Factors Influencing of Pulmonary Vascular Resistances Change Immediately After Balloon Mitral Valvotomy in Mitral Stenosis
Abstract
Background. In mitral stenosis (MS) patients, the increase in pulmonary arterial pressure and severity of the clinical symptom is not always related to the severity mitral valve stenosis and mitral valve gradient, but the pulmonary vascular resistance (PVR) as well.Methods. It’s a cross sectional study. PVR is measurement with invasive procedure before and immediately after the Balloon Mitral Valvotomy (BMV) procedure. The analysis was performed to assess the correlation of the age, gender, mitral valve area (MVA), mitral valve gradient (MVG), systolic pulmonary artery preasure (sPAP), mean pulmonary artery preasure (mPAP), mean left atrial preasure (mLAP), mitral score and improvement of the PVR immediately after BMV procedure.
Results. There were 136 patients with mitral stenosis in the period 2008 Jan – 2010 Oct. Seventy five subjects (55.1%) had a atrial fibrilation (AF), 4 subjects (2.9%) complicated with severe aortic stenosis and 2 (1.4%) moderate to severe mitral regurgitation. Of 29 subjects eligible, 65.5% were women with age of 34 (19-53) years. After BMV, MVA increase from 0.5 (0.2 -1.3) to 1.0 (0.3 to 2.4) cm2 (p <0.001), MVG decreased from 19.0 (4 -29) to 7,0 (2 -10) mmHg (p <0.001), cardiac output increased from 2.8 (1.7 to 4.6) to 3.2 (2 -6) L (p <0.001), mPAP decreased from 56.1 ± 12,1 to 41.4 ± 9.8 mmHg (p <0.001), sPAP decreased from 87 (28-110) to 69 (18-110) mmHg (p <0.001), mLAP decreased 28.9 ± 8.0 to 16.0 ± 6.8 mmHg (p <0.001) and PVR decreased from 9.0 (6.3 to 17.8) to 7.8 (2.6 to 14.3) (P <0.001) immediately after the procedure. MVA pre procedure was significant different between subject with and without PVR reduction below 6WU (0.6[0.4-1.3] vs 0.4[0.2-0.7], p=0.024). Logistic regression analysis showed MVA was a predictor of PVR reduction immediately after procedure (OR 0,003 with p value 0,04 and 95% C.I. 0,0001 – 0,766).
Conclusion. The pre-procedure MVA is a predictor of PVR reduction immediately after BMV procedure.
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References
Carapetis J R. Acute rheumatic fever. In : Warrell DA, Cox TM , Firth JD, Edward J, Benz JR, editor. Oxford Textbook of Medicine 4th edition. Oxford Press. 2003 ; 332-15
Carabello BA, Chatterjee K, Antonio C. de Leon, JR , Faxon DP, Freed MD, Gaasch WH et all. ACC/AHA.2006 Guidelines for the management of patients with valvular heart disease. A Report of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease). JACC, 2006:e1–148
Choi EY, Shim J, Kim SA, Shim CY, Yoon SJ, et all : Value of Echo-Doppler Derived Pulmonary Vascular Resistance, Net-Atrioventricular Compliance and Tricuspid Annular Velocity in Determining Exercise Capacity in Patients With Mitral Stenosis; Circ J 2007; 71: 1721–1727
Gamra H, Zhang HP, Allen JW, Lau Francis and Ruiz CE : Factors Determining Normalization of Pulmonary Vascular Resistance Following Successful Balloon Mitral Valvotomy; Am J Cardiol 1999; 83:392–395
Braunwald E. Valvular heart disease. In : Heart Disease: A Textbook of Cardiovascular Medicine, 6th ed. W. B. Saunders Company. 2001 ; 46 : 134 – 91.
Tuzcu EM, Block PC, Griffin BP, Newell JB and Palacios IF. Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 Years and Older; Circulation 1992;85;963-971
Emanuel R. Valvotomy in mitral stenosis with extreme pulmonary vascular resistance. Br Heart J 1962;25:119 –125
Dalen JE, Matloff JM, Evans GL, Hoppin FG Jr, Bhardwaj P, Harken DE, Dexter L. Early reduction of pulmonary vascular resistance after mitral-valve replacement. N Engl J Med 2008; 277:387–394
Levine MJ, Weinstein JS, Diver DJ, Berman AD, Wyman RM, CunninghamMJ et all. Progressive improvement in pulmonary vascular resistance after percutaneous mitral valvuloplasty. Circulation 1989 ;79:1061–1067.
