S. Gulec et al., Bronchial hyperreactivity in patients with mitral stenosis before and after successful percutaneous mitral balloon valvulotomy, CHEST, 116(6), 1999, pp. 1582-1586
Citations number
22
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objectives: We aimed to identify the bronchial response to inhaled methacho
line in patients with mitral stenosis (MS) and to clarify whether or not th
e bronchial hyperreactivity (BHR) is reversible after percutaneous mitral b
alloon valvulotomy (PBMV).
Patients and setting: Thirty patients with MS and 28 age-matched healthy! c
ontrol subjects were prospectively evaluated with pulmonary function tests
and methacholine challenge. The productive concentration of methacholine ca
using 20% decrease in FEV1 (PC20) was calculated and used as a parameter of
bronchial responsiveness, BHR was defined as a PC20 < 8 mg/mL, Mean pulmon
ary artery pressure (PAP) and mean pulmonary capillary wedge pressure (PCWP
) were recorded in all patients through a Swan-Ganz balloon-tipped catheter
. Sixteen patients underwent PMBV, and a methacholine test was repeated aft
er each procedure.
Results: Bronchial response to methacholine was significantly increased in
patients with MS, so that 53% of them had BHR, whereas all control subjects
were nonresponders. The PC,, was closely correlated with the PAP (r = -0.7
77; p < 0.001), PCWP (r = - 0.723; p < 0.001), and I mitral valve area (MVA
; r = 0.676; p < 0.001). Balloon valvulotomy was successfully performed in
i all of the 16 patients, and the cardiac parameters (MVA, PAP, and PCWP) s
ignificantly improved after the procedure, In contrast, no significant chan
ges were shown in pulmonary function test variables (total lung capacity, v
ital capacity [VC], FEVI, and FEVI/VC). Although significant improvement wa
s observed in the mean PC20 values (from 4.97 +/- 5.24 to 7.47 +/- 6.96 mg/
mL; p 0.0006), BHR was completely eliminated in only one patient,
Conclusions: Our data shows that BHR is fairly common among patients with M
S, and severity of bronchial responsiveness is significantly correlated nit
h the severity of MS, Moreover, PMBV leads to significant I eduction in pul
monary congestion and a consequent improvement in BHR.