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PubMed2002

Silent brain infarction in patients with rheumatic mitral stenosis.

Silent brain infarction (SBI) is defined as asymptomatic infarction areas detected in computerized tomography (CT) scans in patients without a history of stroke. The incidence of SBI is increased in CT or magnetic resonance imaging in patients with carotid stenosis and with atrial fibrillation (AF), but its relation with rheumatic mitral stenosis (MS), another major source of emboli, is uncertain. The aim of this study was to investigate the incidence of SBI in patients with MS. Fifty-three patients with MS (44 females and 9 males; range 25-52 years; mean age 38 +/- 7 years) diagnosed by transthoracic echocardiography (TTE) were enrolled in the study. Mitral valve calcification, left atrium (LA) dimension, and the presence of associating mitral regurgitation on TTE were recorded. Electrocardiographic evaluation was done for rhythm analysis and neurologic examination was performed prior to cerebral CT. Carotid artery Doppler examination was carried out in patients with SBI to exclude carotid artery lesions. Patients with a history of hypertension, diabetes mellitus, anticoagulant drug usage, presence of thrombus in LA, left ventricular segmental or systolic dysfunction, or other valve diseases were excluded from the study. The incidence of SBI was found to be 24.5% in patients with MS (47% cortical, 53% lacunar). SBI was observed to be significantly high in patients with LA dimension > 4 cm or in patients with AF (p < 0.05). The SBI incidence was markedly higher if AF was found with enlarged LA when compared with patients having sinus rhythm and small LA (p < 0.01). When moderate to severe mitral regurgitation was associated with MS, the SBI incidence was found to be lower (p < 0.05). Although SBI was higher in patients with MVA < 1.5 cm2, it was not statistically significant (p > 0.05). No significant correlation was found between calcific and noncalcific valves for SBI (p > 0.05). Our data suggest that SBI may be expected in about 1/4 of patients with MS. The presence of LA enlargement and AF increase the incidence of SBI in patients with MS, whereas the presence of moderate to severe mitral regurgitation decreases the incidence of SBI.

Adult↗
PubMed2005

Percutaneous transvenous mitral commissurotomy and radiofrequency catheter ablation in patients with mitral stenosis.

BACKGROUND: The purpose of this study was to evaluate the short- and long-term results of radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillation (AF) in patients with mitral stenosis (MS) following percutaneous transvenous mitral commissurotomy (PTMC). METHODS AND RESULTS: Four patients (2 males, age 59+/-6 years) underwent simultaneous PTMC and pulmonary vein (PV) ablation. All patient had AF and MS (2 had persistent AF >1 month, 2 had paroxysmal AF), and the mean duration of AF was 3.4+/-3.3 years. The mean left atrial dimension was 47+/-7 mm and the mean ejection fraction was 58+/-4%. After PTMC, RFCA was performed in all patients (3 underwent PV isolation and 1 had PV focal ablation). The mitral valve area increased from 1.11 +/-0.19 to 1.90+/-0.20 cm(2) (p < 0.01). The frequency of AF episodes was dramatically reduced in the 2 patients with paroxysmal AF, and the 1 with persistent AF maintained sinus rhythm, but 1 patient with persistent AF developed recurrent AF. No complications or cardiac events occurred in any of the patients. CONCLUSION: The combination of RFCA and PTMC was safe and feasible, and may be useful in patients with MS and AF.

Catheter Ablation↗
PubMed1991

Successful mitral valvuloplasty using the Inoue balloon in a patient with mitral stenosis associated with subvalvular fibrosis and reduced left ventricular inflow cavity: a case report.

Percutaneous transvenous mitral valvuloplasty (PTMV) was performed with two cylindric pigtail balloon catheters in a 52-year-old woman with symptomatic mitral stenosis. The subvalvular apparatus was fibrous with welded chordae and the subvalvular left ventricular space was markedly reduced. As a result of this distorted anatomy, during the inflations, the two balloons constantly slipped back into the left atrium before full inflation was obtained. After the procedure, the mitral valve area (MVA), as estimated by echo-doppler (ED), increased from 1.00 to 1.34 cm2. After 2 months of mild clinical improvement, the patient again became symptomatic and ED examination showed a MVA of 1.25 cm2. A second PTMV was performed with an Inoue balloon, the entire procedure taking less than 1 hour. A stable position of the Inoue balloon and complete dilatation were achieved. ED examination showed a mitral valve area of 2.30 cm2. There was no mitral regurgitation nor atrial septal defect. After 3 months, she has only N.Y.H.A. class I symptoms and MVA, as estimated by ED, was 2.40 cm2.

