CONCLUSION:
We conclude that MVR is safe and effective even in the presence of
severe PHT as long as the pulmonary arterial pressures are below
systemic pressures. With suprasystemic PHT, MVR carries a high risk of
mortality, and the patient continues to have persistent PHT in the
postoperative period. Significant reduction in PHT following MVR takes
place only gradually and in this study about 1 to 3 months period showed
a decline in PHT as compared to the previous belief of immediate
reduction in PHT in majority of the patients. This explains the
multifactorial causes of PHT in patients with Rheumatic mitral valvular
heart disease and severe PHT.
LIMITATIONS :
Lack of follow-up of Pulmonary vascular dynamics by catheterization
constitutes a limitation of this study and was related primarily to
economic factors. A postoperative lung biopsy might have added to the
information, but this was not undertaken as most of the patients refused
consent for it.