Clinical study
Regression of extreme pulmonary hypertension after mitral valve surgery

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Abstract

Twenty-seven patients with mitral valve disease and pulmonary arterial systolic pressure greater than 100 mm Hg were evaluated. Twenty-five patients have been subjected to mitral valve surgery, consisting of open valvotomy in 6 and mitral valve replacement in 19, with an operative mortality of zero and 16 percent, respectively. Postoperative hemodynamic studies were obtained in 15 of the 19 late survivors, an average of 29 months after operation. Average pulmonary arterial systolic pressure decreased from 115 preoperatively to 50 mm Hg postoperatively; pulmonary vascular resistance decreased from 1,153 to 305 dynes sec cm−5, and cardiac index rose from 1.9 to 2.5 liters/min per m2. Patients with normal left atrial pressure and normal sinus rhythm postoperatively experienced the greatest hemodynamic and clinical improvement. This study indicates that even extreme degrees of pulmonary hypertension and increased pulmonary vascular resistance due to mitral valve disease regress markedly if surgery adequately decompresses the left atrium.

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    This study was supported in part by National Institutes of Health Grants HE-5709 and HE-5866 and General Clinical Research Center Branch Grant N.I.H. RR-70.

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