schedled in two >> > weeks. >> > >> > and Yes... it works....CO2 that is -- ?stimulates formation of collaterals - >> > that's how Ani. >> > >> > Tea -- there I said it. ?'nuff said. ?Don't want the Cardiogenesis lawyers >> > chasing me down again and attempting to sue me for my thoughts on HSF, like >> > they did before. >> > >> > over and out, >> > (silent) Tony >> > >> > PS -- Sorry Ani... I hereby refuse, in advance, argue with your response to >> > this post.... Just don't have the time (can't type fast enough) to get into >> > it. ?Search the archives. Thnx >> > >> > >> > On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: >> > >> >> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her a few >> >> days ago with Class 4 angina; she was admitted to a nearby hospital with an >> >> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all other >> >> (vein grafts) closed. 90% Left main, closed RCA. She is living off that >> >> LIMA. There is an open ramus that is bypassable and a functional lateral >> >> wall. EF is 45%. Inferior wall is only scar on thallium I am planning Left >> >> thoracotomy radial graft to this Ramus from the Subclavian artery; initially >> >> had planned CO2 TMR to the lateral wall. Would anyone rule out adding TMR in >> >> the face of the recent infarct and abnormal EF? >> >> thx chuckdouville >> >> _______________________________________________ >> >> OpenHeart-L mailing list >> >> >> >> Send postings to: >> >> OpenHeart-L@lists.hsforum.com >> >> >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> >> >> All messages transmitted by the OpenHeart-L are subject to the policies >> >> and >> >> disclaimers posted at: >> >> http://www.hsforum.com/listdisclaim >> >> ----------------------------------------- >> >> >> > >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, 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 >> ----------------------------------------- > > _________________________________________________________________ > Save time by using Hotmail to access your other email accounts. > http://clk.atdmt.com/UKM/go/167688463/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 TSalerno at med.miami.edu Sun Oct 4 11:18:35 2009 From: TSalerno at med.miami.edu (Salerno, Tomas) Date: Sun Oct 4 10:19:19 2009 Subject: [HSF] HSF and lawyers etc In-Reply-To: <89c4ed2d0910040635m27d3bef4p75826ffd4f9d2cc7@mail.gmail.com> References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> <89c4ed2d0910040635m27d3bef4p75826ffd4f9d2cc7@mail.gmail.com> Message-ID: This site is monitored and in a recent instance the lawyer brought up everything that I had written in HSF I thought this was a close site and non discoverable - I was wrong Some of us may come to regret what we write or present on this site All will be included should litigation occurs I have written about this before, and even that was brought up Ts Sent from my iPhone On Oct 4, 2009, at 10:07 AM, "Prasanna Simha M" wrote: > Even with all of that I still keep an open offer that I will describe > a problematic case to the list when advice is seeked. > I have learnt a lot from this list by posing problems and have changed > my practice many a time based on suggestions on this list. > I consider it a precious resource and dont hesitate to share my > experiences and my problems. > Prasanna > > On Sun, Oct 4, 2009 at 6:50 PM, Ani Anyanwu > wrote: >> Does not really matter this is a 'closed' list - there are numerous >> non-cardiac surgeons that subscribe to this list. All the big >> industry players all follow this list closely and it won't surprise >> me if some legal companies also do. I have on a few occasions been >> approached by industry regarding (extreme) views I expressed on >> HSF about their's or competitor's products. >> >> I have also always been one to criticize or ignore single theme >> posters (those who lurk and then suddenly post a question about a >> case and never provide further info or contribute to subsequent >> discussion) - I bet you some of these are not surgeons but are >> third parties (lawyers, relatives, insurance companies etc) looking >> to gather ammunition to make a case against a surgeon. >> >> Only 2 days ago my office got a call from attorney in florida >> wanting to enlist me as an 'expert' witness in a case - I refused >> to return the call as I do not deal with lawyers except when I am >> being sued and refuse to be part of this medicolegal machinery. I >> have a strange suspicion they tracked me through HSF and noticed I >> seem to be able to argue anything. That said I do feel somewhat >> guilty because the attorney calling may well have been defending a >> colleague and we probably should all make out time to help in cases >> brought up against colleagues. Else what you have is a pool of >> 'experts' usually made up of non-operating surgeons or even non- >> cardiac surgeons who are the ones that are supposed to fight our >> case. My experience in cases I have been involved in is that I have >> a far better understanding of the issues than the doctors advising >> either side and the lawyers are paying all these experts sums of >> money for nothing. I see that the real case that can be made >> against me is not being made, and that there are wide holes in the >> case being made against me that the experts my lawyers are paying >> have not observed. I could do a much much better job for either side. >> >> Unless this list is revamped and started afresh with strictly named >> surgeons verified off collaborative sources such as society records >> or CTSNET, lawyers, industry and other third parties will always be >> part of any discussions we have. This is anything but a closed list. >> >> Ani >> >>> From: prasannasimha@gmail.com >>> Date: Sun, 4 Oct 2009 07:51:06 +0530 >>> Subject: Re: [HSF] TMR with recent MI >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> Tony and all HSFers, If you want to post incognito forward them >>> to me. >>> All HSFers are repeatedly invited to post any problems via me. A >>> friend can laways "post an question" stripped of all details.HSF is >>> too precious to allow legal wranglers from destroying a free >>> spritied >>> exchange. >>> Also I think that the emails are now removed from "public view" now >>> from the HSF website >>> Prasanna >>> >>> On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD >>> wrote: >>>> Chuck, Tea, Ani, Hal >>>> >>>> If you think she would benefit from TMR, and she dopes not have >>>> ongoing >>>> chest pain, not requiring NTG or heparin drips -- would be safest >>>> to >>>> stabilize her with oral meds, let her "cool down" and do her in 4 >>>> weeks -- >>>> CABG / TMR. I would go midline. Lateral approach OK , but >>>> limits future >>>> redo IMO. >>>> >>>> If she can not be "stabilized" in this fashion, continues to have >>>> rest pain >>>> and needs to be done now -- TMR increases risk of post-op death >>>> following >>>> MI. Risk is 4X for the first two weeks and 2X for the ensuing 2 >>>> weeks, >>>> whence it drops to "normal" (1X) [x being baseline STS risk of >>>> redo CABG. >>>> This is the basis of the STS guidelines on TMR as they relate to >>>> doing it >>>> Post-MI... and why medicare will sometimes not reimburse for post- >>>> MI TMR... >>>> and the basis of several lawsuits regarding poor outcomes >>>> following CABG / >>>> TMR following MI. >>>> >>>> Hal -- Dense perusal of the literature results seem to show benefit >>>> depending on which laser was used. CO2 adn HoYAG although both >>>> called "TMR" >>>> may actually be different procedures. >>>> >>>> Ani / Prasanna -- Yes -- still doing it. Did a redo CABG / TMR >>>> yesterday. >>>> have an isolated TMR Monday. Another Redo CABG / TMR schedled >>>> in two >>>> weeks. >>>> >>>> and Yes... it works....CO2 that is -- stimulates formation of >>>> collaterals - >>>> that's how Ani. >>>> >>>> Tea -- there I said it. 