Catheterization↗
PubMed2006

MRI planimetry for diagnosis and follow-up of valve area in mitral stenosis treated with valvuloplasty.

PURPOSE: We sought to determine whether noninvasive planimetry by magnetic resonance imaging (MRI) is suitably sensitive and reliable for visualizing the mitral valve area (MVA) and for detecting increases in the MVA after percutaneous balloon mitral valvuloplasty (PBMV). MATERIALS AND METHODS: In 8 patients with mitral valve stenosis, planimetry of the MVA was performed before and after PBMV with a 1.5 T MR scanner using a breath-hold balanced gradient echo sequence (True FISP). The data was compared to the echocardiographically determined MVA (ECHO-MVA) as well as to the invasively calculated MVA by the Gorlin formula at catheterization (CATH-MVA). RESULTS: PBMV was associated with an increase of 0.79 +/- 0.30 cm (2) in the MVA (Delta MRI-MVA). The correlation between Delta MRI-MVA and Delta CATH-MVA was 0.92 (p < 0.03) and that between Delta MRI-MVA and Delta ECHO-MVA was 0.90 (p < 0.04). The overall correlation between MRI-MVA and CATH-MVA was 0.95 (p < 0.0001) and that between MRI-MVA and ECHO-MVA was 0.98 (p < 0.0001). MRI-MVA slightly overestimated CATH-MVA by 8.0 % (1.64 +/- 0.45 vs. 1.51 +/- 0.49 cm (2), p < 0.01) and ECHO-MVA by 1.8 % (1.64 +/- 0.45 vs. 1.61 +/- 0.43 cm (2), n. s.). CONCLUSION: Magnetic resonance planimetry of the mitral valve orifice is a sensitive and reliable method for the noninvasive quantification of mitral stenosis and visualization of small relative changes in the MVA. This new method is therefore capable of diagnosing as well as following the course of mitral stenosis. It must be taken into consideration that planimetry by MRI slightly overestimates the MVA as compared to cardiac catheterization.

Anatomy, Cross-Sectional↗
PubMed2001

Coronary artery fistulae from single coronary artery in a patient with rheumatic mitral stenosis.

Here we report coronary artery fistulae (CAF) arising from a single coronary artery in a patient with rheumatic mitral stenosis. A 62-year-old woman underwent a coronary angiogram prior to mitral valve replacement (MVR). The left coronary artery angiogram showed the right coronary artery arising from the left anterior descending coronary artery. From the distal left circumflex artery, two CAF were seen draining into left atrium. The haemodynamically insignificant fistulae were left alone and patient underwent MVR. Such an association has not been reported so far.

Arterio-Arterial Fistula↗
PubMed1993

Percutaneous balloon valvuloplasty for severe mitral stenosis during pregnancy: a review of therapeutic options.

A woman presented at 29 weeks' gestation with previously undiagnosed severe mitral stenosis. She did not respond to medical therapy, and underwent successful percutaneous balloon mitral valvuloplasty with complete resolution of her symptoms. The remainder of her pregnancy was uncomplicated, and she delivered a healthy infant at 40 weeks' gestation. Percutaneous balloon valvuloplasty offers an innovative alternative to standard surgical therapy if medical management is unsuccessful.

Adult↗
PubMed1995

Effect of atrial fibrillation on exercise capacity in mitral stenosis.

To determine the preoperative and postoperative effect of atrial fibrillation (AF) on exercise capacity in mitral stenosis, 12 digitalized patients in AF (7 women and 5 men, age 52 +/- 6.1 years) and 10 in sinus rhythm (5 women and 5 men, age 46 +/- 5 years) underwent maximal cardiopulmonary exercise testing according to Weber's protocol and Doppler echocardiographic examination before and at 3 and 6 months after mitral valve replacement. The ratio of right ventricular acceleration to ejection time was used as an estimate of mean pulmonary artery pressure. Preoperative exercise duration (6.8 +/- 1 vs 8 +/- 2 minutes), peak oxygen consumption (9.7 +/- 3 vs 12.3 +/- 3 ml/kg/min), and right ventricular acceleration to ejection time ratio (0.34 +/- 0.07 vs 0.34 +/- 0.08) were not significantly different between patients with AF and those in sinus rhythm. Postoperative improvement in these parameters was lower in patients with AF than in those in sinus rhythm: exercise duration at 3 months, 7.5 +/- 2 vs 11.9 +/- 2 minutes (p < 0.001); at 6 months, 9 +/- 2 vs 12 +/- 2 minutes (p < 0.001); peak oxygen consumption at 3 months, 10.8 +/- 3 vs 17.5 +/- 3 ml/kg/min (p < 0.001); and at 6 months, 11.9 +/- 3 vs 17.8 +/- 3 ml/kg/min (p < 0.001); right ventricular acceleration to ejection time ratio at 3 months, 0.35 +/- 0.08 vs 0.42 +/- 0.05 (p < 0.05); and at 6 months, 0.38 +/- 0.05 vs 0.44 +/- 0.05 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗
PubMed1995

