Plicní hypertenze u aortální stenózy

Cor Vasa 2004, 45(7):326-330

Pulmonary hypertension in aortic stenosis

Roman Čerbák^*, Helena Bedáňová, Leona Bočková, Sylva Kovalová, Josef Nečas, František Štětka, Jaroslav Vespalec: Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

Aim of study:
In some cases of advanced stages, aortic stenosis is associated with pulmonary hypertension. Our study was designed to determine its incidence, causes and implications for the patient's fate.

Patients and method:
100 consecutive patients with simple aortic stenosis, free of associated valve disease and coronary artery disease, referred for surgery for aortic stenosis at the Brno-based Center of Cardiovascular and Transplant Surgery, were examined using invasive and non-invasive techniques to determine the presence of pulmonary hypertension, left ventricular systolic and diastolic dysfunction, and left atrial size.

Results:
Pulmonary hypertension was present significantly more often in patients with left ventricular systolic and/or diastolic dysfunction (p < 0.01) and more extensive left atrial dilatation (p < 0.001). Operative mortality was 2% and unrelated to pulmonary hypertension. Two patients who died during postoperative follow-up were even shown to have pulmonary normotension. Severe pulmonary hypertension (mean pulmonary artery pressure > 50 mm Hg) was diagnosed in two female patients with a serious and prolonged postoperative course.

Conclusions:
Pulmonary hypertension (mean pulmonary artery pressure ³ 30 mm Hg and ³ 40 mm Hg) was present in 21% and 10% of our patients, respectively, and was associated with the more advanced stages of aortic stenosis showing signs of left ventricular systolic or diastolic dysfunction, and more extensive left atrial dilatation.