'nuff said. Don't want the >>>> Cardiogenesis lawyers >>>> chasing me down again and attempting to sue me for my thoughts on >>>> HSF, like >>>> they did before. >>>> >>>> over and out, >>>> (silent) Tony >>>> >>>> PS -- Sorry Ani... I hereby refuse, in advance, argue with your >>>> response to >>>> this post.... Just don't have the time (can't type fast enough) >>>> to get into >>>> it. Search the archives. Thnx >>>> >>>> >>>> On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: >>>> >>>>> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw >>>>> her a few >>>>> days ago with Class 4 angina; she was admitted to a nearby >>>>> hospital with an >>>>> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to >>>>> LAD, all other >>>>> (vein grafts) closed. 90% Left main, closed RCA. She is living >>>>> off that >>>>> LIMA. There is an open ramus that is bypassable and a functional >>>>> lateral >>>>> wall. EF is 45%. Inferior wall is only scar on thallium I am >>>>> planning Left >>>>> thoracotomy radial graft to this Ramus from the Subclavian >>>>> artery; initially >>>>> had planned CO2 TMR to the lateral wall. Would anyone rule out >>>>> adding TMR in >>>>> the face of the recent infarct and abnormal EF? >>>>> thx chuckdouville >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> >>>>> All messages transmitted by the OpenHeart-L are subject to the >>>>> policies >>>>> and >>>>> disclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>>> >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, 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 >>> ----------------------------------------- >> >> _________________________________________________________________ >> Save time by using Hotmail to access your other email accounts. >> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From msfirst at gmail.com Sun Oct 4 11:22:21 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Oct 4 10:22:53 2009 Subject: [HSF] HSF and lawyers etc In-Reply-To: <89c4ed2d0910040635m27d3bef4p75826ffd4f9d2cc7@mail.gmail.com> References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> <89c4ed2d0910040635m27d3bef4p75826ffd4f9d2cc7@mail.gmail.com> Message-ID: Prasanna, I have often questioned if you are in fact a real surgeon. Ani - I can not blame your avoidance of lawyers in malpractice suits. I have often been approached to review cases against doctors and/or hospital systems - and I will always at least take a look. While I am clearly no expert in terms of decades of experience etc etc etc - sometimes a review by someone who understands what we have to deal with can save one of us a lot of headache. Every case I have reviewed has been dismissed based upon, in part (I think), of comments that I have brought up in the chart and medical literature review. Even if there is something horribly wrong - then a good analytical mind like your might help knock a few zero's off of a judgement. Contrary to Hal's experiences (which I tend to agree with) - have a few lawyers as "friends" is kind of like chicken soup. If you need a good immigration lawyer, I am sure Mario would recommend my mother. -michael On Sun, Oct 4, 2009 at 9:35 AM, Prasanna Simha M wrote: > Even with all of that I still keep an open offer that I will describe > a problematic case to the list when advice is seeked. > I have learnt a lot from this list by posing problems and have changed > my practice many a time based on suggestions on this list. > I consider it a precious resource and dont hesitate to share my > experiences and my problems. > Prasanna > > On Sun, Oct 4, 2009 at 6:50 PM, Ani Anyanwu > wrote: > > Does not really matter this is a 'closed' list - there are numerous > non-cardiac surgeons that subscribe to this list. All the big industry > players all follow this list closely and it won't surprise me if some legal > companies also do. I have on a few occasions been approached by industry > regarding (extreme) views I expressed on HSF about their's or competitor's > products. > > > > I have also always been one to criticize or ignore single theme posters > (those who lurk and then suddenly post a question about a case and never > provide further info or contribute to subsequent discussion) - I bet you > some of these are not surgeons but are third parties (lawyers, relatives, > insurance companies etc) looking to gather ammunition to make a case against > a surgeon. > > > > Only 2 days ago my office got a call from attorney in florida wanting to > enlist me as an 'expert' witness in a case - I refused to return the call as > I do not deal with lawyers except when I am being sued and refuse to be part > of this medicolegal machinery. I have a strange suspicion they tracked me > through HSF and noticed I seem to be able to argue anything. That said I do > feel somewhat guilty because the attorney calling may well have been > defending a colleague and we probably should all make out time to help in > cases brought up against colleagues. Else what you have is a pool of > 'experts' usually made up of non-operating surgeons or even non-cardiac > surgeons who are the ones that are supposed to fight our case. My experience > in cases I have been involved in is that I have a far better understanding > of the issues than the doctors advising either side and the lawyers are > paying all these experts sums of money for nothing. I see that the real case > that can be made against me is not being made, and that there are wide holes > in the case being made against me that the experts my lawyers are paying > have not observed. I could do a much much better job for either side. > > > > Unless this list is revamped and started afresh with strictly named > surgeons verified off collaborative sources such as society records or > CTSNET, lawyers, industry and other third parties will always be part of any > discussions we have. This is anything but a closed list. > > > > Ani > > > >> From: prasannasimha@gmail.com > >> Date: Sun, 4 Oct 2009 07:51:06 +0530 > >> Subject: Re: [HSF] TMR with recent MI > >> To: