Mitral stenosis, perioperative hemodynamic goals

Mitral stenosis

Heart rate/rhythm

  •  Ideal heart rate 70-90 beats/min
  •  Many patients in atrial fibrillation at time of surgery - important to control ventricular rate in this situation

Preload/contractility

  •  Maintain preload and contractility
  •  Inotropic therapy often required following surgery (avoid tachycardia)

Systemic and pulmonary vascular resistance

  •  Long-standing mitral stenosis can lead to pulmonary hypertension
  •  May require pulmonary vasodilator therapy postoperatively and prolonged weaning from ventilation
  •  Inhaled nitric oxide therapy has been used to wean patients from ventilation

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