Pulmonary hypertension in patients with mitral valvular heart disease before and after surgical correction .

Urgency of the problem Hemodynamic consequence of mitral stenosis are stagnant in the pulmonary circulation and increased pulmonary artery pressure. Pulmonary hypertension largely determines the clinical picture of mitral stenosis. According to various authors the frequency of occurrence of pulmonary hypertension in patients with mitral defect is 25 - 56% (Raza, T and Dilawar; 2009), which greatly exacerbates the prediction products (Iwamoto Y, Tamai A, 2011)

The purpose and objectives of the study: Identify changes in hemodynamic parameters in patients undergoing mitral valve replacement To determine the dynamics of pulmonary hypertension in patients with mitral heart disease before and after surgical correction

Materials and Methods. 20 patients (12 women and 8 men) aged 34 to 52 years (42,55 ± 4,92 years) were examined at The Republican Center of Surgery named after Vakhidov V. with a diagnosis of chronic rheumatic heart disease, combined mitral heart disease with severe stenosis of the mitral orifice (mitral orifice area ≤ 1,5 cm ²) and mitral valve insufficiency (MC) II-III degree, pulmonary hypertension of 2-3 degrees. Age blemish more than 3 years.

Exclusion criteria were: Non-rheumatic heart disease etiology Congenital heart defects Systemic connective tissue disease Idiopathic pulmonary hypertension and hereditary Lung diseases

The examination program clinical examination laboratory diagnosis ECG Echocardiography in the Dynamics (before and after prosthesis mitral valve on the 1st day, 1 month, 3 months, 6 months) Chest X-ray Catheterization of the heart cavities

clinical examination Shortness of breath on exertion 12 8 Women n= 12 Men N = 8 Shortness of breath on exertion 12 8 Shortness of breath at rest 6 fainting 4 2 Expressed general cyanosis Orthopnea 7 Pain in the heart of a continuing nature 5 Hemoptysis hoarseness Pain in the liver 10 Swelling in the legs 9

Indicators of Echocardiography

The diameter of the left atrium into the dynamics according to echocardiography norm 2,8–3,5 см initial 5,2±0,68 1 day 5,0±0,39 1 month 4,1±0,72* 3 months 3,6±0,54* 6 months 3,3±0,65 * - р<0,05

The diameter of the right ventricular cavity in the dynamics according to echocardiography norm 2,5–3,9см initial 4,9±0,58 1 day 4,9±0,91 1 month 4,3±0,84 3 months 3,8±0,35* 6 months 3,6±0,46 * - р<0,05

Dynamics of pulmonary hypertension according to echocardiography norm Up to 25 mm Hg. initial 68,6±11,89 1 day 63,2±5,75 1 month 58,1±3,91* 3 months 45,3±3,36* 6 months 42,3±6,02 * - р<0,05

Conclusion Continued existence of pulmonary hypertension is accompanied by the development of natural organic proliferative processes in the wall of the arterioles of the pulmonary circulation, which is gradually obliterating. These irreversible changes in pulmonary vascular support persistent increase in pulmonary artery pressure, which persists even after surgical correction.

The findings 1. After surgical correction of mitral stenosis holes observed statistically significant positive trend of all indicators echocardiography. 2. Mitral orifice area and pressure gradient on the mitral valve was repaired immediately after the operation. 3. The dimensions of the left atrium was significantly decreased at 1 month after mitral valve, right ventricle - 3 months. 4. Pulmonary hypertension has decreased, but in spite of the postoperative period, remained above the norm, combined with the clinical picture.

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