OpenHeart-L@lists.hsforum.com > >> CC: > >> > >> Tony and all HSFers, If you want to post incognito forward them to me. > >> All HSFers are repeatedly invited to post any problems via me. A > >> friend can laways "post an question" stripped of all details.HSF is > >> too precious to allow legal wranglers from destroying a free spritied > >> exchange. > >> Also I think that the emails are now removed from "public view" now > >> from the HSF website > >> Prasanna > >> > >> On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD > >> wrote: > >> > Chuck, Tea, Ani, Hal > >> > > >> > If you think she would benefit from TMR, and she dopes not have > ongoing > >> > chest pain, not requiring NTG or heparin drips -- would be safest to > >> > stabilize her with oral meds, let her "cool down" and do her in 4 > weeks -- > >> > CABG / TMR. I would go midline. Lateral approach OK , but limits > future > >> > redo IMO. > >> > > >> > If she can not be "stabilized" in this fashion, continues to have rest > pain > >> > and needs to be done now -- TMR increases risk of post-op death > following > >> > MI. Risk is 4X for the first two weeks and 2X for the ensuing 2 > weeks, > >> > whence it drops to "normal" (1X) [x being baseline STS risk of redo > CABG. > >> > This is the basis of the STS guidelines on TMR as they relate to > doing it > >> > Post-MI... and why medicare will sometimes not reimburse for post-MI > TMR... > >> > and the basis of several lawsuits regarding poor outcomes following > CABG / > >> > TMR following MI. > >> > > >> > Hal -- Dense perusal of the literature results seem to show benefit > >> > depending on which laser was used. CO2 adn HoYAG although both called > "TMR" > >> > may actually be different procedures. > >> > > >> > Ani / Prasanna -- Yes -- still doing it. Did a redo CABG / TMR > yesterday. > >> > have an isolated TMR Monday. Another Redo CABG / TMR schedled in two > >> > weeks. > >> > > >> > and Yes... it works....CO2 that is -- stimulates formation of > collaterals - > >> > that's how Ani. > >> > > >> > Tea -- there I said it. 'nuff said. Don't want the Cardiogenesis > lawyers > >> > chasing me down again and attempting to sue me for my thoughts on HSF, > like > >> > they did before. > >> > > >> > over and out, > >> > (silent) Tony > >> > > >> > PS -- Sorry Ani... I hereby refuse, in advance, argue with your > response to > >> > this post.... Just don't have the time (can't type fast enough) to get > into > >> > it. Search the archives. Thnx > >> > > >> > > >> > On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: > >> > > >> >> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her > a few > >> >> days ago with Class 4 angina; she was admitted to a nearby hospital > with an > >> >> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all > other > >> >> (vein grafts) closed. 90% Left main, closed RCA. She is living off > that > >> >> LIMA. There is an open ramus that is bypassable and a functional > lateral > >> >> wall. EF is 45%. Inferior wall is only scar on thallium I am planning > Left > >> >> thoracotomy radial graft to this Ramus from the Subclavian artery; > initially > >> >> had planned CO2 TMR to the lateral wall. Would anyone rule out adding > TMR in > >> >> the face of the recent infarct and abnormal EF? > >> >> thx chuckdouville > >> >> _______________________________________________ > >> >> OpenHeart-L mailing list > >> >> > >> >> Send postings to: > >> >> OpenHeart-L@lists.hsforum.com > >> >> > >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> >> > >> >> All messages transmitted by the OpenHeart-L are subject to the > policies > >> >> and > >> >> disclaimers posted at: > >> >> http://www.hsforum.com/listdisclaim > >> >> ----------------------------------------- > >> >> > >> > > >> > _______________________________________________ > >> > OpenHeart-L mailing list > >> > > >> > Send postings to: > >> > OpenHeart-L@lists.hsforum.com > >> > > >> > To UNSUBSCRIBE, to CHANGE email address, 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 > >> ----------------------------------------- > > > > _________________________________________________________________ > > Save time by using Hotmail to access your other email accounts. > > > http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From prasannasimha at gmail.com Sun Oct 4 20:18:57 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Oct 4 10:37:42 2009 Subject: [HSF] Subclavian stenosis case follow up In-Reply-To: References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> <313C0596-BBD0-4592-B603-CB6DD311D16D@bigpond.com> Message-ID: <89c4ed2d0910040648t289e0868gef0421a447360b83@mail.gmail.com> The situation in Leipzig is that they have a separate induction room attached to the main OR where the patient can virtually be induced and lines placed even under GA if required before the patient is wheeled in and they have a full tipping table for induction with an anesthesia machine available if required.. In our hospital we do not have a separate induction room but have a holding area where we can put peripheral lines, radial lines, epidural catheters and occasionally some anesthesiologists put (CVP lines). Since we do not have monitoring stations there ,we do not put PA lines and do not prefer putting neck lines there. Epidurals are placed but formal testing and full dosage is not given there as we do not have a full tipping table etc there.During cleaning radials and peripherals are placed and the patient is wheeled in , induced and lines are placed (femorals a CVP and radial arterial lines). In the hospital where I trained nothing except the peripheral line was placed in the holding area !! Practices vary in various hospitals. I have actually been pressing for full monitoring equipment and tipping tables in the holding area but somehow some of our anesthesiologists are against it while some are very enthusiastic about it and with this controversy it doesnt seem to "move". Prasanna. On Sun, Oct 4, 2009 at 3:23 PM, Roberto Battellini wrote: > > Leipzig technique is: > > > > Lines are put in an Anaesthesia room (Einleitung) continuous to the OR, while the scrub nurse prepares everything. > > Surgeon takes the LIMA while the assistant takes the radial with harmonic Scalpel, then surgeon takes RIMA. > > Never put arm back, is time consuming.