Severe pulmonary hypertension in advanced Rheumatic heart disease: a retrospective analysis of Mitral valve replacement surgery in husm
The purpose of this study is to evaluate the improvement in patient who had mitral valve disease with severe pulmonary hypertension and the differences in the findings of preoperative and post operative echocardiography after their mitral valve replacement operations as well of the association be...
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| Format: | Thesis |
| Language: | English |
| Published: |
2012
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| Subjects: | |
| Online Access: | http://eprints.usm.my/60959/1/DR%20AMINUDDIN%20ABDUL%20RAHMAN%20-%20e.pdf |
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| Summary: | The purpose of this study is to evaluate the improvement in patient who had mitral
valve disease with severe pulmonary hypertension and the differences in the findings of
preoperative and post operative echocardiography after their mitral valve replacement
operations as well of the association between the PASP and NYHA class of patient. To evaluate the safety of mitral valve replacement surgery in rheumatic heart disease
patients with severe pulmonary hypertension (SPH); defined as pulmonary artery
systolic pressure (PASP > 60 mmHg) on patients operated for mitral valve replacement
at Cardiothoracic Unit, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. This retrospective study on 83 patients (54 women, 29 men, mean age 39 ± 14) who had
underwent mitral valve replacement surgery with or without aortic valve repair for the period of 96 months from January 2002 to December 2010. All patients underwent a complete evaluation of transthoracic echocardiography. PASP range from 60 to
135mmHg (mean 80.11 ± 19.36 mmHg). LVEF range from 22 to 77% (mean 61.62 ±
9.36 %) The predominant preoperative mitral valve lesion was mixed lesion (mitral
stenosis and mitral regurgitation) in 48 patients, stenosis in 24 patients and regurgitation
in 11. Nine (10.8%) underwent mitral valve replacement (MVR), 13 (15.7%) underwent dual
valve replacements (DVR), 48 (57.8%) underwent mitral valve replacement with tricuspid annuloplasty (TAP), 12 (14.5%) underwent DVR with TAP and 1 (1.2%)
underwent MVR with closure of atrial septal defect (ASD) Echocardiographic findings revealed there is a significant reduction in PASP postoperatively from 77.72 mmHg to 39.00mmHg (p < 0.01)
Out of 83 patients, 4 (4.8%) patients had stroke within 6 month postoperatively, 2
(2.4%) had bleeding requiring hospital admissions, 2 (2.4%) had reoperations after
oprations ans 2 (2.4%) had post-operative renal failure. Two (2.4%) died first two
operative months. Patient in majority had NYHA II and III preoperatively showed
distinct recovery and recovered well to NYHA I after 6 month operation. Mitral valve replacement can be successfully performed with an acceptable morbidity
and very low mortality in patients with long standing mitral valve disease and SPH. |
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