PURPOSE: Mitral and aortic valve diseases can cause secondary pulmonary hypertension (PH). Initially, PH is due to increased left atrial pressure but with time pulmonary vascular remodeling can occur. The former should rapidly improve with surgery; the latter would be more likely persist. We initiated this study to assess the frequency of and changes in PH in patients with aortic (AVR) versus mitral valve (MVR)repair both immediately before and 24 hours after surgery.
METHODS: Data were retrospectively collected from both preop cardiac cath or from perioperative right heart cath. Three patients with AVR, one with MVR and one with combined AVR/MVR were excluded from analysis for lack of hemodynamic data. PH was defined as a mean PA pressure (mPAP) of 25 mmHg or higher.
RESULTS: Of 76 charts studied, 41 had AVR (51% F; mean age 76 yo), 30 MVR (47% F; 75 yo) and 5 had repair of both valves. In the AVR group, 61% had preop PH; PA pressures preop averaged 45/19 (29) mmHg with CI=2.1 L/min/m2 and LVEDP 22 mmHg. 24h after AVR mPAP fell 28%, CI rose 33% but 15% had persistent PH. In the MVR group 80% had preop PH; preop PA pressure were 53/22 (34) mmHg with CI=2.1 and LVEDP = 19 mmHg. By 24h after MVR, mPAP fell by 18% and CI rose 29% but 66% had persistent PH. In the combined AVR/MVR group 80% had PH; average PA pressures were 52/23 (34) mmHg and CI = 2.4.
CONCLUSION: PH is a common complication of valvular heart disease, being slightly more frequent with mitral than with aortic disease. The fall in PA pressures within 24 h of surgery was more dramatic after AVR, perhaps because of higher left ventricular pressures and less pulmonary vascular remodeling.
CLINICAL IMPLICATIONS: Although elevated PA pressures often fall following valve repair, patients with PH and aortic or mitral valve surgery should be evaluated at regular intervals to determine if fixed remodeling has occurred.
DISCLOSURE: Adam Hurewitz, No Financial Disclosure Information; No Product/Research Disclosure Information