The clinical estimation of pulmonary hypertension accompanying mitral stenosis

Fowler, Noble O.; Noble, W. J. Le; Giarratano, Salvatore J.; Mannix, Edgar P.

doi:10.1016/0002-8703(55)90196-4

Cited by 21 publications

(9 citation statements)

References 4 publications

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“…Heart sounds or intensity of murmurs do not help, the second pulmonic sound particularly offers no reliable indication and heart size is very deceptive as can be seen in previous reports. '4' 20 Our group is unable to make this determination with certainty unless the patient is catheterized and the pulmonary artery pressures are measured directly. Because the tendency at present is to infer rather than demonstrate pulmonary hypertension, its presence may be improperly diagnosed and hence patients are undergoing needless surgery.…”

Section: Methods Of Studymentioning

confidence: 99%

Circulatory Effects of Mitral Commissurotomy with Particular Reference to Selection of Patients for Surgery

et al. 1955

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Of 60 patients w'ith mitral stenosis referred as proper candidates for commissurotomy, less than half (27) proved suitable after further study. One half of these (13) had a good postoperative result as judged not only clinically but by objective physiologic measurements. The latter represent the best criteria for the effects of surgery since subjective impressions may be unreliable. Eight subjects originally advised to undergo surgery would now be rejected inasmuch as myocardial insufficiency and not mitral block was their predominant difficulty. Clinical criteria appeal as yet inadequate for the selection of the proper candidate for mitral commissurotomy, as there is no good clinical means of establishing in every instance the presence of pulmonary hypertension which remains the best evidence of a significant degree of mitral block. SINCE Bailey', 2 and Harken3 have demonstrated the feasibility of the surgical approach to the problem of mitral stenosis, patients with this lesion are being re-evaluated in numerous clinics with the possibility of commissurotomy in mind. It is well to remember that surgical treatment is directed at the relief of the mechanical difficulties imposed by mitral valve obstruction. It has been postulated and recently re-emphasized4-6 that chronic pulmonary hypertension is one of the chief resultants of significant mitral block. This postulate has been confirmed by physiologic studies which also showed decrements in pulmonary artery pressures after successful mitral surgery.2' 7 Thus, it has become established that operative intervention can alleviate at least some of the consequences of mitral block. However, it has also been found

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Section: Methods Of Studymentioning

confidence: 99%

Circulatory Effects of Mitral Commissurotomy with Particular Reference to Selection of Patients for Surgery

et al. 1955

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“…This phenomenon was first described in association with mitral valve disease and was thought to be a mechanism for protecting the capillary bed from higher pressures as the pulmonary arteries become restricted and remodeled. 8 The mechanism for this disproportionate elevation in mean PA pressure is poorly understood but appears to involve at least some of the same pathophysiologic mechanisms as described in PAH, including endothelial cell dysfunction, increased circulating endothelial levels, and decreased release of nitric oxide. 9 Initially, the process is thought to be reversible and PA pressure drops in response to vasodilators, but "fixed" disease, unresponsive to acute vasodilator administration, is thought to occur eventually.…”

Section: Article See P 257mentioning

confidence: 99%

Defining the Phenotypes for Pulmonary Hypertension Associated With Diastolic Heart Failure

Hill

Preston

Roberts

2011

Circ: Heart Failure

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P ulmonary hypertension (PH) is well known to be associated with left heart failure, which is probably the single most common cause of abnormally elevated pulmonary arterial pressure (Ͼ25 mm Hg by consensus). [1][2][3] Estimates range up to 250 000 patients with PH associated with heart failure in the United States today, 3,4 making it far more prevalent than other forms of PH. Consistent with this, more than three-quarters of unselected patients referred for cardiac ultrasound to a single community-based center and found to have an elevated estimated pulmonary arterial (PA) systolic pressure were subsequently determined to have a left ventricular (LV) cause. 5 Despite its prevalence, though, the pathophysiology and phenotypic characteristics of PH associated with left heart failure are not well understood.

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“…Analyses of different types of secondary pulmonary hypertension have also been presented (161,203,463,464), and there is evidence that when the pulmo nary vessels are exposed for some length of time to increased pressure hyper trophic changes, first of the media, then of the intima, occur. The flow resist ance increases concomitantly (compare discussion under "Biophysical as pects," p. 162).…”

Section: Pulmonary Circulationmentioning

confidence: 99%

Peripheral Circulation

Folkow¹

1956

Annu. Rev. Physiol.

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It was intended that the present article should· deal with the complete literature of the field, published from June 1954 to June 1955, but unfor tunately it does not do so. Thus, papers appearing in journals which have been delayed in delivery could not be included, and with all probability others have simply been overlooked, for which apologies are extended.There seem to be as many definitions of peripheral circulation as there are workers in the field. The definition here preferred covers a discussion of all papers dealing with physiological aspects of the circulatory system with exclusion of those with bearing on the heart and its performance, which are dealt with elsewhere in this book. Pharmacological and therapeutic studies are not discussed here, interesting as they may be. Further, to avoid overlap ping, brief preliminary reports are generally omitted, as the studies can and will be dealt with more satisfactorily in future reviews when they have been published in full detail. ApPARATUS AND METHODSPressure and pulse wave measurements.-New manometers, suitable for measuring pressures (190) or pressure differences (or both) (37, 333) have been described, with one of which (333) the author has very favourable personal experience. In man the left atrium has been punctured percutane ously (43, 355) allowing a measurement of the pressures in this and adjacent parts of the cardiovascular system. Also the pulmonary artery can be punc tured for pressure measurements, either percutaneously (356) or by endos copy from the main bronchus (141). This may be of great advantage as it is evident from another study (457) that the movements of the usual cathe ters, caused by the beating of the heart, can produce significant artifacts in the recorded pressure curves. Further, a simple and convenient procedure for arterial catheterisation, useful both for obtaining samples and pressure records, has been worked out (34). Schroeder's method for pressure measure ment has been compared with a direct recording of arterial pressure (176), and at more pronounced pressure changes the error is rather big. Some other more or less simple techniques for continuous recording of pressure variations (17,53,204) and mean pressure (25) are described and also methods for evaluation of the pressure in smaller arterial vessels (�2, 277). The techniques for indirect measurement of arterial pressure in rats has been critically ana lyzed, and a new modification of satisfactory exactness is described (351) . On the whole, in the last ten years the enthusiasm for new, more or less intricate ways to measure arterial blood pressure has been so great that one I The following abbreviations have been used in this chapter: VDM (Vasopressor material); VEM (Vasoexcitor material); ATP (adenosinetriphosphate). 159Annu. Rev. Physiol. 1956.18:159-194. Downloaded from www.annualreviews.org Access provided by University of California -San Francisco UCSF on 02/09/15. For personal use only.Quick links to online content Further ANNUAL REVIEWS

show abstract

The clinical estimation of pulmonary hypertension accompanying mitral stenosis

Cited by 21 publications

References 4 publications

Circulatory Effects of Mitral Commissurotomy with Particular Reference to Selection of Patients for Surgery

Circulatory Effects of Mitral Commissurotomy with Particular Reference to Selection of Patients for Surgery

Defining the Phenotypes for Pulmonary Hypertension Associated With Diastolic Heart Failure

Peripheral Circulation

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