The influence of aortic valve prosthesis diameter on the reversibility of pulmonary hypertension in isolated aortic stenosis.

Patients with pulmonary artery hypertension in the late course of isolated aortic stenosis are considered to have a poor prognosis. The aim of the following study was to determine the incidence of pulmonary artery hypertension, the postoperative course after valve replacement and the reversibility of pulmonary hypertension dependent on the valve prosthesis diameter. Seventy-six consecutive patients with symptomatic aortic stenosis undergoing isolated aortic valve replacement were studied. Preoperative right and retrograde left heart catheterization was performed in the cardiac catheterization laboratory. Three days after valve replacement, hemodynamic evaluation was repeated by a Swan-Gantz catheter. Patients with preoperative pulmonary hypertension (systolic pulmonary artery pressure > 30 mmHg, n = 53) differed significantly from patients without pulmonary hypertension (n = 23) with respect to systolic pulmonary pressure (52.4 +/- 17 vs. 24.3 +/- 4 mmHg), pulmonary capillary wedge pressure (22.3 +/- 10 vs. 8.8 +/- 2, p < 0.001), left ventricular end diastolic pressure (29.6 +/- 13 vs. 21.4 +/- 11) and valve area (0.64 +/- 0.10 vs. 0.79 +/- 0.11 cm2, p < 0.05). No difference was found with respect to age, maximum systolic transvalvular aortic gradient or cardiac output. Following valve replacement, the two groups did not differ significantly in fatal (2/53 vs. 1/23 or non-fatal (14/53 vs. 5/23) complications. In patients with pulmonary hypertension, systolic pulmonary pressure decreased from 52.4 +/- 17 to 38.9 +/- 6, diastolic pressure from 24.7 +/- 9 to 12.6 +/- 3, pulmonary capillary wedge pressure from 22.3 +/- 10 to 12.1 +/- 3, pulmonary capillary wedge pressure from 22.3 +/- 10 to 12.1 +/- 3 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)