[HSF] Mitral ring redux

[Douville, Chuck]

I would also offer him CABG with MV annuloplasty Mitch despite his poor ventricular function. The case would worry me, though I get the sense that others in the forum no longer worry about LV function with MR, regardless of the level of impairment. I must say that my associates and I have not reached that level of confidence with severe MR and depressed LV function, though I am suprised to hear anyone argue the "popoff theory" any longer. 
I presume you will put a lead on the LV for bivent pacing in the future on this case; we do this routinely in these situations. Good luck. chuckdouville

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From: openheart-l-bounces at lists.hsforum.com on behalf of Mitch Lirtzman
Sent: Fri 5/2/2008 7:48 PM
To: OpenHeart-L at hsforum.com
Subject: [HSF] Mitral ring redux



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

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