Effect of isosorbide dinitrate on pulmonary venous compliance

Irreversible poor pulmonary venous compliance (PV comp) could worsened natural course of patients (pts) with high pulmonary capillary wedge pressure especially pts with mitral stenosis. Nitrates (isosorbide dinitrate-ISDN) possessing venous dilating action could increase PV comp in most of pts. The main aim of that study was to assess hemodynamic effects of ISDN, in pts with MS, with special emphasis on PV com changes. PV comp was estimated according to Hirakawa equation (dV/dp = 0.4*k2*SV/(v-d) in 35 pts with MS, during preoperative right heart catheterisation with VYGON 5155-180 thermodilution catheters during rest and effort in supine position (25W). The same protocol was performed after Iso-Mack sprawy 3.75 mg. According to the PV comp response to ISDN, pts were divided in two groups: good responders (I)-15% and higher increase in PV comp and poor responders (II). ISDN increased PV comp in the whole group according to the response to ISDN, there were significant differences in stroke volume index (SVI) and heart rate (HR). In the group of good responders mean right atrial pressure (RA), mean pulmonary artery pressure (PAP), mean pulmonary wedge pressure (PWP) decreased significantly with simultaneous slight not significant decrease in SVI and not significant increase of HR. In the group of poor responders SVI decreased significantly by about 20% with significant increase of HR. In conclusion significant decrease in pulmonary pressures (PAP, PWP) in pts with good response to ISDN are secondary to the increase of PV comp, while among poor responders the same effects are due to diminished flow secondary to the decrease of the systemic venous return.