Halperin J L, Brooks K M, Rothlauf E B, Mindich B P, Ambrose J A, Teichholz L E
J Am Coll Cardiol. 1985 Jan;5(1):34-9. doi: 10.1016/s0735-1097(85)80082-6.
Because the equality of the pulmonary artery wedge pressure and left atrial pressure has been questioned in patients with mitral valve disease and pulmonary hypertension, this study examined how vasomotor activity in the pulmonary capacitance vessels might contribute to a discrepancy between these pressures. The difference between the pulmonary wedge and left atrial pressures (designated as the pulmonary venous gradient) was measured after nitroglycerin administration in nine patients who had pulmonary hypertension (mean pulmonary artery pressure 40 mm Hg) after mitral valve replacement. Five minutes after sublingual nitroglycerin, 0.4 mg, the mean pulmonary wedge pressure decreased from 19 +/- 2 to 13 +/- 2 mm Hg (p less than 0.005), exceeding the decrease in left atrial pressure (15 +/- 2 to 11 +/- 2 mm Hg; p less than 0.005). Pulmonary blood flow increased from 4.6 +/- 0.4 to 4.9 +/- 0.4 liters/min (p less than 0.005). The decrease in mean pulmonary venous gradient from 4.0 +/- 0.8 to 1.7 +/- 0.6 mm Hg (p less than 0.025) was attributed to nitrate-mediated pulmonary venodilation. The ratio of venous gradient to blood flow, an index of pulmonary venous tone, decreased after nitroglycerin from 0.9 +/- 0.2 to 0.4 +/- 0.1 (p less than 0.01). These data indicate that reversible pulmonary vasoconstriction contributes to elevation of the pulmonary wedge pressure above the left atrial pressure in patients with chronic mitral valve disease and pulmonary hypertension and that nitroglycerin may produce pulmonary venodilation decreasing the pulmonary venous gradient.
由于二尖瓣疾病和肺动脉高压患者的肺动脉楔压与左心房压力的相等性受到质疑，本研究探讨了肺容量血管中的血管舒缩活动如何导致这些压力之间的差异。在二尖瓣置换术后患有肺动脉高压（平均肺动脉压40mmHg）的9例患者中，给予硝酸甘油后测量肺动脉楔压与左心房压力之间的差值（称为肺静脉梯度）。舌下含服0.4mg硝酸甘油5分钟后，平均肺动脉楔压从19±2mmHg降至13±2mmHg（p<0.005），超过左心房压力的下降幅度（15±2mmHg降至11±2mmHg；p<0.005）。肺血流量从4.6±0.4升/分钟增加至4.9±0.4升/分钟（p<0.005）。平均肺静脉梯度从4.0±0.8mmHg降至1.7±0.6mmHg（p<0.025）归因于硝酸盐介导的肺静脉扩张。肺静脉张力指数即静脉梯度与血流量之比在硝酸甘油后从0.9±0.2降至0.4±0.1（p<0.01）。这些数据表明，可逆性肺血管收缩导致慢性二尖瓣疾病和肺动脉高压患者的肺动脉楔压高于左心房压力，并且硝酸甘油可能产生肺静脉扩张，降低肺静脉梯度。
