EC Clinical and Medical Case Reports

Introduction: Right ventricular function is a major prognostic factor after cardiac surgery. Postoperative right ventricular dysfunction after cardiac surgery has been recognized for over 30 years. Ventricular dysfunction is also common after mitral regurgitation surgery and this condition improves to some point in the long term.

Objective: The main objective of our study is to expose the prognostic factors of right ventricular dysfunction in patients operated for mitral regurgitation (whether or not associated with tricuspid regurgitation). The secondary objective is to compare these results with those of the literature on one hand, in order to improve the postoperative status of our patients and to assess the impact of a postoperative right ventricular dysfunction.

Patients and Methods: Descriptive retrospective study involving 20 patients operated for scheduled mitral regurgitation surgery associated or not with tricuspid regurgitation from January 2018 to December 2019 at the cardiovascular surgery department CHU in Rochd Casablanca.

Results: In our study of an patients, 75% are female The average age was 38.5 i^th extremes ranging from 11 to 72 years.

Mechanism of mitral regurgitation: 75% of patients had mitral valve prolapse, MR grade IV 35%, tricuspid regurgitation was associated with mitral regurgitation in 16 patients, EUROSCORE mean 2.5.

15% of the patients in our study presented a postoperative right ventricular dysfunction; we found a longer duration of CPB (152 min versus 130 min; p = 0.04) and a longer duration of aortic clamping (95 min versus 70; p = 0.01). Exit from PB required dobutamine/norepinephrine in 14 patients; length of stay in intensive care was 3.55 days, higher in patients with right ventricular dysfunction (5 days versus 2.5 days p = 0.04) patients with postoperative right ventricular dysfunction had a longer duration of mechanical ventilation (35h versus 12h; p = 0.01); as well a longer duration and dosage of inotropic support 10% of the patients had presented an acute kidney failure, 5% pneumonia, 5% infection of the operating site, 20% low cardiac output, 55% an arrythmia. Death rate was 10%.

Conclusion: Right ventricular dysfunction is frequent after mitral and tricuspid regurgitation surgery and responsible for lengthening the length of stay in intensive care, longer duration of mechanical ventilation and higher use of inotropic support, thus responsible for a mortality rate.

 Keywords: Prognostic Value; Right Ventricular Dysfunction; Mitral Insufficiency; Tricuspid Insufficiency

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