Spirometric Changes following Open-Heart Surgery on Rheumatic Mitral Valves

Abstract

Evaluation of pulmonary function by spirometry in adult patients undergoing cardiacsurgery is a simple test to assess pulmonary reserve that has important implications in the operative morbidity. Pulmonary function was studied preoperatively, before discharge, and at the 3-month follow-up in 22 randomly selected patients who underwent open-heart surgery for rheumatic mitral valve disease (2 reconstructions, 20 replacements). The mean preoperative cardiothoracic ratio was 0.58. Lung function was found to be impaired preoperatively in all 22 patients and the majority suffered from restrictive lung disease. Better preoperative lung function was seen in nonsmokers, patients with a cardiothoracic ratio of less than 0.50, and those with a normal pulmonary artery pressure. After mitral valve surgery, the mean pulmonary artery pressure was 20.6 ± 2.9 mmHg, the mean mitral valve pressure gradient was 3.6 ± 2.4 mm Hg, and the mean cardiothoracic ratio was 0.52 ± 0.09. A significant deterioration was seen in the predischarge spirometric values of forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate, flow rate at 25% to 75% of expired vital capacity, and maximum volume ventilation. The deterioration was greater in smokers and those who had prolonged cardiopulmonary bypass (more than 80 minutes). No correlation was found with ventilation because all patients were electively ventilated overnight. There was an overall improvement in spirometric parameters at the 3-month follow-up although the values remained lower than predicted. Spirometry was found to be useful for assessing lung function in patients undergoing mitral valve surgery and we recommended it as a routine test.

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

“…Different studies have correlated pulmonary functions with the functional class. 8,14 However, we in our study found that many patients (52%) were still in class II 6 months post-surgery, which did not correlate well with the improvements in PFTs at the same time. However, the PEFR did not improve at the same pace, which probably was an indication that the small airways involved in the disease process may take more time to improve.…”

“…Chandra et al found that although there was an overall improvement in the spirometric parameters at 3 months after mitral valve replacement, the values remained lower than predicted. 14 This study results showed that by 6 months postoperative period the lung functions improved significantly, but again they also remained below the predicted values.…”

Early changes in pulmonary functions after mitral valve replacement

“…[ 16 ] Chandra and co-workers found that there was an overall improvement in spirometric parameters at 3 months of follow-up after valve replacement, although the values remained lower than the predicted. [ 14 ] Ghosh et al have reported a significant decrease in FVC, FEV1, flow rates at 25–75% of expired vital capacity (FEF 25–75%) and maximum voluntary ventilation (MVV) in all patients at discharge. [ 15 ] In our experience, after 3 months all these parameters improved in all above the preoperative level but remained below the predicted values.…”

Effect of Percutaneous Coronary Intervention (PCI) upon Lung Functions among Patients with Ischemic Heart Disease at Al-Najaf Cardiac Center: Correlation Study

“…Content validity for the early developed instrument is determined through the use of panel of experts (who have more than 5 years of experience at their jobs field). A preliminary copy of the questionnaire was designed and presented to (6) experts. The data were interred into Spss (version 22) in order to describe the statistical results as follow (Frequency distribution, Bar chart, and independent t-test).…”

“…A deflated balloon attached to a catheter (a balloon catheter) is passed over a guide-wire into the narrowed vessel and then inflated to a fixed size. The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow 6 . A stent may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn.…”