tokens: Admission Date : 2015-09-16 Discharge Date : 2015-09-21 Date of Birth : 1962-09-26 Sex : M Service : CARDIOTHOR REASON FOR ADMISSION : Mitral valve repair . HISTORY OF PRESENT ILLNESS : The patient is a 52 year old Czech speaking gentleman with a history of severe mitral regurgitation . For the past several years , the patient has continued to have significant exercise intolerance which has limited his ability to work . He reports severe dyspnea on exertion . The patient had a recent admission earlier in the month and he was discharged on 2015-09-10 , after undergoing cardiac catheterization . This was significant for demonstrating no flow-limited disease in the coronaries but several fistulae from the left anterior descending to the PA . Several of these were coil embolized during this admission . He tolerated this well , was sent home , and now returns for his mitral valve repair . PAST MEDICAL HISTORY : 1. Mitral valve regurgitation . PAST SURGICAL HISTORY : None . MEDICATIONS ON ADMISSION : 1. Atenolol 25 mg p.o. q. day . 2. Enteric-coated aspirin 325 mg p.o. q. day . 3. Nitroglycerin sublingual p.r.n. ALLERGIES : No known drug allergies . SOCIAL HISTORY : The patient is currently on Disability and lives at home with his wife . Kimberly was born in Great Britain . He denies any ETOH or tobacco use . FAMILY HISTORY : Negative . PHYSICAL EXAMINATION : The patient is in no acute distress . Temperature is 98.3 F. ; pulse is 76 ; blood pressure 113/52 ; breathing 18 ; 98% on room air . HEENT : The patient is missing many teeth . Oropharynx is clear . There is no cervical lymphadenopathy . Supple neck . Heart is regular rate and rhythm with a III/VI systolic ejection murmur . His lungs are clear to auscultation bilaterally . Abdomen is soft and nontender . The patient has no cyanosis , clubbing or edema in extremities . LABORATORY : On admission include a white blood cell count of 5.6 , hematocrit of 32.5 , platelets of 202 . Sodium of 140 , potassium of 3.5 , BUN of 4 , creatinine of 0.6 , glucose of 137 . Chest x-ray shows no infiltrate or pneumothorax . Cardiac catheterization demonstrates no significant disease in the coronary arteries . Two branches of an left anterior descending to PA fistula which was successfully coiled . There is a persistent flow through an inferior branch of the left anterior descending to PA fistula and a persistent branch of the circumflex to PA branch fistula which anatomically were not suitable for coil embolization . Ejection fraction was 60% . HOSPITAL COURSE : On the day of admission , the patient went to the Operating Room and underwent a minimally invasive mitral valve repair . He tolerated this procedure well . The patient was brought to the cardiothoracic Intensive Care Unit in stable condition on minimal pressor support . He was successfully weaned off this support . The patient was fully weaned from ventilatory support secondary to a persistent acidemia . This was treated with sodium bicarbonate and a Swan-Ganz was placed to provide close hemodynamic monitoring . The patient was found to have stable hemodynamics with appropriate mixed venous saturations in the 70% range . The patient was corrected to a normal pH of 7.41 by the first postoperative night and remained stable . He was then weaned off of ventilatory support and was successfully extubated . The patient did have a slight bit of confusion early in post-extubation course which cleared . This was also compounded by a language barrier since the patient cannot speak English . In addition , the patient 's early postoperative course had a tremendous urine output . It was equally up to 700 cc. an hour and a renal consultation was obtained . He underwent a head CT scan to rule out intracranial pathology leading to diabetes insipidus . This was negative . The patient 's serum and urine electrolytes indicated that this diuresis was appropriate . The patient 's urine output has decreased and his BUN and creatinine remained normal . The patient 's Foley was discontinued . He had developed some hematuria which has resolved . The patient has remained stable and is now ready for discharge to home with follow-up in approximately four weeks . DISCHARGE DIAGNOSES : 1. Mitral regurgitation status post minimally invasive mitral valve repair . DISCHARGE MEDICATIONS : 1. Lopressor 75 mg p.o. twice a day . 2. Colace 100 mg p.o. twice a day . 3. Percocet one to two p.o. q. four hours p.r.n. 4. Aspirin 325 mg p.o. q. day . CONDITION ON DISCHARGE : Stable . DIGibsonE INSTRUCTIONS : 1. The patient will follow-up with Dr. de las Grau in four weeks . 2. He will follow-up with his primary care physician , Dr. Blake , in two weeks . 3. The patient will call for any fevers or difficulties with the wound care , and will be instructed with an interpreter present . Bruce lou Murphy , M.D. 07-760 Dictated By : Ellen V Wise , M.D. MEDQUIST36 D : 2015-09-21 08:34 T : 2015-09-26 15:44 JO B#: 18430 Signed electronically by : DR. Mary van den Mosley on : WED 2015-10-14 7:16 PM ( End of Report )