[Causes of occurrence of wave V of pulmonary wedge pressure in patients with acquired heart valve diseases].

It is believed that a significant V wave in pulmonary capillary wedge pressure (PWP) is a sign of mitral regurgitation. Of 358 patients with acquired valvular heart disease in 24-cases a significant V wave (15 mm Hg of PWP) was recorded during right heart catheterization. All patients underwent right heart catheterization with a flow- directed, balloon-tipped, thermodilution catheters (Edwards Labs). Mean pulmonary, capillary wedge, and right atrial pressures were monitored and recorded. Cardiac output was determined by thermodilution technique using iced 5% dextrose. After measurements of flow, pulmonary and systemic resistance morphology of V wave from PWP recordings was assessed. We measured dp/dt of the ascending limb of V wave and Libanoff and Rodbard V wave index (dp/dt:CI). Nine patients with significant V wave had no signs of mitral regurgitation and had mainly significant mitral stenosis (group III). Group II (6 patients) consisted of patients with different combinations of acquired left heart valve disease and mitral regurgitation. Group I (9 pts) consisted of patients with isolated mitral regurgitation. There were no differences in right atrial, pulmonary, and capillary wedge pressures, cardiac index, pulmonary and systemic valvular resistance among groups I, II and III. There were significant differences as far as dp/dt V wave was concerned (gr I--136 +/- 31.4, gr II--112.2 +/- 30.7, gr III--72.7 +/- 31.2 mm Hg/s). Libanoff's index of V wave was also significantly different in all three groups--gr I--12.7 +/- 6.2; gr II--8.0 +/- 2.3; gr III--4.8 +/- 1.7 mm Hg/s). It seems that V wave in PWP recordings is not only a sign of mitral regurgitation, but also could be a sign of decreased pulmonary veins compliance.