International Journal of Research in Medical Sciences | February 2022 | Vol 10 | Issue 2 Page 470
International Journal of Research in Medical Sciences
Mukhopadhyay B et al. Int J Res Med Sci. 2022 Feb;10(2):470-476
www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012
Original Research Article
A unique study of post mitral valve surgery status of patients
in pre and intra COVID-19 era
Bhubandeep Mukhopadhyay*, P. Banerjee
INTRODUCTION
Functions of the right and left sided hearts are
interrelated. Left sided heart diseases can affect the right
heart and likewise right sided diseases can affect the
normal functions of the left heart. Pulmonary artery
hypertension results in right ventricular hypertrophy and
right ventricular enlargement. When the pulmonary artery
systolic pressure increases more, both right ventricular
end-diastolic pressure and volume rise gradually, leading
to right ventricular dilatation. This will be further
complicated by the dilatation of the tricuspid valve
annulus. The circumference of the annulus lengthens
primarily along the attachments of the anterior and
posterior leaflets.
1
The septal leaflet is fixed between the
fibrous trigones, preventing lengthening. Dilation of the
tricuspid annulus therefore occurs primarily in its
anterior/posterior (mural) aspect, which can result in
significant functional tricuspid regurgitation (TR) as a
result of leaflet mal coaptation. Pulmonary arterial (PA)
hypertension is a frequent and serious complication of
mitral valve disease, and it is a major risk factor for poor
outcome after surgery for mitral stenosis or mitral
regurgitation.
2-5
Not surprisingly, the impact of PA
Department of Cardiothoracic Vascular Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West
Bengal, India
Received: 15 December 2021
Revised: 06 January 2022
Accepted: 11 January 2022
*Correspondence:
Dr. Bhubandeep Mukhopadhyay,
E-mail: bhubandeep@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: In this study we have studied the change of pulmonary artery pressure after mitral valve replacement
and closed mitral commissurotomy. We have also correlated pulmonary artery pressure before and after operation
with postoperative outcome.
Methods: This study was conducted at Department of CTVS of NRS Medical College and Hospitals from August
2019 to September 2021. All 81 patients had rheumatic mitral valve disease. Among these 73 patients underwent
mitral valve replacement (MVR) and 8 patients underwent closed mitral commissurotomy (CMC). Group 1 (n=35)
consisted of patients who underwent MVR having preoperative systolic PAP measured by TTE was less than 50
mmHg. Group 2 patients (n=38) had preoperative systolic PAP more than or equal to 50 mmHg measured by TTE.
Group 3 patients (n=8), consists of patients who underwent CMC. Compared the results between group 1 and 2 and
documented the results of group 3 separately.
Results: Our results showed a significant decrease in SPAP after MVR, and further fall of SPAP in the immediate
and late postoperative period.
Conclusions: In conclusion, PAP returns to near-normal values after MVR in patients with severe preoperative PAH
and to normal values in patients with mild preoperative PAH. Reductions in PAP in patients with preoperative PAH
occur immediately after MVR. Postoperative period of patients with severe PAH may be hectic. CMC may be a valid
option in isolated MS in selected patients and is very much cost-effective. There were no differences noted among the
types of valves used.
Keywords: Hemodynamic, Mitral valve disease, Mitral valve replacement, Pulmonary hypertension
DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20220294