[HSF] Mitral ring redux

[Mitch Lirtzman]

CABG-yes
LV lead- yes
MAt 05:53 PM 5/3/2008, you wrote:
>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
>
>________________________________
>
>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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