Effects of Mitral-Valve Replacement on the Pulmonary Vascular Dynamics of Patients with Pulmonary Hypertension

Braunwald, Eugene; Braunwald, Nina S.; Ross, John; Morrow, Andrew G.

doi:10.1056/nejm196509022731001

Cited by 190 publications

(62 citation statements)

References 9 publications

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“…Our results extend the observation that substantial PH can develop in patients with left-sided heart failure with normal ejection fraction, similar in severity to that previously reported in patients with mitral valve disease. 7,8 The striking commonality in the patients with PVH at our center is the prevalence of features of the MS. The core feature is obesity, a BMI Ͼ 30 kg/m 2 , with truncal fat deposition.…”

Section: Discussionmentioning

confidence: 92%

Association of the Metabolic Syndrome With Pulmonary Venous Hypertension

Robbins

Newman

Johnson

et al. 2009

Chest

160

130

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Background: Pulmonary venous hypertension (PVH) is a well-described cause of pulmonary hypertension (PH) in patients with left heart disease associated with elevated left heart filling pressure. PVH results from a number of processes, including left-sided valvular disease, constrictive pericardial disease, restrictive cardiomyopathies, and left ventricular (LV) systolic dysfunction. PVH in patients with normal LV systolic function, commonly referred to as diastolic dysfunction, is not well characterized. We observed that many patients with PH due to PVH have obesity, hypertension, diabetes mellitus, and hypercholesterolemia, which are clinical features of the metabolic syndrome (MS), a previously identified cause for systemic vascular disease. Methods: We evaluated 122 consecutive patients referred for diagnosis and treatment of PH and compared the prevalence of features of the MS between patients with PVH and those with pulmonary arterial hypertension (PAH). We also compared clinical and hemodynamic characteristics between these two groups.

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Section: Discussionmentioning

confidence: 92%

Association of the Metabolic Syndrome With Pulmonary Venous Hypertension

Robbins

Newman

Johnson

et al. 2009

Chest

160

130

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“…82,83 Although postoperative management of patients with mitral stenosis (or regurgitation) with associated elevation in PVR is often complicated by residual PH and right heart failure, PVR usually improves in the months following intervention and may normalize. 84 …”

Section: Primarily Hyperkinetic Ph With Elevated or Borderline Pvrmentioning

confidence: 99%

Clinical Evaluation and Management of Pulmonary Hypertension in the Adult With Congenital Heart Disease

Opotowsky

2015

Circulation

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200P ulmonary hypertension (PH) refers to elevated pulmonary artery (PA) pressure (PAP), defined as mean PAP≥25 mm Hg. PH is not synonymous with pulmonary arterial hypertension (PAH), which specifies resistive PH characterized by elevated pulmonary vascular resistance (PVR) and normal pulmonary venous pressure. Approximately 5% to 10% of adults with congenital heart disease (CHD) have PH, and this subset of CHD patients is at higher risk of hospitalization and death. [1][2][3] Understanding the epidemiology of PH associated with CHD (PH-CHD) is not straightforward, however, because definitions of PH-CHD and diagnostic techniques vary. Appropriate diagnosis and the management of PH-CHD rest on identifying the cause of elevated PAP: high pulmonary venous pressure, high pulmonary vascular resistance, high pulmonary flow, or some combination of these factors, which are referred to throughout this review as passive, resistive, hyperkinetic, and polygenic PH, respectively (Table 1).Prognosis in PH-CHD depends on the underlying cause, pulmonary vascular pathophysiology, and the interaction between the right heart and pulmonary circulation. Adult CHD is heterogeneous, with myriad permutations of underlying defects, previous interventions, and associated comorbidities. Although comprehensive understanding of clinical context is a prerequisite, identifying the optimal therapy for a patient with PH-CHD depends more heavily on an understanding of pathophysiology than it does on the underlying diagnosis. Therefore, the goal of this review is to frame an understanding of PH-CHD in terms of fundamental cardiopulmonary hemodynamic pathophysiology and to emphasize the clinical assessment and management of situations commonly encountered by adult cardiologists caring for patients with PH-CHD. Classifications of PH and PH-CHDClassification schemes in PH represent clinical perspectives of underlying pathophysiology and tend to parallel fundamental hemodynamic relationships of the pulmonary circulation. PVR

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“…We tested the hypothesis that mitral valve replacement would reduce the elevated pulmonary vascular resistance by studying the effects of this procedure in patients with markedly elevated pulmonary vascular resistance. 7 Measurements performed 6 months postoperatively showed an almost uniform reduction in this resistance ( Figure V in the online-only Data Supplement). We concluded that even marked elevations of pulmonary vascular resistance in patients with mitral valve disease were reversible and should no longer be considered a contraindication to mitral valve surgery as long as the elevated left atrial pressure was lowered substantially by the procedure.…”

Section: Valvular Heart Diseasementioning

confidence: 91%

Adventures in Cardiovascular Research

Braunwald

2009

Circulation

Self Cite

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Abstract-This article, derived from an invited Distinguished Scientist lecture presented at the American Heart Association Scientific Sessions in 2007, reviews 4 themes (adventures) in clinical cardiovascular research carried out over a period of 58 years. It begins with the author's introduction to cardiovascular hemodynamics during a medical school elective in 1951. The 4 adventures include valvular heart disease, hypertrophic cardiomyopathy, heart failure (HF), and myocardial ischemia. In each of these adventures, the author describes briefly what was known when he entered each field, followed by the author's contribution to the field (the adventure), and ends with comments about the current status of the field. Of particular interest are the changes in the technologies used in clinical cardiovascular research over the past half century, commencing with pressure tracings in left heart chambers with the use of needle puncture in the operating room to genetic technologies designed to understand differences between drugs that inhibit platelet activation. The article ends with some general comments on conducting research and the rewards that can come with this activity.

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Effects of Mitral-Valve Replacement on the Pulmonary Vascular Dynamics of Patients with Pulmonary Hypertension

Cited by 190 publications

References 9 publications

Association of the Metabolic Syndrome With Pulmonary Venous Hypertension

Association of the Metabolic Syndrome With Pulmonary Venous Hypertension

Clinical Evaluation and Management of Pulmonary Hypertension in the Adult With Congenital Heart Disease

Adventures in Cardiovascular Research

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