Background: Patients with mitral valve disease and concomitant severe pulmonary hypertension are less likely to survive mitral valve surgery. However, because of its potential benefits, these patients should not be refused surgery.
Methods: In this study, 19 patients with primary mitral stenosis and severe pulmonary hypertension who underwent mitral valve surgery at the Philippine Heart Center between 2011 and 2014 were studied for perioperative survival. A chart review was conducted and each patient was described according to the NYHA functional class, presence of atrial fibrillation, acute manifestation, right-sided heart failure, presence of concomitant valve lesions and type of surgery done. Hemodynamic parameters pre- and post-operatively were also recorded.
Results: Among all patients, 53% have acute manifestation but are not in cardiogenic shock. Signs and symptoms of right-sided heart failure were present in 11% of the patients. Majority (68%) was in NYHA functional class II. The mean pulmonary artery systolic pressure was 90±19 mm Hg (range, 60 to 137 mmHg), with significant decrease post-operatively.
Conclusion: Ultimately, perioperative risk for mitral valve surgery is increased but is acceptable, and acute presentation and right-sided heart failure are the two parameters that significantly affect morbidity and mortality.