Background: Pulmonary hypertension (PH) is common in patients with
left-side valvular diseases, especially with mitral regurgitation (MR).
Measurement using pulmonal artery catheter (PAC) is the gold standard to asses
pulmonary vascular pressures. During mitral valve surgery echocardiography is
routinely used for valvular management and to evaluate pulmonary hemodynamic. The
accuracy of echocardiographic measurements is controversial in the literature. We
aimed to evaluate the reliability and accuracy of the noninvasive measurement for
systolic pulmonary artery pressure (SPAP) using Doppler echocardiography compared
to the invasive measurement using PAC in patients presenting with MR undergoing
surgery. Methods: This prospective observational study evaluated 146
patients with MR undergoing cardiac surgery between 09/2020 and 10/2021. All
patients underwent simultaneous SPAP assessment by PAC and transesophageal
echocardiography at three different time points: before heart-lung-machine (HLM),
after weaning from HLM and at the end of surgery. Results: Mean
patients’ age was 61 11.5 years, and 51 (35%) patients were female. Most
of patients presented with severe MR (n = 126; 86.3%) or endocarditis (n = 18;
12.3%). Patients underwent either isolated mitral valve surgery (n = 65; 44.5%)
or mitral valve surgery combined with other surgeries (n = 81; 55.5%). Mean SPAP
was underestimated by transesophageal echocardiographic measurement in comparison
to PAC measurement before HLM (41.9 13.1 mmHg vs. 44.8 13.8 mmHg,
p 0.001), after weaning from HLM (37.6 9.3 mmHg vs. 42.4
10.1 mmHg, p 0.001), and at the end of surgery (35.6
9.1 mmHg vs. 39.9 9.9 mmHg, p 0.001). This difference
remained within the sub-analysis in patients presented with moderate or severe PH
during all the time points. Bland-Altman analysis showed that transesophageal
echocardiographic measurement underestimate SPAP in comparison to PAC as these
two approaches are significantly different from one another.
Conclusions: In patients presented with MR, transesophageal Doppler
echocardiography could asses the presence of PH with high probability. This
assessment is however underestimated and the use of PAC in those patients to
diagnose, classify and monitor the therapy of PH remains recommended if required.