GW26-e0253 Outcomes of Mitral Valve Surgery for Mitral Stenosis

Myocardial fibrosis in rheumatic mitral stenosis (MS) is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis predicts worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormalities. However, this issue has not been explored yet among patients with rheumatic MS.The aim of the study was to investigate prognostic impact of myocardial fibrosis to postoperative morbidity after mitral valve surgery in patients with rheumatic MS.This is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) protocol for left ventricular myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidities were defined as stroke, renal failure, and prolonged mechanical ventilation.This study involved 33 women (70.2%) and 14 men (29.8%) with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 patients (91.5%). Estimated fibrosis volume ranged from 0% to 12.8% (median 2.8%). Postoperative morbidities occurred in 11 patients (23.4%). Significant mean difference of myocardial fibrosis volume was observed between patients with and without morbidity after mitral valve surgery (5.97 ± 4.16% and 3.12 ± 2.62%, p = 0.04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups.More extensive myocardial fibrosis is associated with postoperative morbiditiy after mitral valve surgery in patients with rheumatic MS.

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Comparison of Inhaled Nitric Oxide Versus Oxygen on Hemodynamics in Patients With Mitral Stenosis and Severe Pulmonary Hypertension After Mitral Valve Surgery

The American Journal of Cardiology ◽

10.1016/j.amjcard.2010.11.030 ◽

2011 ◽

Vol 107 (7) ◽

pp. 1040-1045 ◽

Cited By ~ 17

Author(s):

Juliano L. Fernandes ◽

Roney O. Sampaio ◽

Carlos M. Brandão ◽

Tarso Augusto D. Accorsi ◽

Luiz F. Cardoso ◽

...

Keyword(s):

Nitric Oxide ◽

Pulmonary Hypertension ◽

Mitral Valve ◽

Mitral Stenosis ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Inhaled Nitric Oxide ◽

Severe Pulmonary Hypertension

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Pulmonary Function Changes Before and After Mitral Valve Surgery in Severe Mitral Stenosis

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0039-1684879 ◽

2018 ◽

Vol 02 (02) ◽

pp. 079-083

Author(s):

Manoj Kumar Sahu ◽

Mayank Yadav ◽

Milind Padmakar Hote ◽

Sarvesh Pal Singh ◽

Shiv Kumar Choudhary

Keyword(s):

Mitral Valve ◽

Pulmonary Function ◽

Mitral Stenosis ◽

Pulmonary Function Tests ◽

Nyha Class ◽

Forced Expiratory Volume ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Female Ratio ◽

Expiratory Flow

Abstract Objective This study was undertaken to assess the pulmonary functions in the patients with predominant severe mitral stenosis before corrective mitral valve surgery, then to reassess the same 6 months after surgery and compare them. Patients and Methods Fifty consecutive patients with predominant severe mitral stenosis undergoing mitral valve replacement surgery were included in this prospective observational study. This study was conducted from July 2016 till January 2018 after obtaining approval from the institute's ethics committee and written consent from all the participants. All the patients were evaluated clinically and divided according to New York Heart Association (NYHA) class symptomatology. Computed spirometric pulmonary function tests (PFTs) such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, forced expiratory flow (FEF) 25–75%, peak expiratory flow rate (PEFR), and maximum voluntary ventilation (MVV) were performed on each patient 1 day before and 6 months after surgery. Results Fifty study patients were analyzed, mean age was 38.4 ± 10.76 years (15–56 years), and male-to-female ratio was 1:1.38 (21 males and 29 females). NYHA class symptoms improved significantly in most of our patients after surgery (p < 0.01). PFTs such as FVC, FEV1, FEV1/FVC ratio, FEF 25–75%, and MVV showed significant improvement 6 months after surgery (p < 0.01). Though PEFR also improved compared with preoperative values, it was not significant statistically (p < 0.07). Conclusion This study showed that the lung functions are impaired in patients with severe mitral stenosis and improved significantly 6 months after surgery, which does not correlate well with the betterment of NYHA class.

