The Common Vein

1) CHD. Remote large anterior MI, complicated by VSD (25years prior). Expedited VSD/aneurysmectomy repair

2) CHF. Combo LV syst.diast dysfn. TTE (6 years ago) with LVEF 30% and severely dilated chamber. Moderately dilated RV. Severe LAE. MiV with chrodal and papillary Ca++ and secondary2+ MR.

3) EHD. Remote VT-s. ICD placed 40 years ago  Later m upgraded to CRT-D (4/2014). Permanent atrial fibrillaiton . Warfarin AC, later switched to DOAC with apixaban 2.5 mg twice daily. (lower diose B/c prior GIBs from Cecal AVMLBB and now Bi-v pacing .

4) VHD (2-3+ MR (see belwo)

5) Cecal AVM (angiodysplasia). Several laser fulgaratiosn for this . Parenteral iron Rx with Fe-Dextran infusions per HEME/ONc clinic. whre his HCT.Hgb is mointoed.

6) Prior colonoscopy with hyperplastic Polyps removed from transverse colon. Also; hemorrhoids; Diverticulosis  Endoscopy NEG for h. Pylorii.

9) RECENT Bx of RLL nodule. PATH: MUCINOUS ADENOCARCINOMA

UPDATED TTE (THEN) LVEF 37% with severely ilated chamber.Scarred akientic base and mild inferior and inferoseptal hypokineisa. Other egions of LV move well. Severe LAE. 3+ posteriorly direct MR. Base on these findings cleared for lung surgery.
2 years ago VATS and RLL wedge resection for Stage 2A3 Adenocarconoma, of RLL. EPS briefly disabled his ICD, then rstored his CRT-D post op.

Echo 2 years ago

Severely dilated LV cavity size; the base- mid inferior wall and inferior
septum are thin, scarred and akinetic; the other walls move normally. No LV
apical clot..
Calculated LVEF (using 3D with post processing) is 37%.
Doppler indices of diastolic function are indeterminate.

RV size is normal but systolic function appears reduced. Pacing wire in right
heart.
Severely dilated LA ( 74 ml/m2); RA size is top normal.
The posterior leaflet of the mitral valve is tethered to the infarcted
posterior wall leading to 3+ posteriorly directed jet of MR ( E velocity 1.4
m/sec; ERO not evaluated).
Other valves appear structurally normal.
Insufficient TR Doppler signal to estimate PA systolic pressure.
IVC is dilated with normal respiratory variation suggesting an RA pressure of
5-10mmHg. No pericardial effusion.

Compared to prior report 4 years priorthe overall findings are similar; the LVEF is
higher on the present study ( previously 30%).