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Effect of percutaneous balloon valvuloplasty on pulmonary hypertension in mitral stenosis
S Georgeson1, I P Panidis, J P Kleaveland
1Department of Medicine, Temple University Hospital, Philadelphia, PA 19140.
Abstract:
Percutaneous mitral balloon valvuloplasty (PMBV) has been useful in decreasing mitral valve obstruction in mitral stenosis; however, the long-term effects of valvuloplasty on pulmonary artery pressure have not been extensively studied. Thirty-three patients underwent PMBV in our institution between January 1988 and December 1991. There were significant reductions in peak (19 +/- 1 to 12 +/- 1 mm Hg) and mean (10 +/- 0.7 to 6 +/- 0.4 mm Hg) mitral valve gradients estimated by Doppler techniques immediately after PMBV. The mitral valve area, as assessed by the pressure half-time method, increased from 1.06 +/- 0.05 to 1.98 +/- 0.08 cm2 (p < 0.001) after the procedure and remained significantly greater (1.68 +/- 0.11 cm2) at 17 +/- 2 months. Right ventricular systolic pressure (RVSP) was estimated in patients with tricuspid regurgitation (TR) using the modified Bernoulli equation. There was a good correlation between Doppler and catheterization for RVSP (r = 0.83 pre valvuloplasty; r = 0.87 post valvuloplasty). Right ventricular systolic pressure by Doppler was 56 +/- 4 mm Hg before valvuloplasty and 48 +/- 4 mm Hg immediately afterwards (p < 0.001). Nine patients had TR on follow-up Doppler studies with an estimated RVSP of 53 +/- 9 mm Hg (p = NS compared with pre- and post-valvuloplasty values). Six of these nine patients had moderate or severe mitral regurgitation (MR), compared with one patient without TR at follow-up (p < 0.05). There appears to be a good correlation between the RVSP determined by Doppler and measured at catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Percutaneous mitral balloon valvuloplasty effectively reduces mitral valve obstruction and pulmonary artery pressure. Long-term follow-up shows sustained improvement, though some patients develop mitral regurgitation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Mitral stenosis causes significant obstruction and elevated pulmonary artery pressure.
- Percutaneous mitral balloon valvuloplasty (PMBV) is a treatment for mitral stenosis.
- Long-term effects of PMBV on pulmonary artery pressure require further investigation.
Purpose of the Study:
- To evaluate the long-term impact of PMBV on pulmonary artery pressure.
- To assess the correlation between Doppler-estimated and catheterization-measured right ventricular systolic pressure (RVSP).
Main Methods:
- Thirty-three patients underwent PMBV between 1988 and 1991.
- Doppler echocardiography was used to measure mitral valve gradients, area, and RVSP.
- Correlation analysis was performed between Doppler and catheterization data for RVSP.
Main Results:
- PMBV significantly reduced mitral valve gradients and increased mitral valve area immediately post-procedure.
- These improvements were sustained at long-term follow-up (17 months).
- RVSP significantly decreased post-PMBV, with good correlation between Doppler and catheterization methods.
Conclusions:
- PMBV is effective in reducing mitral valve obstruction and pulmonary artery pressure in the long term.
- Doppler echocardiography provides reliable estimation of RVSP compared to catheterization.
- Development of mitral regurgitation may be associated with tricuspid regurgitation post-PMBV.