Pulmonary artery hypertension (PAH) is a major risk factor in patients presenting in our hospital for mitral valve replacement (MVR) surgery. In this prospective study, we have focused on hemodynamic changes and postoperative results of MVR in patients with severe PAH. Methods: 136 consecutive patients who underwent mitral valve replacement for severe rheumatic mitral valve disease with severe PAH (pulmonary artery pressure (PAP) > 50 mmHg) were studied prospectively for immediate postoperative

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... hemodynamics and outcomes from December 2013 to January 2016. The mean age of the patients was 34.3 years. 74 (54.41%) patients had mitral stenosis, 30 (22.05%) had mitral regurgitation and 32 (23.52%) had mixed lesions. Patients were randomly given two groups based on preoperative pulmonary artery pressures. In 120 patients (88.23%, group I) PAP was sub-systemic or systemic, with a mean of 59.6 mmHg. Sixteen patients (11.76%, group II) had supra-systemic PAP with a mean of 84.2 mmHg Results: After mitral valve replacement, the PAP and pulmonary vascular resistance (PVR) decreased significantly in group I to near normal levels. However, in group II, despite reduction in the PAP and PVR, significant residual PAH remained. Operative mortality was 1.6% in group I and 12.5% in group II. Conclusion: In patients with mitral valve disease undergoing mitral valve replacement, PAH is a significant risk factor. In cases with sub-systemic or systemic PAH, results are very good but significant PAH persists even after MVR is cases of supra-systemic PAH causing continuation of symptoms.