The Hemodynamics of the Left Side of the Heart as Studied by Simultaneous Left Atrial, Left Ventricular, and Aortic Pressures; Particular Reference to Mitral Stenosis

Abstract

At operation the hemodynamics of the left side of the heart were studied in six patients without mitral stenosis, and in eight patients with mitral stenosis, by means of simultaneous needle puncture of the left atrium, left ventricle, and aorta. This technic permits analysis of the various phases of the cardiac cycale in normal subjects and in patients with mitral stenosis. The fundamental hemo-(lynamic expression of mitral stenosis is the presence of an elevated left atrioventricular filling pressure gradient, which ranged from 4 to 20 mm.Hg, and after valvulotomy fell in relation to the adequacy of the procedure.O UR knowledge of the human cardiac cycle has been retarded by the inability to study completely the hemodynamics of the left side of the heart. The technique of venous catheterization, which has contributed so much to an analysis of events in the right side of the heart of man1-3 does not permit the direct study of the left heart chambers except in isolated instances of congenital communications between the right and left cavities.Previous investigation of the left side of the circulation has been carried out primarily through animal experimentation.

Correlation of Net Atrioventricular Compliance with the Outcome of Successful Percutaneous Transvenous Mitral Valve Commissurotomy

“…17,18 Several factors may contribute to clinical presentation and outcome in MS. Leftheart compliance plays a crucial role in the occurrence of pulmonary hypertension and symptoms. 19 Li et al 20 Nunes et al 23 showed that net atrioventricular compliance,Cn <4 mL/mm Hg best predicted unfavorable outcome in patients with mitral stenosis and Cn was found as a powerful predictor of adverse outcome, adding prognostic information beyond that provided by clinical evaluation and MV area.…”

When to use stress echocardiography in the evaluation of patients with valvular heart disease

“…As the valve narrows the left atrial pressure increases to continue driving blood into the left ventricle; a measurable pressure gradient develops across the valve during diastole. (7,11) The increased left atrial pressure is reflected back into the pulmonary circulation and may lead to pulmonary congestion and pulmonary venous and even pulmonary arterial hypertension. The associated symptoms are dyspnoea and fatigue or pulmonary oedema.…”

“…The associated symptoms are dyspnoea and fatigue or pulmonary oedema. (11,12) The normal mitral valve area is 4-6cm 2 and symptoms usually do not develop until the valve area is less than 2.5cm 2 ; (7,13) a valve area >1.5cm 2 usually does not produce symptoms at rest. (14) Development of symptoms or pulmonary hypertension in mitral stenosis is associated with a poor outcome if left untreated.…”

“…(12) The pressure gradient across the mitral valve is a function of the square of the flow across the valve and is dependent on the diastolic filling period. (7,11) Therefore, symptoms in mitral stenosis are usually precipitated by an increase in flow or heart rate and the degree of valve stenosis at rest may not reflect the true severity of obstruction with exercise. (7,14) Guidelines for management of mitral stenosis are based on a point scale comprised of the mitral valve area, transmitral mean gradient and pulmonary artery systolic pressure (Table 1).…”

Avaliação hemodinâmica na insuficiência cardíaca: papel do exame físico e dos métodos não invasivos

“…Invasive hemodynamic assessment is also very important for the assessment and management of these patients, having been used for decades, initially by direct left ventricular puncture 2 and currently, by Swan-Ganz catheter 3 . However, in recent years, the use of invasive hemodynamic monitoring has been decreasing, especially due to the growing evidence of no benefit with this method 4 .…”