[The importance of hemodynamic monitoring in mitral and tricuspid valve surgery].

INTRODUCTION

Untreated mitral valve disease is associated with marked hemodynamic disorders, low ejection fraction (EF) and poor perfusion. The study aimed to explore the importance of hemodynamic monitoring in intraoperative evaluation and treatment of these patients.

MATERIAL AND

METHODS

This prospective study included 85 patients: group 1: 41 patients, EF<40%; group 11: 44 patients, EF>40%. Hemodynamic parameters were recorded after initation of anesthesia (1), after sternotomy (2), after extracorporeal circulation (ECC) (3) and before leaving the operation theatre (4). The following parameters were assessed: mean arterial pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance index, central venous pressure, cardiac index. Statistical analysis was performed using Student t-test and correlation analyses in time series.

RESULTS AND DISCUSSION: Hemodynamic parameters were changed at the beginnig of surgery, but gradually improved after sternotomy and were normal at the end of the operation. Both examined groups presented with reduction of the pulmonary artery preassure, pulmonary capillary wedge pressure, pulmonary vascular resistance index (reduction more than 30%) and cardiac index (up to 100%). Strong correlation between 1/2 and 3/4 assessments pointed to the importance of intraoperative evaluation. Swan-Ganz catheter ia a valuable tool used for hemodynamic monitoring.

CONCLUSION

Intraoperative medication (based on obtained hemodynamic parameters) and operative treatment led to normalization of all parameters in both groups, regardless of the preoperative values of EF.