(the assistants afterwards get of course some backpain...) > > OR time 3 hours for CABG x 3 > > > > Leipzig > >> From: donross@bigpond.com >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Subclavian stenosis case follow up >> Date: Sun, 4 Oct 2009 10:16:46 +1100 >> CC: >> >> For my standard cabg X 3-4 the radial is taken while the chest is >> opened and the LIMA harvested. >> The T graft is constructed, usually, while the arm incision is closed. >> With the arm back in place the distals are done, the usual total OR >> time is 4 hours. >> Don >> On 04/10/2009, at 9:50 AM, Ani Anyanwu wrote: >> >> > >> > Yes we harvest at same time as ready for sternotomy. Never before - >> > I think our OR police would shreik if i suggested taking out radial >> > while lines and foley being placed. >> > >> > >> > >> > I use a skeletonized procurement technique after several online and >> > off-line discussions with Don. The last two I have also used >> > verapamil as per don. i dont routinely use calcium blockers after >> > surgery. >> > >> > >> > >> > Ani >> > >> >> From: prasannasimha@gmail.com >> >> Date: Sun, 4 Oct 2009 00:03:15 +0530 >> >> Subject: Re: [HSF] Subclavian stenosis case follow up >> >> To: OpenHeart-L@lists.hsforum.com >> >> CC: >> >> >> >> How do you harvest Ani ? After everything is ready ? What do the >> >> others on the list do ? >> >> >> >> On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu >> >> wrote: >> >>> >> >>> Prasanna >> >> >> >>> Do you usually procure the radial artery while anesthesia are >> >>> placing the lines? >> >> >> >>> ani >> >> _______________________________________________ >> >> OpenHeart-L mailing list >> >> >> >> Send postings to: >> >> OpenHeart-L@lists.hsforum.com >> >> >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> >> http://mmp.cjp.com/mailman/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 other email accounts from your Hotmail inbox. Add them now. >> > http://clk.atdmt.com/UKM/go/167688463/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 > ----------------------------------------- > -- Prasanna Simha M From msfirst at gmail.com Sun Oct 4 11:10:50 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Oct 4 10:40:04 2009 Subject: [HSF] TMR with recent MI In-Reply-To: References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> <38FAD97E-88E5-4CF9-9A82-299AC5F56ECB@gmail.com> Message-ID: We all can express whatever we want - but regardless how accurate or true - we must be prepared to deal with the consequences regardless how inappropriate or painful we are fair game and easy targets. -michael On Sun, Oct 4, 2009 at 12:29 AM, Nasser F Abou'Seada wrote: > Michael > Can I express my RIGHT OF FREE SPEECH here ? > I BELIEVE you are RIGHT > > NFA > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael > Firstenberg > Sent: Saturday, October 03, 2009 9:47 PM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] TMR with recent MI > > Doesn't really matter how stripped of identity it is. > We are kidding ourselves if we think concepts such as freedom of > speach or thought really exist. > > The price of expressing ones self particularly if it is something that > is unpopular regardless of how true is too great. > > Right tea? > > Not worth it. We stay silent. A common theme throughout history. > > -michael/iPhone > > On Oct 3, 2009, at 10:21 PM, Prasanna Simha M > wrote: > > > Tony and all HSFers, If you want to post incognito forward them to > > me. > > All HSFers are repeatedly invited to post any problems via me. A > > friend can laways "post an question" stripped of all details.HSF is > > too precious to allow legal wranglers from destroying a free spritied > > exchange. > > Also I think that the emails are now removed from "public view" now > > from the HSF website > > Prasanna > > > > On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD > > wrote: > >> Chuck, Tea, Ani, Hal > >> > >> If you think she would benefit from TMR, and she dopes not have > >> ongoing > >> chest pain, not requiring NTG or heparin drips -- would be safest to > >> stabilize her with oral meds, let her "cool down" and do her in 4 > >> weeks -- > >> CABG / TMR. I would go midline. Lateral approach OK , but limits > >> future > >> redo IMO. > >> > >> If she can not be "stabilized" in this fashion, continues to have > >> rest pain > >> and needs to be done now -- TMR increases risk of post-op death > >> following > >> MI. Risk is 4X for the first two weeks and 2X for the ensuing 2 > >> weeks, > >> whence it drops to "normal" (1X) [x being baseline STS risk of redo > >> CABG. > >> This is the basis of the STS guidelines on TMR as they relate to > >> doing it > >> Post-MI... and why medicare will sometimes not reimburse for post- > >> MI TMR... > >> and the basis of several lawsuits regarding poor outcomes following > >> CABG / > >> TMR following MI. > >> > >> Hal -- Dense perusal of the literature results seem to show benefit > >> depending on which laser was used. CO2 adn HoYAG although both > >> called "TMR" > >> may actually be different procedures. > >> > >> Ani / Prasanna -- Yes -- still doing it. Did a redo CABG / TMR > >> yesterday. > >> have an isolated TMR Monday. Another Redo CABG / TMR schedled in > >> two > >> weeks. > >> > >> and Yes... it works....CO2 that is -- stimulates formation of > >> collaterals - > >> that's how Ani. > >> > >> Tea -- there I said it. 'nuff said. Don't want the Cardiogenesis > >> lawyers > >> chasing me down again and attempting to sue me for my thoughts on > >> HSF, like > >> they did before. > >> > >> over and out, > >> (silent) Tony > >> > >> PS -- Sorry Ani... I hereby refuse, in advance, argue with your > >> response to > >> this post.... Just don't have the time (can't type fast enough) to > >> get into > >> it. Search the archives. Thnx > >> > >> > >> On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: > >> > >>> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw > >>> her a few > >>> days ago with Class 4 angina; she was admitted to a nearby > >>> hospital with an > >>> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, > >>> all other > >>> (vein grafts) closed. 90% Left main, closed RCA. She is living off > >>> that > >>> LIMA. There is an open ramus that is bypassable and a functional > >>> lateral > >>> wall. EF is 45%. Inferior wall is only scar on thallium I am > >>> planning Left > >>> thoracotomy radial graft to this Ramus from the Subclavian artery; > >>> initially > >>> had planned CO2 TMR to the lateral wall. Would anyone rule out > >>> adding TMR in > >>> the face of the recent infarct and abnormal EF? > >>> thx chuckdouville > >>> _______________________________________________ > >>> OpenHeart-L mailing list > >>> > >>> Send postings to: > >>> OpenHeart-L@lists.hsforum.com > >>> > >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>> http://mmp.cjp.com/mailman/listinfo/openheart-l > >>> > >>> All messages transmitted by the OpenHeart-L are subject to the > >>> policies > >>> and > >>> disclaimers posted at: > >>> http://www.hsforum.com/listdisclaim > >>> ----------------------------------------- > >>> > >> > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >> All messages transmitted by the OpenHeart-L are subject to the > >> policies > >> anddisclaimers posted at: > >> http://www.hsforum.com/listdisclaim > >> ----------------------------------------- > >> > > > > > > > > -- > > Prasanna Simha M > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From prasannasimha at gmail.com Sun Oct 4 21:05:38 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Oct 4 10:42:55 2009 Subject: [HSF] HSF