Pulmonary artery occlusion pressure (PAOP/PAWP) normally reflects left atrial pressure and, by extension, left ventricular end-diastolic pressure (LVEDP). In which clinical condition does PAOP OVERESTIMATE LVEDP?

• A Severe aortic stenosis
• B Dilated cardiomyopathy with chronic LV failure
• C Mitral stenosis ✓
• D Tricuspid regurgitation

Explanation

In mitral stenosis, the mitral valve obstruction causes a pressure gradient between the left atrium and left ventricle. PAOP reflects upstream pressure (pulmonary veins → left atrium), but since mitral stenosis prevents this pressure from being transmitted normally to the LV, PAOP overestimates LVEDP. The elevated PAOP reflects the high left atrial pressure due to obstruction, not LV filling pressure. In dilated cardiomyopathy with a non-compliant LV, PAOP may actually underestimate LVEDP. Aortic stenosis causes LV outflow obstruction but does not affect the upstream LA–LV pressure relationship.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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