IMMEDIATE AND LONG-TERM EFFECT OF MITRAL BALLOON VALVOTOMY ON SEVERE PULMONARY-HYPERTENSION IN PATIENTS WITH MITRAL-STENOSIS

The pulmonary vascular hemodynamics were studied in 21 patients with s evere mitral stenosis and severe pulmonary hypertension. Hemodynamic d ata were obtained before and immediately after mitral balloon valvotom y (MBV) and at follow-up 7 to 14 months (mean 12 months) later by repe at catheterization. The mean pulmonary capillary wedge pressure (PCW) decreased from 27 +/- 5 to 15 +/- 4 mm Hg (p< 0.001). The mean mitral valve gradient (MVG) decreased from 18 +/- 4 to 6 +/- 2 mm Hg (p< 0.00 1). Mitral valve area (MVA) increased from 0.6 +/- 0.1 to 1.5 +/- 0.3 cm(2) (p< 0.02). Cardiac index increased from 2.2 +/- 0.3 to 2.6 +/- 0 .5 L/min/m(2) (p< 0.02). The pulmonary artery systolic pressure decrea sed from 65 +/- 13 to 50 +/- 13 mm Hg (p< 0.001), and no significant c hange was seen in pulmonary vascular resistance (PVR) immediately afte r MBV from 461 +/- 149 to 401 +/- 227 dynes/sec/cm(-5) (p=0.02). At fo llow-up the MVA increased from 1.5 +/- 0.3 to 1.7 +/- 0.3 cm(2) (p< 0. 02). Cardiac index increased further to 3 +/- 0.4 L/min/m(2) (p< 0.02) . MVG and PCW pressure remained the same. The pulmonary artery systoli c pressure decreased further to 38 +/- 9 mm Hg (p< 0.02). PVR decrease d significantly to 212 +/- 99 dynes/sec/cm(-5) (p< 0.02). We concluded that the pulmonary artery pressure decreased without normalizing imme diately after MBV and normalized in patients with optimal results from mitral balloon valvotomy 7 to 14 months later. Insignificant change i n PVR was seen immediately after MBV and markedly decreased or normali zed at late follow-up in patients with optimal result from MBV.