Hemodynamic evaluation of stenotic cardiac valves: I. Effect of ventriculography and atropine on mitral stenosis

Mitral area is the parameter used for quantitating mitral stenosis (MS) severity. When mitral gradient (MG) is low and reduction of mitral valve area (MVA) might be critical, interventions presumably increasing mitral valve flow (MVF), such as stress or atrial pacing, have been carried out. The purpose of this study was to analyze in 28 patients the combined effect of left ventriculography (LVG) and intravenous atropine (ATR) in the hemodynamic evaluation of MS. The rationale for combining these two interventions is to add up the ATR‐positive chronotropic effect to the LVG potentiation of cardiac output. The LVG plus ATR markedly accelerated heart rate (from 80 ± 14 to 104 ± 18 bts/min, P < 0.001), mildly increased cardiac index (from 2.6 ± 0.6 to 2.9 ± 0.6 1/min/m2, P < 0.05), and importantly increased MVF (from 136 ± 30 to 172 ± 46 ml/bt, P < 0.001). Pulmonary wedge pressure increased (from 14 ± 5 to 21 ± 5 mmHg, P < 0.001). because of an important increment of MG (from 12± 6 to 18 ± 7 mmHg, P < 0.001). None of six cases with mild MS (MVA > 1.5 cm2) and nine of ten cases with severe MS (MVA ± 1.0 cm2) had MG after LVG plus ATR > 12 mmHg. The remaining case with severe MS and the two cases (out of 12) with moderate MS having MG after LVG plus ATR ± 12 mmHg had, at surgical evaluation, noncritically reduced MVA.