Letang on the Trade Block?

[hf101]

Apparently Letang can be asked to give a list of a 12 team no trade list prior to each season.  Thus the rumors are a plenty these days as Montreal and Pittsburgh were said to be discussing possible trade scenarios.  I don't see this as a Subban for Letang swap though unless Montreal thinks that they can't sign Subban long term or under $7.2M

 

Letang is also rumored to be swapped for Tyler Meyers.  This move makes some sense for both teams, Meyers has a NMC and a NTC that doesn't go into effect until 16-17.  Financially this is a great move by Pittsburgh but I don't see Letang having Buffalo as a team he'd be willing to be traded to this season.

 

I'd be surprised actually if Letang is moved this year.  Too long of a contract for too much money.

[pilldoc]

It would not surprise me, however, as was discussed in depth in a thread earlier this spring, is Letang not in some way damaged goods.  I get the the fact that he would not be playing if not cleared, but I think I read somewhere that this could happen again.  What team would be willing to trade for him, especially with the contract he carries.  I would think he would brink some type of risk health wise where ever he goes.  Please no one misinterpret me.  I wish no ill will on him health wise.  I just feel health wise he is a risk.   There are too few studies regarding stroke victims and returning back to competitive sports.  Therefore I don't know any team that will be willing to trade for him, just for that fact alone.

[B21]

It would not surprise me, however, as was discussed in depth in a thread earlier this spring, is Letang not in some way damaged goods.  I get the the fact that he would not be playing if not cleared, but I think I read somewhere that this could happen again.  What team would be willing to trade for him, especially with the contract he carries.  I would think he would brink some type of risk health wise where ever he goes.  Please no one misinterpret me.  I wish no ill will on him health wise.  I just feel health wise he is a risk.   There are too few studies regarding stroke victims and returning back to competitive sports.  Therefore I don't know any team that will be willing to trade for him, just for that fact alone.

 

If the Pens can get $.80 on the $1.00 for Letang?  I'd consider.  It's not just what you would get in return - it's also what you could use that cap space for.

 

Tyler Myers + $2,000,000 in cap space? Where do I sign?

 

 

Apparently Letang can be asked to give a list of a 12 team no trade list prior to each season.  Thus the rumors are a plenty these days as Montreal and Pittsburgh were said to be discussing possible trade scenarios.  I don't see this as a Subban for Letang swap though unless Montreal thinks that they can't sign Subban long term or under $7.2M

 

Letang is also rumored to be swapped for Tyler Meyers.  This move makes some sense for both teams, Meyers has a NMC and a NTC that doesn't go into effect until 16-17.  Financially this is a great move by Pittsburgh but I don't see Letang having Buffalo as a team he'd be willing to be traded to this season.

 

I'd be surprised actually if Letang is moved this year.  Too long of a contract for too much money.

 

I agree it's unlikely though I think Buffalo would have a shot at his "list" if he has to submit 12 teams he cannot be traded to.  Trying to think like Kris Letang....

 

Edmonton

Calgary

Winnipeg

Ottawa

Florida

Tampa Bay

Nashville

Columbus

Dallas

Phoenix

New Jersey

NY Islanders

[jammer2]

  It sucks, but Letang is basically untradeable at this point....the Pens best move is just to let him play and hope he's close to his old self.

[J0e Th0rnton]

  It sucks, but Letang is basically untradeable at this point....the Pens best move is just to let him play and hope he's close to his old self.

He started to look better towards the middle of the playoffs.

But yeah, HUGE question marks around him and his ability to stay healthy

[jammer2]

@J0e Th0rnton  First and foremost, he needs to string together an entire healthy season. Even injuries that are not related to the unfortunate near death experience will be over-analyzed endlessly. I don't know if his value can ever become what it once was, but a few back to back seasons of healthy play would have to be the starting point. Funny, you know the Pens would never say this publically, nor should they...but the timing of this whole mess could not have been worse for the Pens. Their 4 biggest contracts are Crosby and Malkin, untouchables...Fleury the goalie and Letang....he is literally the only 1 that could be dealt out of those 4, and now he appears to be a Pen for life......wow.

