Cardiac and pulmonary artery pressure pulses in experimental mitral stenosis

OBJECTIVES: To determine the factors responsible for insignificant decrease in pulmonary artery pressure immediately after percutaneous trans-mitral commissurotomy (PTMC) in patients of rheumatic mitral stenosis. METHODS: This cross-sectional study was conducted on patients undergoing PTMC at Cardiology Unit, Lady Reading Hospital, Peshawar, Pakistan from 11th February, 2016 to 28th February, 2018. Pulmonary artery pressure (PAP) was noted before and after PTMC through echocardiography. Data was analyzed with SPSS Version 20.0, categorical and continuous variables were described as frequencies/percentages and mean±SD respectively. Odds Ratio was determined for factors negatively affecting the fall in PAP. RESULTS: Out of 159 patients, 108 (67.9%) were females. Mean age was 25.38±10.67 years. PAP was insignificantly decreased in patients >30 years (p>0.05), symptoms for >5 years (p>0.05), left atrium diameter >4.5cm (p>0.05), atrial fibrillation (p>0.05), right ventricle diameter >2.5cm (p>0.05) and NYHA IV dyspnea (p>0.05). Odds Ratio for failure of significant decrease in PAP immediately post-PTMC was 1.68 for age more than 30 years, 1.10 for symptoms more than 5 years, 3.73 for LA diameter more than 4.5 cm, 2.31 for RV diameter more than 2.5 cm , 2.32 for history of atrial fibrillation and 6.71 for NYHA IV dyspnea. CONCLUSION: Factors which negatively affect the immediate fall in PAP post-PTMC are age >30years, duration of symptoms >5years, LA diameter >4.5cm, history of atrial fibrillation, RV diameter >2.5cm and NYHA IV dyspnea and hence are the poor predictors of successful PTMC while NYHA IV dyspnea has highest Odds for insignificant decrease.

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Abstract 19359: A Novel Parameter to Predict Long-term Cardiac Mortality in Mitral Stenosis

Circulation ◽

10.1161/circ.130.suppl_2.19359 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Maria Carmo P Nunes ◽

Timothy Tan ◽

Sammy Elmariah ◽

Lucas Lodi-Junqueira ◽

Bruno R Nascimento ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Mitral Stenosis ◽

Strong Predictor ◽

Pulmonary Vasculature ◽

Cardiac Mortality ◽

Class Iii ◽

Artery Pressure ◽

Rv Function ◽

Valve Area

The prognosis of patients with mitral stenosis (MS) depends on the severity of obstruction and hemodynamic burden affecting the pulmonary vasculature. Net atrioventricular compliance (C n ) reflects the overall adverse hemodynamic consequence of MS and may be useful in predicting mortality. Methods: A total of 402 MS patients (mean age 51 ± 16 years, valve area of 1.04 ± 0.24 cm 2 , 84% female) undergoing percutaneous mitral valvuloplasty (PMV) between 2000 and 2013 at 2 centers were enrolled. Invasive hemodynamic and echocardiographic measures (pre and 24 hours post PMV) were examined and patients were followed for a median of 28 months post PMV. Endpoints were cardiovascular death (primary), and a composite of death from any cause, mitral valve replacement (MVR) or repeat PMV (secondary). Results: At baseline, 138 (34%) were in atrial fibrillation and 48% were NYHA functional class III or IV. PMV resulted in significant increase in valve area, decrease in transmitral pressure gradients, pulmonary pressures and an improvement in right ventricular (RV) function. A total of 47 (12%) died (39 cardiovascular deaths). In addition, 48 patients underwent MVR, and 12 required repeat PMV with an overall incidence of adverse events of 11.4 events per 100 patient-years. Baseline C n was a strong predictor of both cardiac death (adjusted hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.49 - 0.86, p = 0.008), and composite endpoint (adjusted HR 0.81, 95% CI 0.67 - 0.91, p = 0.016). Cardiac mortality was significantly higher in patients with C n ≤ 4 ml/mmHg than in patients with C n > 4 ml/mmHg (adjusted HR 0.35, 95% CI 0.16 - 0.75, p=0.007), after adjusting for clinical factors, pulmonary artery pressure, tricuspid regurgitation (TR) severity, RV function and immediate procedural results. Survival rate at 1-, 3- and 5-years follow-up was 96%, 94% and 87% in patients with C n > 4 ml/mmHg compared to 89%, 79% and 75% in patients with C n ≤ 4 ml/mmHg. Conclusions: Baseline C n is a strong predictor of cardiovascular-related mortality in patients with significant MS, after adjustment for other prognostic factors including postprocedural pulmonary artery pressure. C n assessment therefore has potential value in evaluation of mortality risk in the setting of MS.

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Per-operative Changes of Pulmonary Artery Pressure following Closed Mitral Commissurotomy

Cardiovascular Journal ◽

10.3329/cardio.v11i2.40415 ◽

2019 ◽

Vol 11 (2) ◽

pp. 147-151

Author(s):

Muhammed Abdul Quaium Chowdhury ◽

Mohammad Fazle Maruf ◽

Minhazur Rahman ◽

Subir Barua ◽

Mamunur Rahman ◽

...

Keyword(s):

Mitral Valve ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Mitral Stenosis ◽

Left Atrial ◽

Atrial Pressure ◽

Left Atrial Pressure ◽

Artery Pressure ◽

Mitral Commissurotomy ◽

Closed Mitral Commissurotomy

Background: Mitral stenosis is often present with pulmonary hypertension. Closed Mitral Commissurotomy (CMC) is a treatment of choice for severe mitral stenosis. In this study, we examined the per-operative changes of pulmonary artery pressure following opening of stenosed mitral valve. Methods: All these CMCs were performed routinely through the left antero-lateral thoracotomy (4th intercostal space) and dilatation was done by metallic Tubb’s Dilator. Peroperative left atrial and Pulminary Arterial pressures were measured before and after dilatation. Results: 15 patients had undergone CMC. Following CMC, per-operative mean Pulmonary artery pressure was reduced from 45.5±7.1 mm of Hg to 39.0±8.8 mm of Hg (p=0.043). Mean left atrial pressure reduced from 35.9±5.6 mm of Hg to 30.0±9.1 mm of Hg (p = 0.049). At three months follow up after closed mitral commissurotomy mitral valve area at echocardiography was found 2.29±0.18 cm2. There was no case of death after closed mitral commissurotomy. Mild mitral regurgitation occurred in 1 patient. Conclusion: We conclude that there is immediate significant reduction of pulmonary Artery pressure following closed mitral commissurotomy. This reduction is apparently comparable with a similar reduction of left atrial pressure. Cardiovasc. j. 2019; 11(2): 147-151

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