The effect of acetylcholine on pulmonary vascular resistance and left atrial pressure in mitral stenosis

Wood, Paul; Besterman, E. M. M.; Towers, M; McIlroy, Malcolm B.

doi:10.1016/0002-9149(72)90201-9

Cited by 15 publications

(26 citation statements)

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“…Increased stretch/tension may also directly (independent of vasoconstriction) stimulate medial hypertrophy and intimal hyperplasia. In the upper right panel, pulmonary capillary wedge pressure (PCWP) is plotted against PVR (pulmonary vascular resistance) in 114 adult patients with mitral stenosis (data from Wood et al 28 ); PVR ranges from normal, despite very high left atrial pressure, to markedly elevated, despite only a modest increase in pulmonary venous pressure. The upper left panel shows the effect of inhaled nitric oxide (iNO) on PVR in 13 children with left atrial hypertension (data from Atz et al 29 ), demonstrating that a component of increased PVR with PVH is often acutely reversible.…”

Section: Causes Of Pvhmentioning

confidence: 99%

“…The response to these agents is variable, and not all patients show vasodilation, but a decrease of approximately 40% in PAP/PVR is typical. 28,[59][60][61] Vasoconstriction is also inferred from the fact that PVR often decreases within hours of mitral valve intervention, followed by a further decrease over months (the latter presumably reflecting remodeling of pulmonary vessels). [34][35][36]62 In 4 series of balloon mitral valvuloplasty (total, 114 patients), the mean (AE standard deviation) percentage decrease in PVR immediately after the procedure was 24% AE 8%, and several months later the PVR was 51% AE 9% lower than at baseline.…”

Section: Causes Of Pvhmentioning

confidence: 99%

“…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%

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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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Section: Causes Of Pvhmentioning

confidence: 99%

Section: Causes Of Pvhmentioning

confidence: 99%

Section: Evolution and Resolution Of Phmentioning

confidence: 99%

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Pulmonary Hypertension Caused by Pulmonary Venous Hypertension

Kulik

2014

Pulm. circ.

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“…Sus mayores intereses lo constituyeron las cardiopatías congénitas [9][10][11][12][13][14][15][16][17][18][19][20][21] , las valvulopatías reumáticas 10,15-17,19 y la hipertensión pulmonar 9,13,21 . Su experiencia en cardiopatías congénitas fue reflejada en una cuantiosa serie de más de 1000 casos clínicos con diagnósticos sustentados mediante cateterismo cardiaco y en muchos casos con confirmación intra-operatoria o anatomopatoló-gica 11,12 .…”

Section: Sus Intereses Aportes Y Personalidadunclassified

“…En el caso de la estenosis mitral, puso en evidencia que la vasoconstricción arteriolar pulmonar intervenía en el mecanismo de la hipertensión pulmonar y que el efecto podía revertirse con la inyección de acetilcolina en la arteria pulmonar. Explicó como esta situación de vasoconstricción proximal a los capilares pulmonares actuaría como barrera protectora contra el edema agudo de pulmón, a expensas de una reducción del gasto cardiaco y del eventual desarrollo de insuficiencia cardiaca derecha 9,13,[15][16][17]19,21 .…”

Section: Sus Intereses Aportes Y Personalidadunclassified

Paul Hamilton Wood (1907-1962): El máximo exponente de la cardiología clínica Británica del siglo XX

Humphreys

Young

2012

Rev. méd. Chile

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Wood fue un clínico brillante e inspirado. Tal vez su mayor contribución a la medicina fue el refinamiento y la perfección de su capacidad diagnóstica al lado de la cama del paciente. Introdujo el concepto cuantitativo en el registro de los datos clínicos. Abordaba al paciente nuevo estableciendo hipótesis diagnósticas, y luego realizaba el interrogatorio y un examen físico minucioso a los fines de probar sus suposiciones. Utilizando esta metodología iba pensando su diagnóstico formulando nuevas hipótesis y recabando nueva información clínica con absoluto rigor científico. A través de este proceso iterativo de prueba y contra prueba, aprobando y descartando las diversas posibilidades llegaba a un diagnóstico de trabajo. Este diagnós-tico luego era ratificado o rectificado sometiendo al paciente a un cateterismo cardiaco que Wood en algún momento definió como el "patrón oro". Dado que una gran cantidad de los pacientes padecían de enfermedad reumática o de cardiopatías congénitas, este enfoque habitualmente permitía dilucidar la fisiopatología del proceso y llegar a un diagnóstico final. De esta manera introdujo precisión en la evaluación preoperatoria de los pa- Rev Med Chile 2012; 140: 121-124

