[Hemodynamic classification of 2d-stage mitral stenosis]

Thirty patients with mitral stenosis were examined according to the Bakulev-Damir classification during right heart catheterization at rest, with loading and during the rehabilitation period. The relationships found between the extent of the resistance at rest and the character of the degree of its changes at loading, reflecting the stenosis evolution, provide grounds for the differentiation of four stages, four substages resp., in its classification, namely: Second A substage with sinus rhythm, without included protective reaction of a. Pulmonalis periphery at rest, with markedly manifested peripheral vasodilation with loading. Second B substage with sinus rhythm, protective reaction of a. Pulmonalis periphery at rest included to a lesser degree, excluded loading, with a following manifested vasodilation. Second C substage with absolute arrhythmia, included to a lesser degree protective reaction of a. Pulmonalis periphery at rest, excluded with loading, with a following slighter vasodilation. Second D substage with sinus rhythm, included protective reaction at a. Pulmonalis periphery at rest, considerably intensified with loading. The extent and dynamics of the rest of the values studied are followed up in the separate stenosis substages aiming at their complete hemodynamic characterization. The pathogenetic mechanism of the pulmonary edema in the second stenosis stage is analyzed, not rarely conditioning the clinical pardox "minor stenosis of mitral valve with menacing pulmonary edemas".