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.