[HSF] Mitral ring redux

[Mitch Lirtzman]

Please help clarify a point I made concerning mitral repair.

I have a 50yo male smoker with no history of drugs, EtOH, industrial 
exposure, etc, and rather severe CAD. The LAD is previously stented and 
occluded at it's origin. Fills rt-to lt. The Cx has a proximal 90% lesion. 
RCA normal. EF is 20%. LVEDD~ 7cm. TEE shows moderate MR with a central jet 
to mid-atrium. Septum and lateral walls still move. Previously refused by 
another surgeon. They putzed around with him at the local Charity hospital 
til he went into VT...and sent him to me. Still has occasional chest pains 
in ICU.


Frankly, the guy has no chance without surgery and at high risk with it. 
I've done bunches of low-EF patients with quite satisfactory results. The 
question is that I plan to put a "quick" ring on his mitral as has been my 
practise for several years. You all know the possible scenario in six 
months with CHF and worsening MR, if the MR is not corrected. The 
cardiologist feels that his LV won't be able to take the added strain 
without that "pop-off valve".

Thanks in advance for your comments and advice in advance.
Mitch