![]() The primary outcome seen was a change in pulmonary hemodynamics after RMA secondary outcomes were composite adverse events, including all-cause mortality and readmission for heart failure. ![]() The mean follow-up period was 54☒7 months. Patients were segregated into two groups: low TPG (≤12 mmHg) and elevated TPG (>12 mmHg). Methods: Pre- and postoperative (1 month) cardiac catheterization was performed in 64 patients with severely impaired left ventricular function (i.e., ejection fraction ≤40%) and pre-existing PH (mean pulmonary artery pressure (PAP) ≥25 mmHg) who underwent RMA. Satoshi Kainuma 1,2, Koichi Toda 1, Shigeru Miyagawa 1, Yasushi Yoshikawa 1, Hiroki Hata 1, Daisuke Yoshioka 1, Takuji Kawamura 1, Ai Kawamura 1, Noriyuki Kashiyama 1, Takayoshi Ueno 1, Toru Kuratani 1, Toshihiro Funatsu 2, Haruhiko Kondoh 2, Takafumi Masai 3, Arudo Hiraoka 4, Taichi Sakaguchi 4, Hidenori Yoshitaka 4, Takashi Daimon 5, Kazuhiro Taniguchi 2, Yoshiki Sawa 1 Osaka Cardiovascular Surgery Research (OSCAR) Groupġ Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan 2 Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan 3 Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Osaka, Japan 4 Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan 5 Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Hyogo, JapanĬontributions: (I) Conception and design: S Kainuma, Y Sawa (II) Administrative support: D Yoshioka, T Kawamura, A Kawamura, N Kashiyama (III) Provision of study materials or patients: K Toda, S Miyagawa, Y Yoshikawa, H Hata, T Ueno, T Kuratani (IV) Collection and assembly of data: T Masai, A Hiraoka, T Sakaguchi, H Yoshitaka, T Funatsu, H Kondoh (V) Data analysis and interpretation: S Kainuma, T Daimon, K Taniguchi (VI) Manuscript writing: All authors (VII) Final approval of manuscript: All authors.īackground: This study retrospectively examined the association between elevated trans-pulmonary gradient (TPG), which reflects pre-capillary contribution to pulmonary hypertension (PH), and postoperative pulmonary hemodynamics and outcomes following restrictive mitral annuloplasty (RMA) in patients with pre-existing PH. Interviews with Outstanding Guest Editors.Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.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. Pulmonary hypertension with elevated TPG occurs in patients with mitral stenosis, and is significantly more common in females. The improvements in NYHA class, TPG and MVA were sustained at 36 months. 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). 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). Females were almost fivefold more likely than males to have an elevated TPG (p = 0.003). The remaining 295 patients (250 females, 45 males mean age 52 +/- 13 years) were prospectively followed up, with each patient underwent serial echocardiography.Īmong the patients, 214 (73%) had pulmonary hypertension (pulmonary artery pressure >25 mmHg) and 55 (19%) also had an elevated TPG. Twenty-two patients were excluded due to valvuloplasty-related significant mitral regurgitation. The transpulmonary gradient (TPG) was measured in 317 patients undergoing PBMC patients were subsequently defined as having either an appropriate or excessive TPG (15 mmHg, respectively). The prevalence of this condition and its impact on clinical outcome following percutaneous balloon mitral commissurotomy (PBMC) is unknown. Pulmonary hypertension frequently complicates mitral stenosis, with a subset of these patients exhibiting pressures well in excess of their mitral valve hemodynamics.
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