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. 1995 Oct;74(4):386–389. doi: 10.1136/hrt.74.4.386

Exercise ventilation after balloon dilatation of the mitral valve.

A P Banning 1, N P Lewis 1, J S Elborn 1, R J Hall 1
PMCID: PMC484044  PMID: 7488452

Abstract

BACKGROUND--Exertional dyspnoea is a limiting symptom in many patients with mitral stenosis but its causes remain incompletely understood. Ventilation during exercise is abnormal in chronic heart failure of all causes and there is increased ventilatory cost of carbon dioxide production. PATIENTS--23 patients with rheumatic mitral stenosis undergoing percutaneous balloon dilatation of the mitral valve were studied to investigate exercise ventilation. METHODS--Treadmill exercise tests with respiratory gas analysis were performed before and 1 day, 7 days, and 10 weeks after balloon dilatation of the mitral valve. The relation between ventilation (VE) and production (VCO2) was analysed by linear regression. RESULTS--The VE/VCO2 slope was linear in all patients and before balloon dilatation of the mitral valve it correlated inversely with peak minute oxygen consumption (VO2) (rs = -0.47, P < 0.05), exercise duration (rs = -0.66, P < 0.01), and mitral valve area (rs = -0.5, P < 0.05). The VE/VCO2 slope declined acutely after balloon dilatation of the mitral valve (n = 10) (mean (SD) 41 (4) v 36 (2.9), P < 0.05) and did not change again thereafter. At 10 weeks (n = 23) exercise duration (460 (230) v 630 (240) s, P < 0.01) and peak VO2 (12.7 (4.3) v 14.9 (4.8) ml/kg/min, P < 0.05) increased significantly. CONCLUSIONS--Patients with rheumatic mitral stenosis have a similar increase in the VE/VCO2 slope to that of patients with heart failure from other causes. Successful balloon dilatation of the mitral valve is associated with an acute reduction in the exercise VE/VCO2 slope.

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Selected References

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  1. Banning A. P., Lewis N. P., Northridge D. B., Elborn J. S., Hendersen A. H. Perfusion/ventilation mismatch during exercise in chronic heart failure: an investigation of circulatory determinants. Br Heart J. 1995 Jul;74(1):27–33. doi: 10.1136/hrt.74.1.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Buller N. P., Poole-Wilson P. A. Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure. Br Heart J. 1990 May;63(5):281–283. doi: 10.1136/hrt.63.5.281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burger W., Kneissl G. D., Kober G., Schräder R. Effect of balloon valvuloplasty for mitral stenosis on right ventricular function. Am J Cardiol. 1993 Apr 15;71(11):994–996. doi: 10.1016/0002-9149(93)90921-x. [DOI] [PubMed] [Google Scholar]
  4. Davies S. W., Emery T. M., Watling M. I., Wannamethee G., Lipkin D. P. A critical threshold of exercise capacity in the ventilatory response to exercise in heart failure. Br Heart J. 1991 Apr;65(4):179–183. doi: 10.1136/hrt.65.4.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dawson A., Rocamora J. M., Morgan J. R. Regional lung function in chronic pulmonary congestion with and without mitral stenosis. Am Rev Respir Dis. 1976 Jan;113(1):51–59. doi: 10.1164/arrd.1976.113.1.51. [DOI] [PubMed] [Google Scholar]
  6. Hughes J. M., Glazier J. B., Rosenzweig D. Y., West J. B. Factors determining the distribution of pulmonary blood flow in patients with raised pulmonary venous pressure. Clin Sci. 1969 Dec;37(3):847–858. [PubMed] [Google Scholar]
  7. Inoue K., Owaki T., Nakamura T., Kitamura F., Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg. 1984 Mar;87(3):394–402. [PubMed] [Google Scholar]
  8. Jebavý P., Runczik I., Oppelt A., Tilsch J., Stanek V., Widimský J. Regional pulmonary function in patients with mitral stenosis in relation to haemodynamic data. Br Heart J. 1970 May;32(3):330–336. doi: 10.1136/hrt.32.3.330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Mohsenifar Z., Amin D. K., Shah P. K. Regional distribution of lung perfusion and ventilation in patients with chronic congestive heart failure and its relationship to cardiopulmonary hemodynamics. Am Heart J. 1989 Apr;117(4):887–891. doi: 10.1016/0002-8703(89)90628-5. [DOI] [PubMed] [Google Scholar]
  10. Puri G. D. Respiratory dead space under anaesthesia in patients with mitral stenosis. Eur J Anaesthesiol. 1992 Sep;9(5):387–391. [PubMed] [Google Scholar]
  11. RAINE J., BISHOP J. M. The distribution of alveolar ventilation in mitral stenosis at rest and after exercise. Clin Sci. 1963 Feb;24:63–68. [PubMed] [Google Scholar]
  12. Reed J. W., Ablett M., Cotes J. E. Ventilatory responses to exercise and to carbon dioxide in mitral stenosis before and after valvulotomy: causes of tachypnoea. Clin Sci Mol Med. 1978 Jan;54(1):9–16. doi: 10.1042/cs0540009. [DOI] [PubMed] [Google Scholar]
  13. Tamai J., Nagata S., Akaike M., Ishikura F., Kimura K., Takamiya M., Miyatake K., Nimura Y. Improvement in mitral flow dynamics during exercise after percutaneous transvenous mitral commissurotomy. Noninvasive evaluation using continuous wave Doppler technique. Circulation. 1990 Jan;81(1):46–51. doi: 10.1161/01.cir.81.1.46. [DOI] [PubMed] [Google Scholar]
  14. Weber K. T., Kinasewitz G. T., Janicki J. S., Fishman A. P. Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure. Circulation. 1982 Jun;65(6):1213–1223. doi: 10.1161/01.cir.65.6.1213. [DOI] [PubMed] [Google Scholar]
  15. Weber K. T., Kinasewitz G. T., West J. S., Janicki J. S., Reichek N., Fishman A. P. Long-term vasodilator therapy with trimazosin in chronic cardiac failure. N Engl J Med. 1980 Jul 31;303(5):242–250. doi: 10.1056/NEJM198007313030502. [DOI] [PubMed] [Google Scholar]
  16. Yoshioka T., Nakanishi N., Okubo S., Kunieda T., Ishikura F., Nagata S. Improvement in pulmonary function in mitral stenosis after percutaneous transvenous mitral commissurotomy. Chest. 1990 Aug;98(2):290–294. doi: 10.1378/chest.98.2.290. [DOI] [PubMed] [Google Scholar]

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