[HSF] Correction of MR in Myopathic Ventricles

[Tea Acuff]

Hmmm. Functional reserve, low acuity, clean operation. I seem to have heard that somewhere before. Hmmm.
tea


----- Original Message ----
From: "Hgrmd at aol.com" <Hgrmd at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, March 8, 2007 5:06:52 AM
Subject: Re: [HSF] Correction of MR in Myopathic Ventricles


Mitch,
  When faced with these types of patients, severe MR with horrible  
ventricles and normal coronaries, I first look at the overall patient.  If  this is 
someone with advanced kidney and liver failure, then forget it.  If  the patient 
has a resting blood pressure in the 80's or low 90's, that's another  red 
flag.  However, a lot of these patients, in spite of an EF of 15%,  will have BP 
systolics of 130 or more.  Many have hypertensive  cardiomyopathies.  The 
patient cited was one of those.  She, and  nearly all of the others, don't even 
require a IABP perioperatively.  The  sad thing is I know I help these patients, 
and probably the majority of them are  never referred or are turned down by 
inexperienced surgeons.  The one  caveat is you must, simply must, repair rather 
than replace the mitral and  tricuspid.  In addition, the repair must be 
perfect.  Closing  interscallop and commissural leaks are often required to get a 
durable  result.
Hal
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