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

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.

scholarly journals Pattern of Pulmonary Function Test in Patients with Severe Mitral Stenosis

2015 ◽  
Vol 2 (2) ◽  
pp. 57-59
Author(s):  
Umme Salma Khan ◽  
Abdullah Al Shafi Majumder ◽  
AKM Monwarul Islam ◽  
Fazle Rabbi Mohammed
Keyword(s):  
Pulmonary Function ◽  
Pulmonary Function Test ◽  
Mitral Stenosis ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Female Ratio ◽  
Function Test ◽  
Male Female Ratio ◽  
Restricted Type ◽  
Impaired Pulmonary Function

Background: The deterioration in lung function in mitral stenosis correlates with the severity of stenotic valves. A correlation is noted between vital capacity and the severity of dyspnoea in patients with mitral stenosis. This study tried to evaluate the pattern of pulmonary function test in patient with severe mitral stenosis.Materials & Methods: This study involving 56 patients of severe mitral stenosis was performed in a referral cardiovascular center at Dhaka, Bangladesh from January to September, 2011. Colour doppler echocardiography and pulmonary function test were performed in each cases. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), FEV1/FVC and peak expiratory flow (PEF) rate was assessed from pulmonary function test. Finally, pattern of pulmonary function test in severe mitral stenosis was assessed.Results: Amomg 56 patients, 46 were female with a male female ratio 1: 0.22 and the mean age of patients was 28.76 ± 7.2. Among patients with severe mitral stenosis, mean FEV1 (%) was 60.18 ± 13.054. Minimum FVC (%) was 26, maximum was 90 with mean 53.80 ± 12.313. The PEF varied from 150 to 330 L/minute with mean 223.75 ± 62.3251. In current study, out of 56 patients, 2 cases had obstructive type and rest of the patients had restricted type of airway on pulmonary function.Conclusion: The brief results of this study reveal that severe mitral stenosis is associated with impaired pulmonary function, usually presenting restrictive airway pattern.Bangladesh Crit Care J September 2014; 2 (2): 57-59

scholarly journals Dexmedetomidine Improves Lung Function by Promoting Inflammation Resolution in Patients Undergoing Totally Thoracoscopic Cardiac Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Junji Cui ◽  
Mintai Gao ◽  
Hongqian Huang ◽  
Xiaoyan Huang ◽  
Qingshi Zeng
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Pulmonary Function ◽  
Inflammatory Cytokines ◽  
Chest Radiography ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Arterial Blood ◽  
Extubation Time ◽  
Thoracoscopic Technique

Objective. Totally thoracoscopic cardiac surgery under cardiopulmonary bypass combined with one-lung ventilation has been identified as the trend in cardiac surgery. The aim of this study was to examine the effects of the selective α2 adrenergic receptor agonist dexmedetomidine on the pulmonary function of patients who underwent mitral valve surgery using the totally thoracoscopic technique. Methods. Fifty-seven patients who underwent thoracoscopic mitral valve surgery between July 2019 and December 2019 were selected. The patients were randomly divided into the control (Con) group (n=28) and the dexmedetomidine (DEX) group (n=29) using the random number table method. Arterial blood gas analyses were performed, and the oxygenation (PaO2/FiO2) and respiratory indexes (P(A-a)O/PaO2) were calculated 5 min after tracheal intubation (T1), 2 h after operation (T2), 6 h after operation (T3), and 24 h after operation (T4). Moreover, the serum cytokines interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) were detected using the enzyme-linked immunosorbent method at all time points. Chest radiography was performed 24 h after surgery. Peripheral blood samples were collected before and after the operation for a complete hemogram. Additionally, the procalcitonin concentration was measured and recorded when the patients were transported to the intensive care unit (ICU). The postoperative extubation time, length of ICU stay, and pulmonary infection rate were also recorded. Results. Inflammatory reaction after surgery was evident. However, the inflammatory cytokines IL-6, TNF-α, and ICAM-1 in the DEX group were lower than those in the Con group after surgery (T2 to T4; P<0.05). Neutrophil counts and procalcitonin concentration were higher in the Con group than in the DEX group (P<0.05). In addition, in the DEX group, pulmonary exudation on chest radiography was lower, and pulmonary function, as shown by an increase in oxidation index and decrease in the respiratory index, improved after surgery (P<0.05). Moreover, the duration of mechanical ventilation in the Con group was 3.4 h longer than that in the DEX group. Conclusion. Dexmedetomidine has a protective effect on pulmonary function in patients undergoing mitral valve surgery using a totally video-assisted thoracoscopic technique, which may be related to a reduction in the concentration of inflammatory cytokines in the early perioperative period.

