Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement.
OBJECTIVE
We sought to determine the impact of valve prosthesis-patient mismatch (PPM) on pulmonary arterial (PA) pressure after mitral valve replacement (MVR).


BACKGROUND
Pulmonary arterial hypertension is a serious complication of mitral valve disease, and it is a major risk factor for poor outcome after MVR. We hypothesized that valve PPM might be a determinant of PA hypertension after MVR.


METHODS
Systolic PA pressure was measured by Doppler echocardiography in 56 patients with normally functioning mitral prosthetic valves. Mitral valve effective orifice area (EOA) was determined by the continuity equation and indexed for body surface area.


RESULTS
Thirty patients (54%) had PA hypertension defined as systolic PA pressure >40 mm Hg, whereas 40 patients (71%) had PPM defined as an indexed EOA < or =1.2 cm(2)/m(2). There was a significant correlation (r = 0.64) between systolic PA pressure and indexed EOA. The average systolic PA pressure and prevalence of PA hypertension were 34 +/- 8 mm Hg and 19% in patients with no PPM versus 46 +/- 8 mm Hg and 68% in patients with PPM (p < 0.001). In multivariate analysis, the indexed EOA was by far the strongest predictor of systolic PA pressure.


CONCLUSIONS
Persistent PA hypertension is frequent after MVR and strongly associated with the presence of PPM. The clinical implications of these findings are important given that PPM can largely be avoided by using a simple prospective strategy at the time of operation.
Li
Mingzhou
M
Research Group in Valvular Heart Diseases, Research Center of Laval Hospital/Quebec Heart Institute, Laval University, 2725 Chemin Saint-Foy, Sainte-Foy, Quebec, Canada G1V 4G5.
Dumesnil
Jean G
JG
Mathieu
Patrick
P
Pibarot
Philippe
P
D000368:Aged; D001794:Blood Pressure; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D013599:Systole