PERCUTANEOUS MITRAL VALVULOPLASTY WITH SEVERE PULMONARY-ARTERY HYPERTENSION

The aim of this study was to assess the initial and midterm outcome of patients with severe pulmonary hypertension undergoing percutaneous m itral valvuloplasty (PMV). Accordingly, the baseline characteristics, immediate results and follow-up of 64 consecutive patients with severe pulmonary artery hypertension (systolic pulmonary artery pressure gre ater-than-or-equal-to 60 mm Hg on cardiac catheterization) (group I) w ere analyzed and compared with those of 194 consecutive patients with lower pulmonary pressures (group II). Patients in group I were more sy mptomatic (New York Heart Association functional class greater-than-or -equal-to III, 72 vs 40%, p <0.001) and had higher echocardiographic s cores (8.6 +/- 2 vs 7.4 +/- 1, p <0.05). Before PMV, mitral gradient w as higher (17 +/- 6 vs 13 +/- 5 mm Hg, p <0.025) and mitral valve area smaller (0.79 +/- 0.2 vs 0.96 +/- 0,2 cm2, p <0.005) in group I patie nts, who also had higher pulmonary vascular resistances (469 +/- 299 v s 157 +/- 125 dynes s-1 cm-5, p <0.005). On multivariate analysis pati ents in group I were more symptomatic, had smaller mitral valve areas and higher mitral gradients. PMV success (area gain >50% without compl ications) was similar (89 vs 87%) in both groups. After PMV final mitr al gradient (5 +/-2 vs 4 +/- 2 mm Hg) and area (1.82 +/- 0.5 vs 1.87 /-0.5 cm2) were similar in both groups. Group I patients had a greater decrease in pulmonary pressures, but final systolic pulmonary pressur es (60 +/- 17 vs 40 +/- 8 mm Hg) and pulmonary vascular resistances (3 59 +/- 226 vs 209 +/- 140 dynes s-1 cm-5) remained significantly highe r in this group (p <0.005). At last follow-up (14 +/- 7 months) of 181 patients (94% of those eligible), the number of patients who were asy mptomatic (63 vs 75%) with symptomatic deterioration (14 vs 6%) and re stenosis (loss greater-than-or-equal-to 50% of area gain by Doppler) ( 14 vs 10%), and who underwent mitral valve surgery (2 patients in each group) or who died (1 patient in each group) was similar in groups I and II. On actuarial analysis event-free survival at follow-up was als o similar in both groups. Serial Doppler studies in 35 group I patient s showed a progressive reduction in systolic pulmonary artery pressure from 57 +/- 15 mm Hg after PMV to 49 +/- 14 mm Hg at last follow-up ( p <0.05). Thus, in patients with severe pulmonary artery hypertension, PMV is a safe and effective technique providing good immediate and mi dterm results. In these patients, PMV induces a significant decrease i n pulmonary artery pressure both immediately after the procedure and s ubsequently at follow-up.