[HSF] MVR in dilated LV

[Nasser F. Abou'Seada]

Well Done Prasanna 
Perhaps that "crack" /tear in the calcified AS mass was a saving factor for
the myocardium and the operation ...!

NFA

> From: prasannasimha
> Nand,
> Thursday's case list had a case with AS (50 mean) with grade IV AR,
> severe MS  and an LV of 7.7 in a patient with a BSA of 1.5. He had an EF
> of 32 % in the presence of AR and an FS of 16 %. He had also AFib. One
> of my carrdiologists was against surgery while another cardiologist was
> pro and we finally did him.
> He had an OMV + AVR + eMAZE . On table  here was calcific AS with a
> "tear in the calcified mass extending from the annulus to the orifice
> and this had caused a fixed orifice AR. His LV was huge and all of this
> in the presence of tight MS which would mean the LV would be worse off
> in size when the MS was removed.
> I did this with continuous cold retroplegia and except for short periods
> during the OMV and intermittent antegrade and switched to warm when the
> major portion of the surgey was over. (Still can't do detailed mitral
> work except MVR with continuous warm perfusion). Patient could not
> afford Milrinone and I came off with 3 mics Dobut and Dopamine and Ad
> lib SNP. He has an EF at present of 25 % and I hope his EF improves. He
> is on Enalapril at maximal doses and I have him on Carvedilol and Digoxin.
> Will now have to observe what happens to him !!
> These cases are doable but their final outcome may be unpredicatable but
> at least allows better medical management in non responders.
> Prasanna