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    <title>CTSNet Discussion Forums: Message List - root</title>
    <link>http://forums.ctsnet.org/ctsnet</link>
    <description>Most recent forum messages</description>
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    <pubDate>Mon, 23 Nov 2009 00:14:14 -0500</pubDate>


    <item>

        <title>acute on chronic SVC syndrome with histoplasmosis</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9698&amp;tstart=0#9698</link>

        

        

            <description><![CDATA[64 yo female s/p right thoracotomy 40 years ago diagnosed with histoplasmosis presents with acute dyspnea, orthopnea and plethoric changes to head and neck.&nbsp; CTPE protocol negative for PE but shows 4.5 cm calcified lymphadenopathy in right paratracheal region with near-total occlusion of SVC, widely patent azygous and no extrathoracic collateralization.&nbsp; No evidence of malignancy.&nbsp; Any thoughts on angioplasty vs extraanatomic bypass vs sternotomy with resection/reconstruction?]]></description>

        

        <pubDate>Fri, 20 Nov 2009 10:48:38 -0500</pubDate>

        

        <jf:creationDate>Fri, 20 Nov 2009 10:48:38 -0500</jf:creationDate>
        <jf:modificationDate>Fri, 20 Nov 2009 10:48:38 -0500</jf:modificationDate>
        <jf:date>Nov 20, 2009</jf:date>
        <jf:author>vgibson</jf:author>
        <jf:replyCount>0</jf:replyCount>
    </item>


    <item>

        <title>Internal policies and procedures for cardiac and thoracic surgery</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9697&amp;tstart=0#9697</link>

        

        

            <description><![CDATA[Internal policies and procedures (IPPs) or (clinical pathways) are basic requirements for hospital accreditation. It is believed that IPPs ensures the delivery of a safe health care that is based on the best evidence. It also facilitate starting new services, and maintains patient's safety before, during and after hospitalization. Many of us have tried to invent their own IPPs or copy those of a near by hospital! Should CTSNet members consider drafting an online IPPs that takes into account the views of CTSNet readers, and is amenable to correction in accordance with the latest evidence-based surgical practice? The aim is to have such IPPs or clinical pathways applied in different institutions worldwide, in order to enhance our practice.]]></description>

        

        <pubDate>Fri, 20 Nov 2009 07:41:44 -0500</pubDate>

        

        <jf:creationDate>Fri, 20 Nov 2009 07:41:44 -0500</jf:creationDate>
        <jf:modificationDate>Fri, 20 Nov 2009 07:41:44 -0500</jf:modificationDate>
        <jf:date>Nov 20, 2009</jf:date>
        <jf:author>reloakley</jf:author>
        <jf:replyCount>0</jf:replyCount>
    </item>


    <item>

        <title>mild rheumatic mitral stenosis with IHD</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9696&amp;tstart=0#9696</link>

        

        

            <description><![CDATA[58 years old male with multivessel disease for CABG . He has mild mitral stenosis
mitral valve area is 2.0 cm2 . mean gradient 6 mmHg .mitral score 10/16 . leftt atrium 4.3 cm. Should the mitral valve be surgically adressed during CABG??????]]></description>

        

        <pubDate>Sun, 15 Nov 2009 09:14:13 -0500</pubDate>

        

        <jf:creationDate>Sun, 15 Nov 2009 09:14:13 -0500</jf:creationDate>
        <jf:modificationDate>Sun, 15 Nov 2009 09:14:13 -0500</jf:modificationDate>
        <jf:date>Nov 15, 2009</jf:date>
        <jf:author>ybalbaa</jf:author>
        <jf:replyCount>0</jf:replyCount>
    </item>


    <item>

        <title>Re: VSD, SEVERE PHTN</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9695&amp;tstart=0#9695</link>

        

        

            <description><![CDATA[We have now 28 patients with fenestrated double patch repair for the last 12 years. We have no infective endocarditis in follow up. This fenestration with valve is not working after long period. In follow up we have only 1 patient with working valve (Eisenmenger complex after 9 years after operation). We have started usage of sildenafil from 2006 for patients with High PVR and High PH not only in postoperative period, but also in preoperative period to decrease PVR. After we start Sildenafil therapy and Inhaled Iloprost in some cases - we didn't use fenestrated patch with the valve. We close VSD and nothing more. I see 2 ways to use this technique
1. For patients with a high risk of postoperative pulmonary hypertension crisis (from 6 months to 1,5 years) if you think that there are will be some problems with a postoperative management of this patient in YOUR ICU ! 
2. Older patients with defects and High PVR. It's very difficult to prognose result. Indications for VSD closure is very rare using only CATH LAB data with vasodilator tests. Lung Biopsy is not full informative. That's why sometimes indications to close VSD maybe overvalued.  In cases of irreversible PH it's better when you have this fenestration on the ventricle level. 

