Coronary Sinus diameter as a predictor of Right Ventricular dysfunction in patients undergoing Mitral Valve surgery

TITLE:   CORONARY SINUS DIAMETER AS A PREDICTOR OF RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS UNDERGOING MITRAL VALVE SURGERY 

The RV function of patients going through Mitral valve surgery is affected in the early stages, and through a range of pathways. Furthermore, the application of cardiopulmonary bypass and pericardiotomy in surgical interventions weakens the natural RV contraction pattern and may lead to further impairment. RV dysfunction is a major clinical problem in the postoperative setting due to the substantial morbidity and mortality it can cause.

Intraoperatively, RV function can be judged by Echo parameters such as Tricuspid Annular Plane Systolic Excursion (TAPSE), RV Fractional Area Change (FAC), and RV Myocardial Performance Index (MPI), although they are intricate and have their own constraints.

Recent literature indicated that Coronary sinus diameter may be indicative of RV impairment in those with heart failure and in the pediatric cardiac surgery population. There is a paucity of literature available in forecasting RV dysfunction in individuals undergoing valve replacement.

AIM AND OBJECTIVES:

The main purpose of the study is to explore the correlation between coronary sinus diameter and right ventricular dysfunction at different intervals in the postoperative period in patients who have undergone mitral valve surgery, as well as its relationship to right ventricular myocardial performance index.

Investigating the association between VIS score (VIS max), mechanical ventilation duration, ICU stay, hospital stay, and mortality is the secondary objective.

STUDY DESIGN:

It will be a prospective observational study over 1 year duration.

One hundred consenting patients going through Mitral valve surgery will be monitored for Coronary Sinus diameters at multiple points like preoperatively, after induction, just before being moved to the recovery ICU and in the postoperative period.

RVMPI ,IVC and LVEF will be measured  at same time points.

VIS Score will be calculated at various time points in the  postoperative period and VIS max will be noted, Mechanical ventilator stay, length of ICU stay, length of Hospital stay and Mortality.

INCLUSION CRITERIA :

Age18 – 65 years

Sex- both

Patients undergoing elective Mitral valve replacement without TR or Mild to moderate TR

EXCLUSION CRITERIA :

Patients With persistent left superior vena cava, total anomalous pulmonary venous return, coronary atrioventricular fistula, anomalous hepatic venous drainage, coronary sinus thrombosis and any  postoperative  coronary sinus obstruction.

Patients With Severe TR or eccentric TR jet towards Coronary Sinus

Patients requiring concomitant  Aortic valve surgery or CABG

Patients With severe LV Dysfunction.

Patients in whom TEE is contraindicated.