Evaluation of pulmonary hypertension in chronic rheumatic mitral regurgitation

The incidence of pulmonary arterial hypertension (PAH) in 39 patients with angiographically proven chronic rheumatic mitral regurgitation (MR) is reported. The overall incidence of PAH were found to be 76.9%. There were 51.3% patients with mild, 15.4% with moderate and 10.2% with severe PAH. Pulmonary arterial hypertension was present in 93% of patients below 20 years of age. Clinical and radiological assessment of PAH did not show any correlation with the haemodynamic data. Electrocardiographic right ventricular hypertrophy was seen in 4, and biventricular hypertrophy in 5 patients. All of them had moderate to severe PAH. Echocardiographic left atrial (LA) size showed an inverse correlation with mean pulmonary artery pressure (PAP) (p less than 0.001), r = 0.63). Presence of mid-systolic notch in pulmonary valve echoes indicated mean PAP more than 37mmHg (mean 54.1 +/- 19.1). Fifty-six percent patients with mid-systolic notch had moderate to severe PAH. Sixteen (94%) out of 17 patients with raised left ventricular end diastolic pressure had elevated mean PAP, and 30% of them had moderate to severe PAH. This data shows that pulmonary hypertension is relatively common in our patients with chronic rheumatic MR, and that the severity of PAH correlates well.