[HSF] endocarditis

[gustavo abuin]

Dear members.
We have a 28 year old patient with an aorto right ventricular fistula, 
subaortic VSD (both small), aortic insufficiency, aortic endocarditis, 
moderate central mitral insufficiency with no structural disease of the 
valve and 18% of EF, 88 of end diastolic diameter.
no pulmonary hypertension, no RV failure, no organ disfunction.
The patient is with antibiotics and low dose of dobutamine, with no fever, 
no acute signs of cardiac failure.
I will place him on the OR next wenesday.
I plan to replace the aortic valve, close the defects with a patch or maybe 
some pledgettes stiches.
The question  about the mitral valve in order to treat the mitral annullus 
and cardiac failure:
-pericardium annuloplasty
-annuloplasty up to a perfect competence with a proper sized mitral ring.
-annuloplasty with a 2-3 downsize mitral ring.
-mitral replacement?

The question about comming offpump:
combination of inotropics
centrifugal pump directly?

What do you do in a routine basis in this cases?

Thanks in advance.
gustavo.