Evaluation of pulmonary artery pressure in response to activity in patients with non-severe mitral valve stenosis after commissurotomy and its relationship with some echocardiographic variables

Abstract

By definition, pulmonary hypertension is equal to the average of of the pulmonary arteriy pressure at least 25 mmHg in rest, with a healthy average of about 14 mmHg. Percutaneous Mitral valve Commisurotomy is a therapeutic method for severe and syptomatic mitral valve stenosis. The aim of this study is evaluation of pulmonary artery pressure in response to activity in patients with progressive non severe mitral valve stenosis after commissurotomy and its relationship with some echocardiographic variables. Materials and Methods: A total number of 200 patients with non severe mitral valve stenosis referred to Shahid Madani Heart center of Tabriz who were compatible with inclusion and exclusion criteria of study. Echocardiography was performed in all patients in left decubitus position and pulmonary artery systolic pressure, left ventricular ejection fraction, and other valvular abnormalities such as mitral and tricuspid valve regurgitation, mitral valve gradient and left atrium diameter were registered. Patients with pulmonary artery systolic pressure below 60 mmHg underwent Bruce's exercise test. The pulmonary artery systolic pressure was measured immediately in the same position after the exercise test was completed and the obtained variables were analyzed. Results: The rate of pulmonary arterial pressure increase was 9.44 ± 9.08 mmHg from 33.80±9.23 mmHg (20-55 mmHg) on resting to 43.24±11.66 mmHg (26-67 mmHg) on exercise test; there was a significant difference between pulmonary arterial pressure with resting pulmonary arterial pressure and after exercise test (p=0.001, r=0.612). Also, 32 patients (16%) had increased pulmonary arterial pressure after exercise test above 60 mmHg with the mean pulmonary arterial pressure of 63.12±1.84 mmHg. There was a statistically inverse relationship between increased systolic pulmonary artery pressure and left atrial diameter (p = 0.001; r = -0.479). Between 32 patients with pulmonary artery hypertension above 60 mmHg, 6 (18.8%) had mild or progressive MR and 26 (61.9%) had severe MR. Therefore, most patients had severe mitral regurgitation.