and lawyers etc In-Reply-To: References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> <89c4ed2d0910040635m27d3bef4p75826ffd4f9d2cc7@mail.gmail.com> Message-ID: <89c4ed2d0910040735ncc1aad4m8d3453863cd9f6e3@mail.gmail.com> Yes I remember. That is why I have offered to present problematic cases on anyones behalf. Prasanna On Sun, Oct 4, 2009 at 7:48 PM, Salerno, Tomas wrote: > This site is monitored and in a recent instance the lawyer brought up > everything that I had written in HSF > > I thought this was a close site and non discoverable - I was wrong > > Some of us may come to regret what we write or present on this site > All will be included should litigation occurs > > I have written about this before, and even that was brought up > > Ts > > > Sent from my iPhone > > On Oct 4, 2009, at 10:07 AM, "Prasanna Simha M" > wrote: > >> Even with all of that I still keep an open offer that I will describe >> a problematic case to the list when advice is seeked. >> I have learnt a lot from this list by posing problems and have changed >> my practice many a time based on suggestions on this list. >> I consider it a precious resource and dont hesitate to share my >> experiences and my problems. >> Prasanna >> >> On Sun, Oct 4, 2009 at 6:50 PM, Ani Anyanwu >> wrote: >>> Does not really matter this is a 'closed' list - there are numerous >>> non-cardiac surgeons that subscribe to this list. All the big >>> industry players all follow this list closely and it won't surprise >>> me if some legal companies also do. I have on a few occasions been >>> approached ?by industry regarding (extreme) ?views I expressed on >>> HSF about their's or competitor's products. >>> >>> I have also always been one to criticize or ignore single theme >>> posters (those who lurk and then suddenly post a question about a >>> case and never provide further info or contribute to subsequent >>> discussion) - I bet you some of these are not surgeons but are >>> third parties (lawyers, relatives, insurance companies etc) looking >>> to gather ammunition to make a case against a surgeon. >>> >>> Only 2 days ago my office got a call from attorney in florida >>> wanting to enlist me as an 'expert' witness in a case - I refused >>> to return the call as I do not deal with lawyers except when I am >>> being sued and refuse to be part of this medicolegal machinery. I >>> have a strange suspicion they tracked me through HSF and noticed I >>> seem to be able to argue anything. That said I do feel somewhat >>> guilty because the attorney calling may well have been defending a >>> colleague and we probably should all make out time to help in cases >>> brought up against colleagues. Else what you have is a pool of >>> 'experts' usually made up of non-operating surgeons or even non- >>> cardiac surgeons who are the ones that are supposed to fight our >>> case. My experience in cases I have been involved in is that I have >>> a far better understanding of the issues than the doctors advising >>> either side and the lawyers are paying all these experts sums of >>> money for nothing. I see that the real case that can be made >>> against me is not being made, and that there are wide holes in the >>> case being made against me that the experts my lawyers are paying >>> have not observed. I could do a much much better job for either side. >>> >>> Unless this list is revamped and started afresh with strictly named >>> surgeons verified off collaborative sources such as society records >>> or CTSNET, lawyers, industry and other third parties will always be >>> part of any discussions we have. This is anything but a closed list. >>> >>> Ani >>> >>>> From: prasannasimha@gmail.com >>>> Date: Sun, 4 Oct 2009 07:51:06 +0530 >>>> Subject: Re: [HSF] TMR with recent MI >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> >>>> Tony ?and all HSFers, If you want to post incognito forward them >>>> to me. >>>> All HSFers are repeatedly invited to post any problems via me. A >>>> friend can laways "post an question" stripped of all details.HSF is >>>> too precious to allow ?legal wranglers from destroying a free >>>> spritied >>>> exchange. >>>> Also I think that the emails are now removed from "public view" now >>>> from the HSF website >>>> Prasanna >>>> >>>> On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD >>>> wrote: >>>>> Chuck, Tea, Ani, Hal >>>>> >>>>> If you think she would benefit from TMR, and she dopes not have >>>>> ongoing >>>>> chest pain, not requiring NTG or heparin drips -- would be safest >>>>> to >>>>> stabilize her with oral meds, let her "cool down" and do her in 4 >>>>> weeks -- >>>>> CABG / TMR. ?I would go midline. ?Lateral approach OK , but >>>>> limits future >>>>> redo IMO. >>>>> >>>>> If she can not be "stabilized" in this fashion, continues to have >>>>> rest pain >>>>> and needs to be done now -- TMR increases risk of post-op death >>>>> following >>>>> MI. ?Risk is 4X for the first two weeks and 2X for the ensuing 2 >>>>> weeks, >>>>> whence it drops to "normal" (1X) [x being baseline STS risk of >>>>> redo CABG. >>>>> ?This is the basis of the STS guidelines on TMR as they relate to >>>>> doing it >>>>> Post-MI... and why medicare will sometimes not reimburse for post- >>>>> MI TMR... >>>>> and the basis of several lawsuits regarding poor outcomes >>>>> following CABG / >>>>> TMR following MI. >>>>> >>>>> Hal -- Dense perusal of the literature results seem to show benefit >>>>> depending on which laser was used. CO2 adn HoYAG although both >>>>> called "TMR" >>>>> may actually be different procedures. >>>>> >>>>> Ani / Prasanna -- Yes -- still doing it. ?Did a redo CABG ?/ TMR >>>>> yesterday. >>>>> ?have an isolated TMR Monday. ?Another Redo CABG / TMR schedled >>>>> in two >>>>> weeks. >>>>> >>>>> and Yes... it works....CO2 that is -- ?stimulates formation of >>>>> collaterals - >>>>> that's how Ani. >>>>> >>>>> Tea -- there I said it. ?'nuff said. ?Don't want the >>>>> Cardiogenesis lawyers >>>>> chasing me down again and attempting to sue me for my thoughts on >>>>> HSF, like >>>>> they did before. >>>>> >>>>> over and out, >>>>> (silent) Tony >>>>> >>>>> PS -- Sorry Ani... I hereby refuse, in advance, argue with your >>>>> response to >>>>> this post.... Just don't have the time (can't type fast enough) >>>>> to get into >>>>> it. ?Search the archives. Thnx >>>>> >>>>> >>>>> On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: >>>>> >>>>>> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw >>>>>> her a few >>>>>> days ago with Class 4 angina; she was admitted to a nearby >>>>>> hospital with an >>>>>> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to >>>>>> LAD, all other >>>>>> (vein grafts) closed. 