Clinical and hemodynamic assessment of patient receiving prosthetic mitral valve replacement

Background and aims: Mitral valve replacement by mechanical or bioprosthetic valves revolutionized the care of patients with severe mitral valve disease. Mitral valve is commonly affected by Rheumatic heart disease, leading to the development of mitral stenosis and regurgitation requiring prosthetic replacement. The clinical and hemodynamic assessment of patients undergoing mitral valve replacement is substantial in measuring the extent of morbidity. The present study assesses patients’ pre and postoperative hemodynamic parameters having mitral valvular diseases requiring prosthetic replacement. Materials and methods: The study included 45 selected cases of the mitral valvular lesion that underwent prosthetic replacement of mitral valve admitted in the cardiothoracic surgery department at a tertiary care centre. A detailed history of each patient was taken, and subsequent management and follow up was done. The hemodynamic assessments of the patients were performed by invasive pressure measurement and by echocardiographic measurement during preoperative, post-operative and follow-up period. Statistical analysis was performed with the Quick Calcs Online calculator (Graph Pad Software). Continuous variables are expressed as mean and standard deviation after checking for normality of distribution. Differences between baseline and follow-up were analyzed using paired t-test. A p-value of <0.05 was considered statistically significant. Results: A total of 45 patients of age ranging from 14 years to 65 years undergoing mitral valve replacement were included in the study. Substantial decrease in the mean pulmonary artery (PA) and left atrium (LA) pressure were observed after valve replacement compared to pre valve replacement in all the three valvular lesion groups, i.e., mitral stenosis, mitral regurgitation and combined valvular lesion groups with p-value <0.0001. The subsequent decrease in left atrial diameter post-operative six months was also noted in all the groups. No significant postoperative improvement in ejection fraction was noticed in the mitral stenosis and mitral regurgitation group. Considerable progress in mean transmitral gradient after valve replacement is seen among all the groups (p- value <0.0001) with a substantial decrease at six-month post-operative compared to the preoperative trans-mitral gradient. Conclusion: Steady, significant improvement in patients with different valvular abnormalities is noticed after prosthetic replacement of the mitral valve. Prosthetic replacement of mitral valve provides satisfying hemodynamic improvement.