Perioperative Changes Of Hemodynamics And Plasma Vascular Active Factors In Rheumatic Valvular Patients With Pulmonary Hypertension

Patients with rheumatic heart disease (RHD) complicated pulmonary hypertension (PH) still had high morbidity and mortality . In contrast to the PH resulted from left-right shunt during the progresses of congenital heart disease (CHD), the PH in RHD is due to the mitral stenosis, which results in the reduced emptying of left atrium, where pressure is elevated and then transmitted to the pulmonary veins and this leads to pulmonary venous congestion followed by PH. The elevated pressure of the pulmonary artery results in the contraction of the terminal pulmonary arteries and elevated the resistance of pulmonary arterial flow. The worsen the valve stenosis is, the higher the resistance and the pressure of the pulmonary artery will be, and finally comes to right heart failure. The effective treatment is to replace the pathologic valve, which can decrease the resistance of the mitral valve . However, it will take a long time, or may be never, for the lung to recover after the improvement of the hemodynamics, and clinically some patients died after the operation. therefore, our experiments is designed to explore the perioperative changes of some vascular active factors in the rheumatic valvular patients, and the relationship between these factors with hemodynamics of the pulmonary and systemic circulation.28 patients, who suffered from RHD combined with PH and operated with mitral valve replacement procedure, were divided into three groups according to the mean pulmonary artery pressure (MPAP) monitored during operation. Group A included 10 patients with MPAP less than 30 mmHg, and 12 patients were included in Group B with MAPA ranging between 30 to 40 mmHg, and the other 6 patients with MPAP higher than 40 mmHg were in Group C. At the end of the cardiopulmonary bypass (CPB), the SPAP, DPAP, MPAP, and PAWP were significantly decreased as well as the levels of SVR and PVR. And then they all decreased gradually , companied with the increase of the cardiac index (CI) and output (CO). On the 7th day after operation, the MPAP were less than 20...