Hemodynamic impact of mitral prosthesis-patient mismatch on pulmonary hypertension: an in silico study

Journal of Applied Physiology
David TannéPhilippe Pibarot

Abstract

Recent clinical studies reported that prosthesis-patient mismatch (PPM) becomes clinically relevant when the effective orifice area (EOA) indexed by the body surface area (iEOA) is <1.2-1.25 cm(2)/m(2). To examine the effect of PPM on transmitral pressure gradient and left atrial (LA) and pulmonary arterial (PA) pressures and to validate the PPM cutoff values, we used a lumped model to compute instantaneous pressures, volumes, and flows into the left-sided heart and the pulmonary and systemic circulations. We simulated hemodynamic conditions at low cardiac output, at rest, and at three levels of exercise. The iEOA was varied from 0.44 to 1.67 cm(2)/m(2). We normalized the mean pressure gradient by the square of mean mitral flow indexed by the body surface area to determine at which cutoff values of iEOA the impact of PPM becomes hemodynamically significant. In vivo data were used to validate the numerical study, which shows that small values of iEOA (severe PPM) induce high PA pressure (residual PA hypertension) and contribute to its nonnormalization following a valve replacement, providing a justification for implementation of operative strategies to prevent PPM. Furthermore, we emphasize the major impact of pulmonary resistan...Continue Reading

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Citations

Nov 22, 2011·Best Practice & Research. Clinical Anaesthesiology·Richard B ColquittRobert H Thiele
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May 9, 2014·The Heart Surgery Forum·Matteo AttisaniMauro Rinaldi

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