Impact of Pulmonary Artery Stiffness on Right Ventricular Function and Tricuspid Regurgitation after Successful Percutaneous Balloon Mitral Valvuloplasty: The Importance of Early Intervention

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 29; no. 10; pp. 1157 - 1163
• Main Author: Mahfouz, Ragab A.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.11.2012
• Subjects: Adolescent; Adult; Balloon Valvuloplasty - methods; Echocardiography, Doppler - methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mitral Valve Stenosis - diagnostic imaging; Mitral Valve Stenosis - physiopathology; Mitral Valve Stenosis - surgery; percutaneous balloon mitral valvuloplasty; Postoperative Complications; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiopathology; pulmonary artery stiffness; Retrospective Studies; right ventricular function; Time Factors; tricuspid regurgitation; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - physiopathology; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - etiology; Tricuspid Valve Insufficiency - physiopathology; Vascular Stiffness - physiology; Ventricular Function, Right - physiology; Young Adult; tricuspid regurgitation; pulmonary artery stiffness; percutaneous balloon mitral valvuloplasty; right ventricular function
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/j.1540-8175.2012.01785.x

Aims: We assessed impact of pulmonary artery stiffness (PAS) on the long‐term right ventricular (RV) function and tricuspid regurgitation (TR) changes after percutaneous balloon mitral valvuloplasty (PBMV). Methods and Results: Using Doppler echocardiography, PAS was calculated by dividing maximal frequency shift of pulmonary flow by the acceleration time, and mitral area, RV function, and degree of TR severity were evaluated before, immediately after, 6 months, and 12 months after successful PBMV in 81 consecutive patients. Compared with control subjects patients with mitral stenosis (MS) had significant higher PAS (P < 0.001). The PAS was significantly lower in patients with progressive RV function improvement and regression of TR (P < 0.001). PAS was significantly correlated with the degree of pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and E/E'm ratio (P < 0.0001, <0.0001, and < 0.001, respectively). Multivariate regression analysis showed that the PAS is an independent predictor of TR regression and sustained RV functional improvement after successful PBMV (P < 0.0001). Conclusions: The changes in RV function and TR after successful PBMV were significantly correlated with the degree of PAS. Despite a sustained increase in mitral valve area, some patients showed no regression of TR, and progressive RV dysfunction suggests a significant role of PAS on RV function and the degree of TR regression in patients with MS suggests that PBMV must be performed early, utilizing PAS as a noninvasive parameter for proper timing for PBMV.