[Polaris922]

What I'm still confused on is the hole in the heart issue that led to the stroke. The show I watched about it, and the information I can find on it, all indicate it can be closed with a simple medical procedure so it is never a risk again. And it's actually fairly common. I don't understand why there hasn't been anything said about whether its been closed, or if not, why not?

[pilldoc]

What I'm still confused on is the hole in the heart issue that led to the stroke. The show I watched about it, and the information I can find on it, all indicate it can be closed with a simple medical procedure so it is never a risk again. And it's actually fairly common. I don't understand why there hasn't been anything said about whether its been closed, or if not, why not?

 

 

Sorry for the lengthy reply..........

 

i found some excellent resources for you.

 

http://www.achaheart.org/resources/for-patients/health-information/ventricular-septal-defect.aspx

 

What are the long-term outcomes for adults with unrepaired VSD?

Many small VSDs never require treatment. Women with large VSDs that were not closed at a young age have a high risk of developing other heart, lung, and blood problems. These would include high blood pressure in the lungs and low blood oxygen levels. If this happens, VSD closure may no longer be an option.

 

What health problems are caused by a VSD?

If the hole between the two sides is too big, blood will go from the left side of the heart into the right side. This means that extra blood is pumped to the lungs, making the heart and lungs work harder. This can cause high blood pressure in the lungs, which over time may lead to permanent damage in the lung's blood vessels. Increased blood flow in the heart may also lead to heart failure.

 

Do all VSDs cause health problems?

No, some children and adults have a small VSD that does not affect the way the heart works. Instead of closing these VSDs, doctors may watch the heart closely to make sure that treatment does not become necessary. If you have a VSD, it is important that you see an ACHD doctor as recommended to make sure your heart stays healthy.

 

Are there limits on how much those with VSD can exercise?

People with a small or repaired VSD and no other problems usually have no exercise limits. It is important for anyone born with a heart defect to ask their ACHD doctor before taking on any new physical activity. If you have other problems, such as a heartbeat that is too fast, too slow or not regular, high blood pressure in your lungs, low blood oxygen levels and/or valve problems, you should ask your ACHD doctor about what kind of exercise is right for you.

 

What are the long-term outcomes for adults with repaired VSD?

The oldest survivors of VSD closure are now in their fifties and sixties—or older if operated on as adults. We do not know what the lifelong impact of VSD closure is nor do we know how long people with repaired VSDs will live. If surgery was done early, before serious heart and lung problems developed, the outlook is excellent. Adults with closed VSDs are expected to have a normal lifespan. A small number have needed re-operation. The most common reason was to close small leaks around the original patch.

 

Even if you have a repaired VSD you do not have a "normal" heart. Everyone born with a VSD has a lifelong risk of other heart problems. Some can occur many years after the original repair. One risk is endocarditis, or infection of the lining of the heart and the valves. It is very important that you ask your ACHD heart doctor about how to protect yourself from endocarditis. People with a repaired VSD can also develop a slow, fast or irregular heartbeat. This is sometimes caused by scars in your heart created by your previous surgery. Other possible problems include valve problems, stroke and heart failure.

 

What kind of heart care is recommended for adults with repaired and unrepaired VSD?

Experts recommend that all adults with CHD be seen once at an ACHD center to make sure that the diagnosis is correct and the repair is still working. Patients who have a small unrepaired VSD are still at risk of developing narrowing under the aortic or pulmonary valves, leaking of the aortic valve, or an infection of the lining of the heart and valves.

 

If you have other heart defects or complex CHD, regular care by a specialized ACHD clinic is recommended. This is also true if you have problems with lung or heart function. If you have high blood pressure in your lungs or low blood oxygen levels, you should also receive regular care at a specialized ACHD clinic. It is important that you see doctors who know about your special needs and can help keep you feeling your best.

 

another very intensive article:

https://uthsc.edu/cardiology/articles/VSD%20review.pdf

 

http://stroke.ahajournals.org/content/20/7/957.full.pdf

 

an article stating there might be a causal relationship between stroke and VSD yet there is still very little evidence to support this.  Cerebral events with patients

with VSD usually do not develop unless other cardiac events are noted.

