“…Our data, albeit in relatively young patients with ideal valve anatomy, has shown near-complete reversibility of elevated pulmonary artery pressures and pulmonary vascular resistance regardless of how high the baseline values 49 ; in older patients with chronic PHT, the data have been less convincing, likely because of irreversible changes in the pulmonary vasculature. 50 The LV dysfunction seen in some 30% of MS patients is likely secondary to altered hemodynamic load rather than primary myocardial involvement from RHD 51 ; although inconsistent, there is some evidence of left ventricular remodeling after successful PBMV, with improved global and regional LV function. 52 Reviews of trends in the United States 53 as well as in Europe 54 over the past several decades correlate with a continuing decline in patients undergoing PBMV.…”