[HSF] Aortic aneurysm gray area?

Thu Oct 1 18:40:48 EDT 2009

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 <drdharris at yahoo.co.uk> 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 <anianyanwu at hotmail.com> wrote:
>
>
> From: Ani Anyanwu <anianyanwu at hotmail.com>
> Subject: RE: [HSF] Aortic aneurysm gray area?
> To: "open heart list" <openheart-l at lists.hsforum.com>
> 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 at gmail.com
> > To: OpenHeart-L at 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, <hgrmd at aol.com> 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 at lists.hsforum.com
> > > To: HSF List
> > > ReplyTo: OpenHeart-L at 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" <msfirst at gmail.com> 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 at lists.hsforum.com
> > > >
> > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > > > http://mmp.cjp.com/mailman/listinfo/openheart-l
> > > >
> > > > All messages transmitted by the OpenHeart-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, to CHANGE email address, or to view archives:
> > > http://mmp.cjp.com/mailman/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 at lists.hsforum.com
> > >
> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > > http://mmp.cjp.com/mailman/listinfo/openheart-l
> > >
> > > All messages transmitted by the OpenHeart-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, to CHANGE email address, or to view archives:
> > http://mmp.cjp.com/mailman/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 at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-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, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>