ROENTGEN INTERPRETATION OF POSTOPERATIVE CHANGES (CLINICAL AND HEMODYNAMIC) IN PURE MITRAL STENOSIS

This study determined those roentgenographic criteria most helpful in evaluation of the postoperative hemodynamic and clinical status in pure mitral stenosis. Twenty-five patients with pure mitral stenosis had cardiac catheterizations twice. Twenty-one had mitral commissurotomy between catheterizations. Hemodynamic data and chest roentgenograms obtained within a few days of the cardiac catheterizations were independently analyzed and scored, and the scores were totaled as roentgen and hemodynamic change indices.

The most useful postoperative changes were: (1) "left atrial size" (area of posterior displacement of the esophagus); (2) ratio of width of main pulmonary artery from midline divided by the diameter of the left hemithorax at the diaphragm; and (3) diameter of the right descending pulmonary artery distal to the right middle lobe artery.

A roentgen sum of changes in these signs was 100 per cent correct in predicting significant hemodynamic improvement, 80 per cent correct in predicting lack of significant hemodynamic change, and 86 per cent correct in predicting significant clinical improvement. Kerley’s "B" lines and abnormal vascular pattern were found not as useful postoperatively as preoperatively.

Atrial fibrillation was associated with larger left atrial sizes. A change from atrial fibrillation to sinus rhythm was associated with a 6 cm.² average decrease in left atrial size, while a change from sinus rhythm to atrial fibrillation was associated with a 2 cm.² average increase in left atrial size.

It is suggested that with decrease in abnormal resistances and pressures, the relatively compliant larger vascular structures become less distended. These changes occur earlier than regression of the relatively fixed fibrous and muscular changes of peripheral pulmonary vasculature and Kerley‘s "B" lines. The main and right descending pulmonary arteries and the left atrial size then become sensitive indicators of hemodynamic and clinical change.

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