Case: Pulmonary Hypertension with Mitral Valve Stenosis with Dissociation Between Left Atrial Pressure and Pulmonary Pressure

Abstract

We would like to report a patient with mitral valve stenosis and dissociation between left atrial pressure and pulmonary artery pressure. The patient is a 75-year-old man with pulmonary hypertension. Echocardiography showed tricuspid valve regurgitation with pressure gradient of 88 mmHg and severe mitral valve stenosis. Because mitral valve stenosis was thought to be a cause of his pulmonary hypertension, we conducted a mitral valve replacement and he was admitted to our hospital. Right heart catheterization showed high pulmonary artery pressure of 104/58 (70) mmHg and pulmonary arterial wedge pressure of 27 mmHg, and mitral valve aria was 0.82 cm2. Although he had no evidences of collagen diseases or pulmonary diseases caused of pulmonary hypertension, the dissociation between mean pulmonary artery pressure and pulmonary artery wedge pressure was observed. Our questions that we would like to discuss in this session are 1) whether a mitral stenosis could be a cause of pulmonary artery (or venous) hypertension with discrepancy between left atrial pressure and pulmonary wedge pressure, and 2) how to treat this patient, mitral valve replacement first or medications by vasodilators to pulmonary hypertension first.