leaflet( MVP/ endocarditis/ rheumatic fever), MI
clinical examination
- displaced forceful apex beat
-AF
-soft S1, PSM radiating to axilla , loud S3
TEE good coz MV closest to esophagus
CXR: dilated LA , +/-
ECG:AF, LA dilatation
SV usually preserved until late
surgery if functional status <4 METS
if mixed lesion- deal with dominant lesion first.
Goals: high normal HR (slower--> more time for diastolic filling and larger volume regurg), adequate preload, low afterload, low PVR
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