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PubMed2004

Hemolysis after mitral valve repair: mechanisms and treatment.

BACKGROUND: The objectives of this study were to determine the mechanisms of hemolysis after mitral valve repair and to determine outcomes after surgical treatment (mitral replacement or re-repair). METHODS: Between 1981 and 2002, 32 patients (mean age, 58 years) presented with hemolytic anemia after mitral valve repair for degenerative, rheumatic, or ischemic mitral regurgitation (MR). Three types of annuloplasty were used at the initial mitral valve repair: Cosgrove-Edwards, Carpentier-Edwards, and bovine pericardial (Perigard). The diagnosis and the mechanisms of hemolysis were investigated with laboratory testing and echocardiography. RESULTS: Median interval from initial mitral valve surgery to diagnosis of hemolysis was 3 months (range, 1 week to 4 years). At presentation, mean hematocrit was 27.5% +/- 4.9% and 22 patients (69%) required transfusion. Echocardiographic findings varied. Twenty-four patients (77%) had grade 3 or 4 MR. Mitral regurgitant jet types included fragmentation (11 patients, 34%), acceleration (10, 31%), slow deceleration (5, 16%), collision (4, 13%), and free jet (2, 6%). Mitral valve replacement was performed in 28 patients, mitral valve re-repair in 3, and 1 patient did not undergo reoperation. At reoperation the mitral valve repair was physically intact in 25 of 31 patients (81%). There were 2 hospital deaths in patients having reoperation (6%). Actuarial survival was 95% at 1 year and 85% at 5 years. In 1 patient recurrent mechanical hemolysis developed caused by a perivalvular leak after mitral valve replacement. CONCLUSIONS: Hemolysis is a mode of failure of mitral valve repair. Patients with hemolysis generally present within 3 months of mitral valve repair. Although echocardiographic features varied, most patients had high-grade MR and regurgitant jets that fragmented or accelerated. Mitral valve replacement yields favorable outcomes for patients with hemolysis after mitral valve repair.

Anemia, Hemolytic↗
PubMed1998

Recent developments and evolving techniques of mitral valve reconstruction.

Experiences with 1,000 patients undergoing mitral valve reconstruction at New York University over the past 18 years are summarized. A continuing follow-up (98% complete) demonstrated that 88% of patients are free from recurrent insufficiency 10 years after the operation. Reconstruction is feasible in nearly 90% of patients with mitral valve prolapse, with an operative mortality near 2%. Accordingly, operation is now recommended at an early stage with the first sign of left ventricular systolic dysfunction, while the patient is still in sinus rhythm. Most operations have been done with the Carpentier techniques of segmental resection with annuloplasty and insertion of a Carpentier ring. Recently, two other repair techniques and a minimally invasive operative approach have been evaluated. A triangular resection of a prolapsing anterior leaflet has been done in more than 100 patients with excellent results. Also, a posterior "folding plasty" has been employed in more than 40 patients with a large redundant posterior leaflet, minimizing the need for annular plication. A minimally invasive approach to the mitral valve has now been employed in 130 patients over the past year, using a right mini-thoracotomy and the Port-Access (Heartport, Inc, Menlo Park, CA) approach. This technique employs catheters introduced through femoral vessels to institute cardiopulmonary bypass and cardioplegic arrest. The operative approach and techniques for mitral valve reconstructive operations continue to evolve, with excellent results and improved patient benefits.

Cardiac Surgical Procedures↗
PubMed1995

[Possibility for clinical use of mitral valve allograft: an experimental histopathological study in consideration with aortic valve allograft].

Morphologic studies were made on antibiotic preserved mitral valve allograft implanted in 8 sheep for 12 to 24 weeks. All allograft showed severe deterioration of connective tissue due to autolysis and immunological/inflammatory reactions. Compared with aortic valve allograft, mitral valve allograft failed more quickly and more severely, presumably because of differences in structure (presence of chordae tendineae and increased surface area of leaflets) and in closing pressure. The durability of cardiac valve allograft is influenced by the degree of preservation of collagen and elastic fibers in the graft. attenuation of immunologic reactions and control of fibrous sheathing.

Animals↗
PubMed2001

A prospective study of changes in the quality of life of patients following mitral valve repair and replacement.

