Khorshid Hospital, Isfahan, Iran
Background- Valvular heart disease is one of the common complications of acute rheumatic fever, which manifests its clinical complications one or two decades after the primary attack of the disease in adults.
The disease may involve one or more valves as stenosis or regurgitation or both and may cause congestive heart failure due to chronic volume or pressure overload.
Method- This prospective study was performed from March 1999 to February 2001 in university affiliated medical centers. 53 patients (28 females and 25 males) who suffered from valvular heart disease in the form of mitral and aortic stenosis or regurgitation were studied. Most of the patients were in functional class I or II (44) and the rest (9) in class III and IV. Non-cardiac surgery procedures were laparotomy, orthopedic surgery, and thoracotomy.
Results- Class I patients were able to easily tolerate the surgery without any significant problems. Only 2 patients had atrial fibrillation with rapid ventricular response in this class. In class II, one case had paroxysmal supraventricular tachycardia after thoracotomy and 3 patients had atrial fibrillation with rapid ventricular response. Another patient in this class had acute pulmonary edema. In class III, one patient had atrial fibrillation with rapid ventricular response after vaginal delivery. Of the two class IV patients, one patient needed reoperation due to prosthetic valve malfunction in the 26th week of pregnancy and the other had no significant hemodynamic problem.
Discussion- Supraventricular arrhythmia, which occurs as atrial fibrillation or paroxysmal supraventricular tachycardia or sinus tachycardia mostly in the first 24 hours after surgery, is preventable with sufficient analgesic prescription. Careful monitoring is necessary in patients with severe mitral or aortic stenosis and double valve disease during surgery or the first 24 hours after surgery. As a result, the important factor in patient prognosis is the functional class of heart disease rather than the type of valvular disease