Dynamics of echocardiography parameters after circular PADN procedure in patients with mitral valve defects, atrial fibrillation, and high pulmonary hypertension

Aim. To analyze the dynamics of echocardiographic parameters after surgical treatment of severe pulmonary hypertension in patients with mitral valve disease and atrial fibrillation.

Material and Methods. Data of surgical treatment in 202 patients with mitral valve disease complicated by severe pulmonary hypertension with blood pressure more than 40 mm Hg and atrial fibrillation were analyzed. Surgical intervention in these patients consisted in surgical correction of mitral dysfunction with artificial prosthetic valve or valve-preserving intervention (group 1, n = 62). In patients of group 2 (n = 89), correction of mitral valve defect was also performed as well as the Maze IV procedure for concomitant atrial fibrillation using bipolar radiofrequency ablator AtriCure. Patients of group 3 (n = 51) underwent integrated surgery, which consisted in the elimination of mitral valve defect, surgical correction of atrial fibrillation by Maze IV procedure, as well as circular radiofrequency denervation of the trunk and mouth of the pulmonary arteries (pulmonary artery denervation (PADN)).

Conclusions. The circular PADN procedure was effective and safe, significantly reduced the level of pulmonary hypertension in the postoperative period (p = 0.018), and promoted reverse remodeling of the heart cavities. Integrated surgical correction in patients with mitral dysfunction, atrial fibrillation, and severe pulmonary hypertension may significantly reduce the phenomenon of heart failure (p = 0.023). Further analysis of the effectiveness of radiofrequency denervation of pulmonary arteries with the study of a larger number of patients, analysis of long-term results, as well as determining the possibility of this technique in patients with non-valvular forms of pulmonary hypertension are required. 

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