Nicks R and Mcgovern VJ. Influence of pulmonary vascular disease and fibrosis on prognosis following closed mitral valvotomy; Thorax 1968: 153-4
Park MH. The Importance of Early Diagnosis and Treatment of Pulmonary Arterial Hypertension; Medscape 2009; 112-116
Messika ZD, Agnes C, Eric B, Bertrand C, Bernard I, Alec V. Evaluation of Mitral Valve Area by the Proximal Velocity Surface Area Method in Mitral Stenosis: Could it be simplified? Eur J Echocardiography.2007;8:116-36
Cortel TJ, Wort SJ, Gatzoulis MA, Mc Donald P, Hansell DM and Wells AU. Pulmonary vascular resistance predicts early mortality in patients with diffuse fibrotic lung disease and suspected pulmonary hypertension; Thorax 2009;64:883-888
Kusmana D, Setianto B, Tobing D, Busro P, Nazar N, Hendrayati H.Standart Pelayanan Medik RS Jantung dan Pembuluh Darah Harapan Kita. Jakarta, 2003
Brice E A and Commerford P J. Rheumatic fever and valvular heart disease. In : Rosendorff. editor. Essential cardiology principles and practice,second edistion. Humana press.2005; 30:548 – 9.
Predictor Selection. In: Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE,eds. Regressison Methods in Biostatistic linear, logistic, survival and Repeated Measures Models. New York: Springer Science; . 2005.133-56
Carroll JD and Feldman T, Percutaneus mitral balloon valvulotomy and the new demographics of mitral stenosis. JAMA 1993;270:1731-36
Siahaan IH. Hipertensi pulmonal berat pada penderita stenosis mitral dan faktor yang berhubungan dengan menetapnya hipertensi pulmonal berat segera setelah ballon mitral valvuloplasty. Jakarta: Universitas Indonesia: 2009.1-45
Fawzy ME, Layth Mimish, Sivanandam V, Lingamanaicker J, Patel A, Khan B et all. Immediate and long-term effect of mitral balloon valvotomy on severe pulmonary hypertension in patients, AM HEART J 1996;131:89-93
Palacios IF, Wilkins GE, Herrmann HC, Brandi SC, Blanco P, Block PC: Follow-up of patients undergoing percutaneous mitral balloon valvotomy (abstract). Circulation 1987; 76(suppl IV):420-497
Fawzy ME, Hegazy H, Shoukri M, El Shaer F, El Dali E and Al Amri M. LongTerm Clinical and Echocardiography Result After Successful Mitral Ballon Valvulotomy and Predictor of long Term Out comes, European Heart Journal.2005; 26:1647-52
Mubeen M, Singh AK, Agarwal SK, Pillai J, MS, Kapoor S and Srivastava AK. Mitral Valve Replacement in Severe Pulmonary Arterial Hypertension; Asian Cardiovasc Thorac Ann 2008;16:37–42
Foltz BD, Hessel EA and Ivey TD: The early course of pulmonary artery hypertension in patients undergoing mitral valvereplacement with cardioplegic arrest. J Thorac Cardiovasc Surg 1984;88:238-247
Ribeiro PA, Al Zaibag M and Abdullah M. Pulmonary artery pressure and pulmonary vascular resistance before and after balloon mitral valvotomy in 100 patients with severe mitral stenosis. Am Heart J 1993;125:1110 –1114
Dev V and Shrivastava S. Time course of changes in pulmonary vascular resistance and the mechanism of regression of pulmonary arterial hypertension after mitral balloon valvuloplasty. Am J Cardiol 1991;67:439–442
Carabello BA, Chatterjee K, Antonio C. de Leon, JR , Faxon DP, Freed MD, Gaasch WH et all. ACC/AHA.2006 Guidelines for the management of patients with valvular heart disease. A Report of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease). JACC, 2006:e1–148
Choi EY, Shim J, Kim SA, Shim CY, Yoon SJ, et all : Value of Echo-Doppler Derived Pulmonary Vascular Resistance, Net-Atrioventricular Compliance and Tricuspid Annular Velocity in Determining Exercise Capacity in Patients With Mitral Stenosis; Circ J 2007; 71: 1721–1727
Gamra H, Zhang HP, Allen JW, Lau Francis and Ruiz CE : Factors Determining Normalization of Pulmonary Vascular Resistance Following Successful Balloon Mitral Valvotomy; Am J Cardiol 1999; 83:392–395
Braunwald E. Valvular heart disease. In : Heart Disease: A Textbook of Cardiovascular Medicine, 6th ed. W. B. Saunders Company. 2001 ; 46 : 134 – 91.
