The Role of Structural Changes in Pulmonary Arteries on Clinical Findings and Hemodynamies in Mitral Valve Disease

In this study, occlusive changes in pulmonary arteries in mitral valve disease were evaluated as an organic component of pulmonary hypertension, and effect of these changes on preoperative clinical findings and on reversibility of pulmonary hypertension was investigated. In 20 patients with mitral valve disease, hypertensive histopathologic changes in the pulmonary arteries were assessed with lung biopsies according to Heath and Edwards' classification, and the patients were divided to grade-0, grade-1, grade-2 and grade-3 groups. Hemodynamic measurements were performed in the preoperative and postoperative periods and postoperative regressions in pulmonary vascular changes were investigated in each group. A significant increase in cardiac output and cardiac index (p<0.01) was observed in all cases postoperatively. Significant decreases were observed in left atrial pressure (p<0.001), pulmonary artery mean pressure (0.001), pulmonary capillary wedge pressure (p<0.001), pulmonary vascular resistance (p<0.05) in the patients whose pulmonary arterial changes were grade-2 or less. No similar improvement occurred in pulmonary hemodynamic parameters in grade-3 group. Pulmonary hypertension and high pulmonary capillary wedge pressure persisted postoperatively in the 2 patients with grade-3 pulmonary artery pathologies.