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High velocity jets after mitral valve repair strongly suggest leaflet perforation. They're usually simple lesions to re-repair. And if patients are stable and have good ventricular function, it's usually worth a second look on bypass to identify them. They can be dynamic and they can also happen from a pressurized ventricle and when you see them, you shouldn't just trust the sailing test, you should go back on and reexamine the valve.


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