Tuzcu EM, Block PC, Griffin BP, Newell JB and Palacios IF. Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 Years and Older; Circulation 1992;85;963-971
Emanuel R. Valvotomy in mitral stenosis with extreme pulmonary vascular resistance. Br Heart J 1962;25:119 –125
Dalen JE, Matloff JM, Evans GL, Hoppin FG Jr, Bhardwaj P, Harken DE, Dexter L. Early reduction of pulmonary vascular resistance after mitral-valve replacement. N Engl J Med 2008; 277:387–394
Levine MJ, Weinstein JS, Diver DJ, Berman AD, Wyman RM, CunninghamMJ et all. Progressive improvement in pulmonary vascular resistance after percutaneous mitral valvuloplasty. Circulation 1989 ;79:1061–1067.
Nicks R and Mcgovern VJ. Influence of pulmonary vascular disease and fibrosis on prognosis following closed mitral valvotomy; Thorax 1968: 153-4
Park MH. The Importance of Early Diagnosis and Treatment of Pulmonary Arterial Hypertension; Medscape 2009; 112-116
Messika ZD, Agnes C, Eric B, Bertrand C, Bernard I, Alec V. Evaluation of Mitral Valve Area by the Proximal Velocity Surface Area Method in Mitral Stenosis: Could it be simplified? Eur J Echocardiography.2007;8:116-36
Cortel TJ, Wort SJ, Gatzoulis MA, Mc Donald P, Hansell DM and Wells AU. Pulmonary vascular resistance predicts early mortality in patients with diffuse fibrotic lung disease and suspected pulmonary hypertension; Thorax 2009;64:883-888
Kusmana D, Setianto B, Tobing D, Busro P, Nazar N, Hendrayati H.Standart Pelayanan Medik RS Jantung dan Pembuluh Darah Harapan Kita. Jakarta, 2003
Brice E A and Commerford P J. Rheumatic fever and valvular heart disease. In : Rosendorff. editor. Essential cardiology principles and practice,second edistion. Humana press.2005; 30:548 – 9.
Predictor Selection. In: Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE,eds. Regressison Methods in Biostatistic linear, logistic, survival and Repeated Measures Models. New York: Springer Science; . 2005.133-56
Carroll JD and Feldman T, Percutaneus mitral balloon valvulotomy and the new demographics of mitral stenosis. JAMA 1993;270:1731-36
Siahaan IH. Hipertensi pulmonal berat pada penderita stenosis mitral dan faktor yang berhubungan dengan menetapnya hipertensi pulmonal berat segera setelah ballon mitral valvuloplasty. Jakarta: Universitas Indonesia: 2009.1-45
Fawzy ME, Layth Mimish, Sivanandam V, Lingamanaicker J, Patel A, Khan B et all. Immediate and long-term effect of mitral balloon valvotomy on severe pulmonary hypertension in patients, AM HEART J 1996;131:89-93
Palacios IF, Wilkins GE, Herrmann HC, Brandi SC, Blanco P, Block PC: Follow-up of patients undergoing percutaneous mitral balloon valvotomy (abstract). Circulation 1987; 76(suppl IV):420-497
Fawzy ME, Hegazy H, Shoukri M, El Shaer F, El Dali E and Al Amri M. LongTerm Clinical and Echocardiography Result After Successful Mitral Ballon Valvulotomy and Predictor of long Term Out comes, European Heart Journal.2005; 26:1647-52
Mubeen M, Singh AK, Agarwal SK, Pillai J, MS, Kapoor S and Srivastava AK. Mitral Valve Replacement in Severe Pulmonary Arterial Hypertension; Asian Cardiovasc Thorac Ann 2008;16:37–42
Foltz BD, Hessel EA and Ivey TD: The early course of pulmonary artery hypertension in patients undergoing mitral valvereplacement with cardioplegic arrest. J Thorac Cardiovasc Surg 1984;88:238-247
Ribeiro PA, Al Zaibag M and Abdullah M. Pulmonary artery pressure and pulmonary vascular resistance before and after balloon mitral valvotomy in 100 patients with severe mitral stenosis. Am Heart J 1993;125:1110 –1114
Dev V and Shrivastava S. Time course of changes in pulmonary vascular resistance and the mechanism of regression of pulmonary arterial hypertension after mitral balloon valvuloplasty. Am J Cardiol 1991;67:439–442
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How to Cite
Purnawarman, A., Haryono, N., & Sakijan, I. (1). Factors Influencing of Pulmonary Vascular Resistances Change Immediately After Balloon Mitral Valvotomy in Mitral Stenosis. Indonesian Journal of Cardiology, 32(3), 170-8. https://doi.org/10.30701/ijc.v32i3.94
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Clinical Research
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