scholarly journals Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

2019 ◽  
Vol 28 (04) ◽  
pp. 237-244
Author(s):  
Teuku Muhammad Haykal Putra ◽  
Renan Sukmawan ◽  
Elen Elen ◽  
Celly A. Atmadikoesoemah ◽  
Dwita Rian Desandri ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Late Gadolinium Enhancement ◽  
Mitral Valve ◽  
Myocardial Fibrosis ◽  
Mitral Stenosis ◽  
Postoperative Morbidity ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Gadolinium Enhancement ◽  
Rheumatic 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.

scholarly journals Redo mitral valve surgery

2018 ◽  
Vol 11 (1) ◽  
pp. 89
Author(s):  
Redoy Ranjan ◽  
Mushfiqur Rahman ◽  
Heemel Saha ◽  
Dipannita Adhikary ◽  
Sanjoy Kumar Saha ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Color Doppler ◽  
Systolic Pressure ◽  
Mechanical Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Pulmonary Artery Systolic Pressure ◽  
Female Ratio

<p class="Abstract">This study is based on the findings of a single surgeon’s practice of mitral valve replacement of 167 patients from April 2005 to June 2017 who developed symptomatic mitral restenosis after closed or open mitral commisurotomy. Both clinical and color doppler echocardiographic data of peri-operative and six months follow-up period were evaluated and compared to assess the early outcome of the redo mitral valve surgery. With male-female ratio of 1: 2.2 and after a duration of 6 to 22 years symptom free interval between the redo procedures, the selected patients with mitral valve restenosis undergone valve replacement with either mechanical valve in 62% cases and also tissue valve in 38% cases. Particular emphasis was given to separate the adhered pericardium from the heart completely to ameliorate base to apex and global contraction of the heart. Besides favorable post-operative clinical outcome, the echocardiographic findings were also encouraging as there was statistically significant increase in the mitral valve area and ejection fraction with significant decrease in the left atrial diameter, pressure gradient across the mitral valve and pulmonary artery systolic pressure. Therefore, in case of inevitable mitral restenosis after closed or open commisurotomy, mitral valve replacement is a promising treatment modality.</p>

Relative Sensitivity of Different Pulmonary Function Tests in the Evaluation of Exercise-Induced Asthma

PEDIATRICS ◽  
1975 ◽  
Vol 56 (5s) ◽  
pp. 860-867
Author(s):  
Gerd J. A. Cropp ◽  
I. J. Schmultzler
Keyword(s):  
Pulmonary Function ◽  
Airway Obstruction ◽  
Pulmonary Function Tests ◽  
Relative Sensitivity ◽  
Forced Expiratory Volume ◽  
Small Airway ◽  
Function Tests ◽  
Expiratory Flow ◽  
Exercise Induced ◽  
Small Airway Obstruction

Sixty asthmatic children were exercised on a bicycle ergometer and had pulmonary function tests performed before and repeatedly after exercise. Pulmonary function measurements included airway resistance (Raw), specific airway conductance (SGaw) functional residual capacity (FRC), peak expiratory flow rate (PEFR), maximum mid-expiratory flow (MMEF), forced expiratory volume during first second of expiration (FEV1), and forced vital capacity (FVC). At any one time during the post-exercise observation period decreases in SGaw were greater than changes in any other pulmonary function test, making SGaw the most sensitive test for the detection. of exercise-induced airway obstruction in asthmatics. Beyond five minutes after exercise PEFR and MMEF were reduced by exercise approximately equally, but somewhat less often and less markedly than SGaw. Exercise-induced reductions in FEV1 were less marked and less frequent than decreases in PEFR and MMEF, and reductions in FVC were the least severe and least often observed abnormality. Decreases in SGaw were significantly, but not linearly correlated with decreases in PEFR, MMEF, FEV1,, FVC, and FEV1/FVC. There were statistically significant linear correlations between exercise-induced increases in FRC and decreases in FVC and between increases in Raw and FRC. If we accept that increases in Raw and FRC indicate increases in large and small airway obstruction respectively, exercise-induced decreases in FVC may indirectly suggest acute hyperinflation and thus small airway obstruction. Although the positive correlation between Raw and FRC indicated that both large and small airway obstruction developed after exercise in many of our asthmatics, increases in Raw were usually greater than increases in FRC, suggesting that large airway obstruction tends to be greater than small airway obstruction in exercise-induced asthma.