90% Left main, closed RCA. She is living >>>>>> off that >>>>>> LIMA. There is an open ramus that is bypassable and a functional >>>>>> lateral >>>>>> wall. EF is 45%. Inferior wall is only scar on thallium I am >>>>>> planning Left >>>>>> thoracotomy radial graft to this Ramus from the Subclavian >>>>>> artery; initially >>>>>> had planned CO2 TMR to the lateral wall. Would anyone rule out >>>>>> adding TMR in >>>>>> the face of the recent infarct and abnormal EF? >>>>>> thx chuckdouville >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@lists.hsforum.com >>>>>> >>>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>>>>> >>>>>> All messages transmitted by the OpenHeart-L are subject to the >>>>>> policies >>>>>> and >>>>>> disclaimers posted at: >>>>>> http://www.hsforum.com/listdisclaim >>>>>> ----------------------------------------- >>>>>> >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> >>>>> To UNSUBSCRIBE, to CHANGE email address, 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 >>>> ----------------------------------------- >>> >>> _________________________________________________________________ >>> Save time by using Hotmail to access your other email accounts. >>> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Oct 4 21:04:47 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Oct 4 10:43:42 2009 Subject: [HSF] HSF and lawyers etc In-Reply-To: References: <8477F771-B0B1-4828-871D-92F4A8E6E3E7@starrwood.com> <89c4ed2d0910031921g17d8a42ex46722dd0de7e994c@mail.gmail.com> <89c4ed2d0910040635m27d3bef4p75826ffd4f9d2cc7@mail.gmail.com> Message-ID: <89c4ed2d0910040734w67bfdbe2k520e30848d8c95fe@mail.gmail.com> Real surgeon ;) May have made more money probably as a Lawyer !! Prasanna On Sun, Oct 4, 2009 at 7:52 PM, Michael Firstenberg wrote: > Prasanna, > I have often questioned if you are in fact a real surgeon. > > Ani - > I can not blame your avoidance of lawyers in malpractice suits. ?I have > often been approached to review cases against doctors and/or hospital > systems - and I will always at least take a look. ?While I am clearly no > expert in terms of decades of experience etc etc etc - sometimes a review by > someone who understands what we have to deal with can save one of us a lot > of headache. ?Every case I have reviewed has been dismissed based upon, in > part (I think), of comments that I have brought up in the chart and medical > literature review. ?Even if there is something horribly wrong - then a good > analytical mind like your might help knock a few zero's off of a judgement. > Contrary to Hal's experiences (which I tend to agree with) - have a few > lawyers as "friends" is kind of like chicken soup. ?If you need a good > immigration lawyer, I am sure Mario would recommend my mother. > > -michael > > > On Sun, Oct 4, 2009 at 9:35 AM, Prasanna Simha M wrote: > >> Even with all of that I still keep an open offer that I will describe >> a problematic case to the list when advice is seeked. >> I have learnt a lot from this list by posing problems and have changed >> my practice many a time based on suggestions on this list. >> I consider it a precious resource and dont hesitate to share my >> experiences and my problems. >> Prasanna >> >> On Sun, Oct 4, 2009 at 6:50 PM, Ani Anyanwu >> wrote: >> ?> Does not really matter this is a 'closed' list - there are numerous >> non-cardiac surgeons that subscribe to this list. All the big industry >> players all follow this list closely and it won't surprise me if some legal >> companies also do. I have on a few occasions been approached ?by industry >> regarding (extreme) ?views I expressed on HSF about their's or competitor's >> products. >> > >> > I have also always been one to criticize or ignore single theme posters >> (those who lurk and then suddenly post a question about a case and never >> provide further info or contribute to subsequent discussion) - I bet you >> some of these are not surgeons but are third parties (lawyers, relatives, >> insurance companies etc) looking to gather ammunition to make a case against >> a surgeon. >> > >> > Only 2 days ago my office got a call from attorney in florida wanting to >> enlist me as an 'expert' witness in a case - I refused to return the call as >> I do not deal with lawyers except when I am being sued and refuse to be part >> of this medicolegal machinery. I have a strange suspicion they tracked me >> through HSF and noticed I seem to be able to argue anything. That said I do >> feel somewhat guilty because the attorney calling may well have been >> defending a colleague and we probably should all make out time to help in >> cases brought up against colleagues. Else what you have is a pool of >> 'experts' usually made up of non-operating surgeons or even non-cardiac >> surgeons who are the ones that are supposed to fight our case. My experience >> in cases I have been involved in is that I have a far better understanding >> of the issues than the doctors advising either side and the lawyers are >> paying all these experts sums of money for nothing. I see that the real case >> that can be made against me is not being made, and that there are wide holes >> in the case being made against me that the experts my lawyers are paying >> have not observed. I could do a much much better job for either side. >> > >> > Unless this list is revamped and started afresh with strictly named >> surgeons verified off collaborative sources such as society records or >> CTSNET, lawyers, industry and other third parties will always be part of any >> discussions we have. This is anything but a closed list. >> > >> > Ani >> > >> >> From: prasannasimha@gmail.com >> >> Date: Sun, 4 Oct 2009 07:51:06 +0530 >> >> Subject: Re: [HSF] TMR with recent MI >> >> To: OpenHeart-L@lists.hsforum.com >> >> CC: >> >> >> >> Tony ?and all HSFers, If you want to post incognito forward them to me. >> >> All HSFers are repeatedly invited to post any problems via me. A >> >> friend can laways "post an question" stripped of all details.HSF is >> >> too precious to allow ?legal wranglers from destroying a free spritied >> >> exchange. >> >> Also I think that the emails are now removed from "public view" now >> >> from the HSF website >> >> Prasanna >> >> >> >> On Sun, Oct 4, 2009 at 4:30 AM, Anthony P Furnary MD >> >> wrote: >> >> > Chuck, Tea, Ani, Hal >> >> > >> >> > If you think she would benefit from TMR, and she dopes not have >> ongoing >> >> > chest pain, not requiring NTG or heparin drips -- would be safest to >> >> > stabilize her with oral meds, let her "cool down" and do her in 4 >> weeks -- >> >> > CABG / TMR. ?I would go midline. ?Lateral approach OK , but limits >> future >> >> > redo IMO. >> >> > >> >> > If she can not be "stabilized" in this fashion, continues to have rest >> pain >> >> > and needs to be done now -- TMR increases risk of post-op death >> following >> >> > MI. ?Risk is 4X for the first two weeks and 2X for the ensuing 2 >> weeks, >> >> > whence it drops to "normal" (1X) [x being baseline STS risk of redo >> CABG. >> >> > ?This is the basis of the STS guidelines on TMR as they relate to >> doing it >> >> > Post-MI... and why medicare will sometimes not reimburse for post-MI >> TMR... >> >> > and the basis of several lawsuits regarding poor outcomes following >> CABG / >> >> > TMR following MI. >> >> > >> >> > Hal -- Dense perusal of the literature results seem to show benefit >> >> > depending on which laser was used. CO2 adn HoYAG although both called >> "TMR" >> >> > may actually be different procedures. >> >> > >> >> > Ani / Prasanna -- Yes -- still doing it. ?Did a redo CABG ?