[??????????????]Re: [HSF] Posterior Post-Infarction VSD, SAM, and other M...

[Jbflegejr at aol.com]

Is the diagnosis of mechanical hemolysis firmly established? LDH,  
haptoglobin levels? If so, then it is due to the mitral insufficiency with the  rbc 
contacting the ring. In time the ring may become endotheliazed, even likely  to, 
and the hemolysis disappear. If the jaundice is receding and the Hct 30 %,  the 
hemolysis is not so bad and you can afford to wait awhile. Of course, the  
mitral insufficiency may constitute an indication for operation, apparently not  
yet, and if so what is done-repair or replacement- will have to be decided on 
 the basis of the operative findings. John Flege



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