[Preoperative erythrocytopheresis in a patient with SC hemoglobinopathy and mitral stenosis].

Hemoglobinopathies are associated with thrombotic complications, when exposed to cardiopulmonary bypass. A 54-year old, black woman with hemoglobinopathy SC and severe mitral stenosis was submitted to eritrocytopheresis 48 hours before mitral commissurotomy surgery. The therapeutic determined appearance of the percentual hemoglobin A of 68% with reduction the hemoglobin S of 48% to 15% and the hemoglobin C of 51% to 17%. No complications occurred during postoperative period. To best of our knowledge, that is the first report about application the eritrocytopheresis in the pre operative extra corporeal circulation care in surgical treatment of patients with chronic rheumatic heart disease and hemoglobinopathy SC.

Erythrocyte Transfusion↗
PubMed2002

[Pulmonary diffusion of carbon monoxide in patients with mitral stenosis].

OBJECTIVE: The aim of our work has been the study of CO diffusion capacity in mitral valve stenosis patients. METHOD: We have studied 15 control subjects and 15 patients with mitral valve stenosis. We performed spirometry study and CO pulmonary diffusion tests (DLCO) by single breath method to determine two components: pulmonary capillary blood volume (Vc) and membrane diffusion factor (Dm). In addition, in mitral valve stenosis patients we performed a ecocardiography-doppler study. RESULTS: The mitral valve stenosis group had higher values of DLCO and Vc and a lower ratio of Dm/Vc than the control group. There is a negative correlation between Vc and the mitral valve area (r = -0.63; p = 0.037). We do not find any another correlation between the rest of ecocardiography doppler parameters and lung function test variables that we have measured. We have not found any differences between both groups in Dm. CONCLUSIONS: Mitral valve stenosis patients present a increase of CO pulmonary diffusion capacity and pulmonary capillary blood volume without changes in membrane diffusion factor.

Carbon Monoxide↗
PubMed1984

Long-term results of open mitral commissurotomy for mitral stenosis with severe subvalvular changes: a ten-year evaluation.

Out of 212 patients undergoing open mitral commissurotomy for mitral stenosis from January, 1972, to December, 1981, 53 patients had extremely severe subvalvular changes. In this study, we evaluated postoperative results in these 53 patients. There were 2 operative deaths (3.8%) and 1 late death (1.9%). Of the 50 surviving patients, 34 (68%) were in New York Heart Association Class I and 13 patients (26%) were in Class II, postoperatively. Three patients (6%) required reoperations an average of 5 years 5 months because of the progression of residual mitral regurgitation. The actuarial rate of freedom from mortality and reoperation was 78.6% at 10 years after operation. When anticoagulant therapy was not given, no patient had thromboembolic complications. Postoperative hemodynamic studies demonstrated that mean diastolic gradients across the mitral valve were 5.30 +/- 1.25 mm Hg (standard deviation) at rest and 9.50 +/- 5.13 mm Hg during exercise. Calculated mitral valve areas were 1.86 +/- 0.48 cm2 at rest and 1.88 +/- 0.51 cm2 during exercise. There was no evidence of any adverse effects of mild to moderate valve calcification. It is concluded that for a follow-up period as long as 10 years, the stenosed mitral valve with greatly advanced subvalvular deformities can be salvaged with low mortality, low incidence of reoperation, and acceptable valve function even when such deformities are associated with mild to moderate calcification.

Blood Pressure↗
PubMed1987

Mechanisms of increase in mitral valve area and influence of anatomic features in double-balloon, catheter balloon valvuloplasty in adults with rheumatic mitral stenosis: a Doppler and two-dimensional echocardiographic study.