OBJECTIVE: The primary aim of medical care and surgery for mitral valve disease is to improve the overall functional capacity and health of patients. AIM: To assess whether there was an actual improvement in quality of life (QOL) of patients 3 months following primary mitral valve repair (MRr) or mitral valve replacement (MVR). METHODS: Prospective study of 61 consecutive patients (34 males, mean age 64+/-12) who underwent primary, isolated mitral valve repair (MRr, n=40) or mitral valve replacement (MVR, n = 21) from April 1997 to October 1998. QOL parameters using the validated short form 36 (SF-36) questionnaire were determined before and at 3 months after surgery and analysed using the Wilcoxon matched pairs rank test. RESULTS: Mean QOL scores (scale 0-100) for all patients following mitral valve surgery showed clinical and statistically significant improvement in seven of eight QOL parameters, namely (i) physical function (post, 60+/-31 vs. pre, 44+/-29; P = 0.0001); (ii) role limitation due to physical function (50+/-42 vs. 23+/-36; P = 0.0002); (iii) social function (76+/-31 vs. 59+/-36; P = 0.0006); (iv) role limitation due to emotional problems (65+/-42 vs. 44+/-45; P = 0.003); (v) energy (57+/-24 vs. 40+/-24; P < 0.0001); (vi) mental health (73+/-20 vs. 66+/-21; P = 0.007); and (vii) general health perception (68+/-19 v 56+/-22; P = 0.0001); but not pain (73+/-29 v 71+/-30; P = 0.4). Following MRr there was significant improvement in seven of eight QOL parameters and following MVR there was significant improvement in three of eight QOL parameters. Whilst patients with ejection fraction > or = 50% showed significant improvement in seven of eight QOL parameters, there was no significant improvement in any QOL parameters in patients with impaired left ventricular (LV) function. Similarly, patients with mitral regurgitation with end-systolic dimensions of > or = 45 mm showed no significant improvement in any QOL parameters at 3 months follow-up. CONCLUSIONS: Our study suggests that following mitral valve surgery there was significant improvement in the QOL of patients especially in those patients requiring mitral valve repair. However, patients with impaired LV function and those with MR with end-systolic dimensions > or = 45 mm were unlikely to demonstrate a significant improvement in QOL at 3 months follow-up.

Adult↗
PubMed1993

Structural basis for mitral valve dysfunction associated with ostium secundum atrial septal defects.

Mitral valve (MV) specimens obtained at operation from 50 patients with ostium secundum atrial septal defect and associated MV dysfunction were studied macro- and microscopically to evaluate the structural lesions. The functional abnormalities in these patients were isolated mitral stenosis, isolated mitral regurgitation, mitral valve prolapse or mitral stenosis with regurgitation. Post-inflammatory lesions were commonly found in those with mitral stenosis who had a past history of rheumatic fever. Patients with mitral valve prolapse had either post-inflammatory lesions or lesions attributable to haemodynamic stress but different from the extensive lesions seen in floppy MV syndrome.

Adolescent↗
PubMed1989

Platelet activation in patients with mitral valve prolapse.

An increased frequency of thromboembolic events in patients with mitral valve prolapse has been demonstrated. It has been suggested that this association may be related to increased systemic platelet activity. Beta-thromboglobulin (BTG) is a platelet specific protein secreted during the platelet release reaction, with BTG levels reflecting ongoing platelet activation. Plasma BTG levels were measured in 14 normal volunteers, 23 patients with mitral valve prolapse and nonthickened mitral leaflets (group 1) and 13 patients with mitral valve prolapse and thickened mitral leaflets (group 2). The BTG level was 8.1 +/- 4.6 ng/mL (mean +/- SD) in normal subjects, 9.6 +/- 5.5 ng/mL in the nonthickened mitral valve prolapse group and 10.0 +/- 5.7 ng/mL in thickened mitral valve prolapse group. There was no significant difference in the BTG levels between groups. Five patients with multiple valvular prolapse did not show elevation of BTG levels. The present study did not demonstrate increased BTG levels in neurologically asymptomatic mitral valve prolapse patients.

Adult↗
PubMed1989

Repair of congenital malformations of the mitral valve in children: early and long-term results in 34 cases.

