Prominent Large V Wave in Mitral Stenosis and It's Clinical Significance

Kim, Sang Wook; Song, Jae Kwan; Kang, Seung Ho; Kang, Duk Hyun; Park, Seong Wook; Kim, Jae Joong; Park, Jong Hun; Park, Seung Jung

Abstract

BACKGROUND AND OBJECTIVES: Although a prominent large V wave in left atrial pressure tracing (PVLAP) has been reported to be associated with significant mitral regurgitation (MR) or decreased left atrial compliance (LAC), it is sometimes observed in patients with tight mitral stenosis (MS). The purpose of this study was to determine the prevalence and the hemodynamic significance of PVLAP in tight MS.
MATERIALS AND METHODS
Catheterization data before percutaneous mitral balloon valvuloplasty (PMV) were analyzed in 84 consecutive patients and PVLAP was defined as V wave 10 mm Hg higher than mean left atrial pressure (MLAP).
RESULTS
PVLAP was observed in 45% (38/84) and factors associated with PVLAP were younger age (p=0.02), higher MLAP (p<0.01), higher mitral gradient (p=0.04), smaller valve area (p=0.01) and low echo score (p=0.02): among them MLAP was the only independent factor in multivariate analysis. The presence of PVLAP had no effect on the result of PMV and successful PMV abolished PVLAP.
CONCLUSION
PVLAP was observed not infrequently in these selected patients with MS referred for PMV. The presence of PVLAP was not associated with MR and had good correlation with MLAP, which suggest that PVLAP be determined by decreased LAC.