Mitral valve replacement in the presence of severe pulmonary hypertension.

Kaul, Tej K; Bain, W H; Sandoval, Juan Pablo; Lorimer, A. R.; Thomson, R. M.; Turner, Murdo; Escarous, A.

doi:10.1136/thx.31.3.332

Cited by 33 publications

(19 citation statements)

References 21 publications

(19 reference statements)

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“…[9][10][11][12][13][14][15][16][17][18][19] To our knowledge, there is no related study about this issue in Iran, and most of the previous, related works are not so recent [5][6][7][8][12][13][14][15][16][17][18][19] and had been conducted with a small sample size. A major proportion of related studies has assessed the late outcome of MVR in patients with severe PAH.…”

Section: Introductionmentioning

confidence: 99%

“…However, there is no consensus about the outcome of patients with PAH after MVR in the literature, some studies have revealed that severe PAH is associated with poorer outcome and higher mortality rate [3][4][5][6][7][8] while some others do not agree with this and believed that severe PAH do not imply the greater risk in corrective surgery; [9][10][11][12][13][14][15][16][17][18][19] but the point is that the definition of PAH varies across studies, pulmonary artery pressure >40, 50, 70 and 110 have been considered as severe PAH in various studies. [9][10][11][12][13][14][15][16][17][18][19] To our knowledge, there is no related study about this issue in Iran, and most of the previous, related works are not so recent [5][6][7][8][12][13][14][15][16][17][18][19] and had been conducted with a small sample size.…”

Section: Introductionmentioning

confidence: 99%

“…A major proportion of related studies has assessed the late outcome of MVR in patients with severe PAH. 12,18,19) A study with adequate sample size that investigates the outcome of MVR in these patients with new operative techniques and improved postoperative care seems necessary. This study is designed to assess the early hemodynamic changes after elective mitral valve replacement in patients with severe and mild pulmonary arterial hypertension and to diagnose the potential hemodynamic problems in patients with severe PAH to prepare necessary preambles to encounter with them in the future.…”

Section: Introductionmentioning

confidence: 99%

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Early Hemodynamic Changes after Mitral Valve Replacement in Patients with Severe and Mild Pulmonary Artery Hypertension

Bayat¹,

Aghdaii

Farivar³

et al. 2013

ATCS

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Purpose: to assess the early hemodynamic changes after elective mitral valve replacement (MVR) in patients with severe and mild pulmonary arterial hypertension (PAH). Methods: a total of 45 consecutive patients, who were candidate for elective MVR, were enrolled in this prospective observational study. Patients were divided into two groups based on the absence (group A, 20 patients) or presence (group B, 25 patients) of severe pulmonary artery hypertension (PAH) defined as systolic pulmonary artery pressure ≥50 mmHg measuring by catheterization. MVR was performed using standard cardiopulmonary bypass (CBD) technique. The hemodynamic and arterial blood gas assessments were carried out at baseline before the induction of general anesthesia, in the operating room immediately after MVR, and then continued after stabilization of hemodynamic status with 2 hr interval up to 24 hours. Results: The mean CPB and aortic cross-clamp times were similar in two groups (95.3 ± 49.5 and 61.8 ± 36.3 minutes in group A and 103.1 ± 34.7and 61.9 ± 20.0 minutes in group B). In group A, the mean PAP showed an increase immediately after the operation (from 40.4 ± 7.3 to 43.10 ± 6.2 mmHg) and then decreased significantly to 32.5 ± 3.9 mmHg (P <0.05). In group B, the mean PAP showed no significant reduction immediately after MVR, but it decreased significantly below the range of severe PAP over the first 24 hours. Conclusion: MVR is safe and effective even in patients with severe PAH. The anesthetic technique and postoperative cares can be useful in improving the outcome in such patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early Hemodynamic Changes after Mitral Valve Replacement in Patients with Severe and Mild Pulmonary Artery Hypertension

