Mitral Valve Replacement in Severe Pulmonary Arterial Hypertension

Abstract

The immediate postoperative hemodynamics in 43 patients with severe pulmonary arterial hypertension who underwent mitral valve replacement between January 2000 and September 2001 were studied prospectively. The mean age was 30.6 years. There was mitral stenosis in 19 (44.1%), mitral regurgitation in 9 (20.9%), and mixed lesions in 15 (34.9%). In 36 patients (83.7%, group 1) pulmonary arterial pressure was sub-systemic, with a mean of 58.1 mm Hg and pulmonary vascular resistance of 743.4 dyne x s x cm(-5). Seven patients (16.3%, group 2) had supra-systemic pulmonary arterial pressure of 83.2 mm Hg and pulmonary vascular resistance of 1,529 dyne x s x cm(-5). Lung biopsies were taken from the right lower lobe in 24 patients. Operative mortality was 5.5% in group 1 and 28.5% in group 2. After mitral valve replacement, the pulmonary arterial pressure and vascular resistance decreased significantly in group 1. In group 2, pulmonary arterial pressure decreased significantly but pulmonary vascular resistance remained elevated. Pulmonary vascular changes did not progress beyond grade III (Heath-Edwards' classification). Mitral valve replacement is safe even in the presence of severe pulmonary arterial hypertension as long as pulmonary arterial pressures are below systemic pressures. Lung biopsy did not help in identifying patients with irreversible pulmonary arterial changes.

Early Hemodynamic Changes after Mitral Valve Replacement in Patients with Severe and Mild Pulmonary Artery Hypertension

“…However, there is no consensus about the outcome of patients with PAH after MVR in the literature, some studies have revealed that severe PAH is associated with poorer outcome and higher mortality rate [3][4][5][6][7][8] while some others do not agree with this and believed that severe PAH do not imply the greater risk in corrective surgery; [9][10][11][12][13][14][15][16][17][18][19] but the point is that the definition of PAH varies across studies, pulmonary artery pressure >40, 50, 70 and 110 have been considered as severe PAH in various studies. [9][10][11][12][13][14][15][16][17][18][19] To our knowledge, there is no related study about this issue in Iran, and most of the previous, related works are not so recent [5][6][7][8][12][13][14][15][16][17][18][19] and had been conducted with a small sample size.…”

“…[9][10][11][12][13][14][15][16][17][18][19] To our knowledge, there is no related study about this issue in Iran, and most of the previous, related works are not so recent [5][6][7][8][12][13][14][15][16][17][18][19] and had been conducted with a small sample size. A major proportion of related studies has assessed the late outcome of MVR in patients with severe PAH.…”

Results of Mitral Valve Surgery with Pulmonary Arterial Hypertension: Analysis of a Retrospective Study

“…Until now, there is no consensus in the literature on the results after surgery for this category of patients; Some studies have associated PAH with a poor outcome and an estimated high mortality rate of 31% [1], which has led some authors to consider PAH as an absolute contraindication to MVR [5][6][7][8][9], while others do not fully agree and argue that severe PAH does not imply a greater surgical risk [10][11][12][13][14][15].…”

Mitral valve replacement at Tygerberg Hospital: a 5 year follow-up

“…(22) Mitral valve replacement should still be offered, albeit with a higher risk, even in the presence of severe pulmonary hypertension as long as pulmonary pressures are below systemic pressure. (23) MiTrAl vAlvE rEplAcEMEnT…”