Abstract
Adverse effects of cardiopulmonary bypass on blood and lungs are encountered more severelyin pulmonary hypertensive patients undergoing mitral valve surgery. Aim of this study is to identify the favorable effects of conventional ultrafiltration on postoperative pulmonary functions, hemodynamics, morbidity or mortality in pulmonary hypertensive patients undergoing mitral valve surgery. 40 patients with severe pulmonary hypertension who underwent mitral valve surgery were included in study. Patients were divided into two groups according to whether conventional ultrafiltration was applied or not. Demographic data, preoperative transthoracic echocardiography, respiratory functions, complete blood count, biochemical parameters, alterations in pulmonary functions, bleeding, use of inotropic agents and blood products, intubation time, mortality, morbidity, length of intensive care unit and hospital stay, were evaluated. Intubation time (7.97±2.77 vs. 10.12±2.95; p 0.05) and inotropic agents (14 vs. 18; p>0.05) were less than the control group. Increase of pulmonary compliance, cardiac index, oxygen index, decrease of alveolar-arterial oxygen pressure difference and ventilation index were significant in both groups. Hematocrit (28.07±3.18 vs. 26.96±2.51; p>0.05) and white blood cell (13.56±2.37 vs. 13.03±2.51; p>0.05) were higher in the study. No morbidity and mortality were presentin both groups. Conventional ultrafiltration decreased the intubation time, intensive care unit stay, hospital stay, bleeding, use of blood products and inotropic agents. Favorable effects were also detected on pulmonary compliance, cardiac index, oxygen index, alveolar-arterial oxygen pressure difference and ventilation index. Studies with larger patient population, application of conventional and modified ultrafiltration together may give significant results for pulmonary functions.
Highlights
The group of mitral valve diseases is one of the major reasons of secondary pulmonary hypertension
The aim of this study is to determine the effects of Conventional UF (CUF), especially in patients undergoing mitral valve surgery with severe secondary pulmonary hypertension
CUF was applied in the study group (n=20) at the end of the cardiopulmonary bypass (CPB) and patients in the control group did not receive any type of ultrafiltration
Summary
The group of mitral valve diseases is one of the major reasons of secondary pulmonary hypertension. Pulmonary hypertension occurs in a passive way, by the high left atrial pressure that is transmitted backwards as a result of increased resistance against the pulmonary venous drainage. Pulmonary vasoconstriction and anatomic changes of the vessels would be added to the procedure. This pulmonary status that occurs in patients with mitral valve disease is called as “Mitral Lung” and mostly includes obstructive and/or restrictive pulmonary dysfunction and pulmonary trunk stenosis [1]. CPB, decreases pulmonary compliance, increases pulmonary resistance, corrupts alveolar gas exchange and pulmonary endothelial
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