[HSF] redo mitral case

[Tea Acuff]

I'm am kinda of wondering whether I caused the HSF to "crash" after my last "random" post.

If not, maybe some would like to comment on a recent patient. 

A mid 70s female re-presented to me 7 years after a CAB X 1 and mitral repair (posterior quad resection with suture annuloplasty). Her symptoms are primarily fatigue with associated DOE.

She now has 3+ MR with large LA, borderline enlarged LV, moderate TR, normal RV size and function, and occluded graft to the LAD. There are, to me at least, some quixotic issues in this case and to follow intraop. Excuding the theory that I am an inferior surgeon, which fortunately is not provable based on one case, does anyone wish to guess the findings, suggest possible causes, and make specific recommendations?

tea