 

http://www.surgery.ucsf.edu/conditions--procedures/ventricular-septal-defect.aspx

 

Finally..the most compelling argument against closing the small VSD.....

 

[Journal of the American College of Cardiology]

 

 

http://content.onlinejacc.org/article.aspx?articleid=1127821

 

In the present study, only 5% of patients reported mild symptoms, whereas 95% were asymptomatic. Similarly, in NHS–2 (2), 94% of patients with small VSDs were in New York Heart Association functional class I. Backer et al. in their study (10) argue that a definite socioeconomic stigma is associated with living with an uncorrected cardiac defect. Patients may not be allowed or may hesitate themselves to participate freely in physical education and sports and may have difficulty obtaining health and life insurance. In view of the low risk of repair in the era of modern cardiac surgery, the investigators use this as one of the arguments to consider surgery even in patients with small VSDs

 

In addition, patients with a small VSD should have no restrictions placed on physical activities, and there is no evidence that competitive sports are more dangerous with a small VSD than with an intact septum nor do data confirm the safety of competitive sports after surgery

 

A major limitation of the present study is that many of our patients are still young adults, and problems may increase with advancing age. However, although average age at last follow-up was significantly higher in the series by Otterstad et al. (8), it was very similar in the study by Neumayer et al. (9), the second previous report with markedly worse patient outcome compared to the one in our population. Nevertheless, we will continue to follow these patients carefully to learn about outcome at advanced age.

Conclusions

The results of the present study confirm that it is safe to withhold surgery in patients with an isolated small VSD as long as patients are carefully selected and carefully followed in a specialized congenital heart disease program. Surgery does not appear to be required as long as left-to-right shunt is definitely <50% and signs of LV volume overload are absent, when pulmonary pressure is not elevated, and no VSD-related AR and/or symptoms are present

 

So there you have....

 

basically there are some risks associate with have an unclosed surgically repaired VSD.  Though there could be a causal relationship between the stroke and the VSD nothing has been confirmed.  As I bolded in red above, patients who have a small VSD should have no restrictions placed on the individual.

 

Hope this helps answer your question Polaris

[jammer2]

And it's actually fairly common. I don't understand why there hasn't been anything said about whether its been closed, or if not, why not?

 

 Tanger leaves it open, 24/7 like Seven Eleven at Sid's request. To us it's just a heart, but to Sid...that **** is home.....LMAO!  That is why his bangs are always in his face, he does not want to see what is happening. ....ha ha.

[Polaris922]

@pilldoc

Thank you. It explains that surgery is not necessarily required and I get all that. My question though remains... If surgery to close it does no harm, why wouldn't they just close it?

@jammer2

I need someone to interpret that. I'll get back to you when I figure it out?

@everyone else

Anyone speak Canadian? I need help with Jammer's post.

Edited July 16, 2014 by Polaris922

[jammer2]

Anyone speak Canadian? I need help with Jammer's post.

 

 HA HA.....an instant classic right there!   Just a vain attempt at yet another (groan) gay Sid joke.

[pilldoc]

@pilldoc

Thank you. It explains that surgery is not necessarily required and I get all that. My question though remains... If surgery to close it does no harm, why wouldn't they just close it?

 

 

probably because the only way to close it is to do open heart surgery which is a major surgery.........there is no other way to get to the heart

[Polaris922]

@jammer2

Figured you'd get a chuckle out of it. Lol

@pilldoc

Yeah but major surgery at his age seems less risky than the possibility if another stroke. I get your point. It's the only thing that seems to make sense.

[mojo1917]

@Polaris922

Re: surgery that surgery would be a big,risky deal... it is not like getting a knee 'scoped.

[Polaris922]

@Polaris922

Re: surgery that surgery would be a big,risky deal... it is not like getting a knee 'scoped.

The show I watched on it made it sound fairly run of the mill. *shrugs*. Guess it depends on who you ask?

[J0e Th0rnton]

@B21@Polaris922

 

I'd take Letang in a heartbeat on the Sharks. I'd even take the whole salary as long as I did not need to give up certain prospects for him. God our need for a Left handed Dman to play alongside Braun.....

Even despite the question marks on his health.

 

But that will never happen. The fact that most of our players have NMC's, and certain prospects and younger players have been declared untouchable(Hertl, Nieto, Mueller, Braun, Vlasic).

