Copyright © 1996 by the European Society of Cardiology.
© 1996 The European Society of Cardiology
Exercise tolerance in patients with mitral stenosis before and after acute percutaneous mitral valvuloplasty
Role of lung diffusing capacity limitation?
Services de Cardiologie et Laboratoire Central d'Explorations Fonctionnelles Respiratoires Montpellier, France
*Hospital Arnaud de Villeneuve Montpellier, France
Received 29 August 1995; accepted 20 September 1995.
Correspondence: Patrick Messner-Pellenc, MD, PhD, Services de Cardiologie, C.H.U. Arnaud de Villeneuve, 371 Av. Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
Abstract
The aim of this study was to specify in patients with tight mitral stenosis whether lung diffusing capacity could play a role in their exercise intolerance. A similar study was recently carried out in patients with moderate chronic heart failure.
Ten patients with tight mitral stenosis were studied before and 6 months after successful percutaneous transvenous balloon valvuloplasty and compared to six control subjects. Measurements of diffusing capacity, evaluated by the lung transfer factor (TLCO) and by the transfer coefficient (TLCO/VA), obtained at rest and during early recovery after cardiopulmonary exercise testing were performed. Cardiac output was determined non-invasively, both at rest and during exercise, using the carbon dioxide exponential rebreathing technique.
Prior to valvuloplasty, TLCO and TLCO/VA were not different at rest between the two groups. During exercise, patients differed from control subjects, with lower oxygen uptake (P<0·00l) and lower cardiac output at peak exercise (P<000l). These values at peak exercise were significantly correlated (p=0·02; r=0·75). Moreover, patients differed from control subjects at early recovery after peak exercise with an absence of increase in TLCO (P<0·05).
Six months after valvuloplasty, a decrease of both TLCO (P<O and TLCO/VA (P<0 was observed at rest. During exercise, comparison of patients demonstrated a significant increase of both peak exercise oxygen uptake (SLVO P<0·0l) and cardiac output (P<0·00l). At early recovery after peak exercise there was a significant increase in TLCO (P<O05) and TLCO/VA (P<0·01), such that a 
TLCO and a TLCO/VA appeared (P<0·05) identical to that observed in control subjects. Moreover, SLVO2 was significantly correlated in patients with Q+TLCO/VA (p=0·02; r=0·72).
In conclusion, this study suggests a role, at least partial, of lung diffusing capacity in exercise intolerance in patients with tight mitral stenosis and in the improvement of their aerobic exercise capacity demonstrated after successful percutaneous balloon valvuloplasty.
Key Words: Mitral valve stenosis • percutaneous balloon valvuloplasty • lung diffusing capacity • cardiopulmonary exercise testing • cardiac output
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