Evaluation of plain radiograph in mitral stenosis related to hemodynamics

Choe, K O; Park, C Y; Choi, B S; Suh, J H

Abstract

Mitral stenosis, the most frequent heart disease in adult, showed relatively characteristic pulmonary findingsin plain chest X-ray. In recent years the knowledge of the altered physiology of hemodynamics could offerconsiderable amount of hemodynamic barrier in plain chest. But the value of several parameters was stillcontroversial. In this study a variety of roentgen signs were related to physiologic data and these were acquiredby the cardiac catheterization in total of 67 cases of mitral stenosis. 1. Correlation of DPA/DHT ratio (Diameterof pulmonary arterial segment/Diameter of hemithorax X 100) to hemodynamic data: The pulmonary arterial segmentwas dilated by two factors, the one was pulmonary blood flow and the other the blood pressure within it. In mitralstenosis, the cardiac output was decreased to quite uniform level, hence measuremet of pulmonary arterial segmentmight be valuable. The correlation coefficient of DPA/DHT ratio to hemodynamic datas were as follows; 0.54 to meanpulmonary artery pressure, 0.32 to pumonary capillary wedge pressure, -0.37 to mitral valvular area and 0.07 topulmonary vascular resistence. No significant difference was noted in between pure mitral stenosis and mitralstenosis associated with other valvular disease. 2. Correlation of diameter of right descending pulmonary arteryto hemodynamic data: The measurement was made near the first bifurcation of right descending pulmonary artery atits widest point. Pulmonary vascular pattern was best correlated (r=0.71). Another had rough correlation: 0.05 tomean pulmonary artery pressure, 0.31 to pulmonary capillary wedge pressure, -0.44 to mitral valcular area incorrelation coefficient. No pulmonary arterial hypertension was observed in the cases diameter of less than 12 mm,but all except two cases had pulmonary hypertension in which diameter exceeded 16 mm. According to increase of themean pulmonary arterial pressure, the same increment in pressure increased change produced progressively smallerdegrees of dilatation of main pulmonary artery and right descending pulmonary artery. Quite frequently primarypulmonary arterial segment and right descending pulmonary artery were enlarged with all degrees of pulmonaryhypertension and which made enlargement of pulmonary artery as a sign but little value in determining the degreeof pulmonary hypertension. 3. Correlation of pressure of hemosiderosis and intraalveolar edema to hemodynamics:Hemosiderosis was found in 8 cases among 67 cases. No relationship was observed in between the existence ofhemosiderosis and the height of pulmonary venous pressure or other hemodynamic factors. Intraalveolar edema wasdetected in 7 cases and no significant difference of hemodynamic data was observed whether it is present or not.But the present group all had pulmonary capillary wedge pressure exceeds 19 mmHg. 4. Correlation of Kerley's B lineto hemodynamic datas : Distinctively present septal line was found in 18 among 65 cases (27.3%): 3 cases in rightside, only one case in left side and most of them, 14 cases in both sides. The confirmative factor was not foundin distribution of hemodynamic data to the existence itself or detected number of Kerley's B line. But when septalline was found distinctly, pulmonary capillary wedge pressure was all exceeded to 20 mmHg except one case. 5.Correlation of pulmonary vascular pattern to hemodynamic data: For the extimation of hemodynamics the aboveradiographic findings were frequently fraught with overlapping or gave us only limited information. This pulmonaryvascular patterns classified in table 1 including peripheral portion as well as central were aimed to compareaccordingly with hemodynamic datas. These group showed relative apparent separation in each group especially inmean pulmonary artery pressure: Most of mean pulmonary artery pressure was included in the range of below 30 mmHg in group 1, from 25 to 40 mmHg in group 2, from 30 to 55 mmHg in group 3, and above 50 mmHg in group 4. Thepulmonary vascular resistence was roughly included below 300 dyne sec cm-5 in group 1 and 2, where no arterialconstriction is and above 200 dyne sec cm-5 in group 3 and 4 where arterial constriction is may also enhance thereliability of value of vascular pattern in radiographs. It is suggested that estimation of hemodynamics by plainchest could be obtained through summation of multiple radiographic goal and this estimation by the pulmonaryvascular pattern of our method resulted the relatively separable range of hemodynamics.