 

I am still trying to figure out if we should be ade at you for unloading Kennedy on us? Or if you are mad at us for Unloading Doug Murray on you We did turn the pick for Murray into a trade up for Mirco Mueller lol.

[B21]

@B21@Polaris922

 

I'd take Letang in a heartbeat on the Sharks. I'd even take the whole salary as long as I did not need to give up certain prospects for him. God our need for a Left handed Dman to play alongside Braun.....

Even despite the question marks on his health.

 

But that will never happen. The fact that most of our players have NMC's, and certain prospects and younger players have been declared untouchable(Hertl, Nieto, Mueller, Braun, Vlasic).

 

I am still trying to figure out if we should be ade at you for unloading Kennedy on us? Or if you are mad at us for Unloading Doug Murray on you We did turn the pick for Murray into a trade up for Mirco Mueller lol.

 

Straight up for (edit) Pavelski?

Edited July 18, 2014 by B21

[J0e Th0rnton]

Straight up for (edit) Pavelski?

Nah. I'd consider that for Keith Yandle, but not Letang

[Polaris922]

@B21@Polaris922

I'd take Letang in a heartbeat on the Sharks. I'd even take the whole salary as long as I did not need to give up certain prospects for him. God our need for a Left handed Dman to play alongside Braun.....

Even despite the question marks on his health.

But that will never happen. The fact that most of our players have NMC's, and certain prospects and younger players have been declared untouchable(Hertl, Nieto, Mueller, Braun, Vlasic).

I am still trying to figure out if we should be ade at you for unloading Kennedy on us? Or if you are mad at us for Unloading Doug Murray on you We did turn the pick for Murray into a trade up for Mirco Mueller lol.

.

Murray served his purpose here and moved on. Kennedy? We were happy to be rid of him. You poor saps just paid him too much to have him.

[chughes6]

Letang would be unreal for the oilers !! Everyone knows they are thin on the back end and adding Letang would take pressure of schultz, plus help out the powerplay. May be unrealistic however you never know with mactavish at gm he could make it happen. Overall oilers are a far ways away from anything at all but letang would definitely help the cause.

[Polaris922]

Letang would be unreal for the oilers !! Everyone knows they are thin on the back end and adding Letang would take pressure of schultz, plus help out the powerplay. May be unrealistic however you never know with mactavish at gm he could make it happen. Overall oilers are a far ways away from anything at all but letang would definitely help the cause.

The guy's a world class offensive defenseman. But we don't even know for sure he's on the market. The Pens would want a pretty good return for him I'd think.

[pilldoc]

@hf101

@Polaris922

@jammer2

@B21

 

Doing some research here at work. There seems to me relatively new treatment fot VSD.  If Letang's VSD is of the uncomplicated nature he might benefit from this:

 

http://www.uptodate.com/contents/ventricular-septal-defect-in-adults?source=machineLearning&search=adult+vsd&selectedTitle=1%7E148&sectionRank=1&anchor=H21905014#H21905014

 

 

Percutaneous repair — Transcatheter device VSD closure is a treatment option for isolated uncomplicated muscular VSDs, and for membranous VSDs, in selected patients with suitable anatomy. Appropriate anatomy for transcatheter closure includes a VSD location remote from the tricuspid and aortic valves with an adequate rim of tissue. Successful transcatheter closure has been accomplished in the presence of multiple muscular or membranous fenestrations [33,45].

The technical success rate of transcatheter closure of selected muscular and membranous VSDs is high and the mortality rate is low [46].

●In experienced hands, device closure of muscular VSDs using an Amplatzer device has a reported success rate of 93 to 100 percent and a mortality rate of 0 to 2.7 percent [47].  

 

●Success rates for percutaneous closure of membranous VSDs with Amplatzer devices are also high. In a series of 104 patients with membranous VSDs, the defect was successfully closed in 96 percent and no deaths occurred [33]. Among those successfully closed, a trivial residual shunt was present in 47 percent at the completion of the procedure, but this decreased to 16 percent at discharge and 1 percent after a median follow-up of 38.5 months.

