Key result
Mitral valve replacement in young children with pulmonary venous hypertension substantially lowered postoperative pulmonary arterial pressure in 13 of 16 evaluated patients.
Why the study?
Does mitral valve intervention reduce pulmonary arterial resistance in young children with pulmonary venous hypertension?
Observational (n=94)
No
Does mitral valve intervention reduce pulmonary arterial resistance in young children with pulmonary venous hypertension?
In young children with mitral stenosis, relief of pulmonary venous hypertension via mitral valve intervention leads to a significant reduction in pulmonary arterial resistance, similar to the response seen in adults.
Answers are grounded in this paper and cite their sources.
May support mitral valve replacement to lower pressures in young children; leaves open resistance reduction and long-term outcomes.
OBJECTIVE AND DESIGN: Pulmonary venous hypertension is a well-characterized cause of pulmonary hypertension in adults, but little is known regarding the relationship between left atrial pressure and pulmonary arteriolar resistance in the young. Also, in adults relief of pulmonary venous hypertension results in a marked fall in pulmonary arteriolar resistance, but this could be different in children because vascular changes are more severe in young patients than adults with mitral stenosis. We inspected records of children at Children's Hospital Boston having mitral balloon valvuloplasty, and patients ≤5 years old having mitral valve replacement, to determine (1) the relationship between left atrial pressure and pulmonary arterial pressure and resistance (n = 94 children, median age 17.8 months) and (2) how pulmonary arteriolar resistance changes after mitral valve replacement. RESULTS: The average indexed pulmonary arteriolar resistance was 7.8 ± 5.9 units and was unrelated to age but was positively related to left atrial pressure. There was great variability in pulmonary arteriolar resistance for any given left atrial pressure. Pulmonary arterial pressure (n = 16) and pulmonary arterial resistance (n = 9) were measured before and after mitral valve replacement (median = 29.4 months old). Despite preoperative indexed pulmonary arterial resistance of ≥5 units in 11 of 15 patients, postoperative pulmonary arterial pressure was substantially lower in all save three, and two patients with high pulmonary arterial pressure still had high left atrial pressure postoperatively (25 mmHg). CONCLUSIONS: We conclude that in young children, as in adults, pulmonary arterial resistance generally falls greatly with reduction in left atrial pressure.
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Kulik et al. (2011) conducted an observational in Pulmonary venous hypertension (n=94). Mitral valve replacement vs. Preoperative baseline was evaluated on Pulmonary arterial pressure and resistance. Mitral valve replacement in young children with pulmonary venous hypertension substantially lowered postoperative pulmonary arterial pressure in 13 of 16 evaluated patients.
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