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

2. 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 % (Raza, T and Dilawar; 2009), which greatly exacerbates the prediction products (Iwamoto Y, Tamai A, 2011)

3. 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

4. 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.

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

6. 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

7. 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

8. Indicators of Echocardiography

9. 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

10. 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

11. 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

12. 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.

13. 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.

14. Thank you for your attention