To study the mechanism of increase in the mitral valve area (MVA) and the anatomic features of the mitral valve that may affect the results of catheter double-balloon valvuloplasty (CBV) in adult patients with mitral stenosis, Doppler and two-dimensional echocardiography was performed in 12 patients before and immediately after CBV. Immediately after CBV, there was an increase in the transverse diameter of the mitral valve orifice from 18 +/- 1.6 to 25 +/- 2.8 mm (mean +/- SD, p less than .001). The anterior angles at the commissure increased from 33 +/- 6 to 57 +/- 20 degrees (p less than .05) and the posterior angles from 36 +/- 9 to 54 +/- 14 degrees (p less than .05). The MVA was greater after CBV in patients with pliable mitral valves (2.6 +/- 0.7 cm2) compared with those with rigid mitral valves (1.9 +/- 0.8 cm2; p = .08). After CBV, MVA was smaller in patients with calcification (2.1 +/- 0.2 cm2) compared with those without (2.7 +/- 0.5 cm2; p = .10) and in those with subvalvular disease (2.0 +/- 0.6 cm2) compared with those without (2.9 +/- 0.9 cm2;p = .03). The MVA by Doppler ultrasound before CBV (1.0 +/- 0.2 cm2) correlated well with MVA by cardiac catheterization (1.0 +/- 0.3 cm2; r = .8, SEE = 0.2 cm2). After CBV, the correlation of MVA by Doppler ultrasound (2.0 +/- 0.5 cm2) with MVA by cardiac catheterization (2.4 +/- 0.8 cm2) was poor (r = .3, SEE = 0.44 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Closed versus open mitral commissurotomy in pure noncalcific mitral stenosis: hemodynamic studies before and after operation.

Controversy persists regarding whether the efficacy of closed instrumental mitral commissurotomy compares well enough with that of open commissurotomy to warrant its continued use. The purpose of this study was to compare the results of operation as determined by catheterization studies in 63 patients with pure, severe, and noncalcified mitral stenosis. The patients were randomly assigned to one of two groups: thirty-two patients were operated on by the closed technique (group I) and 31 by the open technique (group II). All patients underwent left-sided and right-sided catheterization before and 4 months after operation. Preoperatively the two groups were statistically similar with regard to major clinical data and hemodynamic findings. There were no deaths at operation or systemic embolism in the two groups. The prevalence of surgically induced mitral regurgitation was similar in the two groups (12.4% versus 12.9%). Pulmonary arterial pressure and arteriolar and total pulmonary vascular resistance decreased significantly in the two groups. Pulmonary capillary wedge pressure decreased from 23.3 +/- 8.5 to 15.8 +/- 7 mm Hg in group I (p less than 0.001) and from 23.7 +/- 6 to 14 +/- 5.8 mm Hg in group II (p less than 0.001). Cardiac index increased from 2.86 +/- 0.84 to 3.14 +/- 0.78 L/min/m2 in group I, but this increase did not reach statistical significance. In group II cardiac index increased from 2.89 +/- 0.6 to 3.6 +/- 0.6 L/min/m2 (p less than 0.005). The mean and end-diastolic transmitral pressure gradients decreased significantly in the two groups, but the decrease was statistically greater in the open mitral commissurotomy group (p less than 0.001). Mitral valve area increased from 0.82 +/- 0.18 to 1.4 +/- 0.40 cm2 in group I (p less than 0.01) and from 0.84 +/- 0.15 to 2.14 +/- 0.53 cm2 in group II (p less than 0.001). The mean increase in mitral valve area was 0.61 cm2 in group I and 1.34 cm2 in group II (p less than 0.001). At exercise, in patients with resting pulmonary capillary wedge pressures of 18 mm Hg or less, cardiac index increased by 36% in group I (23 patients) and 48% in group II (24 patients), because of a smaller mitral valve area in group I (1.61 +/- 0.39 cm2) than in group II (2.45 +/- 0.65 cm2). Thus open commissurotomy improved hemodynamic values to a greater extent than closed commissurotomy at both rest and exercise.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1997

Physical training improves exercise capacity in patients with mitral stenosis after balloon valvuloplasty.

