Mitral stenosis with severe pulmonary hypertension.

Consecutive catheterizations in 512 patients with mitral valve disease revealed 85 cases of mitral stenosis with systolic pulmonary artery pressures equal to or in excess of 100 mm Hg. Forty-four patients (51.8%) were in New York Heart Association functional Class IV; 30 (35.3%) were in Class III; and 11 (12.9%) were in Class II. Symptoms related to pulmonary capillary hypertension were prominent in 48 patients (56.5%) while the remaining patients showed signs of low cardiac output syndrome. Forty patients underwent surgery: mitral commissurotomy was performed in 26 patients; mitral valve replacement in 10 patients, and double valve replacement in four patients. Nitroprusside was infused into the pulmonary artery in six patients with severe perioperative low cardiac output; four of these patients survived. The overall operative mortality was 15% (six patients). Good long-term results were achieved in 30 cases.