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Atrial fibrillation and early clinical outcomes after mitral valve surgery in patients with rheumatic vs. non-rheumatic mitral stenosis

Heart Views ◽

10.4103/1995-705x.105730 ◽

2012 ◽

Vol 13 (4) ◽

pp. 136 ◽

Cited By ~ 2

Author(s):

SJ Mirhosseini ◽

Sadegh Ali-Hassan-Sayegh ◽

Mehdi Hadadzadeh ◽

S. M. Y Mostafavi Pour Manshadi ◽

Nafiseh Naderi

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Clinical Outcomes ◽

Mitral Stenosis ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Rheumatic Mitral Stenosis ◽

Early Clinical Outcomes

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BEATING HEART MITRAL VALVE REPLACEMENT. EXPERIENCE AT A TERTIARY CARE HOSPITAL

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70isuppl-4.6029 ◽

2021 ◽

Vol 70 (Suppl-4) ◽

pp. S809-13

Author(s):

Musfireh Siddiqeh ◽

Imran Khan ◽

Fakher -e- Fayaz ◽

Asif Janjua ◽

Ali Gohar Zamir ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Stenosis ◽

Mitral Valve Surgery ◽

Beating Heart ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Valve Prosthesis ◽

Care Hospital

Objective: To study the early outcomes of mitral valve surgery performed with a beating heart and cardiopulmonary bypass. Study Design: Prospective descriptive study. Place and Duration of Study: Cardiac Surgery department, Rawalpindi Institute of Cardiology, Rawalpindi, from Aug 2017 to Aug 2019. Methodology: Consecutive patients requiring mitral valve surgery were included in the study. Those requiring multiple procedures, redo procedures and emergency procedures were excluded from the study. Data was collected on preformed proformas and perioperative variables were recorded. Patients were followed till discharge or 30 days after the surgery. Statistical Package for Social Sciences version 23.0 was used to analyse the data. Results: A total of 27 patients were included in the study, 21 (77.78%) female and 6 (22.2%) male patients. The mean age of the patients was 30.89 ± 10.8 years. Of the cohort, 4 (14.8%) had mitral stenosis, 16 (59.3%) had mitral regurgitation and mixed disease (both mitral stenosis and mitral regurgitation) was present in 7 (25.9%). The median pulmonary artery pressure (mPAP) was 34 mmHg. All the patients received mechanical mitral valve prosthesis, 27 (100%). A modified Devaga’s procedure for tricuspid valve repair was done in 4 (14.8%) patients. Most of the patients required only mild inotropic support, 22 (81.4%). Median intensive care unit stay was 24 hours with a mean of 33 ± 16 hours. All the patients were alive at the end of the early follow up. Conclusion: Beating heart mitral valve surgery on cardiopulmonary bypass is a feasible technique. It has acceptable early outcome in terms of mortality and major morbidity indicators.

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Improvement of exercise capacity after early phase II cardiac rehabilitation in patients who undergo rheumatic mitral valve surgery

Indonesian Journal of Cardiology ◽

10.30701/ijc.1038 ◽

2020 ◽

Author(s):

Ade Meidian Ambari ◽

Budhi Setianto ◽

Anwar Santoso ◽

Basuni Radi ◽

Bambang Dwiputra ◽

...

Keyword(s):

Mitral Valve ◽

Cardiac Rehabilitation ◽

Exercise Capacity ◽

Phase Ii ◽

Mitral Stenosis ◽

Early Phase ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Rheumatic Mitral Stenosis ◽

