Background: The reduction of right ventricular function after heart valve surgery was associated with mortality and morbidity after cardiac surgery, prolonged ICU length of stay, and higher hospital cost. Inspiratory muscle training can be considered for improving right ventricular systolic function by optimizing afterload dan cardiac contractility. The study aims to determine the effect of inspiratory muscle training on right ventricular systolic function in patients after heart valve surgery.Methods: Patients undergoing heart valve surgery were randomized into a conventional preoperative rehabilitation group and conventional preoperative rehabilitation added high-intensity inspiratory muscle training at least 14 days before surgery. Echocardiography examination was performed before rehabilitation and after cardiac surgery.Results: There were 24 subjects consist of 12 control group and 12 intervention group. By using independent t-test or Mann Whitney test, we found significant differences on right ventricular function between intervention and control group, by using RV free wall strain (17.7 + 3.0% and 14.4 + 4.0%; p=0.033), RV FAC (43.2 + 4.9% and 35.1 + 8.8%; p=0.006), and TAPSE (12.7 + 3.4 mm and 9.9 + 2.7 mm; p=0.039). ICU length of stay in the intervention group was significantly shorter than the control group (3.2 + 0.8 and 4.2 + 1.3 days; p=0.044).Conclusion: Patients underwent conventional preoperative rehabilitation added inspiratory muscle training had better right ventricular systolic function than patients in control group.

Background: Valvular heart disease (VHD) is one third of all heart disease. In industrialized countries, the prevalence is estimated at 2,5% and in developing countries is between twenty to thirty cases per-1000 people. VHD presents a huge health burden worldwide. If heart failure has occured, surgery is the treatment of choice. Cardiorespiratory fitness declined in post-surgical patients. Preoperative cardiac rehabilitation is considered to be able to increase the cardiorespiratory fitness baseline so that postoperative outcomes are better.Case Presentation: We reported 28 years-old female with severe MS and MR as well as mild TR with symptoms dyspnea on effort which improves with rest. She was the candidate for mitral valve replacement. She was given a 14-days preoperative cardiac rehabilitation program including breathing exercise by pursed lips breathing, effective cough exercise, range of motion exercise, ankle pumping exercise, endurance exercise based on the result of the 6 minutes walking test (6MWT) and inspiratory muscle training (IMT) using threshold IMT. Conclusion: Preoperative cardiac rehabilitation program improved pulmonary functional capacity, cardiorespiratory fitness and functional activity.Keyword: valvular heart disease, cardiac rehabilitation, pulmonary functional capacity, cardiorespiratory fitness.