Skip to main content
Duke University Libraries
DukeSpace Scholarship by Duke Authors
  • Login
  • Ask
  • Menu
  • Login
  • Ask a Librarian
  • Search & Find
  • Using the Library
  • Research Support
  • Course Support
  • Libraries
  • About
View Item 
  •   DukeSpace
  • Duke Scholarly Works
  • Scholarly Articles
  • View Item
  •   DukeSpace
  • Duke Scholarly Works
  • Scholarly Articles
  • View Item
JavaScript is disabled for your browser. Some features of this site may not work without it.

Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis.

Thumbnail
View / Download
139.2 Kb
Date
2010-11
Authors
Hart, Stephen A
Krasuski, Richard A
Wang, Andrew
Kisslo, Katherine
Harrison, J Kevin
Bashore, Thomas M
Repository Usage Stats
210
views
1,520
downloads
Abstract
BACKGROUND AND AIM OF THE STUDY: Pulmonary hypertension frequently complicates mitral stenosis, with a subset of these patients exhibiting pressures well in excess of their mitral valve hemodynamics. The prevalence of this condition and its impact on clinical outcome following percutaneous balloon mitral commissurotomy (PBMC) is unknown. METHODS: The transpulmonary gradient (TPG) was measured in 317 patients undergoing PBMC; patients were subsequently defined as having either an appropriate or excessive TPG (< or =15 mmHg or >15 mmHg, respectively). Twenty-two patients were excluded due to valvuloplasty-related significant mitral regurgitation. The remaining 295 patients (250 females, 45 males; mean age 52 +/- 13 years) were prospectively followed up, with each patient underwent serial echocardiography. RESULTS: Among the patients, 214 (73%) had pulmonary hypertension (pulmonary artery pressure >25 mmHg) and 55 (19%) also had an elevated TPG. Females were almost fivefold more likely than males to have an elevated TPG (p = 0.003). Patients with an elevated TPG had a worse mean NYHA functional class than those with a normal TPG (3.0 +/- 0.5 versus 2.7 +/- 0.6, p = 0.01), while the mitral valve area (MVA) was slightly smaller in patients with an elevated TPG (1.0 +/- 0.2 versus 1.1 +/- 0.2 cm2, p = 0.003). All patients demonstrated a significant increase in MVA after commissurotomy (final MVA 1.7 +/- 0.6 cm2, p < 0.001 for elevated TPG; 1.8 +/- 0.4 cm2, p < 0.001 for normal TPG), and the NYHA class at six months was improved for all patients (2.8 +/- 0.6 versus 1.6 +/- 0.7, p < 0.001). The improvements in NYHA class, TPG and MVA were sustained at 36 months. CONCLUSION: Pulmonary hypertension with elevated TPG occurs in patients with mitral stenosis, and is significantly more common in females. Despite worse symptoms and higher right-sided pressures, PBMC is equally successful in patients with a normal TPG, and provides sustained benefit for up to 36 months after the procedure.
Type
Journal article
Subject
Adult
Aged
Blood Pressure
Cardiac Catheterization
Catheterization
Chi-Square Distribution
Echocardiography, Doppler
Echocardiography, Transesophageal
Female
Follow-Up Studies
Humans
Hypertension, Pulmonary
Male
Middle Aged
Mitral Valve Stenosis
North Carolina
Prospective Studies
Pulmonary Artery
Pulmonary Circulation
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
Permalink
https://hdl.handle.net/10161/11035
Collections
  • Scholarly Articles
More Info
Show full item record

Scholars@Duke

Bashore

Thomas Michael Bashore

Professor of Medicine
The major areas of research involve mostly hemodynamic and imaging research: 1. Valvular heart disease. 2. Adult congenital heart disease. 3. Pulmonary Hypertension. 4. Complex cardiovascular problems. The Valvular Disease Program and Adult Congenital Program are nationally recognized, and many trainees have gone on to academic careers at a number of universities. Dr. Bashore is now or recently has been on the Editorial Boards of Circulation, the American Jou
Harrison

John Kevin Harrison

Professor of Medicine
Krasuski

Richard Andrew Krasuski

Professor of Medicine
Wang

Andrew Wang

Professor of Medicine
Structural heart diseases, including valvular heart disease, hemodynamics, infective endocarditis, and hypertrophic cardiomyopathy
Alphabetical list of authors with Scholars@Duke profiles.
Open Access

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy

Rights for Collection: Scholarly Articles


Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info

Make Your Work Available Here

How to Deposit

Browse

All of DukeSpaceCommunities & CollectionsAuthorsTitlesTypesBy Issue DateDepartmentsAffiliations of Duke Author(s)SubjectsBy Submit DateThis CollectionAuthorsTitlesTypesBy Issue DateDepartmentsAffiliations of Duke Author(s)SubjectsBy Submit Date

My Account

LoginRegister

Statistics

View Usage Statistics
Duke University Libraries

Contact Us

411 Chapel Drive
Durham, NC 27708
(919) 660-5870
Perkins Library Service Desk

Digital Repositories at Duke

  • Report a problem with the repositories
  • About digital repositories at Duke
  • Accessibility Policy
  • Deaccession and DMCA Takedown Policy

TwitterFacebookYouTubeFlickrInstagramBlogs

Sign Up for Our Newsletter
  • Re-use & Attribution / Privacy
  • Harmful Language Statement
  • Support the Libraries
Duke University