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