Ischemic MR AND TR

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TEEIntraOpMEAVLAXCFD
Short case presentation
78 yo with hx of atrial fibrillation, mild RAE and mild LAE, mild MR, mild to moderate TR, LVEF 50%, and aortic sclerosis. The patient had a CABG LIMA to LAD and RIMA to RCA 10 years ago. He presents with increasing SOB and angina. A cath showed a 70% LIMA lesion. The preop and post induction TEE showed trace MR, mild-moderate TR, LVEF 45% with anterior wall hypokinesis. Shortly before CPB the following loops were obtained. What is your assessment of the severity of the valvular lestions? What recommendations, if any, do you have for the surgeon?