EVOLUTION OF PULMONARY ARTERIAL HYPERTENSION IN SEVERE MITRAL STENOSIS FOLLOWING SUCCESSFUL PTMC

Manjunath R; Ravi Math; Ravindranath K S; Manjunath C N.

Volume : V, Issue : IX, September - 2016

EVOLUTION OF PULMONARY ARTERIAL HYPERTENSION IN SEVERE MITRAL STENOSIS FOLLOWING SUCCESSFUL PTMC

Manjunath R, Ravi Math, Ravindranath K S, Manjunath C N.

Abstract :

BACKGROUND:– Pulmonary Hypertension (PH) frequently complicates mitral stenosis. Pulmonary hypertension significantly influences symptomatology and long–term prognosis. Pulmonary artery pressures also decrease following PTMC. The determinants of change and extent of reversibility in pulmonary hypertension among patients undergoing balloon valvuloplasty has not been studied extensively. OBJECTIVE:– To identify the determinants of decrease in pulmonary arterial hypertension after percutaneous balloon mitral commissurotomy in Severe Mitral Stenosis. METHODOLOGY:– Patients with severe mitral stenosis and pliable valve having no significant mitral regurgitation, aortic valve disease, or left atrial thrombus were selected for Percutaneous Trans venous Mitral Commissurotomy (PTMC). All patients underwent echocardiography, left and right heart catheterization before and after PTMC. Echocardiography was repeated at day 1, day 7, day 30, & day 90. Univariate and multivariate analysis was done to assess the relation of age, gender, left atrial size, right atrial size, gradient across mitral valve, valve area, and presence of Tricuspid Regurgitation (TR) on the decrease in pulmonary arterial pressure over a period of 3 months. RESULTS:– Left atrial pressure, Right Ventricular systolic pressure(RVSP), peak and mean Mitral valve gradient and Pulmonary artery systolic pressure(PASP) decreases in younger aged group more commonly than in older aged patients. Mitral valve orifice area(MVOA) improves more earlier in <30 years than in older aged groups. linear correlation improving from negative to positive at 3 months indicating good prognosis. CONCLUSION:– Patients with successful PTMC has marked reduction in pulmonary arterial pressure which is greatest after first 24 hours, but continues to declines up to 3 months. This reduction is more in younger and male patients.