SOB after MV Repair

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TEEIntraOpME4CV2D
Short case presentation
54 yo male presents with increasing SOB and DOE 5 years after a mitral valve repair for MR. A cardiac cath showed normal coronary arteries. He is currently on Toprol and Crestor. His ECG showed atrial fibrillation. He has been off of his Coumadin for 7 days and his INR is 1.0. A preop TTE showed a normal LVEF, LAE, and MS.

Please review the echo loops and indicate what operation you would recommend for this patient: MVR and/or Cox 3 Maze. Please discuss the accuracy of the MVG, MVA by PHT, and MVA by PISA (Flow Convergence).