Volume 33, Issue 5, Pages 513-532 (May 1958) Differentiation of the Causes of Pulmonary Hypertension in Rheumatic Heart Disease by Simultaneous Right and Left Heart Catheterization  PHILIP SAMET, M.D., F.C.C.P., WILLIAM H. BERNSTEIN, M.D., ROBERT S. LITWAK, M.D.  Diseases of the Chest  Volume 33, Issue 5, Pages 513-532 (May 1958) DOI: 10.1378/chest.33.5.513 Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 1 Pulmonary artery, right ventricle and brachial artery pressure curves in R. R. before surgery. The resting pulmonary hypertension is further increased during exercise. Paper speed 25 mm. per second. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 2 Left heart exercise curves in R. R. pre-operatively. The mean diastolic left atrial-left ventricular gradient is 24 mm. Hg. Paper speed is 75 mm. per second. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 3 Post-operative right heart catheterization data in R. R. Mild pulmonary hypertension is present only during exercise. Study performed October 24, 1956. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 4 One month after surgery the resting mean diastolic left atrial—left ventricular gradient is 3 mm. Hg. at rest. (R. R.) Study performed October 24, 1956. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 5 During exercise the gradient rises to 6 mm. Hg. Study performed October 24, 1956. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 6 Right heart Catheterization data in D. D., pre-operatively. There is marked pulmonary hypertension at rest with a further increase during exercise. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 7 Pre-operative left heart catheterization data in the same patient. The left atrial hypertension and mean diastolic left atrial—left ventricular pressure gradient is readily noted. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

Figure 8 Operating room pre-commissurotomy pressures in D. D. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

Figure 9 Operating room post-commissurotomy pressures in D. D. The marked decrease in the diastolic gradient is readily seen. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 10 Right heart curves in D. D. one month after surgery. There has been a decrease in the level of pulmonary artery pressure at rest and exercise, but marked pulmonary hypertension persists. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 11 Left heart catheterization data in D. D. one month after commissurotomy. The diastolic gradient is 1 mm. Hg. at rest and 4 mm. Hg. during exercise. The left ventricular end-diastolic pressure is normal throughout. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIG. 12 Ten months after surgery a further fall in pulmonary artery pressure is noted in D. D Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIG. 13 Right and left heart curves in D. D., at rest supine ten months after commissurotomy. The resting gradient is 1 mm. Hg Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIG. 14 The exercise gradient is 3 mm. Hg., D. D. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIG. 15 Left heart catheterization curves (prone) in S. B., pre-operatively. There is no evidence of mitral insufficiency Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIG. 16 One month after commissurotomy. The diastolic gradient has been reduced to 3 mm. Hg., prone position. The left atrial curve is suggestive of mitral insufficiency. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIG. 17 Left heart curves one year after surgery in S. B. A mean diastolic atrioventricular gradient has reappeared. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 18 Severe aortic stenosis in S. M. The left atrial mean and left ventricular end-diastolic pressures are markedly elevated. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIG. 19 Pulmonary “capillary” pressure in E.C. The mean pressure is 12 mm. Hg., at the upper limit of normal. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIG. 20 There is an obvious significant mean diastolic left atrial—left ventricular gradient. Tight mitral stenosis was found at surgery. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions

FIGURE 21 The mean diastolic atrio-ventricular gradient supine is plotted on the abcissa; the prone gradient is on the ordinate. The deviation from the 46° line of identity is to be noted. Diseases of the Chest 1958 33, 513-532DOI: (10.1378/chest.33.5.513) Copyright © 1958 American College of Chest Physicians Terms and Conditions