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ORIGINAL ARTICLE
Year : 2020  |  Volume : 2  |  Issue : 2  |  Page : 60-69

Pulmonary dysfunction: A predictor of postoperative outcome in severe mitral stenosis


1 MPS Hospital, Podbelskovo Street, Department of Cardiac Surgery, RUDN University, Moscow, Russia
2 Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, RUDN University, Moscow, Russia

Correspondence Address:
Dr. Usha T Parvathy
Department of Cardiac Surgery, MPS Hospital, Podbelskovo Street, RUDN University, Moscow
Russia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ACCJ.ACCJ_11_19

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Background: Pulmonary function (PF) derangements in mitral stenosis (MS) can have an impact on the postmitral valve-replacement (MVR) period, which is not well studied. Objectives: The objectives were (1) to study the impact of the preoperative PF derangements intrinsic to MS on the early postoperative outcome and (2) to assess the prognostic relevance of spirometric tests as to the postoperative complications and morbidity. Methods: Prospective observational study: The spirometric pulmonary function tests (PFTs) performed in 25 patients with isolated MS (nonrandomized sampling) and arterial blood gas (ABG) were correlated to postoperative (post-MVR) variables: duration of ventilation, intensive care unit (ICU) stay, hospital stay, ABG, pulmonary complications, and outcome. Data were analyzed and compared under types, grades, and risk-based groups using nonparametric (Spearman's correlation, Kruskal–Wallis, and Mann–Whitney) tests. Results: The significant correlations were forced vital capacity (FVC)%, forced expiratory volume in 1 s (FEV1), FEV1%, peak expiratory flow rate (PEFR), and oxygen status to ventilation duration (P < 0.05); FEV1, PEFR, forced expiratory flow (FEF)-50, and oxygenation with ICU duration (P < 0.05); FVC, PEFR, and FEF-50 with hospital stay (P < 0.05); FVC, FEV1, and oxygenation to postoperative oxygen status (P = 0.02); FVC and FEV1 to pulmonary complications (P < 0.05); and FVC, PEFR, and FEF-50 with ventilation modification (P < 0.05). The morbidity and respiratory events showed a higher incidence with the mixed and severe categories (though not significant) and also with high-risk group in terms of postoperative pulmonary complications (P = 0.044) and prolonged ventilation. Mild trend toward hypercarbia needed ventilation optimization. Conclusions: PFT derangements in MS play an impact on the postoperative course to varying degrees. The advanced (severe and mixed) derangements and the high-risk group associate with greater morbidity and complications, calling for precautionary care, but on the whole do not contraindicate surgery. Spirometric evaluation can to a certain extent predict the postoperative morbidity risk.


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