Rheumatic Heart

Background: Rheumatic heart disease still become a major concern in developing countries. Recent studies showed the benefits of early phase II cardiac rehabilitation (CR) on improving the exercise capacity but the evidence in patients after rheumatic mitral valve surgery due to rheumatic heart disease is limited. This study aims to investigate the effects of early phase II CR program on increasing exercise capacity in the rheumatic mitral valve surgery patients. Methods: This is a cohort retrospective study. A review of medical records identified 254 patients who underwent early phase II CR after rheumatic mitral valve surgery between July 2009 – June 2019. Effects of CR was assessed by 6 Minutes Walking Distance (6MWD) pre and post early phase II CR and peak oxygen uptake (VO2 peak) calculated by Cahallin formula. In this study, we observed and analyzed the increasing of 6MWD and VO2 peak. Results: Our findings showed that 6MWD and VO2 peak increased significantly in these patients after early phase II CR program (p = 0.001). Mean of 6MWD increased from 316.3 ± 71.7 meters to 378.6 ± 60.3 meters and VO2 peak increased from 7.7 ±2.4 mL/kg/min to 8.9 ± 2.2 mL/kg/min. The mean difference of 6MWD was 62.3 meters and VO2 peak was 1.2 mL/kg/min. There was a strong correlation between VO2 peak and 6MWD (r = 71%; R2 = 51%; p = 0.001). Conclusion: Early phase II CR in patients with Rheumatic Mitral Stenosis after mitral valve surgery improved the exercise capacity. Based on 6MWD, we can predict the value of VO2 peak patients with rheumatic mitral stenosis surgery patients. Keywords: Cardiac rehabilitation, rheumatic mitral stenosis, 6MWD, VO2 peak

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Restoration and maintenance of sinus rhythm after mitral valve surgery for mitral stenosis

The American Journal of Cardiology ◽

10.1016/0002-9149(84)90260-1 ◽

1984 ◽

Vol 54 (6) ◽

pp. 617-619 ◽

Cited By ~ 56

Author(s):

Moshe Y. Flugelman ◽

Yonathan Hasin ◽

Nachum Katznelson ◽

Michael Kriwisky ◽

Arie Shefer ◽

...

Keyword(s):

Mitral Valve ◽

Sinus Rhythm ◽

Mitral Stenosis ◽

Mitral Valve Surgery ◽

Valve Surgery

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Left Ventricular Dimension after Mitral Valve Surgery in Rheumatic Mitral Stenosis: the Impact of Myocardial Fibrosis

The Journal of Tehran University Heart Center ◽

10.18502/jthc.v15i3.4222 ◽

2020 ◽

Author(s):

Teuku Muhammad Haykal Putra ◽

Renan Sukmawan ◽

Dwita Rian Desandri ◽

Celly A. Atmadikoesoemah ◽

Elen Elen ◽

...

Keyword(s):

Mitral Valve ◽

Myocardial Fibrosis ◽

Mitral Stenosis ◽

Mitral Valve Surgery ◽

Left Ventricular ◽

Valve Surgery ◽

P Value ◽

Rheumatic Mitral Stenosis ◽

Dimensional Parameters ◽

The Impact

Background: Patients with rheumatic mitral stenosis (MS) experience changes in left ventricular (LV) dimensions after mitral valve surgery. We sought to investigate changes in LV dimensional parameters after mitral valve surgery and find out whether the same changes occurred in different extents of myocardial fibrosis. Methods: This prospective observational study comprised 43 patients with rheumatic MS planned for mitral valve surgery between October 2017 and April 2018 in National Cardiovascular Center Harapan Kita (NCCHK) Jakarta. All the patients underwent cardiac magnetic resonance imaging based on the late gadolinium enhancement (LGE) protocol for myocardial fibrosis assessment prior to surgery. The patients were classified according to the estimated fibrosis volume considered to influence hemodynamic performance (myocardial fibrosis <5% and myocardial fibrosis ≥5%). Serial transthoracic echocardiographic examinations before and after surgery were performed to detect changes in LV dimensional parameters. Results: This study consisted of 31 (72.1%) women and 12 (27.9%) men at a mean age of 46±9 years. The LGE protocol revealed myocardial fibrosis of less than 5% in 32 (74.4%) patients. A significant increase was detected in the LV end-diastolic diameter postoperatively, specifically in the patients with myocardial fibrosis of less than 5% (44.0±4.8 mm vs 46.6±5.6 mm; P value=0.027). A similar significant increase was not found in the other group (45.0±6.6 mm vs 46.7±6.9 mm; P value=0.256). Other changes in echocardiographic parameters showed similar patterns in both groups. Conclusion: Our patients with rheumatic MS who had myocardial fibrosis of less than 5% demonstrated better improvements in terms of increased preload. Myocardial fibrosis of less than 5% is associated with more favorable improvements in LV geometry.

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