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14
Figure legend
Fig. 1. Perioperative transesophageal echocardiography images. (A) Preoperative mitral
valve regurgitation on 2-D color Doppler imaging from the commissure view. (B)
Postoperative mitral valve regurgitation on 2-D color Doppler imaging from the
commissure view.
Supplementary Fig. 1. Changes in the values of physical function measures and activities
of daily living over time in the patient.
15
Table 1
Instructional content provided by the multidisciplinary cardiac rehabilitation staff.
Occupation
Content
Doctor
Pathologic explanation of heart failure
Explanation and instructions regarding the
risk of rehospitalization
Explanation and instructions on the
pharmacotherapy used for treatment
Explanation and instruction on diet, exercise
therapy, and lifestyle
Provision of information to family doctors
Nurse
Patient education on self-measurement of
blood pressure, pulse, and body weight
Confirmation of symptoms and physical
condition
Confirmation and instruction on medications,
diet intake, snacks, and physical activity
Confirmation and instruction on bathing and
toilet methods
Confirmation and instruction on sleep state,
stress conditions, and leisure time
Public health nurse
Looking back on one's lifestyle
Life guidance about self-care
Confirmation of the key person and how to go
to hospital
Nutritionist
Learning about the patient’s diet at home
Explanation and instruction on nutrient
balance, caloric intake, sodium restriction, fat
quality and quantity, luxury goods (coffee,
alcohol, snacks), and eating out
Pharmacist
Explanation and instruction on medicine used
for treatment
Confirmation of efficacy and side effect
Confirmation of the patient’s degree of
understanding of the pharmacotherapy
Confirmation of the management method and
patient compliance
Physiotherapist
Confirmation of physical function, activities
of daily living, and physical activity
Explanation of the effects of the exercise
therapy
Instruction in the exercise method
Explanation of matters requiring attention
during exercise
Table 2
Changes in laboratory and cardiac echocardiography data, physical function, and activities of daily living over time.
On
PrePost1 month
2 months
7 months
1 year
admission operation
operation after
after
after
after
discharge discharge discharge discharge
Laboratory data
Hemoglobin (g/dL)
12.1
11.6
10.8
11.2
11.3
12.3
11.9
Total bilirubin (mg/dL)
3.1
1.7
2.3
2.1
1.9
2.3
GNRI
99.1
86.8
85.4
94.6
94.4
96.4
96.2
eGFR (mL/min/1.73 m2)
33.3
34.3
45.2
39.7
47.0
46.4
43.9
BNP (pg/mL)
590.1
272.7
162.5
303.0
264.7
279.8
287.7
Cardiac echocardiography data
LVEF (%)
54
66
52
56
61
64
58
Stroke volume (mL)
54
92
91
100
112
145
LVOT-VTI (cm)
13.9
22.6
21.4
28.1
30.1
28.1
29.2
LVDd/LVDs (mm)
62/38
58/38
55/39
57/37
58/41
56/37
61/41
Left atrial dimension (mm)
65
57
49
59
56
67
61
E/e’
13
16
18
12
13
17
Aortic valve regurgitation
Severe
Severe
Severe
Severe
Severe
Severe
Severe
Mitral valve regurgitation
Severe
Moderate
Mild
Mild
Mild
Mild
Moderate
Tricuspid valve regurgitation
Severe
Moderate
Mild
Moderate
Mild
Mild
Moderate
TRPG (mm)
63
25
36
27
35
24
40
Physical function
SPPB (points)
12
11
12
12
12
12
Gait speed (m/s)
0.89
0.94
0.83
0.83
0.93
0.94
Handgrip strength (kgf)
23.9
25.2
24.9
25.4
26.0
Knee extensor muscle strength (kgf/kg)
0.41
0.49
6MWD (m)
310
280
310
300
Activities of daily living
FIM (points)
118
123
123
123
123
122
122
BNP, brain natriuretic peptide; eGFR, estimated glomerular filtration rate; FIM, Functional Independence Measure; GNRI, Geriatric
Nutritional Risk Index; LVDd, left ventricular end-diastolic diameter; LVDs, left ventricular end-systolic diameter; LVEF, left
ventricular ejection fraction; LVOT-VTI, left ventricular outflow tract velocity time integral; SPPB, Short Physical Performance
Battery; TRPG, tricuspid valve regurgitation pressure gradient; 6MWD, 6-minute walk distance.
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