Pulmonary Arterial Hemodynamic Assessment by Pulmonary Pulse Transit Time before and after Balloon Mitral Valvuloplasty.

Abstract

Background: Transthoracic echocardiography remains a crucial diagnostic tool for the identification of pulmonary arterial hypertension (PAH). We eagerly await the novel noninvasive techniques development that significantly advances our knowledge of the pulmonary circulation and right ventricle.

Objective: The objective of this study was to assess pulmonary arterial hemodynamics using pulmonary pulse transit time (pPTT) following balloon mitral valvuloplasty (BMV).

Patients and methods: Thirty-three patients with moderate-to-severe mitral stenosis (MS) with varying pulmonary hypertension degree who were presented to the National Heart Institute to do percutaneous mitral balloon valvuloplasty. Participants were evaluated for their echocardiographic variables including the pPTT, and they were followed up immediately, 1 week, 1 month, and 6 months after BMV.

Results: The study demonstrated a significant and progressive improvement in the right ventricular fractional area change and the tricuspid annular plane systolic excursion (TAPSE) following BMV; on the other hand, the pulmonary artery systolic pressure demonstrated a significant decrease postprocedure and during the follow-up period. On analysis, we found a significant change observed in pPTT values postprocedure (P < 0.001). This value showed a significant reduction immediately following the procedure and the decline continued over the subsequent follow-up periods. Each of these postprocedure measurements showed a significant decrease from the baseline (P < 0.001).

Conclusion: The pPTT was high in postcapillary pulmonary hypertension (in MS patients) and reduced after correction of causative pathology; the pPTT is a valid measure to assess the improvement in PAH after BMV.