Hemodynamic studies on 72 patients with pure rheumatic mitral stenosis; hemodynamic aspects and correlation with electrocardiographic findings.

Abstract

Data in regard to alterations in circulatory dynamics at rest noted in 72 patients (74 studies) with pure rheumatic mitral stenosis are reported. The resting hemodynamic parameters are assessed and analyzed statistically with special emphasis upon inter-relationship among physiologic variables and their relation to electrocardiographic findings. The patterns of hemodynamic response to exercise in part of the patients are also presented. Catheterization of the right side of the heart was performed in 34 studies and catheterization of both right and left sides of the heart in 40. Only one patients was in Class 1, 22 patients were in Class 2 and the remaining 50 patients were in Class 3 or 4 (American Heart Association Functional Classification.) (There was one patient who was studied twice, once before operation when he was in Class 3 and the other time one year after operation, being in Class 2). Their ages ranged from 16 to 53 years; 37 were males and 35 were females. Thirty-two of the total 72 patients were in auricular fibrillation. The diagnoses were confirmed in 40 patients, 38 at surgery and 2 by autopsy. A majority of the patients at rest showed considerable mitral end-diastolic pressure gradient, elevated left atrial, pulmonary "capillary" and pulmonary artery mean pressures, increased total pulmonary and pulmonary arteriolar resistance, and/or not infrequently low cardiac index and stroke index. In some patients there was also some elevation of right ventricular end-diastolic and right atrial mean pressure, increased right ventricular work, low peripheral arterial mean pressure and some peripheral arterial oxygen desaturation. Left ventricular end-diastolic pressure was elevated in about a third of the patients in whom the pressures were measured. Calculated mitral valve area ranged from 0.4 to 2.5cm2 with an average of 1.0cm2.