Exercise Haemodynamics after Valve Surgery

The hemodynamic improvement after valve surgery depends on preoperative degree of impairment and the valve lesion. In patients with aortic stenosis and impaired left ventricular function preoperatively, hemodynamics improve significantly at rest and during exercise after valve surgery. In contrast, patients after mitral valve replacement have a markedly lower exercise tolerance; only 40-60% of patients have normal hemodynamics at rest and only 25% during exercise. In patients with mitral stenosis, pulmonary capillary wedge pressure falls significantly after surgery as well as pulmonary hypertension. The degree of pulmonary hypertension preoperatively and the speed of postoperative regression of pulmonary hypertension is of importance for further management, including exercise training.26-28

Besides symptomatic and hemodynamic improvement, several other factors need to be taken into account to determine the type and intensity of exercise training, including the degree of regression of left ventricular hypertrophy and improvement in left ventricular function following correction of the various valve lesions.

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