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Persistent pulmonary hypertension after mitral valve surgery: does surgical procedure affect outcome?
Michael C Walls1, Nina Cimino, Steven F Bolling
1Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109-5853, USA.
The Journal of Heart Valve Disease
|March 28, 2008
Summary
Pulmonary hypertension is common after mitral valve surgery, regardless of the procedure type. While pressures generally decreased, physiological repair showed favorable hemodynamics and lower rates of post-operative pulmonary hypertension.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pulmonary Hypertension Research
Background:
- Prosthesis-patient mismatch after mitral valve replacement (MVR) may cause persistent pulmonary hypertension.
- Pulmonary hypertension is a recognized complication following mitral valve interventions.
Purpose of the Study:
- To determine the prevalence and severity of pulmonary hypertension post-mitral valve surgery.
- To assess if the type of mitral valve surgery (replacement vs. repair) influences post-operative pulmonary hypertension.
Main Methods:
- Evaluated Doppler estimates of right ventricular systolic pressure (RVSP) in 179 patients.
- Compared pre-operative and post-operative (>= 1 year) RVSP across different mitral valve surgery types.
- Included mitral valve replacement (bioprosthetic, mechanical) and various repair techniques.
Main Results:
- Pulmonary hypertension was prevalent both pre- (78%) and post-operatively (64%).
- No significant differences in post-operative pulmonary hypertension prevalence were observed between surgical groups.
- RVSP decreased significantly after bioprosthetic replacement, mechanical replacement, and physiological repair.
Conclusions:
- Pulmonary hypertension is a common finding before and after mitral valve surgery.
- Physiological repair of organic mitral regurgitation demonstrates favorable hemodynamics.
- Bioprosthetic valve replacement may contribute to post-operative pulmonary hypertension due to higher transmitral gradients.
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