الفهرس 
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Abstract
Cardiothoracic surgical patients are often critically ill, and the magnitude of cardiothoracic procedures often results in a severe assault on normal physiology with increased catabolism and augmented nutritional requirements. These adverse effects are compounded by the fact that, increasingly, these patients are older and present the surgeon with a panoply of comorbid conditions, including malnutrition, which increases the risk of postoperative complications. Open heart surgery continues to be associated with disconcerting complication rates, often necessitating a prolonged ICU stay until the organ functions recover. In general, an oral or enteral nutritional intake shall be started before surgery to reduce surgical stress, maintain physiological function capacity, and facilitate postoperative functional recovery. Accordingly, it is incumbent upon the surgical team to identify those patients who are poorly nourished preoperatively and, whenever possible, improve their nutritional status prior to the surgery. Theoretically, immunonutrients significantly modulate the immune response. Therefore, they are useful for the recovery of patients undergoing major surgery, because for patients who are in the catabolism and have stress induced by the disease and surgical injury, the immune response is impaired and should be modulated in order to improve prognosis. Most authors recommend the use of preoperative IMN in order to decrease the rate of the postoperative infectious rate and the length of hospital stay We have studied 60 adult patients in the age group of 18-60 years. Patients were divided into two groups of 30 patients each. group N (nutrition group) 30 patients were given glutamine 0.4 g/kg/day by intra venous infusion for 3 days before surgery and group C (control group) 30 patients were given normal saline for 3 days before surgery. The following data were collected: Demographic data, preoperative and postoperative follow up characteristics were reported and analyzed. The cardiac function: Serum proBNP (Brain Natriuretic Peptide) level preoperatively and postoperative at first and forth days. Inotropic score every 2 hours in the first postoperative 6 hours and then every 6 hours for the rest of 48 hours postoperatively. Kidney function: - Urine output in the postoperative first and second days. - Serum urea and creatinine in postoperative first and second days - Serum NGAL (Neutrophil gelatinase-associated lipocalin) preoperatively and postoperative first and forth days. Hemodynamic Parameters: - MAP, HR every 2 hours in first 6 hours then every 6 hours for the rest of 48 hours postoperatively Hours of mechanical ventilation. Hospital and ICU stay. Our study showed that preoperative glutamine administered 3 days before mitral valve replacement surgery augment cardiac function with statistically significant difference in postoperative inotropic score and postoperative serum proBNP level regarding 1st and 4th day in nutrition group in comparison with control group without significant difference in postoperative serum NGAL level also there was significant difference between the two groups regarding ICU stay and hospital stay days.
Limitation to our study, the study involved mitral valve replacement only. We recommend further studies involving larger sample size and other cardiac surgeries
Conclusion
Our study demonstrated that short term of preoperative glutamine has significantly decreased the postoperative proBNP and ICU stay in cardiac valve replacement surgery. However no significant implication upon postoperative human NGAL and kidney function.