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J Am Coll Cardiol, 2005; 45:1034-1040, doi:10.1016/j.jacc.2004.10.073
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: VALVULAR HEART DISEASE

Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement

Mingzhou Li, MD, PhD, Jean G. Dumesnil, MD, FACC, Patrick Mathieu, MD and Philippe Pibarot, DVM, PhD, FACC*

Research Group in Valvular Heart Diseases, Research Center of Laval Hospital/Quebec Heart Institute, Laval University, Sainte-Foy, Quebec, Canada

Manuscript received April 1, 2004; accepted October 14, 2004.

* Reprint requests and correspondence: Dr. Philippe Pibarot, Laval Hospital, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada, G1V 4G5 (Email: philippe.pibarot{at}med.ulaval.ca).

OBJECTIVES: We sought to determine the impact of valve prosthesis-patient mismatch (PPM) on pulmonary arterial (PA) pressure after mitral valve replacement (MVR).

BACKGROUND: Pulmonary arterial hypertension is a serious complication of mitral valve disease, and it is a major risk factor for poor outcome after MVR. We hypothesized that valve PPM might be a determinant of PA hypertension after MVR.

METHODS: Systolic PA pressure was measured by Doppler echocardiography in 56 patients with normally functioning mitral prosthetic valves. Mitral valve effective orifice area (EOA) was determined by the continuity equation and indexed for body surface area.

RESULTS: Thirty patients (54%) had PA hypertension defined as systolic PA pressure >40 mm Hg, whereas 40 patients (71%) had PPM defined as an indexed EOA ≤1.2 cm2/m2. There was a significant correlation (r = 0.64) between systolic PA pressure and indexed EOA. The average systolic PA pressure and prevalence of PA hypertension were 34 ± 8 mm Hg and 19% in patients with no PPM versus 46 ± 8 mm Hg and 68% in patients with PPM (p < 0.001). In multivariate analysis, the indexed EOA was by far the strongest predictor of systolic PA pressure.

CONCLUSIONS: Persistent PA hypertension is frequent after MVR and strongly associated with the presence of PPM. The clinical implications of these findings are important given that PPM can largely be avoided by using a simple prospective strategy at the time of operation.

Abbreviations and Acronyms
  EOA = effective orifice area
  MVR = mitral valve replacement
  PA = pulmonary arterial
  PPM = prosthesis-patient mismatch


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