Mitral Regurgitation in Patients Undergoing Noncardiac Surgery

Perioperative Care of Heart Failure, Arrhythmias, and Valvular Heart Disease

Frequently, the question of whether or not a patient is stable for surgery boils down to the question, "Does this patient need a preoperative stress test?" However, coronary artery disease and ischemic heart disease are only some of the many cardiac conditions that patients present with preoperatively-and that can negatively impact their intraoperative management and postoperative outcomes. This article will explore the evidence based, patient centered best practices surrounding the perioperative evaluation and management of heart failure, arrhythmias, and valvular heart disease.

Risk of Recurrent and Frequent Preterm Birth Among Women With Mitral Valve Prolapse: A Systematic Review and Meta-Analysis

Preterm delivery remains a prominent problem in obstetrics with significant adverse implications for both mothers and the offspring. The incidence of mitral valve prolapse (MVP) in women of childbearing age has raised concerns about pregnancy and pregnancy connotations. The objective of this systematic review and meta-analysis is to help in understanding the plausibility of the association between MVP and preterm birth in women with a history of frequent deliveries. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we searched the databases, including PubMed, Embase, Cochrane Library, Web of Science, and Scopus, for studies published in the period 1999 through 2024. Inclusion criteria consisted of studies such as cohort, cross-sectional, and case-control studies related to women diagnosed with MVP out of a total number of 1,029 articles found. Overall, a total of 19 studies were included in this review, with 3 of which were considered for further meta-analysis. It was revealed in the analysis that there was an association between MVP and preterm delivery when the severity of MVP was at Types II and III. The evidence also underscores the importance of both follow-up and preemptive measures among women suffering from MV prolapse for improved maternal and neonatal outcomes. The average Z-value (4.47) and p-value (0.00) for the test for overall effect size indicate the presence of a high correlation between MVP and premature delivery, suggesting satisfactory statistics on the association. The findings do indicate that MVP is a risk factor for preterm delivery (pooled ES = 0.24, 95% CI = 0.14 to 0.35, P <0.001).

Perioperative Management of Valvular Heart Disease in Patients Undergoing Non-Cardiac Surgery

Postoperative cardiovascular complications (either in a hospital or within 30 days after the operation) are among the most common problems with non-cardiac surgeries (NCSs). Pre-existing cardiac comorbidities add significant risk to the development of such complications. Valvular heart disease (VHD), a rather frequent cardiac comorbidity (especially in the elderly population), can pose serious life-threatening peri-/postoperative complications. Being familiar with the recommended perioperative management of patients with VHD or an implanted prosthetic heart valve who are scheduled for NCS is of great importance in daily clinical practice. Although recently published guidelines by the European Society of Cardiology (ESC) and the American College of Cardiology and American Heart Association (ACC/AHA) for the management of VHD and perioperative management of patients undergoing NCS addresses the mentioned problem, a comprehensive review of the guidelines that provides an easy-to-use summary of the recommendations and their similarities and differences is missing in the published literature. In this review article, we summarize all of the relevant important information based on the latest data published in both guidelines needed for practical decision-making in the perioperative management of patients with VHD or after valvular repair (with prosthetic heart valve) who are scheduled for NCS.

Mitral regurgitation in the critically ill: the devil is in the detail

Mitral regurgitation (MR) is common in the critically unwell and encompasses a heterogenous group of conditions with diverging therapeutic strategies. MR may present acutely with haemodynamic instability or more insidiously with failure to wean from mechanical ventilation. Critical illness is associated with marked physiological stress and haemodynamic changes that dynamically influence the severity and implication of MR. The expanding role of critical care echocardiography uniquely positions the intensivist to apply advanced bedside valvular assessment to recognise haemodynanically significant MR, manipulate and optimise cardiopulmonary physiology and identify patients requiring urgent cardiology and surgical referral. This review will consider common clinical scenarios, therapeutic strategies and the pearls and pitfalls of echocardiographic assessment and quantification in the critically unwell.