Airway hyper-reactivity in rheumatic mitral stenosis improves after balloon valvotomy.

BACKGROUND

Dyspnea is a common symptom in a patient with valvular heart disease. The mechanism underlying this is still uncertain.

METHODS

We prospectively studied 20 patients with rheumatic mitral valve stenosis who were candidates for percutaneous balloon mitral valvotomy. Assessment of airway hyper-reactivity by histamine challenge test was done on all patients at baseline and at 1 week after the procedure. The provocative concentration of histamine solution required producing a 20% fall in forced expiratory volume in 1 second (FEV(1)) (PC20) was recorded as a measure of airway hyper-reactivity. The severity of dyspnea in study subjects was also studied by the 6-minute-walk test and visual analog scale.

RESULTS

After balloon valvotomy, a significant improvement was seen in the six minute walking distance (219+/-30.15 to 237.55+/-32.25; p < 0.001), visual analog scale as a measure of dyspnea (60.95+/-12.16 to 44.4+/-13.71; p < 0.001) and airway hyper-reactivity (PC20; 5.69+/-6.01 mg/ml to 10.16+/-7.93; p < 0.001).

CONCLUSIONS

Improvement in dyspnea in mitral stenosis after balloon valvotomy is associated with significant improvement in airway hyper-reactivity.