Effectiveness of Bilateral Pulmonary Capillary Wedge Pressure and Pulmonary Venous Flow Evaluation for Unilateral Pulmonary Edema With Mitral Valve Prolapse

Case: A 76-years-old woman, who had chronic hepatitis C, was admitted for treatment of dyspnea. Nevertheless she had severe mitral regulation (MR) due to posterior leaflet prolapse, she initially diagnosed as pneumoniae because of the fever and the unilateral decrease of radiolucency in right lung. Although antibiotics was prescribed, the symptoms were not improved. Accordingly, the symptoms were supposed to be caused by congestive heart failure. Her symptoms were improved with diuretics, but the unilateral pleural fluid was replenishment. She was referred to our hospital for further investigation. The right heart catheterization revealed large V wave of pulmonary capillary wedge pressure (PCWP) in only right pulmonary artery, but not in left pulmonary artery. Transesophageal echocardiography showed large pulmonary venous flow (PVF) reversal only in the right superior pulmonary vein (RSPV). Surgical mitral valve repair was performed and the unilateral pleural fluid was diminished. A previous report suggested the unilateral pulmonary edema with MR with leaflet prolapse was induced by the direct eccentric jet into RSPV. Our examinations revealed the effects of eccentric MR jet into RSPV using bilateral measurements of PCWP and PVF reversal in RSPV. This findings indicated eccentric MR jet affect the right lung directly, not only the left atrium pressure arise. Bilateral evaluations of PCWP and PVF were needed to understand the detailed hemodynamic characteristics.