Early Results of Mitral Valve Replacement in Severe Pulmonary Artery Hypertension—An Institutional Prospective Study

Introduction: In patients undergoing surgery for mitral valve replacement (MVR) for valvular heart disease, pulmonary artery hypertension (PAH) has been considered a major risk factor. In this prospective study, we have studied the early hemodynamic changes and post-operative outcomes of MVR among patients with severe PAH. Methods: 68 consecutive patients who underwent mitral valve replacement for severe rheumatic mitral valve disease with severe PAH (pulmonary artery pressure (PAP) > 50 mmHg) were studied prospectively for immediate postoperative hemodynamics and outcomes. The mean age of the patients was 32.1 years. 32 (47.05%) patients had mitral stenosis, 13 (19.11%) had mitral regurgitation and 23 (33.82%) had mixed lesions. Patients were divided into two groups based on preoperative pulmonary artery pressures. In 56 patients (82.35%, group I) PAP was sub-systemic or systemic, with a mean of 58.4 mmHg. Twelve patients (17.65%, group II) had supra-systemic PAP with a mean of 82.4 mmHg. Results: After mitral valve replacement, the PAP and pulmonary vascular resistance (PVR) decreased significantly in group I to near normal levels. In group II also the PAP and PVR decreased significantly but significant residual PAH remained. Operative mortality was 3.5% in group I and 16.6% in group II. Conclusions: MVR is safe and effective at the presence of severe PAH as long as the PAP is below or equal to systemic pressures. With suprasystemic PAP, MVR carries a high risk of mortality and the patient continues to have severe PAH in the postoperative period.

Fresh Pericardial Valved Conduit for Reconstruction of Right Ventricular Outflow Tract in Tetralogy of Fallot with Pulmonary Stenosis or Pulmonary Atresia—Early Results

Objective: To study early results of hand made fresh (autologous/homologous) pericardial valved conduit in achieving right ventricle to pulmonary artery continuity. Method: Between November 2014 and September 2015, 19 cases, with diagnosis of Tetralogy of Fallot with Pulmonary stenosis (PS) or Pulmonary atresia (PA) underwent intracardiac repair and Right Ventricular Outflow Tract (RVOT) reconstruction with hand made fresh [autologous (n = 2)/ homologous (n = 17)] pericardial valved conduit. Mean age of the patients at time of surgery was 6.37 years (range 3 months to 18 years), mean weight was 18.52 kilograms (range 6 kg to 40 kg) and mean size of the conduit was 20.7 mm (range 16 mm to 24 mm). Results: All patients had a smooth post-operative course, with mean ICU (Intensive Care Unit) stay of 3.6 days (range 3 days to 6 days) and mean post-operative hospital stay 8.5 days (range 7 days to 16 days). Intra-operative and Post-operative echocardiography revealed moderate Pulmonary regurgitation (PR) in one patient, mild PR in 5 patients and no or trace PR in 13 patients. No patient has developed conduit stenosis or calcification till now. Conclusion: Autologous or homologous pericardial valved conduit provides good early results and is especially suitable for developing world because of zero cost. Long term usefulness of such option remains to be confirmed in terms of dilation, calcification and freedom from intervention.