/ TMR >> yesterday. >> >> > ?have an isolated TMR Monday. ?Another Redo CABG / TMR schedled in two >> >> > weeks. >> >> > >> >> > and Yes... it works....CO2 that is -- ?stimulates formation of >> collaterals - >> >> > that's how Ani. >> >> > >> >> > Tea -- there I said it. ?'nuff said. ?Don't want the Cardiogenesis >> lawyers >> >> > chasing me down again and attempting to sue me for my thoughts on HSF, >> like >> >> > they did before. >> >> > >> >> > over and out, >> >> > (silent) Tony >> >> > >> >> > PS -- Sorry Ani... I hereby refuse, in advance, argue with your >> response to >> >> > this post.... Just don't have the time (can't type fast enough) to get >> into >> >> > it. ?Search the archives. Thnx >> >> > >> >> > >> >> > On Oct 1, 2009, at 1:53 PM, Douville, Chuck wrote: >> >> > >> >> >> Pt of mine, 67 yo female returns 15 years after 1 st CABG. I saw her >> a few >> >> >> days ago with Class 4 angina; she was admitted to a nearby hospital >> with an >> >> >> MI yesterday, troponin peaks at 5. Anatomy is a nice LIMA to LAD, all >> other >> >> >> (vein grafts) closed. 90% Left main, closed RCA. She is living off >> that >> >> >> LIMA. There is an open ramus that is bypassable and a functional >> lateral >> >> >> wall. EF is 45%. Inferior wall is only scar on thallium I am planning >> Left >> >> >> thoracotomy radial graft to this Ramus from the Subclavian artery; >> initially >> >> >> had planned CO2 TMR to the lateral wall. Would anyone rule out adding >> TMR in >> >> >> the face of the recent infarct and abnormal EF? >> >> >> thx chuckdouville >> >> >> _______________________________________________ >> >> >> OpenHeart-L mailing list >> >> >> >> >> >> Send postings to: >> >> >> OpenHeart-L@lists.hsforum.com >> >> >> >> >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> >> >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> >> >> >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies >> >> >> and >> >> >> disclaimers posted at: >> >> >> http://www.hsforum.com/listdisclaim >> >> >> ----------------------------------------- >> >> >> >> >> > >> >> > _______________________________________________ >> >> > OpenHeart-L mailing list >> >> > >> >> > Send postings to: >> >> > OpenHeart-L@lists.hsforum.com >> >> > >> >> > To UNSUBSCRIBE, to CHANGE email address, 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 >> >> ----------------------------------------- >> > >> > _________________________________________________________________ >> > Save time by using Hotmail to access your other email accounts. >> > >> http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > ?OpenHeart-L@lists.hsforum.com >> > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > http://mmp.cjp.com/mailman/listinfo/openheart-l >> > >> > All messages transmitted by the OpenHeart-L are subject to the policies >> and >> > disclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From ebender001 at me.com Sun Oct 4 11:29:26 2009 From: ebender001 at me.com (Edward Bender) Date: Sun Oct 4 11:33:49 2009 Subject: [HSF] OR Police In-Reply-To: <8CC12F8BB62C6D8-292C-2F71A@webmail-m041.sysops.aol.com> Message-ID: Is the physical plant completed? If not, avoid long transport distances (ie, OR to ICU). One well known institution I worked in required a half mile trip and up 2 floors for adults and worse for pediatric cases (the surgery was done in the adult hospital and they were transferred back to the children's hospital via a series of very long corridors and bridges). The items that concern me about conduct of the cases are: 1. Presence of satellite lab for quick results. 2. Blood product availability. 3. Proximity of additional supplies (is the OR stocked or do you need to constantly access central supply) 4. Compatibility of OR and ICU monitors (same module setup) 5. Most importantly, the personnel - are they interested and trainable? Ed Bender, MD On 10/4/09 5:58 AM, "ichfno@aol.com" wrote: > > As you all know, we are trying to improve pediatric cardiac surgery in a > number of different institutions world-wide. We have been invited to start a > program de novo, in a new Maquet constructed center, that has never, ever > performed ANY cardiac surgery. We have been requested to build the program > from zero, no policy and procedures yet, nor Quality Assurance Comm, no > nothing is in place. Ani's allusion (perhaps illusion is a better term) to OR > police of course started the synapses firing. Would everyone send me thoughts > on what organizational committee's, check lists, overseer's and what nots they > think are valuable to improve care, proficiency and standardization, > additionally thoughts on what is a waste of time would be kindly welcomed as > well. Should be an interesting thread. > > Bill > > > > > > > > -----Original Message----- > From: Roberto Battellini > To: lists HSF > Sent: Sun, Oct 4, 2009 4:53 am > Subject: RE: [HSF] Subclavian stenosis case follow up > > > > > > > > > > > > Leipzig technique is: > > > > Lines are put in an Anaesthesia room (Einleitung) continuous to the OR, while > the scrub nurse prepares everything. > > Surgeon takes the LIMA while the assistant takes the radial with harmonic > Scalpel, then surgeon takes RIMA. > > Never put arm back, is time consuming.(the assistants afterwards get of course > some backpain...) > > OR time 3 hours for CABG x 3 > > > > Leipzig > >> From: donross@bigpond.com >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Subclavian stenosis case follow up >> Date: Sun, 4 Oct 2009 10:16:46 +1100 >> CC: >> >> For my standard cabg X 3-4 the radial is taken while the chest is >> opened and the LIMA harvested. >> The T graft is constructed, usually, while the arm incision is closed. >> With the arm back in place the distals are done, the usual total OR >> time is 4 hours. >> Don >> On 04/10/2009, at 9:50 AM, Ani Anyanwu wrote: >> >>> >>> Yes we harvest at same time as ready for sternotomy. Never before - >>> I think our OR police would shreik if i suggested taking out radial >>> while lines and foley being placed. >>> >>> >>> >>> I use a skeletonized procurement technique after several online and >>> off-line discussions with Don. The last two I have also used >>> verapamil as per don. i dont routinely use calcium blockers after >>> surgery. >>> >>> >>> >>> Ani >>> >>>> From: prasannasimha@gmail.com >>>> Date: Sun, 4 Oct 2009 00:03:15 +0530 >>>> Subject: Re: [HSF] Subclavian stenosis case follow up >>>> To: OpenHeart-L@lists.hsforum.com >>>> CC: >>>> >>>> How do you harvest Ani ? After everything is ready ? What do the >>>> others on the list do ? >>>> >>>> On