From March 1972 through December 1986, 34 children underwent surgical treatment of mitral valve dysplasia at our institution. There were 14 males and 20 females, with a mean age of 6 years (range, 5 months to 15 years). Eighteen patients had significant mitral valve insufficiency; 16 had significant mitral valve stenosis. Mitral valve reconstruction was possible in 30 patients (88.2%); replacement of the mitral valve with a mechanical prosthesis was necessary in the other 4 patients (11.8%), after at least 1 attempted reconstruction. Five patients died in the hospital (14.7%): 4 after conservative surgery, and 1 after mitral valve replacement. A 6th patient died 26 months after mitral valve replacement and resection of a subaortic membrane. Four patients required reoperation 2 to 66 months after conservative treatment: in 3 of these, the mitral valve was replaced; in the 4th, additional reconstruction was successful. Upon follow-up (range, 3 months to 14 years after surgery), 26 of the 28 surviving patients were asymptomatic; 2-dimensional and Doppler echocardiography performed in 22 patients after mitral valve repair showed normal pulmonary artery pressure in all, and moderate mitral valve dysfunction in 2. Our results indicate that reconstructive surgery for mitral valve dysplasia may prove effective and reliable in children, despite the frequent severity of valve malformation. We believe, therefore, that mitral valve repair should always be attempted in the pediatric population to avoid the disadvantages of prosthetic valve replacement.

Journal Article↗
PubMed1987

A comparison of the assessment of mitral valve area by continuous wave Doppler and by cross sectional echocardiography.

Transmitral pressure half time (PHT) was assessed by continuous wave Doppler in 44 patients with rheumatic mitral valve stenosis (14, pure mitral valve stenosis; 15, combined mitral stenosis and regurgitation; and 15 with associated aortic valve regurgitation). The mitral valve area, derived from transmitral pressure half time by the formula 220/pressure half time, was compared with that estimated by cross sectional echocardiography. The transmitral pressure half time correlated well with the mitral valve area estimated by cross sectional echocardiography. The correlation between pressure half time and the cross sectional echocardiographic mitral valve area was also good for patients with pure mitral stenosis and for those with associated mitral or aortic regurgitation. The regression coefficients in the three groups of patients were significantly different. Nevertheless, a transmitral pressure half time of 175 ms correctly identified 20 of 21 patients with cross sectional echocardiographic mitral valve areas less than 1.5 cm2. There were no false positives. The Doppler formula significantly underestimated the mitral valve area determined by cross sectional echocardiography by 28(9)% in 19 patients with an echocardiographic area greater than 2 cm2 and by 14.8 (8)% in 25 patients with area of less than 2 cm2. In thirteen patients with pure mitral valve stenosis Gorlin's formula was used to calculate the mitral valve area. This was overestimated by cross sectional echocardiography by 0.16 (0.19) cm2 and underestimated by Doppler by 0.13 (0.12) cm2. Continuous wave Doppler underestimated the echocardiographic mitral valve area in patients with mild mitral stenosis. The Doppler formula mitral valve area = 220/pressure half time was more accurate in predicting functional (haemodynamic) than anatomical (echocardiographic) mitral valve area.

Adult↗
PubMed1985

Improved intraoperative evaluation of mitral valve operations utilizing two-dimensional contrast echocardiography.

Whenever possible, precise mitral valve repair is preferable to valve replacement. Present methods for intraoperative detection of mitral regurgitation, primarily hemodynamic measurements and direct palpation, may underestimate or not detect the presence and severity of regurgitation. We have investigated two-dimensional contrast echocardiography as a means of improving our intraoperative assessment of mitral valve function both before and after repair or replacement. After exposure of the heart, a baseline two-dimensional echocardiogram (in modified long- and short-axis planes) is performed using a hand-held 5 mHz mechanical transducer. Five milliliters of agitated 5% dextrose in water is injected into the left ventricle through a transseptal needle to generate detectable microbubbles. In the absence of mitral regurgitation, virtually all microbubbles exit through the aorta; in the presence of regurgitation, a mass of microbubbles reflux into the left atrium. After repair of the mitral valve and immediately after bypass, the contrast echocardiogram is repeated and hemodynamic measurements are obtained. Forty-three patients (37 with mitral valve disease and six additional patients without mitral disease) undergoing cardiac operations were evaluated. Experience with intraoperative two-dimensional contrast echocardiography has accurately demonstrated relatively small degrees of mitral regurgitation when conventional techniques failed to do so and has allowed more precise repair of the residual regurgitation. Two commissurotomy and two annuloplasty patients who were thought to have satisfactory repairs underwent immediate second procedures because of significant residual mitral regurgitation demonstrated solely by this echocardiographic microbubble technique. No complications associated with this technique have developed. We conclude that intraoperative two-dimensional contrast echocardiography is a sensitive and safe technique that allows intraoperative detection of even small degrees of mitral regurgitation and provides a basis for precise repair of mitral valve lesions.