BACKGROUND: Haemodynamic measurements taken at rest and during exercise showed that percutaneous transvenous mitral commissurotomy results in both acute and long-term improvement. However, the time lag before there is an increase in exercise and in peak oxygen uptake appears to be delayed and irregular. PATIENTS AND METHODS: To assess the potential of physical training to restore better physical capacity after percutaneous transvenous mitral commissurotomy, 26 patients with mitral stenosis were studied after the procedure. The group was split into two. Thirteen underwent a 3-month rehabilitation programme, and the other 13, who did not, acted as controls. RESULTS: The mitral valve orifice area increased similarly, from 1.12 +/- 0.17 to 1.88 +/- 0.28 cm2 in the training group and from 1.04 +/- 0.16 to 1.88 +/- 0.19 cm2 in the control group. Cardiopulmonary parameters were similar before percutaneous transvenous mitral commissurotomy (peak VO2: 19.9 +/- 2.4 vs 18.9 +/- 4.5 ml. min-1.kg-1; peak workload: 94.6 +/- 29.3 vs 96.1 +/- 25 watts; VO2 at anaerobic threshold: 17 +/- 3.4 vs 16.1 +/- 5.2 ml.min-1.kg-1; all P = ns). Three months later the results were higher in the training group 1 (peak VO2: 26.6 +/- 4.7 vs 21.6 +/- 3.8 ml.min-1.kg-1, P = 0.03; peak workload: 125.4 +/- 26.6 vs 108.5 +/- 23 watts, P = 0.03; VO2 at anaerobic threshold: 19.6 +/- 5.8 vs 15.8 +/- 2.9 ml.min-1.kg-1; P = 0.02). CONCLUSION: These results indicate that patients should take up exercise after successful percutaneous transvenous mitral commissurotomy for better functional improvement.

Adult↗
PubMed1980

Double diastolic murmur in mitral stenosis with atrial fibrillation and complete heart block.

A double diastolic murmur was heard in a patient with mitral stenosis, atrial fibrillation, and complete heart block. Echo-phonocardiographic examination showed two separate opening and closing movements of the mitral valve in the same long diastole. A clear time relation was observed between the valve closing movements and the separate diastolic murmurs, giving support to the theory that the backward motion of the mitral valve against the forward blood flow through the valve is responsible for the production of these murmurs.

Atrial Fibrillation↗
PubMed1992

[Large thrombus in the left atrium and rheumatic mitral stenosis. Value of cardiac imaging].

Thromboses in the left atrium, which are a commonplace complication of mitral stenoses with major dilatation of the left atrium lead to a major risk of systemic embolism. It is important to discover them, because they constitute a contraindication to mitral valvuloplasty. The authors report the case of a large left intra-atrial thrombus complicating a pure, tight, mitral stenosis. They also highlight the value of new medical imaging techniques in cardiology: chest CT scan, nuclear magnetic resonance and cardiac scintigraphy. Subsequently, transesophageal cardiac ultrasound, not available in France at the time for this patient, has become the reference method for visualizing and detecting left intra-atrial thrombi.

Aged↗
PubMed2006

Hemodynamic change in transmitral gradient during Valsalva maneuver and its relation with left atrial function, functional capacity, and pulmonary artery pressure in patients with mitral stenosis in sinus rhythm.

BACKGROUND: The hemodynamic factors contributing to the clinical symptomatology in patients with mitral stenosis (MS) have been under investigation. The objective of this study was to evaluate the use of the Valsalva maneuver in patients with MS and whether there is an association between the degree of the hemodynamic changes in transmitral gradient (TG) in response to Valsalva maneuver and functional status, systolic pulmonary artery pressure, and left atrial function in patients with MS in sinus rhythm. METHODS: The study prospectively evaluated 42 patients (37 female, mean age 40 +/- 10 years) with a diagnosis of pure MS in sinus rhythm. Patients were divided into 3 groups according to their New York Heart Association (NYHA) functional class. In all, 12 patients were in NYHA functional class I, 17 patients in class II, and 13 patients in class III. TG, including the mitral peak, mean, and late filling gradients, were calculated by the modified Bernoulli equation at rest and during the strain phase of Valsalva maneuver. The percentage changes in all TG in response to Valsalva were calculated. Traditional echocardiographic parameters for atrial function were also measured. RESULTS: We found that, in patients who were more symptomatic according to NYHA classification, a reduction in TG in response to Valsalva maneuver was blunted and associated with higher systolic pulmonary artery pressure compared with those who were asymptomatic or had mild symptoms. Patients in NYHA class III decreased mitral mean pressure gradient by only 13.5%, significantly less (P < .001) than those in classes I (53.9%) and II (41.7%). However, despite the fact that left atrial ejection fraction was low in all patients, it was not associated with functional status in patients with MS. CONCLUSION: This study, for the first time, suggests that echocardiographically determined changes in TG in response to the Valsalva maneuver may provide an objective, noninvasive means of evaluating patients with MS.

