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Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis.

Publication ,  Journal Article
Hart, SA; Krasuski, RA; Wang, A; Kisslo, K; Harrison, JK; Bashore, TM
Published in: The Journal of heart valve disease
November 2010

Pulmonary hypertension frequently complicates mitral stenosis, with a subset of these patients exhibiting pressures well in excess of their mitral valve hemodynamics. The prevalence of this condition and its impact on clinical outcome following percutaneous balloon mitral commissurotomy (PBMC) is unknown.The transpulmonary gradient (TPG) was measured in 317 patients undergoing PBMC; patients were subsequently defined as having either an appropriate or excessive TPG (< or =15 mmHg or >15 mmHg, respectively). Twenty-two patients were excluded due to valvuloplasty-related significant mitral regurgitation. The remaining 295 patients (250 females, 45 males; mean age 52 +/- 13 years) were prospectively followed up, with each patient underwent serial echocardiography.Among the patients, 214 (73%) had pulmonary hypertension (pulmonary artery pressure >25 mmHg) and 55 (19%) also had an elevated TPG. Females were almost fivefold more likely than males to have an elevated TPG (p = 0.003). Patients with an elevated TPG had a worse mean NYHA functional class than those with a normal TPG (3.0 +/- 0.5 versus 2.7 +/- 0.6, p = 0.01), while the mitral valve area (MVA) was slightly smaller in patients with an elevated TPG (1.0 +/- 0.2 versus 1.1 +/- 0.2 cm2, p = 0.003). All patients demonstrated a significant increase in MVA after commissurotomy (final MVA 1.7 +/- 0.6 cm2, p < 0.001 for elevated TPG; 1.8 +/- 0.4 cm2, p < 0.001 for normal TPG), and the NYHA class at six months was improved for all patients (2.8 +/- 0.6 versus 1.6 +/- 0.7, p < 0.001). The improvements in NYHA class, TPG and MVA were sustained at 36 months.Pulmonary hypertension with elevated TPG occurs in patients with mitral stenosis, and is significantly more common in females. Despite worse symptoms and higher right-sided pressures, PBMC is equally successful in patients with a normal TPG, and provides sustained benefit for up to 36 months after the procedure.

Duke Scholars

Published In

The Journal of heart valve disease

EISSN

2053-2644

ISSN

0966-8519

Publication Date

November 2010

Volume

19

Issue

6

Start / End Page

708 / 715

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Sex Factors
  • Risk Factors
  • Risk Assessment
  • Respiratory System
  • Pulmonary Circulation
  • Pulmonary Artery
  • Prospective Studies
  • North Carolina
 

Citation

APA
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ICMJE
MLA
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Hart, S. A., Krasuski, R. A., Wang, A., Kisslo, K., Harrison, J. K., & Bashore, T. M. (2010). Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis. The Journal of Heart Valve Disease, 19(6), 708–715.
Hart, Stephen A., Richard A. Krasuski, Andrew Wang, Katherine Kisslo, J Kevin Harrison, and Thomas M. Bashore. “Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis.The Journal of Heart Valve Disease 19, no. 6 (November 2010): 708–15.
Hart SA, Krasuski RA, Wang A, Kisslo K, Harrison JK, Bashore TM. Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis. The Journal of heart valve disease. 2010 Nov;19(6):708–15.
Hart, Stephen A., et al. “Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis.The Journal of Heart Valve Disease, vol. 19, no. 6, Nov. 2010, pp. 708–15.
Hart SA, Krasuski RA, Wang A, Kisslo K, Harrison JK, Bashore TM. Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis. The Journal of heart valve disease. 2010 Nov;19(6):708–715.

Published In

The Journal of heart valve disease

EISSN

2053-2644

ISSN

0966-8519

Publication Date

November 2010

Volume

19

Issue

6

Start / End Page

708 / 715

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Sex Factors
  • Risk Factors
  • Risk Assessment
  • Respiratory System
  • Pulmonary Circulation
  • Pulmonary Artery
  • Prospective Studies
  • North Carolina