title: Pressure reflection in the pulmonary circulation in patients with severe mitral regurgitation indicates adverse postoperative outcome.
abstract: OBJECTIVE
  Severe pulmonary hypertension (PH) is a known risk factor in valvular surgery. In the present study, we hypothesized that the assessment of pressure reflection (PR) in the pulmonary circulation, indicating increased pulmonary vascular resistance, might improve the identification of patients with increased morbidity and mortality following surgery for severe mitral regurgitation.
  
  
  METHODS
  A total of 103 patients without atrial fibrillation were divided into three groups: Group 1 (n = 48), patients without PR; Group 2 (n = 36), patients with PR and pulmonary artery systolic pressure (PASP) ≤ 60 mmHg and Group 3 (n = 19), patients with PR and PASP >60 mmHg. Three variables related to PR were selected: the acceleration time in the right ventricular outflow tract (RVOT), the interval between peak velocity in the RVOT and peak tricuspid regurgitant jet velocity and the right ventricular pressure increase after peak RVOT velocity.
  
  
  RESULTS
  There were no differences between groups in age, ejection fraction, need for coronary bypass grafting or creatinine. Patients with PR (Groups 2 and 3) had more use of vasoactive drugs (overall P < 0.0001, Group 1 vs Group 2 P = 0.018). The proportion of patients with >24 h in the intensive care unit was 27% in Group 1, 54% in Group 2 and 84% in Group 3 (overall P < 0.0001, Group 1 vs Group 2 P = 0.006). The in-hospital mortality in patients without PR (n = 49) was 0% compared with 10.9% in patients with PR (P = 0.029).
  
  
  CONCLUSIONS
  Echocardiography assessment of PR in the pulmonary circulation and severe PH may identify patients with adverse outcome following mitral surgery.
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Odd
authors.initials: O
authors.lastname: Bech-Hanssen
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Malm
authors.forename: Lena
authors.initials: L
authors.lastname: Nguyen
authors.forename: Anders
authors.initials: A
authors.lastname: Jeppsson
authors.forename: Henrik
authors.initials: H
authors.lastname: Scherstén
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Ricksten
mesh_terms: D000368:Aged; D003422:Critical Care; D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery*; D011652:Pulmonary Circulation / Q000502:physiology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012189:Retrospective Studies; D014655:Vascular Resistance
keywords: Echocardiography; Mitral regurgitation; Pressure reflection; Pulmonary hypertension; Pulmonary vascular resistance