A unique study of post mitral valve surgery status of patients in pre and intra COVID-19 era

Bhubandeep Mukhopadhyay, P. Banerjee


Background: In this study we have studied the change of pulmonary artery pressure after mitral valve replacement and closed mitral commissurotomy. We have also correlated pulmonary artery pressure before and after operation with postoperative outcome.

Methods: This study was conducted at Department of CTVS of NRS Medical College and Hospitals from August 2019 to September 2021. All 81 patients had rheumatic mitral valve disease. Among these 73 patients underwent mitral valve replacement (MVR) and 8 patients underwent closed mitral commissurotomy (CMC). Group 1 (n=35) consisted of patients who underwent MVR having preoperative systolic PAP measured by TTE was less than 50 mmHg. Group 2 patients (n=38) had preoperative systolic PAP more than or equal to 50 mmHg measured by TTE. Group 3 patients (n=8), consists of patients who underwent CMC. Compared the results between group 1 and 2 and documented the results of group 3 separately.

Results: Our results showed a significant decrease in SPAP after MVR, and further fall of SPAP in the immediate and late postoperative period.

Conclusions: In conclusion, PAP returns to near-normal values after MVR in patients with severe preoperative PAH and to normal values in patients with mild preoperative PAH. Reductions in PAP in patients with preoperative PAH occur immediately after MVR.  Postoperative period of patients with severe PAH may be hectic. CMC may be a valid option in isolated MS in selected patients and is very much cost-effective. There were no differences noted among the types of valves used.



Hemodynamic, Mitral valve disease, Mitral valve replacement, Pulmonary hypertension

Full Text:



Deloche A, Guerinon J, Fabiani JN, Morillo F, Caramanian M, Carpentier A, et al. Anatomical study of rheumatic tricuspid valve diseases: Application to the study of various valvuloplasties. Ann Chir Thorac Cardiovasc. 1973;12:343-9.

Vincens JJ, Temizer D, Post JR, Edmunds Jr LH, Herrmann HC. Long-term outcome of cardiac surgery in patients with mitral stenosis and severe pulmonary hypertension. Circulation. 1995;92:II137-42.

Salomon NW, Stinson EB, Griepp RB, Shumway NE. Mitral valve replacement: long-term evaluation of prosthesis-related mortality and morbidity. Circulation. 1977;56: II94-101.

Crawford MH, Souchek J, Oprian CA. Determinants of survival and left ventricular performance after mitral valve replacement department of veterans affairs cooperative study on valvular heart disease. Circulation. 1990;81:1173-81.

Otto CM. Surgical intervention for mitral regurgitation. In: Otto CM, edr. Valvular Heart Disease. Philadelphia, PA: W.B. Saunders Company; 1999:340-361.

Zielinski T, Pogorzelska H, Rajecka A, Biedermavn A, Sliwinski M, Korewicki J. Pulmonary hemodynamics at rest and effort, 6 and 12 months after mitral valve replacement: a slow regression of effort pulmonary hypertension Int J Cardiol. 1993;42:57-62.

Leavitt JI, Coats MH, Falk RH. Effects of exercise on transmitral gradient and pulmonary artery pressure in patients with mitral stenosis or a prosthetic mitral valve: a Doppler echocardiographic study J Am Coll Cardiol. 1991;17:1520-6.

Patel H, Desai M, Tuzcu EM. Pulmonary hypertension in mitral regurgitation J Am Heart Assoc. 2014;3:e000748.

Mubeen M, Singh AK, Agarwal SK, Pillai J, Kapoor S, Srivastava AK. Mitral valve replacement in severe pulmonary arterial hypertension. Asian Cardiovasc Thorac Ann. 2008;16(1):37-42.

Song X, Zhang C, Chen X, Chen Y, Shi Q, Niu Y, et al. An excellent result of surgical treatment in patients with severe pulmonary arterial hypertension following mitral valve disease. J Cardiothorac Surg. 2015;10(1):1-5.

Lee S, Joo HC, Lee H, Park B, Youn YN, Yoo KJ, et al. Effect of pulmonary hypertension on clinical outcomes in patients with rheumatic mitral stenosis. Ann Thorac Surg. 2020;109(2):496-503.

Mandal I. Pulmonary hypertension before and after balloon mitral valvuloplasty. 2017, Int J Med Res Rev. 2017;5(3).

