[Correlation between pulmonary vascular changes and hemodynamic parameters during exercise before and after mitral valve surgery].
Sixteen cases with mitral valvular disease were studied with regard to the correlation between pathological changes in the pulmonary vasculature and pulmonary hemodynamics during exercise before and after surgery. In muscular pulmonary arteries obtained by open lung biopsy, medial wall thickness (MWT) was 13.8 +/- 3.2% and intimal thickness (IT) was 37.3 +/- 13.5%. MWT was correlated with IT (r = 0.60, p < 0.05). Wall thickness in pulmonary veins was 8.21 +/- 1.8%. Preoperative mean pulmonary arterial pressure (MPAP) during exercise was 45.9 +/- 9.4 mmHg, and decreased significantly to 38.1 +/- 11.3 mmHg postoperatively. However, in 4 patients, MPAP during exercise increased after surgery. Pulmonary vascular resistance (PVR) during exercise was unchanged before and after surgery (2.74 +/- 1.90 U.M2-->2.69 +/- 1.3 U.M2). MWT was significantly correlated with preoperative MPAP at rest only. In patients showing an increase of MPAP during exercise postoperatively, mean MWT was 16.2% and mean IT was 47.4%. In conclusion our data suggest that postoperative pulmonary hemodynamics does not improve in patients whose MWT exceeds 15% and IT exceeds 40% and that irreversibility may be due to pulmonary vascular lesions.
Tobe
M
M
First Department of Surgery, Yokohama City University School of Medicine, Japan.
Kondo
J
J
Imoto
K
K
Ozaki
T
T
Sakamoto
A
A
Uchida
K
K
Matsumoto
A
A
Yamaki
S
S
D000328:Adult; D000368:Aged; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008168:Lung / Q000098:blood supply* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation