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Abstract：
Left ventricular (LV) valvular diseases, make up one of the most common etiologies for pulmonary hypertension (PH), and it is not well understood how and at which degree it affects prognosis. The aim of the present study was a comprehensive review of the pathophysiologic mechanism of PH in patients with LV valvular diseases and the prognostic value of baseline and post-intervention PH in patients undergoing interventional treatment. The pathophysiology of PH in patients with LV valvular diseases involves gradual elevation of left ventricular filling pressure and left atrial pressure, which are passively transmitted to the pulmonary circulation and raise pulmonary artery systolic pressure (PASP). A long-lasting exposure to elevated PASP progressively leads to initially functional and thereafter irreversible structural changes in the pulmonary vasculature, leading up to high pulmonary vascular resistance. Surgical treatment of severe LV valvular diseases is highly effective in patients without resting PH or those with exercise-induced PH (EIPH) before intervention. In the case of pre-operative PH, successful interventional therapy decreases PASP, but the post-operative cardiac and all-cause mortality remain higher compared to patients without pre-operative PH. Hence, it is of paramount importance to detect patients with severe LV valvulopathies before the development of PH, since they will get greater benefits from early intervention.
摘要：
左心室（LV）瓣膜疾病，构成肺动脉高压（PH）最常见的病因之一，目前尚不清楚它如何以及在多大程度上影响预后。本研究的目的是全面回顾左心室瓣膜疾病患者PH的病理生理机制以及基线和介入后PH在接受介入治疗的患者中的预后价值。左心室瓣膜疾病患者PH的病理生理包括左心室充盈压和左心房压的逐渐升高,被动传输到肺循环并升高肺动脉收缩压（PASP）。长期暴露于升高的PASP会逐渐导致肺脉管系统的最初功能变化，此后不可逆的结构变化。导致高的肺血管阻力。对于没有静息性PH或运动诱发PH（EIPH）的患者，手术治疗严重的LV瓣膜疾病非常有效。在术前PH的情况下,成功的介入治疗降低了PASP，但与没有术前PH的患者相比,术后心脏和全因死亡率仍然较高.因此，最重要的是在PH发展之前检测出严重的左心室瓣膜病变患者，因为他们会从早期干预中获得更大的好处。
