HEMODYNAMIC EVALUATION OF STENOTIC CARDIAC VALVES .1. EFFECT OF VENTRICULOGRAPHY AND ATROPINE ON MITRAL-STENOSIS

Mitral ara is the parameter used for quantitating mitral stenosis (MS) severity. When mitral gradient (MG) is low and reduction of mitral valve area (MVA) might be critical, interventions presumably increasing mitral valve flow (MVF), such as stress or atrial pacing, were carried out. The aim of this study was to analyze in 28 patients the combined effect of left ventriculography (LVG) and i.v. atropine (ATR) in the hemodynamic evaluation of MS. The rationale for combining these 2 interventions is to add up the ATR-positive chronotropic effect to the LVG potentiation of cardiac output. The LVG plus ATR markedly accelerated heart rate (from 80 .+-. 14 to 104 .+-. 18 beats/min, P < 0.001), mildly increased cardiac index (from 2.6 .+-. 0.6 to 2.9 .+-. 0.6 1/min/m2, P < 0.05) and importantly increased MVF (from 136 .+-. 30 to 172 .+-. 46 ml/beat, P < 0.001). Pulmonary wedge pressure increased (from 14 .+-. 5 to 21 .+-. 5 mm Hg, P < 0.001) because of an important increment of MG (from 12 .+-. 6 to 18 .+-. 7 mm Hg, P < 0.001). None of 6 cases with mild MS (MVA > 1.5 cm2) and 9 of 10 cases with severe MS (MVA .ltoreq. 1.0 cm2) had MG after LVG plus ATR > 12 mm Hg. The remaining case with severe MS and the 2 cases (out of 12) with moderate MS having MG after LVG plus ATR .ltoreq. 12 mm Hg had, at surgical evaluation, noncritically reduced MVA. This study shows that LVG plus ATR is a valid and easy intervention for increasing MVF during cardiac catheterization. It also allows the reclassification of patients with low baseline MG and reduced MVA into 2 subgroups: Cases with critically reduced MVA at surgery achieve a postintervention MG > 12 mm Hg and those cases with noncritically reduced MVA achieve a postintervention MG .ltoreq. 12 mm Hg.