Adult↗
PubMed1995

Can an echocardiographic score predict who will benefit clinically from balloon dilation of the mitral valve?

Deciding whether a patient with sub-optimal mitral valve anatomy will benefit from percutaneous mitral valvotomy remains a demanding clinical problem. We assessed the ability of an established echo score applied to transoesophageal images to predict absolute increases in mitral valve area and improvement in exercise capacity. Twenty five consecutive patients undergoing routine percutaneous mitral valvotomy were studied. Changes in exercise tolerance were measured by serial cardiorespiratory treadmill exercise testing. Before the procedure, exercise duration was directly related to mitral valve area (rs = 0.44, P < 0.05). Following percutaneous mitral valvotomy there was an increase in valve area (0.9 +/- 0.2 to 1.4 +/- 0.3 cm2, P < 0.0001) and repeat exercise testing demonstrated increases in exercise duration (470 +/- 220 to 610 +/- 240 s, P < 0.001) and peak VO2 (12.6 +/- 4.2 to 15.1 +/- 4.5 ml/kg/min, P < 0.01). There was an inverse correlation between the echo score and the increase in valve area (rs = -0.52, P < 0.05) but no relationship between the echo score and the increase in exercise duration or peak minute oxygen consumption (VO2). These data demonstrate that a score applied to transoesophageal images echocardiographic images can predict changes in mitral valve area but that the score fails to predict functional improvement for an individual patient. This suggests, therefore, that patients without contraindications to valvotomy whose valves have a high echo score should still be considered for valvotomy as they may benefit considerably from the procedure.

Adult↗
PubMedDate not supplied

Valve repair versus replacement in the surgical management of ruptured chordae. A post-operative echocardiographic assessment of mitral valve function.

Between January 1971 and December 1978, 74 patients (pts) underwent surgery for ruptured chordae (RC) of the mitral valve. Thirty-eight patients underwent mitral valve replacement and 36 patients underwent repair. The hospital mortality was 8.3% after repair and 7.9% after replacement. Repair was performed by trapezoidal excision of redundant leaflet, re-approximation of the leaflet edges and annuloplasty. At six years the incidence of re-operation after repair was 3% (1/33) and after mitral valve replacement was 14.7% (5/35). The five years survival was 68 +/- 8% after mitral valve replacement and 100% after repair. The incidence of major thrombo-embolic episodes was 0.67 per 100 patient years, without anticoagulation, after repair and 5.7 per 100 patient years, with anticoagulation, following mitral valve replacement. The peak rate of dimension change (PRDC) of the transverse dimension of the left ventricle was determined by echocardiography in 17 patients after repair. The PRDC was within normal range (10/20 cms/sec) in 15 patients, in the stenotic range (10 cms/sec) in 1 patient, and in the regurgitant range (20 cms/sec) in 1 patient. Mitral valve replacement invariably produces PRDC values in the stenotic range. Valve repair is the procedure of choice in ruptured chordae of the posterior leaflet.

Bioprosthesis↗
PubMed1987

In vitro identification of different degrees of mitral valve disease by online evaluation of radiofrequency ultrasound signal.

Sixty five mitral valves were studied in vitro with a 2.25 MHz transducer. Radiofrequency signals were analysed by a microprocessor system (implemented on an M-mode commercially available echocardiography) for online evaluation of ultrasonic backscatter (8 bits of amplitude resolution, 40 MHz sampling rate, 1 microsecond acquisition gate). The integrated value of the rectified signal amplitude was expressed as the integrated backscatter index (in db). The highest value recorded with ultrasonic scanning of each sample was taken as representative of that specimen. Calcification of mitral valves was assessed by radiography (24 mitral valves). Non-calcified mitral calves underwent pathological examination, and fibrotic valves (22 mitral valves) were differentiated from normal valves (19 mitral valves). A statistically significant (p less than 0.005) difference was recorded among the three groups for the index maximal value: calcific -7.4(3.1) db (mean(SD)), fibrotic -18.9(4.9) db, and normal -37.9(7.6) db. In conclusion, a microprocessor based system for online evaluation of radiofrequency ultrasonic signals, which may also be feasible for in vivo studies, provided a clear differentiation in vitro of calcific, fibrotic, and normal mitral valves.

