Pulmonary vascular disease and hypertension after valve surgery for mitral stenosis

Tryka, A. Francine; Godleski, John J.; Schoen, Frederick J.; Vandevanter, Stephen

doi:10.1016/s0046-8177(85)80215-x

Cited by 13 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a subset of these patients, the resultant venous hypertension may be complicated by an additional “reactive” phenomenon of vasoconstriction and remodeling in the distal pulmonary arteries [10]. This vascular remodeling has been identified in autopsy specimens from patients with mitral stenosis that reveal typical pulmonary arterial vasculopathic changes like those encountered in Group 1 [11]. …”

Section: Who Group 2: Pulmonary Venous Hypertension (Pvh) Due To Leftmentioning

confidence: 99%

Pulmonary Hypertension: Types and Treatments

Rose-Jones¹,

McLaughlin

2014

CCR

View full text Add to dashboard Cite

Pulmonary arterial hypertension (PAH) is a panvasculopathy that affects the distal pulmonary arteries and leads to restricted blood flow. This increased afterload leads to adaptive mechanisms of the right ventricle, with eventual failure once it can no longer compensate. Pulmonary hypertension from associated conditions, most importantly left heart disease, i.e. heart failure, can also lead to the same sequela. Patients often experience early vague symptoms of dyspnea and exercise intolerance, and thus PH can elude clinicians until right heart failure symptoms predominate. Evidence-based treatment options with pulmonary vasodilators are available for those with PAH and should be employed early. It is essential that patients be accurately categorized by their etiology of PH, as treatment strategies differ, and can potentially be dangerous if employed in the wrong clinical scenario.

show abstract

Section: Who Group 2: Pulmonary Venous Hypertension (Pvh) Due To Leftmentioning

confidence: 99%

Pulmonary Hypertension: Types and Treatments

Rose-Jones¹,

McLaughlin

2014

CCR

View full text Add to dashboard Cite

show abstract

“…In the setting of left HF, elevated PA pressures may be a result of "passive" back pressure due to elevations in left heart pressures or "reactive" changes due to superimposed pulmonary vasoconstriction and vascular remodeling. 23,24 Several studies have identified intrinsic pulmonary arterial vasculopathy on autopsy and biopsy specimens in both mitral stenosis 25 and left HF with reduced ejection fraction (systolic HF). 23,24,26 Whether these changes are common, and whether they are present in HFPEF, is unknown.…”

Section: Pathogenesismentioning

confidence: 99%

Pulmonary Hypertension

Shah¹

2012

JAMA

View full text Add to dashboard Cite

Pulmonary hypertension (PH), defined as elevated pulmonary artery pressure, is common in the general population and associated with increased mortality. Accordingly, physicians commonly encounter patients with dyspnea, exercise intolerance, and/or right heart failure who have elevated pulmonary artery systolic pressure (PASP) on echocardiography. Although pulmonary arterial vasodilators may often be considered in this setting, these drugs have been predominantly tested in the subset of PH patients with pulmonary arterial hypertension (PAH). Elevated PASP alone is not sufficient for the diagnosis of PAH, and secondary causes of PASP elevation, most commonly left heart disease, are far more prevalent than isolated PAH. Treatment of this more common group of patients with PH due to left heart disease is challenging because there are few evidence-based treatment options, and pulmonary vasodilator therapy may lead to worsening symptoms. Therefore, improving symptoms and avoiding adverse outcomes in patients with PH requires the following: (1) understanding the optimal use of echocardiography for the diagnosis of PH; (2) recognizing the utility and proper interpretation of invasive hemodynamic testing prior to starting pulmonary vasodilator therapy; (3) differentiating PAH from pulmonary venous hypertension due to left heart disease; and (4) understanding the appropriate treatment strategies for PH and resultant right heart failure.

show abstract

“…The degree of change in vessel structure and vascular resistance varies widely, which implies that the natural evolution of PH is very different across the spectrum of patients with group II PH. The most severe histological changes have been reported in patients with mitral stenosis with substantially increased systolic and diastolic left atrial pressure over a long time period [Tandon and Kasturi, 1975;Tryka et al 1985]. In contrast, the main changes found in patients with systolic heart failure were discrete medial hypertrophy of the distal arterioles (<600 µm) and only mild or no vascular intimal fibrosis was detected [Delgado et al 2005].…”

Section: Functional and Structural Pathology In Reactive Phmentioning

confidence: 99%

Section: Functional and Structural Pathology In Reactive Phmentioning

confidence: 99%

Management of pulmonary hypertension in left heart disease

Schmeißer

Schroetter

Braun-Dulleaus

2013

Therapeutic Advances in Cardiovascular Disease

View full text Add to dashboard Cite

Pulmonary hypertension (PH) due to left heart disease is classified as group II according to the Dana Point classification, which includes left ventricular systolic and/or diastolic left heart failure, and left-sided valvular disease. PH due to left heart disease is the most common cause and when present, especially with right ventricular dysfunction, is associated with a worse prognosis. Left heart disease with secondary PH is associated with increased left atrial pressure, which causes a passive increase in pulmonary pressure. Passive PH could be superimposed by an active protective, and in some patients by an 'out of proportion', elevated precapillary pulmonary vasoconstriction and vascular remodelling which leads to greater or lesser further increase of the pulmonary artery pressure. In this review, epidemiological and pathophysiologic mechanisms for the development of group II PH are summarized. The conflicting data about the haemodynamic and possible parameters to diagnose passive versus reactive and 'out of proportion' PH are presented. The different therapeutic concepts, along with novel treatment strategies, are reviewed in detail and critically discussed regarding their effectiveness and safety.

show abstract

Pulmonary vascular disease and hypertension after valve surgery for mitral stenosis

Cited by 13 publications

References 26 publications

Pulmonary Hypertension: Types and Treatments

Pulmonary Hypertension: Types and Treatments

Pulmonary Hypertension

Management of pulmonary hypertension in left heart disease

Contact Info

Product

Resources

About