HAeMODYNAMICS IN MITRAL STENOSIS BEFORE, DURING, AND AFTER VALVOTOMY

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Abstract
In 32 patients with mitral stenosis, observations were made of the pressures in the pulmonary artery, left atrium, and left ventricle before and after valvotomy; the reduction of the ventricular diastolic filling pressure gradient following the operation was also determined. Of these cases 16 had detailed hemodynamic studies by right heart catheterization before and about 7-12 months after operation. This observation included determination of pulmonary vascular resistance, mitral valve flow, and mitral valve area. The pressures at operation, and particularly the gradient fall, were correlated with the pre- and postoperative catheterization findings and also with the eventual clinical state and the disability grades of the patients. It was found that when the fall in gradient had been satisfactory (preferably to below 2 mm Hg), the eventual clinical and hemodynamic state of the patient was good, provided that the left ventricular pressure had not fallen significantly and provided complications such as mitral regurgitation, atrial fibrillation, and chronic myocardial failure had not occurred. The gradient fall may thus supplement the surgeon''s estimate of the split in assessing the benefit likely to result from the operation. The pulmonary arterial pressure does not always fall to any extent immediately following valvotomy even when the split is adequate, but whenever, the gradient is well reduced, there is a progressive fall of this pressure over the course of months and the final pressure may almost reach normal. The left atrial pressure follows more closely the reduction in the gradient and falls concurrently following satisfactory split of the commissures. An exception must be made of those patients in whom the ventricular diastolic pressure shows some rise after valvotomy; then the left atrial pressure also remains raised although the gradient is reduced.