The mechanism underlying dyspnea in mitral stenosis is still a matter of debate. We aimed to study the prevalence of airway hyperreactivity in patients with Rheumatic Mitral stenosis and change in airway reactivity after balloon valvotomy.
A prospective study was done with 20 patients of Rheumatic Mitral valve stenosis who underwent Percutaneous Balloon Valvotomy. The following tests were done on all patients at baseline and at 1 week and 6 months after the procedure: Pulmonary function tests, Assessment of Airway Hyperreactivity by Histamine Challenge Test, Echocardiography, Assessment of severity of dyspnea by the Six Minute Walk test and visual analog scale. The provocative concentration of histamine solution required producing a 20% fall in FEV1 (PC20) was recorded as a measure of airway hyperreactivity.
Airway hyperreactivity was seen in 16 of these 20 (80%) patients. After balloon valvotomy, a significant improvement in the Six Minute Walking distance(219 ± 30.15 to 237.55 ± 32.25; p < 0.001) and the visual analog scale of dyspnea (60.95 ± 12.16 to 44.4 ± 13.71;p < 0.001) were seen. At 1 week after valvotomy. A significant reduction in airway hyperreactivity was seen in 11 of the 16 patients (PC20; 5.69 ± 6.01 mg/ml to 10.16 ± 7.93; p < 0.001). At 6 months of follow up, the improvements in dyspnea and airway hyperreactivity were sustained.
Dyspnea in Rheumatic Mitral valve stenosis is associated with significant airway hyperreactivity. Improvement in dyspnea after balloon valvotomy is associated with a significant and sustained improvement in airway hyperreactivity.
Though balloon valvotomy or valve repair remains the definitive treatment for rheumatic mitral stenosis, beta agonists may be used for symptomatic management of dyspnea in patients awaiting the procedure.
Chandrasekar Palaniswamy, No Financial Disclosure Information; No Product/Research Disclosure Information