Mitral valve surgery

In the normal individual a high protein intake probably does not cause increases in blood urea nitrogen (BUN). However, in the individual with even minimal renal or liver dysfunction, major increases can be observed. In a dehydrated patient with septicemia and pleural abscess after mitral valve surgery, a high-protein diet produced an increase in BUN from normal limits to 100 mg/100 ml (Dll). The serum creatinine only rose to 2.9 mg/100 ml (Dll). Hemorrhage will also create elevations in BUN. In a patient who experienced gastric hemorrhage and hypotension, the BUN rose to 135 mg/100 ml while the creatinine rose only to 2.5 mg/100 ml (Dll). 

A 61-year-old woman undergoing mitral valve surgery received fentanyl, midazolam, nitrous oxide, and propofol infusion 3 mg/kg/hour during a 5-hour anesthetic. She developed lactic acidosis soon after the completion of surgery and required reintubation and ventilation. The peak lactate concentration, which occurred 1 day later, was 14.3 mmol/1. There was also mild disturbance of liver function. She eventually recovered. 

Prostacyclin lowers peripheral, pulmonary, and coronary resistance. It has been used to treat both primary pulmonary hypertension and secondary pulmonary hypertension, which sometimes occurs after mitral valve surgery. A commercial preparation of prostacyclin (epoprostenol) is approved for treatment of primary pulmonary hypertension, in which it appears to improve symptoms and prolong survival. However, because of its extremely short plasma half-life, the drug must be administered as a continuous intravenous infusion through a central line. Several prostacyclin analogs with longer half-lives have been developed and treprostinil was recently approved for use in pulmonary hypertension (Horn, 2002). This drug is administered by continuous subcutaneous infusion. 

I Aldosterone antagonist, nesirltide I Consider multidisciplinary team I Revascularization, mitral-valve surgery I Cardiac resynchronization if bundle-branch block preseht Dietary Na restriction, diuretics, and dlgoxln I ACE Inhibitors and p blockers in all patients I ACE Inhibitors or AT blockers In all patients J3 blockers In selected patients Treat hypertension, diabetes, dyslipidemla ACE inhibitors or ATr blockers In some patients Risk-factor reduction, patient and family education... 

Komoda, T., Hetzer, R., Uyama, C., Siniawski, H., Maeta, H., Rosendahl, P, and Ozaki, K. 1994. Mitral annular function assessed by 3D imaging for mitral valve surgery. /. Heart Valve Dis. 3 483-490. 

Gammie, J.S. et al.. Trends in mitral valve surgery in the United States Results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg, 2009. 87(5) p. 1431-7 discussion 1437-9. 

Implantable valves, particularly mechanical valves which continue to encroach on tissue valves, are unique. Methods such as valvuloplasty, mitral valve repair, or use of ultrasound are unlikely to reduce the number of valve replacements into the twenty-first century. Valve selection remains in the hands of the surgeon because of the critical nature of the procedure. If anything goes wrong, the result can be catastrophic to the patient. Cost of a valve, from 3000— 4000, is a relatively small part of the cost of open-heart surgery which can mn as high as 30,000. Growth of the cardiovascular valve market has slowed in the United States with the decline of the threat of rheumatic fever. 

Mitral stenosis or regurgitation Mitral valve prolapse Chronic obstructive pulmonary disease Pulmonary embolism Idiopathic ("lone" atrial fibrillation) Thoracic surgery ... 

Valve surgery with severe aortic stenosis or mitral regurgitation... 

In the past, rheumatic heart disease was a prevalent risk factor for IE, but the incidence of this disease continues to decline. The risk of IE in persons with mitral valve prolapse and regurgitation is small however, because the condition is prevalent, it is an important contributor to the overall number of IE cases. Prosthetic valve endocarditis occurs in 1 % to 4% of patients undergoing valve replacement surgery. ... 

Low- or no-risk conditions Secundum atrial septal defect, ischemic heart disease, previous coronary artery bypass graft surgery, and mitral valve prolapse with thin leaflets in the absence of regurgitations Temperature >38°C (100.4°F)... 

Previous coronary artery bypass graft surgery Mitral valve prolapse without valvar regurgitation Physiologic, functional, or innocent heart murmurs Previous Kawasaki disease without valvar dysfunction Previous rheumatic fever without valvar dysfunction Cardiac pacemakers (intravascular and epicardial) and implanted defibrillators... 

A 60-year-old woman taking digoxin, furosemide and warfarin (ESTR 3.5 to 5) developed a fever after mitral valve replacement surgery and was given rifampicin 450 mg twice daily and teicoplanin 400 mg twice daily. Within 3 days her ESTR began to fall and by day 6 the anticoagulant effect was completely lost. Despite progressive warfarin increases to 10, 15, and then 20 mg daily, her INR stayed between 1.2 and 1.6, even when the rifampicin was stopped, and remained low for a further 20 days, at whieh point the teicoplanin was also stopped. ... 

The use of traditional knotted sutures for mitral valve reconstructive surgery has a number of disadvantages. A size 5-0 polypropylene suture has been reported to leave sharp tails or ears protruding from their knots that could damage the opposing anterior leaflet after quadrangular resection (Fig. 13.33) (Lam et al., 2003). The use of a barbed suture could be a possible alternative to traditional sutures, since the barbed suture would stay inside the eye so there would be no abrasion with surrounding tissue. Further, the... 

Lam, B.-K., GiUrnov, A. M. and Cosgrovein, D. M. (November 2003). Failed mitral valve repair caused by polypropylene suture. The Annals of Thoracic Surgery, 76 (5), 1716-1717. 

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