الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
 |  | from | 71 |  |  |
| | | from | 71 | | |
Abstract
Mitral valve disease with pulmonary hypertension is characterized by a progressive increase in pulmonary vascular resistance leading to right ventricular (RV) failure and mortality. Prognosis of patients with severe PAH is poor, and treatment options are limited.
Mitral valve diseases increase left atrial pressure which leads to an initially passive and potentially reversible increase in pulmonary pressures. Vascular injury then triggers a cascade of venous and small artery remodeling, which result in non-reversible arterial pulmonary hypertension, and eventually, right ventricular dysfunction.
We designed our study to evaluate the effect of preoperative administration of sildenafil on operative and early postoperative outcome after mitral valve replacement in patients with pulmonary hypertension.This prospective randomized study was conducted between March 2017 and October 2019 in Menoufia University Hospitals.
This prospective randomized study was carried out on 31 males and 36 females with mean age of 52.30 years; all patients who had mitral valve disease requiring surgery associated with high systolic pulmonary artery pressure (PASP) more than 50 mmHg.
Patients were randomized into three groups: group A who received sildenafil one week preoperative, group B who received sildenafil one month preoperative and group C who didn‘t receive sildenafil preoperatively. All patients underwent conventional surgical mitral valve replacement.
All patients were subjected to trans-thoracic echocardiography Pre-operatively, one week and one month postoperatively. Data were collected and statistically analyzed.
There was a single case of mortality in group C who died intraoperatively most likely due to severe reaction to fresh frozen plasma transfusion. However, there was no statistically significant difference between the three groups regarding post-operative mortality
All groups were comparable concerning preoperative and operative data, as we detected no statistically significant difference in patients‘ demographics, symptoms and comorbidities.
Operatively, all groups did not have statistically significant difference concerning total bypass or cross clamp time.
Regarding the duration of post-operative mechanical ventilation, ICU stay and hospital stay. There was highly significant statistical difference between the three groups.
Regarding postoperative drugs to decrease pulmonary hypertension (milrinone) and glyceryl trinitrate infusion. There was highly significant statistical difference between the sildenafil groups and control group.
The transthoracic echocardiographic study 5-7 days and one month after the operation showed that pulmonary artery systolic pressure significantly decreased in groups A and B to 28.30 ± 3.3 and 28.2 ± 4.98 while in group C it decreased to 43.12 ± 4.99 and this difference was highly statistically significant (p value <0.001). However,
there was no statistically significant difference between groups A and B regarding PASP in either echocardiographic study.
As there was no statistically significant difference between the echocardiographic findings, operative or post-operative outcome for patients who received Sildenafil for one week pre-operatively (group A) and patient who received Sildenafil for one month pre-operatively (group B); giving sildenafil for those patients for more than 1 week pre-operatively is not needed.