EFFECT OF PERCUTANEOUS BALLOON VALVULOPLASTY ON PULMONARY-HYPERTENSION IN MITRAL-STENOSIS

Percutaneous mitral balloon valvuloplasty (PMBV) has been useful in de creasing mitral valve obstruction in mitral stenosis; however, the lon g-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 signifi cant 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 te chniques 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 sys tolic pressure (RVSP) was estimated in patients with tricuspid regurgi tation (TR) using the modified Bernoulli equation. There was a good co rrelation between Doppler and catheterization for RVSP (r = 0.83 pre v alvuloplasty; 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 postvalvuloplasty values). Six of these ni ne 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 meas ured at catheterization. Despite an initial improvement in RVSP after valvuloplasty, this effect may not persist at 17 months of follow-up. Therefore Doppler echocardiography may be used to assess pulmonary hyp ertension before and after PMBV in mitral stenosis and to assess possi ble causes of persistently elevated RVSP after valvuloplasty (such as significant MR).