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Mean pulmonary arterial pressure after percutaneous mitral valvuloplasty predicts long-term adverse outcomes

Jorge

Baptista

Faria

et al. 2012

Revista Portuguesa de Cardiologia

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Introduction and aim: Percutaneous mitral valvuloplasty (PMV) is an effective treatment option for mitral stenosis (MS), but its success is assessed on the basis of clinical and echocardiographic outcomes in studies with relatively short follow-up. We aimed to characterize a cohort of patients undergoing PMV with long-term follow-up and to determine independent predictors of post-PMV mitral re-intervention and event-free survival. Methods: We studied 91 consecutive patients with MS who underwent PMV with a median clinical follow-up duration of 99 months. Two endpoints were considered: post-PMV mitral re-intervention (PMV or mitral surgery) and a composite clinical events endpoint including cardiovascular death, mitral valve re-intervention and hospital admission due to decompensated heart failure. We compared patients who required post-PMV mitral re-intervention with those who did not during follow-up. Results: The study population included 83.5% females and mean age was 48.9 ± 13.9 years. The 1-, 3-, 5-, 7-and 9-year rates of clinical event-free survival were 93.0 ± 2.8%, 86.0 ± 3.9%, 81.0 ± 4.4%, 70.6 ± 5.6%, and 68.4 ± 5.8%, respectively. The 1-, 3-, 5-, 7-and 9-year rates of mitral re-intervention-free survival were 98.8 ± 1.2%, 97.5 ± 1.7%, 92.1 ± 3.1%, 85.5 ± 4.5%, and 85.5 ± 4.5%, respectively. The median time to mitral re-intervention was 6.2 years. Patients who required mitral re-intervention during follow-up were younger (43.3 vs. 51.2 years, p=0.04) and had higher pre-and post-PMV mitral gradient (14.9 vs. 11.5 mmHg, p=0.02 and 6.4 vs. 2.1 mmHg, p<0.001) and higher post-PMV mean pulmonary artery pressure (mPAP) (30.0 vs. 23.2 mmHg, p=0.01). In a Cox proportional hazards model, mPAP ≥25 mmHg was the sole predictor of both mitral re-intervention .528], p=0.025) and clinical events .260], p=0.039). PALAVRAS-CHAVEEstenose mitral; Valvuloplastia mitral percutânea; Prognóstico; Pressão média na artéria pulmonar A pressão média na artéria pulmonar após a valvuloplastia mitral percutânea é um preditor de mau prognóstico a longo prazo Resumo Introdução e objetivos: A valvuloplastia mitral percutânea (PMV) é uma opção eficaz para o tratamento da estenose mitral. Contudo, os resultados deste procedimento são baseados em estudos clínicos e ecocardiográficos com tempos de seguimento relativamente curtos. Os objetivos deste estudo são caracterizar uma população de doentes submetidos a PMV, realizar um seguimento clínico de longa duração e determinar os preditores independentes de reintervenção mitral após PMV e de sobrevida livre de eventos. Métodos: Foi estudada uma população de 91 doentes com estenose mitral tratada por PMV e realizou-se um seguimento clínico com a duração média de 99 meses. Foram pré-definidos dois endpoints: reintervenção mitral pós-PMV (PMV ou cirurgia mitral) e um endpoint clínico combinado que incluiu morte de causa cardiovascular, reintervenção mitral e internamento hospitalar por insuficiência cardíaca descompensada. Foi realizado um estudo comparativo entre os doentes que necessi...

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The effect of acetylcholine on pulmonary vascular resistance and left atrial pressure in mitral stenosis

Cited by 15 publications

References 1 publication

Pulmonary Hypertension Caused by Pulmonary Venous Hypertension

Pulmonary Hypertension Caused by Pulmonary Venous Hypertension

Paul Hamilton Wood (1907-1962): El máximo exponente de la cardiología clínica Británica del siglo XX

Mean pulmonary arterial pressure after percutaneous mitral valvuloplasty predicts long-term adverse outcomes

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