scholarly journals Simple and Short-term Inspiration Training Accelerates Recovery from Residual Pulmonary Hypertension after Mitral Valve Surgery: A randomized control trial

Author(s):  
Basuni Radi Radi ◽  
Bima Suryaatmaja ◽  
Ario Suryo Kuncoro ◽  
Amiliana M Soesanto

Background: Residual pulmonary hypertension after mitral valve surgery predicts a worse prognosis. This study aimed to explore the effect of inspiratory muscle training on functional capacity and pulmonary artery pressure in patients with residual pulmonary hypertension after mitral valve surgery. Methods: Forty-three patients with residual pulmonary hypertension soon after mitral valve repair or replacement surgery were consecutively enrolled in this randomised controlled trial. They were randomly allocated to either an intervention group (n=22) or a control group (n=21). Both groups participated in usual 10-12 sessions of supervised aerobic exercise training, with low to moderate intensity. The subjects in the intervention group participated in additional inspiratory muscle training using an incentive spirometer with a series of 10-12 inspiration repetitions of 50% of maximum inspiratory volume in each aerobic session. Echocardiography and the 6-minute walking test were performed before and after the programme. Results: The patients were 70% female, mean age 43.5+/-13 years. Both groups had similar baseline characteristics. The systolic pulmonary artery pressure declined from 51(43-68) mmHg to 35 (29-39) mmHg, p<0.001 in intervention group, and from 46(43-55) mmHg to  43(40-51)mmHg, p<0.01 in control group. The reduction was higher in the intervention group than in the control group, 16 (12-30) vs 3.5 (2-4) mmHg respectively, p<0.001, and in patients with higher baseline systolic pulmonary artery pressure. The 6-minute walk test distance increased from 308(242-353) meters to 407(377-433) meter, p<0.01 in intervention group, and from 353(334-381) meter to 391(376-429) meter, p<0.01 in control group. The improvement was higher in the intervention group than in control group, 101 (93-131) vs 48 (35-53) meter respectively, p<0.001. Conclusion: Adding inspiratory muscle training to a usual exercise programme resulted in faster recovery from residual pulmonary hypertension and higher increase in functional capacity.

Author(s):  
Mario Castillo-Sang ◽  
Tracey J. Guthrie ◽  
Marc R. Moon ◽  
Jennifer S. Lawton ◽  
Hersh S. Maniar ◽  
...  

Objective We sought to study the outcomes of redo-mitral valve surgery in patients with pulmonary hypertension. Methods We reviewed data on redo mitral valve surgery in patients with pulmonary hypertension measured by Swan-Ganz catheter (mean pulmonary artery pressure ≥ 25 mm Hg or systolic pulmonary artery pressure ≥ 40 mm Hg). Results Between 1996 and 2010, 637 patients underwent 658 redo mitral valve operations; 138 of them had pulmonary hypertension. The mean patient age was 61.3 (13.9) years, with mean left ventricular ejection fraction of 47.6% (13.2%). The mean systolic pulmonary artery pressure was 61.5 (16.8) mm Hg, and mean pulmonary artery pressure was 40.8 (11.6) mm Hg. Patients had one (71%, 98/138), two (23.9%, 33/138), and three (5.1%, 7/138) previous mitral valve operations. Thirty-day mortality was 10.1% (14/138). Multivariate predictors of 30-day mortality were chronic renal failure [odds ratio (OR), 8.041; P = 0.022], peripheral vascular disease (OR, 5.976; P = 0.025), previous mitral valve replacement (OR, 9.034; P = 0.014), and increasing age (OR, 1.077; P = 0.013). The severity of pulmonary hypertension did not impact 30-day ( P = 0.314) or late mortality ( P = 0.860). Kaplan-Meier survival rates at 1, 3, and 5 years were 76.6% (n = 99), 65.7% (n = 62), and 55.9% (n = 41), respectively. Conclusions Patients with pulmonary hypertension that undergo redo mitral valve surgery have a 55.9% 5-year survival rate. Increasing age, chronic renal insufficiency, peripheral vascular disease, and preexisting mitral valve prosthesis are associated with early mortality. The severity of pulmonary hypertension does not affect operative mortality rates, but it may decrease 1-, 3-, and 5-year survival.


2021 ◽  
Vol 10 (5) ◽  
Author(s):  
Michael V. Genuardi ◽  
Daniel Shpilsky ◽  
Adam Handen ◽  
Gabrielle VanSpeybroeck ◽  
Ann Canterbury ◽  
...  

