This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Liu, C. P. Articles by Kass, D. A. Search for Related Content PubMed PubMed Citation Articles by Liu, C. P. Articles by Kass, D. A.

Circulation, Vol 85, 1447-1456, Copyright © 1992 by American Heart Association

ARTICLES

Reduced left ventricular compliance in human mitral stenosis. Role of reversible internal constraint

CP Liu, CT Ting, TM Yang, JW Chen, MS Chang, WL Maughan, W Lawrence and DA Kass
Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Md.

BACKGROUND. The mechanisms of depressed left ventricular (LV) pump performance in human mitral stenosis (MS) remain poorly understood, because reduced filling alone affects many hemodynamic measurements. Therefore, pressure-volume relations were examined in nine subjects with MS and compared with eight age-matched normal controls. METHODS AND RESULTS. Data were obtained by conductance catheter/micromanometer technique with transient inferior vena cava occlusion used to alter load and generate pressure-volume relations. In a subset of patients (n = 5), data were obtained both acutely and at 3 months (n = 4) after balloon valvuloplasty. MS patients had reduced cardiac output (3.3 +/- 0.9 versus 5.6 +/- 1.7 l/min) and end-diastolic volume (68.0 +/- 6.9 versus 115 +/- 31 ml) versus controls (p less than 0.001), with a mean transvalvular gradient of 14 +/- 6 mm Hg and estimated valve area of 0.6 +/- 0.2 cm2. Systolic function as assessed by the end-systolic pressure-volume relation was virtually the same in MS and control subjects. In contrast, end-diastolic pressure-volume relations in MS were consistently shifted leftward and had an increased slope (lower compliance) at matched pressure ranges (6.5 +/- 3.0 versus 2.2 +/- 0.53 ml/mm Hg at a mean diastolic pressure of 8 mm Hg, p less than 0.001). This change was not a result of reduced LV filling or probably of increased right heart loading. Valvuloplasty acutely returned chamber compliance to near normal, a change that was sustained at 3-month follow-up. Systolic function was little altered at this time. CONCLUSIONS. These data indicate an impairment of diastolic function in human MS that can be acutely reversed by balloon valvuloplasty. Lowered LV compliance probably results from a functional restriction caused by ventricular attachment to a thickened and immobile valve apparatus.

This article has been cited by other articles:

				A. A. Mangoni, T. M. Koelling, G. S. Meyer, C. W. Akins, and M. A. Fifer Outcome following mitral valve replacement in patients with mitral stenosis and moderately reduced left ventricular ejection fraction Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 90 - 94. [Abstract] [Full Text] [PDF]

				C. S Hayward, W. V Kalnins, and R. P Kelly Gender-related differences in left ventricular chamber function Cardiovasc Res, February 1, 2001; 49(2): 340 - 350. [Abstract] [Full Text] [PDF]

				C. S. Hayward, W. V. Kalnins, and R. P. Kelly Acute effects of 17beta -estradiol on ventricular and vascular hemodynamics in postmenopausal women Am J Physiol Heart Circ Physiol, November 1, 2000; 279(5): H2277 - H2284. [Abstract] [Full Text] [PDF]

				Y F Cheung, D J Penny, and A N Redington Serial assessment of left ventricular diastolic function after Fontan procedure Heart, April 1, 2000; 83(4): 420 - 424. [Abstract] [Full Text]

				T. Sakai, Y. Okita, Y. Ueda, T. Tahata, H. Ogino, K. Matsuyama, and S. Miki DISTANCE BETWEEN MITRAL ANULUS AND PAPILLARY MUSCLES: ANATOMIC STUDY IN NORMAL HUMAN HEARTS J. Thorac. Cardiovasc. Surg., October 1, 1999; 118(4): 636 - 641. [Abstract] [Full Text] [PDF]

				H. J. Patel, D. J. Polidori, J. J. Pilla, T. Plappert, D. Kass, M. S. J. Sutton, E. B. Lankford, and M. A. Acker Stabilization of Chronic Remodeling by Asynchronous Cardiomyoplasty in Dilated Cardiomyopathy : Effects of a Conditioned Muscle Wrap Circulation, November 18, 1997; 96(10): 3665 - 3671. [Abstract] [Full Text]

				P. Colin, M. Slama, A. Vahanian, Y. Lecarpentier, G. Motte, and D. Chemla Hemodynamic correlates of effective arterial elastance in mitral stenosis before and after balloon valvotomy J Appl Physiol, October 1, 1997; 83(4): 1083 - 1089. [Abstract] [Full Text] [PDF]

				A. Nussbacher, S. Arie, R. Kalil, P. Horta, M. D. Feldman, G. Bellotti, F. Pileggi, M. Ellis, W. H. Johnson, G. B. Camarano, et al. Mechanism of Adenosine-Induced Elevation of Pulmonary Capillary Wedge Pressure in Humans Circulation, August 1, 1995; 92(3): 371 - 379. [Abstract] [Full Text]

				R. D. Berger, M. R. Wolff, J. H. Anderson, and D. A. Kass Role of Atrial Contraction in Diastolic Pressure Elevation Induced by Rapid Pacing of Hypertrophied Canine Ventricle Circ. Res., July 1, 1995; 77(1): 163 - 173. [Abstract] [Full Text]