Fri, Oct 2, 2009 at 6:35 AM, Ani Anyanwu >>>> wrote: >>>>> >>>>> Prasanna >>>> >>>>> Do you usually procure the radial artery while anesthesia are >>>>> placing the lines? >>>> >>>>> ani >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> http://mmp.cjp.com/mailman/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 other email accounts from your Hotmail inbox. Add them now. >>> http://clk.atdmt.com/UKM/go/167688463/direct/01/____________________________ >>> ___________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> disclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > > > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From tacuff at swbell.net Sun Oct 4 10:47:06 2009 From: tacuff at swbell.net (Tea Acuff) Date: Sun Oct 4 12:47:38 2009 Subject: [HSF] Subclavian stenosis case follow up Message-ID: <595455.74582.qm@web81608.mail.mud.yahoo.com> Aussies do swear a lot. Tea Sent from my iPhone On Oct 3, 2009, at 1:36 PM, Prasanna Simha M wrote: When the radial was revived , people were screaming the use of calcium channel blockers !! It was described then at every conference as 'The difference" and people used to swear by it !! Having said that removing it enmasse helped I find it conflicting that a skeletonized artery would be better - conflicting thinking. I do take the radial with the veins with a non touch technique still. Worried about skeletonizing though Don swears by it. Prasanna On Sat, Oct 3, 2009 at 8:53 AM, Ani Anyanwu wrote: I don't think antispasmodic pharmacology was behind revival of the radial - there are no data, previous or present, supporting efficacy of such drugs. I think the key change was with surgical technique avoiding handling and manipulation that can precipitate spasm. Harvesting as pedicle rather than skeletonized was one such maneuver thought we have gone full circle and now skeletonize again. Ani From: prasannasimha@gmail.com Date: Sat, 3 Oct 2009 07:57:19 +0530 Subject: Re: [HSF] Subclavian stenosis case follow up To: OpenHeart-L@lists.hsforum.com CC: I am in a bit of conflict here - one of the reasons for revival of the radial was the supposed antispasmodic therapy protocols that were inititated that was supposed to be the ameliorating factor for spasm - read improved current patency. On the other hand use of calcium channel blockers was not found to be useful in some studies. How is this dichotomy in thinking resolved by those who would not give long term CCB's. Incidentally I have used He's solution with the addition of Phenoxybenzamine after doing some literature search and it does produce an elegant pipe with the hopeful advantage that adding phenoxy blocks the receptors for at leastthe first 5 days !! Prasanna On Sat, Oct 3, 2009 at 2:05 AM, Tea Acuff wrote: Liberal use of nitro periop. I useHe solution, which is TNG, verapamil, and bicarbonate to block intraop and then nothing at discharge. Tea Sent from my iPhone On Oct 2, 2009, at 7:02 AM, Prasanna Simha M wrote: What is your calcium channel protocol after surgery. I use intravenous Diltiazem followed with Amlodipine for a year. I have seen people not giving any periop calcium channel blockers (and giving a calcium channel blocker next day) to full coverage ?. Giving a calcium channel blocker can be a pain especially if the patient is vasoplegic. Prasanna On Fri, Oct 2, 2009 at 4:49 AM, Donald Ross wrote: Goodness, Prasanna, that sounds like one of my operations. Yesterday I had a critical LM patient with 50% L subclavian stenosis.( pre-op ima dopplers: both imas 25ml/ min) Did the lad with the rima and took the T-radial off the rima to graft the pda ( around L side as usual) The lima was used for the om and the whole shebang covered with mobilised pericardial fat. ( lima 40ml/min, rima 95 ml/min ) My second case an even worse unstable LM with 30%EF and recent stemi infarct, started to sag while I was trying to sneak the rima onto the lad so I went on pump and did the bilateral ima, T-radial cabgX4 beating heart on pump. ( It is very satisfying to see an anterior wall contractility recover the instant it's graft is opened.) Don On 02/10/2009, at 5:18 AM, Prasanna Simha M wrote: Did the subclavian stenosis case today (Postponed due to some non medical reasons) Did RIMA to LAD, LIMA to OM and radial to Diagonal (I had made a mistake in my original post and there was no RCA disease on reviewing the angiogram). My logic was RIMA and LIMA have identical patencies to the LAD. Steneted subclavian has a good patency but not the same as virgin LIMA so I placed it to the OM as the patencies seemed to match that. Used a radial to the diagonal which was big as he is young. Incidentally used the right radial as he still complained of some tingling etc in the left fingers and did not want to worsen anything (or give an opportunity to have long term complaints ascribed to radial artery harvest in the stented side !!). I just harvested the radial and closed the arm by the time the Neck lines and Swan were floated and tucked the arm in and proceeded to harvest the IMA's so did not have to do the turn towards the head LIMA harvest as was advocated in the discussion. Despite skeletonization etc the RIMA could not be made to course superiorly under the innominate vein and required a straighter course to the LAD crossing the aorta under the covering RA appendage. I mobilized both mediastinal fat pads and covered the RIMA and LIMA to protect itfor a future redo and if at any time the RCA/PD requires a graft I will approach it basally by dividing the diaphragm and use an RGEA (or so I wishfully think !!) I was considering doing it OPCAB as the targets were good and he initially had excellent hemodynamics but he started developing hypotension and ST's during the final stages of LIMA harvest (which I had harvested last) so I did it beating supported (I had an alternate choice of a balloon pump but was worried about the very tight Left main). He came off with NTG and Diltiazem infusions that were prophylactically started. Comments ? -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/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 ----------------------------------------- _________________________________________________________________ Learn how to add other email accounts to Hotmail in 3 easy steps. http://clk.atdmt.com/UKM/go/167688463/direct/01/_______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From nfaabouseada at gmail.com Sun Oct 4 12:43:55 2009 From: nfaabouseada at gmail.com (Nasser F Abou'Seada) Date: Sun Oct 4 12:51:35 2009 Subject: [HSF] OR Police In-Reply-To: <8CC12F8BB62C6D8-292C-2F71A@webmail-m041.sysops.aol.com> References: <89c4ed2d0910011218r6eac5c53k536867728f1ac812@mail.gmail.com> <8CC12F8BB62C6D8-292C-2F71A@webmail-m041.sysops.aol.com> Message-ID: <24D03D91A0524BBFAAE0C5911DF8849F@AbouSeadaN> "Walter and Israel, Pathology" There are many chapters there, about [OR] organization NFA -----Original Message----- From: openheart-l-bounces@lists.hsfo