الفهرس 
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Abstract
Development of pulmonary hypertension (PH) in association with valvular
dysfunction is a marker of advanced disease. PH is a hemodynamic and
pathophysiological condition defined as an increase in mean pulmonary arterial
pressure (mPAP) more than or equals 25 mmHg at rest as assessed by right heart
catheterization
Conflicting reports are available in the literature on the outcome of patients with
PH after corrective surgery. Some authors have reported no greater risk in patients
with severe PH when compared with those with a lesser degree of PH. Other reports
have reported that severe PH is associated with greater operative risk, higher operative
mortality, and a poorer long- term prognosis.
It is desirable to reassess the outcome in these patients with newer anesthetic
agents, improved mitral valve prostheses, myocardial protection, and postoperative
care.
We designed our study to evaluate and compare the early hemodynamic results
and echocardiographic data after rheumatic Mitral valve replacement in patients with
mild and severe pulmonary hypertension
Between September 2013 and May 2015, this multicenter prospective
observational study included forty patients with rheumatic mitral valve stenosis need
mitral valve replacement (MVR) divided into two equal groups: Group A (mild PH
group): with mean Pulmonary Artery Pressure (mPAP) equal 26 - 40 mmHg and
Group B (severe PH group): with mPAP more than 55 mmHg.
Both groups were comparable concerning preoperative data, as we detected no
statistically significant difference in patients’ demographics, comorbidities, or even
preoperative echo data (except for mPAP which used for stratification of patients)
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But we detected statistically significant difference between both groups
regarding their preoperative NYHA class and preoperative O2 saturation on room air
being better in Group A than in Group B.
Operatively, both groups did not have statistically significant difference
concerning total bypass time, cross clamp time and total operative duration.
We also didn’t detect statistically significant difference concerning intraoperative
use of drugs to decrease pulmonary hypertension or Tricuspid Valve repair.
On comparing both groups regarding their central venous pressure (CVP) at
various stages of our study we detected statistically significant difference post
induction and on ICU admission immediate post-operative, being higher in Group B.
On comparing both groups regarding their Mean arterial blood pressure (MAP)
at various stages of our study we detected statistically significant difference post
induction, being higher in Group B.
On comparing both groups regarding their systolic pulmonary artery pressure
(SPAP) at various stages of our study we detected high statistically significant
difference between both groups in all stages of our study, being lower in Group A.
On comparing both groups regarding their mean pulmonary artery pressure
(MPAP) at various stages of our study we detected high statistically significant
difference between both groups in all stages of our study, being lower in Group A.
On comparing both groups ABG regarding their pH, PaCO2 and Hco3 values at
various stages of our study we detected statistically significant difference between
both groups after extubation from mechanical ventilation. pH, and Hco3 being lower
in Group B, while PaCO2 was higher in Group B than in Group A.
On comparing both groups regarding post-operative Nitroglycerine use and
inotropic support; there was statistically significant difference between both groups
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regarding Nitroglycerine (NG) use and duration, as more patients in Group B needed
NG and for more prolonged duration than Group A patients. Also Dobutamine was
used for a prolonged duration in Group B patients.
There was statistically significant difference between both groups regarding
duration of mechanical ventilation and total hospital stay, being longer in Group B
patients. Although there was no significant difference between both groups regarding
duration of ICU stay.
Comparing both groups in our study regarding their follow up echo one week
and three months post-operative we detected statistically significant difference
regarding cardiac dimensions (LVEDD, LVESD), PASP and pressure across the valve
between both groups.
Comparing both groups in our study regarding morbidity, there was no
morbidity in Group A, in Group B there was a single case of morbidity. There was no
mortality in both groups for three months post-operative.