June 1, 2010
I recently had the pleasure of seeing your patient, Ms. Ingrid Kantola in a clinic for follow-up. As you may recall, Ms. Kantola is a 24 year old woman who presented with mitral valve vegetation and endocarditis and was found to be in congestive heart failure. On May 11, 2010, she underwent mitral valve repair with a pericardial patch augmentation of the anterior and posterior leaflet and a 28mm Cosgrove Edwards annuloplasty band. Her postoperative course was uneventful and she was discharged home on May 17, 2010.
She returns today to clinic for follow-up. She states she is feeling well and denies fevers. Her appetite has normalized. She is able to walk without difficulty and has no shortness of breath.
On physical examinations, she is afebrile with a heart rate of 60 and regular and a respiratory rate of 12. Her blood pressure is 121/65. Her cardiac examination reveals a regular rhythm. Her chest is clear to auscultation and her respiration is non-labored. Her submammary incision is healing well. Her lower extremities are without edema.
Ms. Kantola is recovering well from her mitral valve repair with a pericardial patch augmentation of the anterior and posterior leaflet. I recommend continuation of Coumadin for 3 months for her prosthetic annuloplasty ring. I defer to you and further judgements in her medication as well as her enrollment in cardiac rehabilitation program.
It certainly has been a pleasure to participate in the care of Ms. Kantola. If I can be of any further assistance, please do not hesitate to contact me.
Sincerely yours,
Abbas Ardehali, M.D.
Description of Procedure (ammended)
Patient was brought into the operating room and after satisfactory anesthesia the chest, abdomen, groins, and legs were prepped and draped in the usual fashion. Submammary incision was made, the incision was carried out, and a flap was created overlying the sternum. Median sternotomy was completed. Pericardium was opened.... With adequate ACT, the patient was placed on cardiopulmonary bypass and cooled to a temperature of 32 degrees. Aorta was crossclamped, a dose of antegrade cardioplaegia was given which resulted in arrest of the heart. The right atrium was opened... There was significant destruction of the A1 and P1 segment of the mitral valve leaflet, furthermore there was a hole in the anterior leaflet. This area was debrided in it entirety. Then I used a piece of autologus pericardium and it was sewn to create a patch where the anterior and posterior P1 and A1 segments of the mitral valve. The valve was tested and appeared to be quite competent and the patient was rewarmed. With a dose of warm retrorade cardioplaegia followed by administration of warm blood... After normal de-airing manuvers, the aortic crossclamp was removed. The heart resumed regular activity. With optimal hemostatis and hemidynamics, the patient was successfully weaned off cardiopulmonary bypass.... The sternum was reapproximated with wires and cables. The muscle layers were used to cover all the wires and cables.... The skin was closed in subcuticular fashion. Sponge and needle counts were correct. Estimated blood loss: unknown.
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