P.S.: 
You can read our results as a part of international experience in Dr. William Novick paper in Annals of Thoracic Surgery. [b]Novick WM, Sandoval N, Lazoryshynets VV,  Flap valve double patch closure of ventricular septal defects in children with increased pulmonary vascular resistance. Ann Thorac Surg. 2005 Jan;79(1):21-8; discussion 21-8.[/b]

Another interesting paper from China. [b]Unidirectional monovalve homologous aortic patch for repair of ventricular septal defect with pulmonary hypertension.
Zhang B, Wu S, Liang J, Zhang G, Jiang G, Zhou M, Li X.
Ann Thorac Surg. 2007 Jun;83(6):2176-81.[/b]

Message was edited by: Oleksandr Golovenko]]></description>

        

        <pubDate>Sat, 14 Nov 2009 09:09:13 -0500</pubDate>

        

        <jf:creationDate>Sat, 14 Nov 2009 09:03:38 -0500</jf:creationDate>
        <jf:modificationDate>Sat, 14 Nov 2009 09:09:13 -0500</jf:modificationDate>
        <jf:date>Nov 14, 2009</jf:date>
        <jf:author>agolovenko</jf:author>
        <jf:replyCount>0</jf:replyCount>
    </item>


    <item>

        <title>Re: VSD, SEVERE PHTN</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9694&amp;tstart=0#9694</link>

        

        

            <description><![CDATA[Hi, did you use Sildenafil? I don&acute;t use fenestrated patch because i wonder if you maintain the risk of endocarditis&nbsp;associated to VSD. I&acute;d prefer open the atrial septum if necessary.]]></description>

        

        <pubDate>Fri, 13 Nov 2009 07:25:13 -0500</pubDate>

        

        <jf:creationDate>Fri, 13 Nov 2009 07:25:13 -0500</jf:creationDate>
        <jf:modificationDate>Fri, 13 Nov 2009 07:25:13 -0500</jf:modificationDate>
        <jf:date>Nov 13, 2009</jf:date>
        <jf:author>mtravessa</jf:author>
        <jf:replyCount>1</jf:replyCount>
    </item>


    <item>

        <title>Re: Mitral valve insufficiency and kidney transplantation</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9693&amp;tstart=0#9693</link>

        

        

            <description><![CDATA[With few data, in my opinion she&acute;s a high risk patient for infective endocarditis and will need immunosuppresion, increasing the risk of infections, so i wonder it&acute;s better to operate before transplant, although the CRF patient has a higher opperative risk, it won&acute;t be much smaller after transplantation.]]></description>

        

        <pubDate>Thu, 12 Nov 2009 12:06:34 -0500</pubDate>

        

        <jf:creationDate>Thu, 12 Nov 2009 12:06:34 -0500</jf:creationDate>
        <jf:modificationDate>Thu, 12 Nov 2009 12:06:34 -0500</jf:modificationDate>
        <jf:date>Nov 12, 2009</jf:date>
        <jf:author>mtravessa</jf:author>
        <jf:replyCount>0</jf:replyCount>
    </item>


    <item>

        <title>Severe AS, CHF, Ventricular Tachycardia</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9692&amp;tstart=0#9692</link>

        

        

            <description><![CDATA[65 yo, female, presenting on syncope - on monitor VT - cardioversion 360 J - Sinus rythm, LBBB&nbsp;with&nbsp;2nd Dregree AV&nbsp;block Mobitz II HR 40 bpm. Echo: EF 33%, Max Sist Gradient LV-AO 86. Options:<br />1) ARV&nbsp;+ EF Study<br />2) AVR + VRT<br />3) AVR + VRT + ICD]]></description>

        