 

Similar complication rates have been reported for percutaneous closure of muscular VSDs (3 to 10 percent [47]) and membranous VSDs (0 to 12 percent) [33]. Procedural related complications could include rhythm disturbance, conduction abnormalities, and hypotension [23].

Development of complete atrioventricular block is the most significant of the procedural complications [33,47]. In a series of 104 patients who underwent transcatheter closure of membranous defects, 6 percent developed complete heart block necessitating pacemaker implantation [33]. Real-time three-dimensional transesophageal echocardiography has been increasingly used to guide such procedures [48]. Given the lack of data on long-term outcomes following catheter closure of VSD in adults, patients should be followed every one to two years at an adult congenital heart disease center.

 

Anyway..thought I would pass it on.

[pilldoc]

Here is an Echo of the heart with a VSD:

 

Apical four-chamber view demonstrating a large inlet VSD underneath the mitral and tricuspid valves.

RA: right atrium; LA: left atrium; RV: right ventricle; LV: left ventricle.

 

 

[Polaris922]

@hf101

@Polaris922

@jammer2

@B21

Doing some research here at work. There seems to me relatively new treatment fot VSD. If Letang's VSD is of the uncomplicated nature he might benefit from this:

http://www.uptodate.com/contents/ventricular-septal-defect-in-adults?source=machineLearning&search=adult+vsd&selectedTitle=1%7E148&sectionRank=1&anchor=H21905014#H21905014

Percutaneous repair — Transcatheter device VSD closure is a treatment option for isolated uncomplicated muscular VSDs, and for membranous VSDs, in selected patients with suitable anatomy. Appropriate anatomy for transcatheter closure includes a VSD location remote from the tricuspid and aortic valves with an adequate rim of tissue. Successful transcatheter closure has been accomplished in the presence of multiple muscular or membranous fenestrations [33,45].

The technical success rate of transcatheter closure of selected muscular and membranous VSDs is high and the mortality rate is low [46].

●In experienced hands, device closure of muscular VSDs using an Amplatzer device has a reported success rate of 93 to 100 percent and a mortality rate of 0 to 2.7 percent [47].

●Success rates for percutaneous closure of membranous VSDs with Amplatzer devices are also high. In a series of 104 patients with membranous VSDs, the defect was successfully closed in 96 percent and no deaths occurred [33]. Among those successfully closed, a trivial residual shunt was present in 47 percent at the completion of the procedure, but this decreased to 16 percent at discharge and 1 percent after a median follow-up of 38.5 months.

Similar complication rates have been reported for percutaneous closure of muscular VSDs (3 to 10 percent [47]) and membranous VSDs (0 to 12 percent) [33]. Procedural related complications could include rhythm disturbance, conduction abnormalities, and hypotension [23].

Development of complete atrioventricular block is the most significant of the procedural complications [33,47]. In a series of 104 patients who underwent transcatheter closure of membranous defects, 6 percent developed complete heart block necessitating pacemaker implantation [33]. Real-time three-dimensional transesophageal echocardiography has been increasingly used to guide such procedures [48]. Given the lack of data on long-term outcomes following catheter closure of VSD in adults, patients should be followed every one to two years at an adult congenital heart disease center.

Anyway..thought I would pass it on.

Thanks! I think you should come visit the facility and pass this on to the doctors

[FD19372]

Apparently Letang can be asked to give a list of a 12 team no trade list prior to each season.  Thus the rumors are a plenty these days as Montreal and Pittsburgh were said to be discussing possible trade scenarios.  I don't see this as a Subban for Letang swap though unless Montreal thinks that they can't sign Subban long term or under $7.2M

 

Letang is also rumored to be swapped for Tyler Meyers.  This move makes some sense for both teams, Meyers has a NMC and a NTC that doesn't go into effect until 16-17.  Financially this is a great move by Pittsburgh but I don't see Letang having Buffalo as a team he'd be willing to be traded to this season.

 

I'd be surprised actually if Letang is moved this year.  Too long of a contract for too much money.

Unless a team is absolutely desperate, I don't think Pittsburgh will get appropriate equal value for Letang until after he plays a full season without any stroke effects.  No matter if they can or can't sign Subban long term, I doubt Montreal would do that at this point.