abstract
Pulmonary vascular disease frequently complicates long standing mitral stenosis and may significantly influence prognosis ( Folt et al, 1985). Although often reversible increased pulmonary vascular resistance (PVR) it may be fixed in some patients despite an adequate surgical or percutaneous balloon mitral valvuloplasty (BMV) (Levine et al, 1989). Pulmonary vascular resistance (PVR) which the most sensitive index of pulmonary vascular disease was shown to decrease substantially after successful balloon mitral valvuloplasty (BMV) (Georgeson et al, 1993).
Our aim of this study was to determine the factors that may influence normalization of pulmonary vascular resistance in patients with adequate relief of mitral valve obstruction after balloon mitral valvuloplasty.
So Percutaneous mitral valvuloplasty (PMV) using Inoue balloon was performed in 40 patients with symptomatic rheumatic mitral stenosis; Patients were selected from Benha University hospital during the period from (March 2004 to May 2007).
All patients were subjected to the following:
• History taking and clinical examination:
With particular emphasis to : the patient’s degree of physical disability according to NYHA functional classification , history of systemic embolism , anticoagulant therapy , history suggestive of rheumatic fever , age, sex, body height, cardiac rhythm, , and full clinical examination..
• ECG and plain chest X- ray.
• Echo–Doppler study both transthoracic and transesophageal echocardiography: All patients were studied with M-mode, two-dimensional and color Doppler echocardiography before mitral valvuloplasty, and within 24 hs after the procedure.
Mitral valve morphology and scoring system: The morphologic features of the mitral valve leaflets and subvalvular apparatus were assessed according to the scoring system described by Wilkins et al., 1988.
Color flow Doppler imaging
1) Mitral valve area:
Mitral valve area was measured before and immediately after balloon mitral valvuloplasty and after 6 to 9 months using the pressure half time and plenemetry method.
Trans-esophageal echocardiography (TEE)
TEE Was done for all patients within 24-48 hs before the procedure, sometimes at the morning of the procedure.
Percutaneous mitral valvuloplasty procedure:
- BMV was performed with Inoue balloon (Inoue et al., 1992).
- The procedure of BMV was completed when reasonable results (opening of the commissures with resulting valve area > 1.5 cm2) were achieved or the appearance of MR > I / IV.
Measurement of cardiac output and vascular resistance
Cardiac output by thermodilution technique was measured for all patients before, immediately after the procedure and after 6 to 9 months of follow up, we used Swan Ganz catheter for this purpose.
Post procedural assessment:
Immediately after balloon mitral valvuloplasty,
• Clinical: assessment for the presence and the severity of residual stenosis and complicating or associated mitral incompetence.
• Local (groin) or systemic complications of the procedure.
• Subjective assessment of the functional class according to NYHA functional classification.
A detailed echocardiographic and Doppler assessment of the same predilatation variables: transmitral pressure gradient, MVA, MR, ASD and pulmonary artery pressure.
Hemodynamic assessment of: left atrial pressure, pressure gradient, PAP and MR.
Short-Term follow up of the results (6 to 9 months after):
• Clinical assessment for the presence and severity of any residual stenosis, and complicating MR.
• Subjective assessment of the functional class according to the NYHA classification.
• Echocardiographic and Doppler assessment of the MVA, pressure gradient, MR and PAP.
Statistical analysis of the result of this study revealed:
There were significant differences between group 1 and group 2 as regard to the following hemodynamic data that were measured before the procedure,
1- Mean pulmonary artery pressure (MPAP) was (Mean ±SD 35±3.8 mm Hg.) in group 1 versus (45±3.6 mm Hg.) in group2 and P |
