OBJECTIVE OF PROPOSED RESEARCH: To assess the relevance and prognostic ability of TAPSE to PASP ratio as compared to the individual parameters in patients undergoing mitral valve replacement surgery.

BACKGROUND OF PRESENT STUDY: Patients with mitral valvular defects, both stenosis and regurgitation, often have pathology of the pulmonary circulation due to increased Left Atrial pressures. These patients are at high risk of Right Ventricular failure and frequently have Right Ventricular hypertrophy and consequent RV dysfunction. TAPSE to PASP ratio is a relatively new index which aims to better model right ventricular function in relation to the afterload experienced by the RV. This serves as a measure of RV contractility independent of the loading condition. 

METHODOLOGY: The proposed study is to be conducted under the Department of Cardiac Anaesthesiology, IPGMER & SSKM Hospital, on patients undergoing Mitral Valve Replacement Surgery. Patients meeting the inclusion criteria are selected and proper informed consent is taken after due approval of the Institutional Ethics Committee. A pre-anaesthetic check-up is performed as per routine protocols and on the day of the surgery, anaesthesia is administered and TEE probe and Pulmonary artery catheter are inserted. TAPSE and PASP values and hemodynamic parameters are recorded post induction. Time on pump, inotrope requirement, duration of surgery, urine output, time to extubation and time spent in ICU are also noted. Appropriate statistical methods are applied to the collected data to reach up to conclusion.

EXPECTED OUTCOME: Due to the importance of right ventricular function in the face of pulmonary arterial remodelling and increased afterload conditions seen with mitral valve pathology, analysis of RV function using TAPSE to PASP ratio will give us a better idea of overall cardiac function compared to measuring TAPSE or PASP alone. It is expected that the calculated ratio will have higher sensitivity and specificity compared to the individual parameters.