Pre-operative care
As pre-operative assessment, swallowing and coughing were judged as well as physical activity assessment for the patient. Given the high risk of aspiration pneumonia, a physical therapist taught each patient how to cough efficiently and a nutritionist arranged the diet (such as adding viscosity to prevent aspiration).
Evaluation of cardiac function was performed by transthoracic echocardiogram; cardiac chamber dimensions were measured by the standard M-mode method and ejection fraction was calculated by the modified Simpson’s method. Mitral valve regurgitation was assessed using color-flow Doppler as “trivial”, “mild”, “moderate” or “severe” which correspond “1+”, “2+”, “3+” or “4+”, respectively.