Bayat¹,

Aghdaii

Farivar³

et al. 2013

ATCS

View full text Add to dashboard Cite

show abstract

“…Until now, there is no consensus in the literature on the results after surgery for this category of patients; Some studies have associated PAH with a poor outcome and an estimated high mortality rate of 31% [1], which has led some authors to consider PAH as an absolute contraindication to MVR [5][6][7][8][9], while others do not fully agree and argue that severe PAH does not imply a greater surgical risk [10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

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

Bendjaballah¹,

Lakehal²,

Aimar³

et al. 2017

J Cardiovasc Dis Diagn

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“…2); even patients with mean PAP >50 mmHg generally show a large reduction in PAP and PVR. 28,63,65,66 Most available hemodynamic data are for ≤1 year of follow-up, but one large series demonstrated that the reduction in PVR lasts at least several years. 67 Reliable reduction of PVR with mitral valve replacement or repair probably also occurs in the first few years of life, 31,54,56 although the available data are limited and far from definitive.…”

Section: Evolution and Resolution Of Phmentioning

confidence: 99%

Pulmonary Hypertension Caused by Pulmonary Venous Hypertension

Kulik

2014

Pulm. circ.

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The effect of pulmonary venous hypertension (PVH) on the pulmonary circulation is extraordinarily variable, ranging from no impact on pulmonary vascular resistance (PVR) to a marked increase. The reasons for this are unknown. Both acutely reversible pulmonary vasoconstriction and pathological remodeling (especially medial hypertrophy and intimal hyperplasia) account for increased PVR when present. The mechanisms involved in vasoconstriction and remodeling are not clearly defined, but increased wall stress, especially in small pulmonary arteries, presumably plays an important role. Myogenic contraction may account for increased vascular tone and also indirectly stimulate remodeling of the vessel wall. Increased wall stress may also directly cause smooth muscle growth, migration, and intimal hyperplasia. Even long-standing and severe pulmonary hypertension (PH) usually abates with elimination of PVH, but PVH-PH is an important clinical problem, especially because PVH due to left ventricular noncompliance lacks definitive therapy. The role of targeted PH therapy in patients with PVH-PH is unclear at this time. Most prospective studies indicate that these medications are not helpful or worse, but there is ample reason to think that a subset of patients with PVH-PH may benefit from phosphodiesterase inhibitors or other agents. A different approach to evaluating possible pharmacologic therapy for PVH-PH may be required to better define its possible utility.Keywords: pulmonary hypertension, pulmonary venous hypertension. As a perfect example of how clinical imperative can drive basic physiological investigation, studies of the effect of pulmonary venous hypertension (PVH) on the lung's circulation were in full swing by the very early 1950s, 1 close on the heels of the development of surgical relief of mitral valve stenosis. Cardiac catheterization of patients with mitral valve disease has characterized the physiology of PVH, and histological investigations demonstrated the microvascular changes provoked by PVH. Just as important, the effect of relief of left atrial (LA) hypertension on the circulation has been extensively reported, usually for patients who have had mitral valve intervention. We have learned that the circulatory alterations provoked by PVH share some characteristics with other forms of pulmonary hypertension (PH), such as the idiopathic variety, PH due to chronic alveolar hypoxia, and PH secondary to congenital cardiac shunting lesions. For example, acute "reactivity" to vasodilators may be observed, and there is overlap in the microarchitectural abnormalities seen. On the other hand, the "natural history" of PVH-PH is very different than that of the idiopathic variety or that seen with shunting defects: in the former (as demonstrated with mitral valve disease), PH is likely to largely or completely resolve if PVH is relieved, even with long-standing and severely increased pulmonary vascular resistance (PVR), 2,3 while in the latter two, PH is more likely to inexorably increase. PVH-PH is ther...

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Mitral valve replacement in the presence of severe pulmonary hypertension.

Cited by 33 publications

References 21 publications

Early Hemodynamic Changes after Mitral Valve Replacement in Patients with Severe and Mild Pulmonary Artery Hypertension

Early Hemodynamic Changes after Mitral Valve Replacement in Patients with Severe and Mild Pulmonary Artery Hypertension

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

Pulmonary Hypertension Caused by Pulmonary Venous Hypertension

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