Improvement in Cardiopulmonary Function in Mitral Stenosis after Percutaneous Balloon Mitral Valvuloplasty

Abstract

The pulmonary function study reported recently by Yoshioka et al1Yoshioka T Nakanishi N Okubo S Kunieda T Ishikura F Nagata S Improvement in pulmonary function in mitral stenosis after percutaneous transvenous mitral commissurotomy.Chest. 1990; 98: 290-294Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar suggests that in mitral stenosis the greater part of ventilatory dysfunction is caused by hemodynamic alterations and is reversible after percutaneous balloon mitral valvuloplasty. That this is indeed the case is further supported by the cardiopulmonary exercise testing results reported recently from China in patients following percutaneous mitral valvuloplasty.2Chen C Lo Z Huang Z Inoue K Cheng TO Percutaneous transseptal balloon mitral valvuloplasty: the Chinese experience in 30 patients.Am Heart J. 1988; 115: 937-947Abstract Full Text PDF PubMed Scopus (48) Google Scholar, 3Chen CR Hu SW Chen JY Zhou YL Mei J Cheng TO Percutaneous mitral valvuloplasty with a single rubber-nylon balloon (Inoue balloon): long-term results in 71 patients.Am Heart J. 1990; 120: 561-568Abstract Full Text PDF PubMed Scopus (37) Google Scholar Although the cardiopulmonary exercise testing showed no immediate improvement within 30 days of the procedure, very good results were seen in the maximal oxygen pulse and maximal oxygen consumption per kilogram of body weight as well as the anaerobic threshold per kilogram of body weight during the follow-up period of 14 to 48 months (mean, 27.1±11.6 months) Table 1).3Chen CR Hu SW Chen JY Zhou YL Mei J Cheng TO Percutaneous mitral valvuloplasty with a single rubber-nylon balloon (Inoue balloon): long-term results in 71 patients.Am Heart J. 1990; 120: 561-568Abstract Full Text PDF PubMed Scopus (37) Google Scholar Therefore, regarding the expectation that percutaneous balloon mitral valvuloplasty will improve not only the ventilatory function but also exercise performance, I do not think that it is “stretching the effect of the balloon” too much.4Bittl JA Stretching the effect of the balloon: mitral valvuloplasty and pulmonary function (editorial).Chest. 1990; 98: 259-260Abstract Full Text Full Text PDF Scopus (2) Google ScholarTable 1Cardiopulmonary Exercise Testing Results*Values are expressed as mean ± SD. PMV denotes percutaneous mitral valvuloplasty; AT, anaerobic threshold.VariablePre-PMVPost-PMVFollow-upO2 pulsemax, ml/beat5.9± 1.56.8±1.6†p>0.05.8.9±2.2‡p<0.001. V˙o2max/kg. ml/min/kg36.8±9.941.5±8.5†p>0.05.49.9±9.2‡p<0.001. V˙o2AT/kg, ml/min/kg14.3±1.616.4±4.9†p>0.05.19.5±5.8‡p<0.001.* Values are expressed as mean ± SD. PMV denotes percutaneous mitral valvuloplasty; AT, anaerobic threshold.† p>0.05.‡ p<0.001. Open table in a new tab Incidentally, there was a typographic error in paragraph 3, line 12 of Bittl's editorial in that same issue of Chest.4Bittl JA Stretching the effect of the balloon: mitral valvuloplasty and pulmonary function (editorial).Chest. 1990; 98: 259-260Abstract Full Text Full Text PDF Scopus (2) Google Scholar The first part of the fourth sentence in that paragraph should read: “Since the effect of lowering left atrial pressure alone would be to decrease [not increase] pulmonary vascular resistance… .”