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

Heart Views ◽  
2012 ◽  
Vol 13 (4) ◽  
pp. 136 ◽  
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

scholarly journals GW26-e0253 Outcomes of Mitral Valve Surgery for Mitral Stenosis

2015 ◽  
Vol 66 (16) ◽  
pp. C223
Author(s):  
Alqasem Al Mosa ◽  
Hani Najm ◽  
Aamir Omair
Keyword(s):  
Mitral Valve ◽  
Mitral Stenosis ◽  
Mitral Valve Surgery ◽  
Valve Surgery

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

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.

Reversive Loss of Pulmonary Function Induced by Acute Chest Syndrome: A Report from the National Acute Chest Syndrome Study Group (NACSG).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 315-315 ◽  
Author(s):  
Lynne Neumayr ◽  
C. Morris ◽  
A. Wen ◽  
A. Earles ◽  
S. Robertson ◽  
...  
Keyword(s):  
Lung Function ◽  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Forced Expiratory Volume ◽  
Therapeutic Interventions ◽  
Acute Chest Syndrome ◽  
P Value ◽  
Lung Volumes ◽  
Expiratory Flow

Abstract Acute Chest Syndrome (ACS) remains the leading cause of death and hospitalization in patients (pts) with sickle cell disease (SCD). There is limited data on the effects of ACS on lung function. From 1993 to 1997, 30 centers participated in the NACSG and prospectively analyzed 671 episodes of ACS in 538 pts. Pulmonary function tests (PFTs) included forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), forced expiratory flow during 25% to 75% of FVC (FEF 25–75), peak expiratory flow rate (PEF) and the ratio of FEV1/FVC. Data is reported as percent-predicted of normal values based on age and height. 128 pts (mean 16yrs, 4 to 52 yr range) had PFTs during an ACS episode (within a mean of 2.5 days of diagnosis) and then 12 weeks later. 94% of pts had abnormal lung volumes, defined as either FEV1 or FVC < 80%. Mean lung volumes during ACS and at follow-up are shown below. Table 1: Decreased Lung Volumes During ACS PFT During ACS Follow-up p-value FEV1 52% 79% <.0001 FVC 55% 83% <.0001 FEF 25–75 50% 69% <.0001 PEF 61% 83% <.0001 Pts with abnormal lung volumes (FEV1 or FVC < 80%) and considered to have an obstructive pattern if the FEV1/FVC ratio was < to 85. Obstructive patterns in pts with abnormal lung volumes and the percent of pts who responded to bronchodilators (15% improvement in either FEV1 or FVC) are shown below. Table 2: Patterns of Abnormal Lung Volumes in SCD SCD Patients During ACS Follow-up Abnormal PFTs 94% 45% Obstructive Pattern 48% 46% Respond to bronchodilators 25% 8% In summary, ACS resulted in decreased pulmonary function in 94% of pts. It is striking that 49% pts had their PFTs reduced by half (FEV1 52% and FVC 55%). In pts with abnormal PFTs, 48% had evidence of obstruction and 25% of all pts tested improved with a bronchodilator. This is the first description of reversible abnormalities of pulmonary function occurring during ACS compared to baseline. An obstructive pattern is identified in a higher percentage of pts with SCD than in the local Oakland African American population (asthma prevalance 16%). While some pts PFTs improved with time, 45% remained abnormal at 12-week follow-up. ACS results in acute and chronic worsening of lung function. Future studies of ACS may reveal common pathogenic mechanisms with asthma, and lead to improved therapeutic interventions.

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