An excellent result of surgical treatment in patients with severe pulmonary arterial hypertension following mitral valve disease

Abstract

ObjectiveObserve the efficacy of surgical treatment in patients with severe pulmonary arterial hypertension caused by mitral valve disease.MethodsWe examined the results of surgical treatment in 32 patients with mitral valve disease and severe pulmonary arterial hypertension (pulmonary arterial systolic pressure ≥ 80 mmHg) retrospectively. Operative and postoperative data collection included type of the surgery, cardiopulmonary bypass time, cross-clamp time and the mortality rate. Pulmonary arterial systolic pressure, left atrial diameter, left ventricular end-diastolic diameter, and left ventricular ejection fraction were recorded and compared.ResultsA total number of 32 patients had the operation of mitral valve replacement. Among those subjects, twenty-seven patients were surgically replaced with mechanical prosthesis and five patients with tissue prosthesis. Only one patient died of pneumonia, with a mortality rate of 3.1 %. The statistical results of preoperative and postoperative echocardiographic data showed significant decrease in pulmonary arterial systolic pressure (101.2 ± 20.3 versus 48.1 ± 14.3 mmHg, P < 0.05), left atrial diameter(67.6 ± 15.7 versus 54.4 ± 11.4 mm, P < 0.05) and left ventricular end-diastolic diameter (52.3 ± 9.5 versus 49.2 ± 5.9 mm, P < 0.05). There was no significant change in left ventricular ejection fraction (59.2 ± 6.5 versus 57.9 ± 7.6, P = NS). At the time of follow-up, twenty-eight (96.6 %) patients were classified in New York Heart Association functional class I or II, one(3.4 %) in class III, with the mortality rate is zero percent.ConclusionsMitral valve replacement can be performed successfully in patients with mitral valve disease and severe pulmonary arterial hypertension with an acceptable perioperative risk.

Results of Mitral Valve Surgery with Pulmonary Arterial Hypertension: Analysis of a Retrospective Study

“…Patients undergoing surgery are for the majority in stage II of the NYHA (76.47% and 69.69% in group A and B respectively); In the other series, patients are in stage III or IV [11,16,[20][21][22]. Postoperatively, it is interesting to report an improvement in the quality of life; 68.36% and 73.19% of patients in group A and B respectively were in stage I of NYHA (P<0.05 for both groups).…”

“…Group A Group A P (Preoperative) (Control) Citation Our population is young and predominantly female; the young age of the patients is explained by the rheumatic origin of valvulopathy, which is supported by the various publications [11,16,20,21].…”

“…In the various studies, preoperative arrhythmia was observed in 84.4%, 68% of patients in Cesnjevar and according to Song [16,21]; atrial fibrillation was found in both groups with severe PAH (56.66%) and moderate PAH (50%) [10]. The presence of atrial fibrillation is strongly correlated with the importance of PAH.…”

“…Some authors find a close association between LAD regression and reduction of cardiovascular events [11,21,23]. In the literature, the decline in the diameter of the LA was strongly observed after mitral surgery.…”

“…Bayat [1] compares 02 groups (severe and moderate PAH) from a series of 45 patients; he observed in the "moderate" group a significant reduction in sPAP within 24 hours after surgery, whereas in the "severe" group, the sPAP decreased gradually to be significant after 24 hours. cSong [21] studied the result of a series of 32 patients operated in severe PAH, he noticed a consequent fall in sPAP following surgery (from 101.2 mmHg ± 20.3 mmHg to 48.1 mmHg ± 14, 3 mmHg).…”