Anesthesia for patients with mitral valve disease secondary to rheumatic and coronary artery disease1
Jean-Pierre Yared, M.D.
Fawzy G. Estafanous, M.D.
Andrew M. Zurick, M.D.
Hemodynamic changes during anesthesia were studied in 53 patients undergoing mitral valve surgery. The patients were divided according to type of lesion (stenosis or insufficiency), etiology (rheumatic or ischemic), and anesthetic technique (halothane or fentanyl). One group was also treated with a vasodilator (sodium nitroprusside). Following intubation and except for minor variations, all patients showed a decrease in cardiac index (CI), an increase in systemic vascular resistance (SVR), and no change in central venous pressure (CVP) or pulmonary capillary wedge pressure (PCWP). These changes persisted following sternotomy and occurred irrespective of type of lesion, etiology, or anesthetic technique. Sodium nitroprusside resulted in an increase in CI and a decrease in SVR. Fentanyl anesthesia was characterized by a stable mean arterial pressure (MAP), whereas with halothane, MAP was labile.