        <pubDate>Wed, 11 Nov 2009 17:09:49 -0500</pubDate>

        

        <jf:creationDate>Wed, 11 Nov 2009 17:09:49 -0500</jf:creationDate>
        <jf:modificationDate>Wed, 11 Nov 2009 17:09:49 -0500</jf:modificationDate>
        <jf:date>Nov 11, 2009</jf:date>
        <jf:author>mtravessa</jf:author>
        <jf:replyCount>0</jf:replyCount>
    </item>


    <item>

        <title>Re: What is Minimally Invasive Cardiac Surgery Anyway?</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9691&amp;tstart=0#9691</link>

        

        

            <description><![CDATA[I, like Dr. Chitwood, am interested in achieving the least trauma when operating on my patients.  However, my PRIMARY concern is a term we do not discuss often -- DURABILITY.  If this goal can be achieved with smaller incisions, in a reasonable amount of time, good.  For cardiac disease, we should aim first for DURABILITY.]]></description>

        

        <pubDate>Tue, 10 Nov 2009 18:45:31 -0500</pubDate>

        

        <jf:creationDate>Tue, 10 Nov 2009 18:45:31 -0500</jf:creationDate>
        <jf:modificationDate>Tue, 10 Nov 2009 18:45:31 -0500</jf:modificationDate>
        <jf:date>Nov 10, 2009</jf:date>
        <jf:author>jgibson</jf:author>
        <jf:replyCount>0</jf:replyCount>
    </item>


    <item>

        <title>Re: VSD, SEVERE PHTN</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9690&amp;tstart=0#9690</link>

        

        

            <description><![CDATA[Congratulations,
In our clinic we perform catheterization for these patients to measure Qp/Qs, Wood Units before and after pulmonary vasodilatation test. Sometimes we are using fenestrated patch with the valve for VSD closure.]]></description>

        

        <pubDate>Wed, 04 Nov 2009 18:14:29 -0500</pubDate>

        

        <jf:creationDate>Wed, 04 Nov 2009 18:14:29 -0500</jf:creationDate>
        <jf:modificationDate>Wed, 04 Nov 2009 18:14:29 -0500</jf:modificationDate>
        <jf:date>Nov 4, 2009</jf:date>
        <jf:author>agolovenko</jf:author>
        <jf:replyCount>0</jf:replyCount>
    </item>


    <item>

        <title>Re: Hybrid Revascularization</title>
        <link>http://forums.ctsnet.org/ctsnet/thread.jspa?messageID=9689&amp;tstart=0#9689</link>

        

        

            <description><![CDATA[What exactly is Hybrid revascularization?&nbsp; LIMA-LAD OPCAB, followed by PTI to another vessel?&nbsp; Hasn&#39;t this been occuring already?&nbsp; I guess the only difference is that it is done in the same setting.&nbsp; Is this good for the patient?&nbsp; For years, the standard practice for elective CABG was to wait a least 24 hours after cath, to decrease risk of acute renal insufficiency assoc with CABG.&nbsp; Now were are doing surgery and caths on the same day electively?&nbsp; What good can come from stenting vessels illsuited for stenting?&nbsp; Stenting a 0.8mm vessel will not help the patient, as the stent will close.&nbsp; The criteria for stenting dictates a &quot;suitable&quot; target, i.e., greater than 2mm.&nbsp; The viabilty of the stent can not be assured in a vessel less than 2.&nbsp; It says so on the package insert.&nbsp; Simply do the LIMA-LAD, and TMR, and leave the cardiologist out of it. Secondly, how can hospitals be going for this?&nbsp; They will lose countless money by allowing 2 procedures to be done at the same time.&nbsp; There is no data supporting its use, therefore reimbursements will reflect a lesser DRG= less money.&nbsp; The only hybrid OR should be an endovascular suite.]]></description>

        

        <pubDate>Wed, 04 Nov 2009 16:17:26 -0500</pubDate>

        

        <jf:creationDate>Wed, 04 Nov 2009 16:17:26 -0500</jf:creationDate>
        <jf:modificationDate>Wed, 04 Nov 2009 16:17:26 -0500</jf:modificationDate>
        <jf:date>Nov 4, 2009</jf:date>
        <jf:author>krichardson</jf:author>
        <jf:replyCount>0</jf:replyCount>
    </item>



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