PURPOSE: Evaluation of pulmonary function in adult patients undergoing cardiothoracic surgery is a simple test to assess pulmonary reserve and has an important implication in perioperative and post operative morbidity. This study evaluates the spirometric changes in adult patients with rheumatic heart disease before and after mitral valve surgery at the Philippine Heart Center.
METHODS: Twenty five randomly patients with rheumatic heart disease, with predominant mitral valve lesions were divided into four groups, based on New York Heart Association class. They were evaluated for changes in pulmonary functions preoperatively, one month and three months after surgery to evaluate improvements of lung function after mitral valve surgery.
RESULTS: Lung function was found impaired in all 25 patients and all had restrictive lung disease. After surgery, the mean pulmonary artery pressure was 26.1 ±8.3 mm Hg, the mean mitral valve area was 2.3 ±0.5 cm2. A slight improvement was seen in the spirometric values one month after surgery of FVC (57.2 ± 9.2 to 60.6 ±10.1, p value 0.012), FEV1 (57.9 ±10.1 to 59.8 ±10.5, p value 0.130), PEF 25% -75% (53.7 ±18.8 to 56.9 ±16.8, p value 0.405) and MVV (55.7 ±12.5 to 58.6 ±11.7, p value 0.091) and a statistically significant improvement in TLC (77.1 ±9.2 to 80.6 ±8.3, p value 0.017), DLCO (81.5 ±14 to 96.0 ±12.8, p value 0.000), RV (145.2 ±20.3 to 115.0 ±17.1, p value 0.000) and sRAW (199.1 ±57.7 to 62.4 ±40.1, p value 0.000). There was an overall improvement in all spirometric parameters including lung volume and DLCO at 3-months follow-up although the values remained lower than predicted.
CONCLUSION: Spirometry can evaluate respiratory reserve in cardiopulmonary patients who will undergo surgery and is simple and reproducible. Other parameters such as the Lung volume studies and DLCO were found to be sensitive in predicting perioperative and post operative morbidity.
CLINICAL IMPLICATIONS: Spirometry predicts perioperative and post operative morbidity. We therefore recommend it to be included in the routine evaluation of pulmonary function prior to cardiothoracic surgery.
DISCLOSURE: Jerome Santos, None.