Many forms of left-sided heart disease can be associated with pulmonary hypertension (PH-LHD) which typically indicates more advanced heart disease, more severe symptoms and worse prognosis. Mitral valve disease, both insufficiency and stenosis, can lead to the downstream development of PH. Current guidelines suggest that the most effective therapy for severe mitral valve disease (stenosis and/or regurgitation) is surgical intervention, yet in some cases, the operative outcome bordered by high perioperative risks. Patients and methods: Data for this study included 680 cases of adult patients underwent first-time mitral valve replacement. All patients of the study were divided into 2 groups: those who had PASP 50-80mmHg categorized as severe pulmonary hypertension=(group I) and those who had PASP above 80mmHg Categorized as extreme PH=( group II).
Results: Echo-cardio graphic data revealed that 60.3% (410/680) of patients had signs of mitral stenosis, 25% (170/680) had mitral regurgitation while 14.7% (100/680) had double mitral valve pathology (MS and MR). 76 patients (11.2%) had less than moderate TR, 132 (19.4%) had moderate TR and 472 (69.4%) had severe TR. Most of mortality in both groups occurs during the first post-operative week and occurred due to hemodynamic instability and acute heart failure. It was 3.7% (20/540) in group I and 14.3% (20/140) in group II with a marked rise in this rate between patients of group II (p=0.03). 12 cases out of the 20 (60%) of mortality of group I were above fifty years old and 16 cases out of the 20 cases of mortality of group II (80%) were above fifty years old and the statistical analysis revealed that increased age with the severity of pulmonary hypertension increase the rate of mortality (p=0.031).
Conclusion: Early referral of cases of mitral valve disease with PHT to surgery once indicated to avoid increased operative risk secondary to long standing PHT. Mitral valve replacement (MVR) with severe PHT could be done with less risk when surgery offered at proper time with management strategy to avoid pulmonary hypertensive events. |
