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