Calcinosis↗
PubMed2002

Accessory mitral valve leaflet in an adult with coronary artery disease.

Accessory mitral valve leaflet is a very rare cause of left ventricular outflow tract obstruction. We report a patient presenting this cardiac abnormality who undergone cardiac surgery. A 60-year-old man, presented coronary artery disease and moderate left ventricular tract obstruction due to accessory mitral valve leaflet. The accessory mitral valve leaflet had the typical morphology of a parachute-shaped attached partially to the anterior mitral valve leaflet, with chordae tendinae attached to: 1) an accessory papillary muscle inserted at the free-wall closed to the apex; 2) interconnected with the chordae tendinae of the anterior mitral valve leaflet; 3) a second accessory papillary muscle inserted to the interventricular septum. He underwent successful coronary revascularization of 2 vessels and accessory leaflet excision. A review of 21 cases with accessory mitral valve leaflet is reported.

Cardiac Catheterization↗
PubMed2001

[Surgery in terminal mitral valve diseases].

In the past few years both the spectrum of mitral valve diseases leading to surgery and the surgical techniques have changed. We present our experience with the preservation of the subvalvular apparatus when mitral valve replacement is performed. In addition to preservation of the subvalvular apparatus of the posterior mitral leaflet, five techniques of subvalvular preservation are described. We conclude that mitral valve replacement should always aim at preservation of the subvalvular structures. The surgical method of choice in cases of isolated mitral valve insufficiency is mitral valve reconstruction. Treatment of associated atrial fibrillation, preferably by radiofrequency ablation, should always be performed concomitantly. Surgery of the mitral valve represents a palliative operation in selected patients with terminal cardiomyopathy.

Atrial Fibrillation↗
PubMed1992

Mitral valve resistance as a hemodynamic indicator in mitral stenosis.

Variability of the valve area calculated by the Gorlin formula has been noted in bioprosthetic and aortic valves, but few data are available for native stenotic mitral valves. Valve resistance has been proposed as an alternative hemodynamic indicator; however, its value in mitral stenosis has not been assessed. Thirty-four patients had simultaneous recordings of left atrial and ventricular pressures, 26 after percutaneous balloon mitral dilatation (PBMD). Patients with shunt or mitral regurgitation were excluded. Mitral valve resistance correlated exponentially with Gorlin mitral area (y = 133*[area]-1.5; p less than 0.0001). Both Gorlin mitral area and mitral resistance improved after PBMD (0.89 +/- 0.07 cm2 to 2.22 +/- 0.15 cm2; p less than 0.001; and 166 +/- 20 to 40 +/- 8 dynes.s.cm-5; p less than 0.001). Gorlin area and mitral resistance correlated with New York Heart Association functional class. After infusion of isoproterenol in 17 patients, there was an increase in Gorlin area (baseline 1.77 +/- 0.22 cm2, change 0.23 +/- 0.10; p less than 0.03), whereas mitral resistance did not change (baseline 96 +/- 16 dynes.s.cm-5, change 2 +/- 5; p = not significant). Mitral resistance is valuable in the assessment of mitral stenosis. It varies less than Gorlin mitral area under changing hemodynamic conditions.

Adolescent↗
PubMed1994

[Estimation of the effect of mitral valve correction].

From September 1958 to December 1992, 488 patients underwent mitral valve repair in Fuwai Hospital. Patients ages ranged from 49 days to 60.5 years (mean age 29.02 +/- 9.97 years). The cause of mitral valve disease was rheumatic in 415 patients (85.04%). 391 patients (80.12%) had isolated mitral valve disease and 97 patients (19.88%) had associated with aortic or tricuspid valve disease, or both. There were 167 patients (34.22%) with pure mitral stenosis, 106 patients (21.72%) with pure mitral regurgitation and 215 patients (44.06%) with both. 64.96% of the patients were in New York Heart Association (NYHA) III and IV before the operation. There were 433 patients (88.73%) with isolated mitral valve repair and 55 patients (11.27%) with mitral valve repair associated with other valve repair. The hospital mortality rate was 11.27% (7.00% after 1980). 7.39% of the patients were in NYHA III and IV after operation (P < 0.01). Follow-up was 92.38% complete and totaled 4824. 12 patient-years. The mean follow-up time was 12.3 +/- 8.83 years. The 5-year, 10-year and 20-year survival rates were 94.92%, 89.70% and 70.19%, respectively. The rate of reoperation was 4.16% (0.37%/pt-yr) and the one of thromboemboli was 5.54% (0.498%/pt-yr). The follow-up mortality and reoperation rate of rheumatic mitral valve disease were significantly higher than the other causes (P < 0.01). In hospital and follow-up results of the pure MI were better than the MS and MSI (P < 0.01). The better results were obtained in mitral annuloplasty with prosthetic valve ring.

