A 64 year old, 60 kg female presented
with pulmonary edema and ascites and
functional class IV symptoms. EKG
showed biventricular enlargement,
right ventricular strain and atrial
fibrillation. Cardiac catheterization
revealed critical aortic stenosis,
critical mitral stenosis and severe
pulmonary hypertension. The pressures
were:

    RA mean 15    RV 120/114
    PA 120/57     PAW mean 35
    LV 150/20     Ao 110/75

She underwent aortic valve replacement
(23 mm tissue valve) and mitral valve
replacement (29 mm tissue valve).

After a 68 minute crossclamp time and
30 minutes of de-airing and cardiac
resuscitation with the heart in sinus
rhythm, we are ready to discontinue
cardiopulmonary bypass.

How would you manage this patient?