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European Heart Journal 1994 15(1):10-16;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Studies on the elimination of bilirubin pre-operatively in patients with mitral valve disease

T. BØHMER*,, E. KJEKSHUS{dagger} and S. NITTER-HAUGE{ddagger}

{ddagger}Department of Medicine B
{dagger}Department of Obstetrics and Gynecology Rikshospitalet, Oslo
*Department of Medicine Aker Hospital, Oslo, Norway

Received 26 October 1992; revised 28 June 1993; .

Correspondence: Thomas Bøhmer, Department of Medicine. Aker Hospital 0514, Oslo 5, Norway

Abstract

This study looked at the hypothesis that patients with mitral valve disease have a reduced capacity to eliminate bilirubin prior to surgery for valve implantation. Radiolabelled bilirubin was administered as a bolus and as a steady state i. v. infusion so that its incorporation into plasma bilirubin, and the latter's elimination after the load, could be measured.

Patients with mitral valve disease (10) and aortic valve disease (10), in NYHA functional classes II–III, with total bilirubin concentration <26 µmol. 1–1, were studied.

The plasma conjugated bilirubin increased significantly during infusion with radiolabelled bilirubin, radioactivity also increased after 3–5 min both in mitral and aortic valve diseased patients. After termination of the infusion the decrease in plasma-free bilirubin concentration followed an exponential decay curve with a rate constant of 0·0101 ± 0·0013 (mean ± SD) and 0·00419 ± 0·00130 for patients with aortic valve disease and mitral valve disease (P<0·05) respectively. The rate constant correlated significantly with cardiac index (r=0·55) (P<0·01), and inversely with bilirubin concentration (r= – 0·57) (P<0·01).

Patients with advanced, mitral valve disease and normal bilirubin concentration demonstrated normal uptake. However, conjugation of bilirubin in the liver, with a diminished ability to eliminate a bilirubin load, indicated a functional block in the elimination of conjugated bilirubin, most likely related to a reduced liver flow.

Key Words: Aortic-valve disease • bilirubin conjugation • bilirubin elimination • mitral-valve disease • open-heart surgery • pre-operative • postoperative jaundice • steady-state technique


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