Isolated chronic mitral regurgitation with preserved systolic left ventricular function and severe pulmonary hypertension

Department of Medicine, Mount Sinai Medical Center, New York, New York 10029.

Pulmonary hypertension in chronic mitral valve disease has been related most commonly to left ventricular dysfunction or mitral stenosis; its association with chronic, isolated mitral regurgitation and preserved left ventricular systolic function is unclear. In 41 catheterized patients with chronic mitral regurgitation (known history of mitral regurgitation for greater than 18 months) and preserved left ventricular systolic function (ejection fraction greater than 0.55), historic, electrocardiographic, echocardiographic and hemodynamic variables were analyzed. Ten patients (Group I) had normal pulmonary artery systolic pressure (less than 30 mm Hg), whereas 31 patients had pulmonary hypertension. Pulmonary artery systolic pressure was mildly increased (30 to 49 mm Hg) in 13 patients (Group II) and was greater than or equal to 50 mm Hg in 18 patients (Group III). Univariate analysis showed the more frequent occurrence of male gender and ruptured chordae tendineae in the groups with pulmonary hypertension. Mean pulmonary capillary wedge pressure, size of the V wave in pulmonary capillary wedge pressure and pulmonary arteriole resistance were higher, whereas cardiac index was lower in the hypertension groups. Multivariate stepwise analysis revealed higher mean pulmonary capillary wedge pressure and pulmonary arteriole resistance as the only variables independently differing among groups. In conclusion, pulmonary hypertension occurs frequently (76% of cases) in patients with chronic, isolated mitral regurgitation with preserved left ventricular systolic function. In these patients, a severe increase in pulmonary capillary wedge pressure is associated with elevation in pulmonary artery resistance, a finding similar to that in mitral stenosis.

This article has been cited by other articles:

				M. Ghoreishi, C. F. Evans, C. R. DeFilippi, G. Hobbs, C. A. Young, B. P. Griffith, and J. S. Gammie Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation: Implications for timing of surgery J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): 1439 - 1452. [Abstract] [Full Text] [PDF]

				A. Barbieri, F. Bursi, F. Grigioni, C. Tribouilloy, J. F. Avierinos, H. I. Michelena, D. Rusinaru, C. Szymansky, A. Russo, R. Suri, et al. Prognostic and therapeutic implications of pulmonary hypertension complicating degenerative mitral regurgitation due to flail leaflet: A Multicenter Long-term International Study Eur. Heart J., March 2, 2011; 32(6): 751 - 759. [Abstract] [Full Text] [PDF]

				T. Le Tourneau, D. Messika-Zeitoun, A. Russo, D. Detaint, Y. Topilsky, D. W. Mahoney, R. Suri, and M. Enriquez-Sarano Impact of Left Atrial Volume on Clinical Outcome in Organic Mitral Regurgitation J. Am. Coll. Cardiol., August 10, 2010; 56(7): 570 - 578. [Abstract] [Full Text] [PDF]

				T. Le Tourneau, M. Richardson, F. Juthier, T. Modine, G. Fayad, A.-S. Polge, P.-V. Ennezat, C. Bauters, A. Vincentelli, and G. Deklunder Echocardiography predictors and prognostic value of pulmonary artery systolic pressure in chronic organic mitral regurgitation Heart, August 1, 2010; 96(16): 1311 - 1317. [Abstract] [Full Text] [PDF]

				J. Magne, P. Lancellotti, and L. A. Pierard Exercise Pulmonary Hypertension in Asymptomatic Degenerative Mitral Regurgitation Circulation, July 6, 2010; 122(1): 33 - 41. [Abstract] [Full Text] [PDF]

				D.-H. Kang, J. H. Kim, J. H. Rim, M.-J. Kim, S.-C. Yun, J.-M. Song, H. Song, K.-J. Choi, J.-K. Song, and J.-W. Lee Comparison of Early Surgery Versus Conventional Treatment in Asymptomatic Severe Mitral Regurgitation Circulation, February 17, 2009; 119(6): 797 - 804. [Abstract] [Full Text] [PDF]

				S. Rich and M. Rabinovitch Diagnosis and Treatment of Secondary (Non-Category 1) Pulmonary Hypertension Circulation, November 18, 2008; 118(21): 2190 - 2199. [Full Text] [PDF]