Halo Dr. Talal Reda, Thank you for replying my inquiries previously.

Continuing my inquiries,
Herewith I explained the chronology of my husband's medical observations :

1. Date : November 28th, 2023, at HARAPAN KITA Cardiovascular Hospital Jakarta, by Heart's USG, the doctor diagnosed my husband as severe Mitral Valve Regurgitation and proposed further for TEE observation.

2. Date : December 4th, 2023, at HARAPAN KITA Cardiovascular Hospital Jakarta, proceed with TEE observation with result :
-Left ventricle is dilated. There is eccentric left ventricular hyperthrophy. LV mass ind 123 g/m2. Global lef ventricular systolic function is normal. LVEF bilang 82%. LV Diastolic Function is abnormal. IvRT/T E-e' 1.9
- Right ventricle is normal size. Wall thickness is normal. Right ventricle systolic function is normal. TAPSE 23.2 mm.
- Left atrium is dilated. LAVI 37.4 ml/m2
- Right atrium size is normal. RA area is 14.4 cm2
- Intact interatril septum
- Intact interventricular septum
- Aortic valve is trileafet. The aortic valve opens well. There is mild aortic regurgitation. VcD 1.2 mm. There is no valvular aortic.
- There is prolapse of P2 and some part of P3. There is severe mitral Regurgitation. MR VCA 1.7 cm2. MR VCD 6.4 mm. MR Vol 178 mlm. (PW volumetric). MR RF 74% (PW volumetric). Regurgitation jets is eccentric. Pulmonary vein systolic reversal flow is present. There is no mitral stenosis. No vegetation is seenaknya.
- The tricuspid valve structure is normal. Triscupid valve opens well. There is mild triscupid regurgitation. There is no tricuspid stenosis.
- The pulmonic valve is grossly normal. Pulmonic valve opens well. There is mild pulmonary regurgitation. PHT 944 ms. There is no pulmonary stenosis.
- There is no abnormal mass or thrombus.
-Pericardium is normal
- Low probability of pulmonary hypertension. TR Vmax 2.2 m/s.
The doctor suggest to continue with open-heart surgery to replace or fix the faulty of mitral valve. The doctor said that he will bring my husband's case up to the doctors committee meeting.

3. Date : December 20th, 2023, at HARAPAN KITA Cardiovascular Hospital Jakarta, one of surgery's preparation, my husband had Heart Catheter, with result : Normal Coroner.

4. Date : 3 January 2024, we went to NHCS Singapore, and did an echocardiogram test, with result :
- normal LV size. Normal LV systolic function. LVEF 64% (LVEF simpson biplane). No regional wall motion abnormality. No LV hyperthrophy
- Normal LV diastolic function. Septal e' 10.5 cm/s. Lateral e' 11.4 cm/s
- Normal right ventricle size. Normal RV systolic function. TAPSE 23mm. TA s' is 12.1 cm/s
- Severe left atrium dilatation. LA volume 102 ml (55.24 ml/m2). Normal right atrium. RA Area 14.3 cm2.
- Posterior mitral leaflet prolapse (P2, P3). Thickened and redundant mitral valve leaflets. The mitral annulus is dilated (34 mm). At least moderator mitral regurgitation. Systolic pulmonary vein flow blunting, no increase in E velocity. Vena contracta 0.6 cm. Eccentric mitral regurgitation jet anterior directed.
- rest of valves are normal. Mild tricuspid regurgitation. Trivial pulmonary regurgitation.
- low eechocardiographic probability of pulmonary hypertension. TR velocity is 201 cm/s. PASP 19 mmHg, assumsing memang RAP of 3 mmHg. RVOT AT 137 ms.
- Normal aortic root, pulmonary arteri and IVC dimensions.
- No pericardial effusion. No thrombus. No vegetation

Since the first doctor 's observation on Nov 28th, the medication taken are :

1. Spironolactone 25 mg - 1 tablet at Morning after breakfast

2. Concor 1,25mg - 1 tablet Morning after lunch

3. Lansoprazole 30 mg - 1 tablet Afternoon before lunch (if required)

4. Ramipril 2.5 mg - 1 tablet Night before sleep.
Yesterday, the Ramipril was changed to Candersartan 4mg @1 after breakfast and Candersartan 4mg @1 after dinner.

My husband 's age is 51 years and 6 months old.

Please find my further inquiries based on above facts :
1. For surgery, is it Open-Heart Surgery ?

2. what is more prioritize, for Mitral valve, will it repair or replacement mitral valve or both repair and replacement ?

3. How about the Mild tricuspid regurgitation. Trivial pulmonary regurgitation. Will it be repair too ?

4. There are different fact between Harapan Kita Jakarta and NHCS Singapore about condition of Left Ventricle. Is my husbad 's left ventricle dilated or normal ?

5. Left atrium LAVI on 5Des2023 is 37.4ml/m2 , but on 3Jan2024 is 55.24 ml/m2. Is it normal ?
Is that dangerous ? What is the normal LAVI for a man with 51years old, 70kg weight, 167cm height ?

6. For the medication given, are they enough ?

7. If we plan to have surgery at Glenegles Penang, can you give me the more detail treatment and its cost ?
A. For preparation: what kind of test and treatment ? How long will it take ? How much ?
B. For surgery : how much ?
C. For treatment care inpatient after surgery : how long estimation time to stay and how much will it cost ?
D. after discharge from hospital : how much are the medication to bring home ?
E. For recovery treatment after surgery : what will be the treatment ? Is it like teraphy, exercise, fisiotherapy ? How long will it take ? How much ?
F. Control and check back to the doctor after surgery : when should we go back to control and check to the doctor ? How many times / interval? How much will it cost?


If possible, please kindly also advise us for other cost incurred, if the most extreme conditions should be taken ( during the preparation, surgery, and its recovery time)., so we can prepare the overall cost too.

The reason why i ask this is, we don't want to stop the treatment because of financial issue, I need to prepare the overall cost , including the accomodation for myself too.
Please kindly understand, that we are not using any insurance , thus we need to ensure that our own piggy bank’s saving enough to cover the most important cost of process. But still, we want to have the most experience hospital , that’s why we choose GLENEGLES Penang.

Sorry for asking so many questions

awaiting your reply.

Thanks and Best regards