Pulmonary Hypertension Among Patients with Mitral Valve Stenosis Disease

Abstract

Objectives: This study aims to evaluate the impact of mitral valve stenosis on the right heart, particularly assessing the prevalence and implications of PHT as a marker of disease progression and poor prognosis.

Methods: We conducted a cross-sectional study with data analysis on 41 patients presenting at the outpatient department of Shahid Al-Mihrab Hospital, Marjan Medical City, Al-Hilla, Iraq. Patients were referred for transthoracic echocardiographic (TTE) evaluation, assessing mitral valve area (MVA), right heart function, tricuspid regurgitation velocity, and the presence and severity of PHT. Additional transesophageal echocardiography (TEE) was performed to assess left atrial appendage and MVA. Data were collected between November 2021 and November 2022.

Results: All 41 patients (100%) presented with mitral valve stenosis, predominantly due to rheumatic heart disease. The cohort included 15 women (36.6%) and 26 men (63.4%) with an age range of 32 to 60 years (mean ± SD: 43.1 ± 6.9 years). Sinus rhythm was observed in 37 patients (90.2%), with the remaining four patients exhibiting atrial fibrillation. Both 2D and 3D echocardiography were utilized to obtain MVA measurements, with data from bicommissural and long-axis views.

Conclusion: The presence of PHT in patients with mitral valve stenosis is indicative of disease decompensation, accompanied by left ventricular and atrial dysfunction and compromised compensatory mechanisms. This condition, initially presenting as post-capillary PHT, may evolve with ongoing vascular remodeling as left atrial pressure remains elevated. Persistent PHT is common in these patients and is a marker of poor prognosis.