Adaptation, Physiological↗
PubMed2004

Relationship between control of ventricular rate in atrial fibrillation and systemic coagulation activation in patients with mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: Systemic thromboembolism is a major complication in patients with mitral stenosis (MS), especially in those who have atrial fibrillation (AF). It has been suggested that systemic coagulation activity may be increased in these patients. The study aim was to investigate the relationship between control of ventricular rate and systemic coagulation factors in patients with MS and AF by measuring plasma levels of prothrombin fragment (PF) 1+2, thrombin-antithrombin III complex (TAT) and plasminogen activator inhibitor-1. METHODS: Fifty-four consecutive patients with moderate to severe MS and AF were included in the study. Patients with resting heart rates < 100 beats per min were considered as having a controlled ventricular response rate (group A; n = 28) and those with > 100 beats per min as an uncontrolled ventricular response rate (group B; n = 26). RESULTS: Group A patients had a lower mean mitral gradient and pulmonary artery pressure than group B patients (11 +/- 6 versus 15 +/- 5 and 35 +/- 7 versus 39 +/- 8; p < 0.05, respectively). Plasma concentrations of PF 1+2 (4.17 +/- 2.1 versus 2.95 +/- 1.21; p < 0.01) and TAT III (4.61 +/- 1.75 versus 3.12 +/- 1.01; p < 0.01) were elevated in group B compared with group A. Similarly, group B patients had higher plasminogen activator inhibitor-1 levels than group A patients (7.87 +/- 3.8 versus 5.8 +/- 2.9; p < 0.05). A significant correlation was found between heart rate and plasma PF 1+2 and TAT levels. Multiple logistic regression analysis revealed that heart rate and mean mitral gradient were independent predictors of systemic coagulation activation. CONCLUSION: Besides contributing towards hemodynamic and symptomatic relief, the control of AF rate in MS patients induces a drastic decline in coagulation activation, and may also reduce the incidence of thromboembolism.

Adolescent↗
PubMed2004

Increased plasma levels of soluble P-selectin in rheumatic mitral stenosis.

BACKGROUND: Previous studies have demonstrated that platelet activation occurs in peripheral blood of patients with rheumatic mitral stenosis (MS). However, in patients with MS, the plasma level of soluble P-selectin (a marker of platelet activation) remains unsettled. METHODS AND RESULTS: A total of 20 patients with symptomatic MS undergoing percutaneous transluminal mitral valvuloplasty (PTMV) were studied (group 1; 16 patients in permanent atrial fibrillation, and 4 patients in sinus rhythm). The plasma levels of soluble P-selectin in the femoral vein and artery, and right and left atria before PTMV and those in the peripheral venous blood at the 1-week and 4-week follow-ups after PTMV were determined by solid-phase, sandwich, enzyme-linked immunosorbent assay. The mitral valve area was calculated by means of the Doppler pressure half-time method. In addition, we measured plasma concentrations of soluble P-selectin in the peripheral venous blood samples obtained from 22 control patients (including 14 healthy volunteers in sinus rhythm [group 2] and 8 patients in permanent lone atrial fibrillation [group 3]). The plasma levels of soluble P-selectin were significantly elevated in group 1 patients (49.78 +/- 37.72 ng/mL) [mean +/- SD] compared with group 2 (25.52 +/- 15.38 ng/mL) and group 3 patients (32.17 +/- 14.18 ng/mL) [p < 0.005]. In group 1 patients, the plasma levels of soluble P-selectin in the left atrium did not significantly differ from those in the right atrium, femoral vein, or femoral artery (p = 0.05). The area of mitral valve increased significantly after PTMV (1.06 +/- 0.17 cm(2) vs 1.48 +/- 0.32 cm(2), p < 0.0001). The mean left atrial pressure fell significantly and immediately after PTMV (23.0 +/- 5.1 mm Hg vs 17.6 +/- 5.9 mm Hg, p < 0.0001). The peripheral venous plasma levels of soluble P-selectin obtained before PTMV did not significantly fall after PTMV (before, 49.8 +/- 37.7 ng/mL; 10 min after, 39.8 +/- 19.1 ng/mL; 1 week after, 46.1 +/- 20.8 ng/mL; and 4 weeks after, 41.2 +/- 15.9 ng/mL; p = 0.145). CONCLUSIONS: The venous plasma levels of soluble P-selectin in patients with moderate-to-severe MS were significantly higher than those in healthy volunteers or patients with lone atrial fibrillation. In addition, in patients with MS, there was no difference in the plasma levels of soluble P-selectin between the left and right atrial blood and between peripheral and atrial blood. Moreover, there was no change in soluble P-selectin levels as a result of PTMV.

Adult↗