Correlation of hemodynamic data and pulmonary angiography in mitral stenosis

The abnormalities of pulmonary arterial blood supply in mitral stenosis, consisting primarily of constriction of lower lobe vessels with resultant upper lobe preferential flow, was assessed by means of pulmonary angiography in 30 patients with mitral stenosis uncomplicated by other cardiac diseases. The abnormalities in blood flow correlated best with both the pulmonay artery pressure and the pulmonary arteriolar resistance, and only reasonably well with the area of the mitral valve and the pulmonary capillary wedge pressure. It is suggested that the reversal of the normal lower lung field preferential blood flow in mitral stenosis is primarily a function of pulmonary artery hypertension due to increased pulmonary arteriolar resistance. Similarly, the width of the right main pulmonary artery as measured on pulmonary angiograms correlated well with both the pulmonary artery pressure and pulmonary arteriolar resistance and less well with the area of the mitral valve. Pulmonary artery size in mitral stenosis is most likely a function of the severity of the pulmonary arteriolar resistance as reflected in the pulmonary artery pressure.