Maeder MT, Weber L, Buser M, Gerhard M, Haager PK, Maisano F, et al. Pulmonary hypertension in aortic and mitral valve disease. Front Cardiovasc Med. 2018;5:40.

Nair KK, Pillai HS, Titus T, Varaparambil A, Sivasankaran S, Krishnamoorthy KM, et al. Persistent pulmonary artery hypertension in patients undergoing balloon mitral valvotomy. Pulmon Circ. 2013;3(2):426-31.

Kiefer TL, Bashore TM. Pulmonary hypertension related to left-sided cardiac pathology. Pulmon Med. 2011;2011.

Durairaj M, Mommin H, Vaidya S, Makhale CM, Sathe S, Grant P. Persistent pulmonary hypertension after balloon mitral valvuloplasty. J Am Coll Cardiol. 2018;71(11S):A1380.

Carpentier A, Loulmet D, Le Bret E, Haugades B, Dassier P, Guibourt P. Open heart operation under videosurgery and minithoracotomy. First case (mitral valvuloplasty) operated with success. Comptes rendus de l'Academie des sciences. Serie III, Sciences de la vie. 1996;319(3):219-23.

Carpentier A, Loulmet D. Computer-assisted cardiac surgery. Lancet. 1999;353(9150):379-80.

Mohr FW, Falk V, Diegeler A, Walther T, Gummert JF, Bucerius J, et al. Computer-enhanced “robotic” cardiac surgery: experience in 148 patients. J Thorac Cardiovasc Surg. 2001;121(5):842-53.

Silver MD, Gotlieb AI, Schoen FJ. Cardiovascular pathology. In: Silver MM, Silver MD, eds. Examination of the Heart and of Cardiovascular Specimens in Surgical Pathology. 3rd edn. Churchill Livingstone Publishers; New York, Edinburgh; 2001.

Kamblock J, N'Guyen L, Pagis B, Costes P, Le Goanvic C, Lionet P, et al. Acute severe mitral regurgitation during first attacks of rheumatic fever: Clinical spectrum, mechanisms and prognostic factors. J Heart Valve Dis. 2005;14:440-6.

Dreyfus GD, Corbi PJ, Chan KM. Secondary tricuspid regurgitation or dilatation: which should be criteria for surgical repair? Ann Thorac Surg. 2005;79:127-32.

Arslan S, Buyukkaya S, Gundogdu F, Sevimli S, Buyukkaya E, Aksakal E, et al. Assessment of right ventricular functions by tissue Doppler echocardiography in patients with rheumatic mitral valve stenosis associated with sinus rhythm or atrial fibrillation. Türk Kardiyol Dern Arş. 2007;35:475-81.

Davlouros PA, Niwa K, Webb G, Gatzoulis MA. The right ventricle in congenital heart disease. Heart. 2006;92(suppl 1):i27-38.

Messika-Zeitoun D, Thomson H, Bellamy M, Scott C, Tribouilloy C, Dearani J, et al. Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. J Thorac Cardiovasc Surg. 2004;128:296-302.

Schattke S, Knebel F, Grohmann A, Dreger H, Kmezik F, Riemekasten G, et al. Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: a Doppler Tissue and Speckle Tracking echocardiography study. Cardiovasc Ultrasound. 2010;8:3.

Simonneau G, Galie N, Rubin LJ. Clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2004;43:5S-12S.

Wencker D, Borer JS, Hochreiter C, Devereux RB, Roman MJ, Kligfield P, et al. Preoperative predictors of late postoperative outcome among patients with nonischemic mitral regurgitation with ‘high risk’ descriptors and comparison with unoperated patients. Cardiology. 2000;93:37-42.

Sciomer S, Badagliacca R, Fedele F. Pulmonary hypertension: echocardiographic assessment. Italian Heart J. 2005;6:840-5.

Tempe DK, Hasija S, Datt V, Tomar AS, Virmani S, Banerjee A, et al. Evaluation and comparison of early hemodynamic changes after elective mitral valve replacement in patients with severe and mild pulmonary arterial hypertension. J Cardiothorac Vasc Anesth. 2009;23(3):298-305.

Bayat F, Aghdaii N, Farivar F, Bayat A, Valeshabad AK. Early haemodynamic changes after mitral valve replacement in patients with severe and mild pulmonary hypertension. Ann Thorac Cardiovasc Surg. 2013;19(3):201-6.