[HSF] (no subject)

[Hgrmd at aol.com]

Mark,
  Thanks for your valuable input.  As you know, this case has  tortured me 
the past week.  The problem is the patient is so alert and  really wants to 
live.  I totally agree that my standard policy of fixing  everything would likely 
end with a bad outcome.  In addition to all of his  problems, he developed a 
large groin pseudoaneurysm that had to be injected with  thrombin.  The 
cardiologist decided to send him home for a couple of weeks,  and then bring him back 
for PCI of the LAD.  We are also going to dry him  out as much as possible.  
I'll repeat the TEE.  If I can convince  myself that the MR is only moderate, 
then I will ask Jim Gammie to proctor me on  an aortic valve bypass.  However, 
if the MR is wide open, then I will  probably punt.
Hal



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