Lung water, hemodynamics and dyspnea before and after valvuloplasty in mitral stenosis

The investigation was to elucidate the role of the reduction of extravascul ar pulmonary fluid in the immediate symptomatic improvement and its impact on hemodynamics in patients with mitral stenosis treated by percutaneous tr ansluminal valvuloplasty. Methods: In a prospective study of 12 patients wi th severe mitral stenosis extravascular pulmonary fluid volume was determin ed by a combined dye and thermodilution technique (COLD Z-021(TM) Version 5 .x, Pulsion(R)) before and after valvuloplasty. Cardiac output, left atrial pressures, atrial V-waves, diastolic transmitral gradients and their respi ratory changes were measured. Dyspnea was assessed by validated questionnai res. Results: Symptomatic improvement correlated (r = 0.808) with a decreas e of extravascular lung water, but not with either an increase or a decreas e of cardiac output or left atrial filling pressures. The decrease of the l ung water index may be predicted from the lung water index before valvulopl asty, the final left atrial mean pressure and the cardiac index prior to in tervention. The change of the mean difference between inspiratory and expir atory mitral gradient demonstrated a significant inverse correlation with t he change of mean left atrial filling pressures (r = -0.778) and with extra vascular lung water after valvuloplasty (r = -0.871). Conclusion: There is a complex relationship between left atrial filling pressures, extravascular lung water, respiratory changes of gradients, and dyspnea that need Furthe r investigation. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved .