Left ventricular diastolic pressure-volume response immediately after successful percutaneous transvenous mitral commissurotomy

Abstract

The left ventricular (LV) diastolic pressure-volume response after percutaneous transvenous mitral commissurotomy (PTMC) was investigated to determine whether rt was related to the baseline conditions of the left ventricle. Left ventriculography was performed, and the measurements of LV pressure were obtained in 32 patients before and after PTMC. Mitral valve area increased from 1.0 ± 0.3 to 1.9 ± 0.4 cm 2 (p < 0.005) after PTMC, which caused a decrease in left atrial mean pressure (14.8 ± 5.9 to 7.4 ± 2.7 mm Hg; p < 0.005). LV end-diastolic pressure increased in all patients 5 minutes after PTMC. However, patients could be divided into 2 groups according to the following changes in LV end-diastolic pressure 20 minutes after PTMC: In 22 patients, LV end-diastolic pressure returned to the near-baseline level 20 minutes after PTMC (before 5.0 ± 2.2, 5 minutes after 8.6 ± 3.1, and 20 minutes after 6.3 ± 2.5 mm Hg) with a significant increase in LV end-diastolic volume index (64 ± 12 to 74 ± 14 ml/m 2; p < 0.001) and augmentation of LV stroke volume index (39 ± 9 to 47 ± 11 ml/m 2; p < 0.001). However, in the remaining 10 patients with a larger LV volume (>80 ml/m 2) and reduced ejection fraction (<50%) at baseline, LV end-diastolic pressure further increased 20 minutes after PTMC (before 5.5 ± 2.8, 5 minutes after 7.8 ± 2.7, and 20 minutes after 11.0 ± 2.9 mm Hg) without significant changes in LV volume. These findings suggest that the increase in LV end-diastolic pressure immediately after PTMC increased LV volume with the augmentation of LV stroke volume and that this diastolic pressure-volume response was affected by the baseline LV condition.