Background Preoperative pulmonary hypertension (PH) is associated with excess mortality among patients with severe mitral regurgitation undergoing mitral valve surgery (MVS). However, the links between PH phenotype, pulmonary vascular remodeling, and persistent postoperative PH are not well understood. We aimed to describe the associations between components of pulmonary hemodynamics as well as postoperative residual PH with longitudinal mortality in patients with severe mitral regurgitation who received MVS. Methods and Results Patients undergoing MVS for severe mitral regurgitation from 2011 to 2016 were retrospectively identified within our health system (n=488). Mean pulmonary artery pressure and other hemodynamic variables were determined by presurgical right‐heart catheterization. Postoperative pulmonary artery systolic pressure was assessed on echocardiogram 42 to 365 days post‐MVS. Longitudinal survival over a mean 3.9 years of follow‐up was evaluated using Cox proportional hazards modeling to compare survival after adjustment for demographics, surgical characteristics, and comorbidities. Pre‐MVS prevalence of PH was high at 85%. After adjustment, each 10‐mm Hg increase in preoperative mean pulmonary artery pressure was associated with a 1.38‐fold increase in risk of death (95% CI, 1.13–1.68). Elevated preoperative pulmonary vascular resistance, transpulmonary gradient, and right atrial pressure were similarly associated with increased mortality. Among 231 patients with postoperative echocardiogram, evidence of PH on echocardiogram (pulmonary artery systolic pressure ≥35 mm Hg) was associated with increased risk of death (hazard ratio [HR], 2.02 [95% CI, 1.17–3.47]); however, this was no longer statistically significant after adjustment (HR, 1.55 [95% CI, 0.85–2.85]). Conclusions In patients undergoing MVS for mitral regurgitation, preoperative PH, and postoperative PH were associated with increased mortality.


2014 ◽  
Vol 17 (4) ◽  
pp. 201 ◽  
Author(s):  
Adem İ Diken ◽  
Garip Altıntaş ◽  
Adnan Yalçınkaya ◽  
Gökhan Lafçı ◽  
Onur Hanedan ◽  
...  

<p><strong>Background:</strong> Ischemic heart disease is a significant complication of atherosclerosis. Myocardial infarction after the development of coronary artery disease can lead to a number of serious complications, including ischemic mitral regurgitation (IMR). Currently there is no consensus regarding the preferred therapeutic modality for moderately severe IMR. In this study, the postoperative outcome of concomitant coronary artery bypass (CABG) and mitral valve repair was compared with that of CABG alone in two groups of patients with moderately severe IMR.</p><p><strong>Methods:</strong> A total of 84 patients who underwent operations for coronary artery disease and moderately severe IMR were included in the study. Preoperative demographic and clinical characteristics were recorded at the time of admission. The severity of mitral regurgitation was graded using transthoracic echocardiography and left ventriculography.</p><p><strong>Results:</strong> Significant postoperative improvements were observed in ejection fraction and systolic diameter compared to preoperative values (<em>P</em> = .006 and <em>P</em> = .020 respectively, in the intervention group, <em>P</em> = .001 and <em>P</em> = .001 respectively, in the control group). The decrease in pulmonary artery pressure (PAP) was significant only in the intervention group (<em>P</em> = .001). There was a significantly marked reduction in the severity of IMR in the intervention group compared to control.</p><p><strong>Conclusion:</strong> Surgical repair of the mitral valve in conjunction with CABG for moderately severe IMR appears to be more effective than isolated CABG for certain outcome parameters, including decreased severity of mitral regurgitation and decreased pulmonary artery pressure.</p>


2010 ◽  
Vol 7 (2) ◽  
pp. 146-151
Author(s):  
Egorovich Babokin Vadim ◽  
Alexandrovich Trofimov Nikolai ◽  
Pavlovich Medvedev Aleksander ◽  
Viktorovich Nikolskiy Alexander ◽  
Gennadievich Dragunov Andrey ◽  
...  

2013 ◽  
Vol 114 (3) ◽  
pp. 154-161 ◽  
Author(s):  
Mehmet Demir ◽  
U. Uyan ◽  
S. Keçeoçlu ◽  
C. Demir

Vitamin D deficiency actives renin-angiotensin-aldosterone system (RAAS) which affects cardiovascular system. Activation of RAAS is associated with pulmonary hypertension (PHT). Relation between vitamin D deficiency and PHT could be therefore suggested. In  our study we compared pulmonary artery pressure between vitamin D deficiency and control groups. 115 consecutive patients (average age: 61.86 ± 5.86) who have detected very low vitamin D (vitamin D levels < 10 ng/ml) were enrolled. 117 age matched persons (average age: 61.74 ± 5.99) were selected as the control group. All groups underwent transthoracic echocardiography. Routine biochemical measurement of 25-OH vitamin D and parathormon (PTH) levels were performed. Baseline characteristics of the study groups were comparable. Systolic pulmonary artery pressure (SPAP) of patients in  the low vitamin D group was higher than the control groups. As a  result our study, a  relation between vitamin D deficiency and pulmonary artery hypertension was revealed.


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