Re: [金山毒霸识别此邮件为垃圾邮件]Re: [HSF] Posterior Post-Infarction VSD, SAM, and other Misery

[陈鑫]

Dear Members, I would like to have your thoughts about the following case.

57 male had severe MR ( 4+) from mitral posterior leaflet prolapes, And received mitral repair ( Q resection of the posteroir leaflet and 29# ring  ( O shape ), TEE showed 1 one +  MR during surgery. He had uneventful recovery and went home. Three weeks after surgery, he had jaundice and hemolysis with elevated hepatic enzyme. HCT went down from 40 to 30%. Even after 6 weeks medical treatment, his jaundice getting better and hepatic enzyme went down too, but not normal yet. We checked echo again it shows that the size of LA and LV is smaller that that before surgery, and have + to ++ MR, with a II/6 systolic murmer. EF is normal. Now he is about 3 months after. 

Is his jaundice and hemolysis related to the ring or repair? Should we do anything surgically? Replacememt of the mitral valve? or wait? or other? 

Many thanks in advance for your help. 

Steve