Adolescent↗
PubMed2004

Impact of mitral regurgitation on long-term survival in patients with ischemic cardiomyopathy: efficacy of combined mitral valve repair and revascularization.

Ischemic cardiomyopathy complicated by severe mitral regurgitation (MR) has a poor prognosis. In such cases, whether mitral valve repair for MR improves the prognosis of survival remains unclear. In this study, 50 patients diagnosed with ischemic cardiomyopathy at our hospital between August 1991 and August 1996 were studied to examine the long-term prognosis and factors determining the prognosis. Among 17 patients with the complication of severe MR, 11 underwent mitral valve repair (repair group) and 6 did not (nonrepair group). Among the 33 patients without MR, 15 underwent revascularization (revascularization group) and 18 received medical treatment alone (medical group). Patients with MR showed significantly poorer baseline activities of daily living (ADL) [New York Heart Association (NYHA) class III or above: MR(+) vs MR(-) = 14 vs 8; P = 0.0001] and survival rate [MR(+) vs MR(-); log rank = 3.8, P = 0.05]. In contrast, patients in whom mitral valve repair was actively performed to resolve MR had favorable outcomes for both ADL (NYHA class improved from 3.9 +/- 0.3 to 2.7 +/- 1.0; P = 0.0004) and survival rate (MV repair vs nonrepair: long rank = 10.1, P = 0.0015). In addition, among patients without MR, the revascularization group showed more favorable results in terms of ADL (NYHA class improved from 3.5 +/- 0.7 to 2.5 +/- 0.8; P = 0.0059) and survival rate (revascularization vs medical: log rank = 3.7, P = 0.05), irrespective of improvement of left ventricular function. When the factors determining the prognosis for ischemic cardiomyopathy were examined by multivariate analysis, whether or not revascularization was conducted, the presence or absence of mitral regurgitation, and if present, whether or not mitral valve repair was performed were identified as independent factors determining the prognosis (revascularization: hazard ratio = 0.121, P = 0.012; absence of MR: hazard ratio = 0.104, P = 0.050; mitral valve repair: hazard ratio = 0.018, P = 0.005). These results showed that revascularization should be conducted as actively as possible in patients with ischemic cardiomyopathy; in addition, for those patients with mitral regurgitation, mitral valve repair should be conducted actively to relieve it.

Aged↗
PubMed1992

Inhaled nitric oxide after mitral valve replacement in patients with chronic pulmonary artery hypertension.

Patients with mitral valve disease can develop pulmonary artery hypertension that persists after mitral valve replacement. In 1987, nitric oxide (NO) was reported to be an important factor accounting for the biologic activity of endothelium-derived relaxing factor. Inhaled NO was subsequently reported to be a selective pulmonary vasodilator in animals and patients. Therefore we investigated the vasodilating effect of inhaled NO in patients with mild pulmonary artery hypertension after mitral valve replacement. Six patients who underwent mitral valve replacement for mitral stenosis presented with a mean pulmonary artery pressure greater than 25 mmHg within 24 h after surgery. During mechanical ventilation at FIO2 0.5, NO (36.8-38.4 ppm) was breathed for 10 min. Hemodynamic data were recorded before NO, after 10 min of NO inhalation, and 30 min after the end of NO inhalation. Statistically significant (P < 0.05) hemodynamic response to inhaled NO included a transient decrease in systolic (-10%), diastolic (-8%), and mean (-10%) pulmonary artery pressures; a decrease in pulmonary vascular resistance (-22%); an increase in mixed venous hemoglobin O2 saturation (+6%); and a decrease in arteriovenous O2 content difference (-7%). During NO inhalation, there was no change in systemic arterial or pulmonary wedge pressures. Methemoglobin levels remained < 1%. Inhalation of this concentration of NO for 10 min causes transient pulmonary artery vasodilation and hemodynamic improvement in patients with mild chronic pulmonary artery hypertension after mitral valve replacement.

Administration, Inhalation↗