Intracardiac Pressures in Pregnant Patients with Mitral Stenosis

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The influences of pregnancy on the pulmonary circulation in mitral stenosis (MS), were studied.1) Twenty-two cardiac patients underwent serial right heart cath-eterization with the use of flow-directed catheter without X-ray fluoroscopy during the course of pregnancy. 2) In 23 cases of MS, in whom cardiac catheterization had been performed before pregnancy, clinical courses during the pregnancy were studied.In the 26-32 weeks gestation: in MS (Group I), an elevation of peak systolic pulmonary arterial pressure (s-PAP) (mean+14.9mmHg, p<0.001) was seen; in contrast, in atrial septal defect (Group II), s-PAP remained constant. Right atrial pressure rose in the 26-32 weeks gestation in both the groups. Infusion of 200ml of dextran in 12-16 weeks gestation induced an elevation of s-PAP in Group I, especially in those who fell into heart failure in the succeeding courses of pregnancy; but not in Group II.In MS, in 12 cases, whose s-PAP before the pregnancy was below 35mmHg, no heart failure occurred during the pregancy; in 6 of 8 cases with s-PAP between 35 and 50mmHg, mild heart failure occurred; and in 2 cases with s-PAP over 50mmHg, severe heart failure occurred during the pregnancy.In conclusion, in MS, PAP rises during pregnancy, and s-PAP be-fore pregnancy and the reaction to dextran infusion can give suggestions for allowing pregnancy
International Heart Journal刊行会の論文