investigation of tenascin-c levels in rheumatic mitral stenosis and their response to percutaneous mitral balloon valvuloplasty

The purpose of this study was to evaluate the tenascin-C levels in severe rheumatic mitral stenosis before and after percutaneous mitral balloon valvuloplasty [PMBV]. Forty patients with severe mitral stenosis requiring PMBV and 20 age-matched healthy subjects were included in the study. The mitral valve areas, mitral gradients and systolic pulmonary artery pressure [sPAP] were measured by echocardiography. The sPAP values and mitral gradients were also measured by catheterization before and after PMBV. The blood tenascin-C levels were measured before PMBV and 1 month after the procedure. The echocardiographic mean mitral gradients had a significant decrease after PMBV [11.7 +/- 2.8 vs. 5.6 +/- 1.7 mm Hg; p < 0.001] and also those of catheterization [13.9 +/- 4.4 vs. 4.0 +/- 2.4 mm Hg; p < 0.001]. Mitral valve areas increased significantly after PMBV [from 1.1 +/- 0.1 to 1.8 +/- 0.2 cm[2], p < 0.001]. Tenascin-C levels decreased significantly in patients after PMBV [from 15.0 +/- 3.8 to 10.9 +/- 3.1 ng/ml; p < 0.001]. Tenascin-C levels were higher in patients with mitral stenosis before PMBV than in healthy subjects [15.0 +/- 3.8 and 9.4 +/- 2.9 ng/ml; p < 0.001, respectively]. There were no significant differences between patients with mitral stenosis after PMBV and healthy subjects [10.9 +/- 3.1 and 9.4 +/- 2.9 ng/ml; p = 0.09, respectively]. There was a significant positive correlation between tenascin-C levels and sPAP [r = 0.508, p < 0.001]. In multivariant analysis, tenascin-C predicted mitral stenosis [p = 0.004, OR: 2.31]. Tenascin-C was an independent predictor for rheumatic mitral stenosis

Changes in hematologic markers in patients with mitral stenosis after successful percutaneous balloon mitral valvuloplasty.

Systemic embolism is a major complication of mitral stenosis which is usually related to a presence of left atrial thrombus. Percutaneous balloon mitral valvuloplasty (PBMV) was previously reported to reduce the incidence of this complication. However, the mechanisms of this beneficial procedure was under investigated. The aim of this study was to investigate the changes in coagulation activity, platelet activity and endocardial function in 29 patients with mitral stenosis after successful PBMV. All subjects had good left ventricular systolic function and 48.3% had atrial fibrillation. There was a significant reduction in thrombin-antithrombin complex (TAT) after a successful procedure and the level of thrombomodulin was also significantly higher one month after successful procedure. However, the level of platelet factor 4 (PF4) and beta-thromboglobulin (beta-TG) were increased after this procedure but not achieved the statistical significance. In conclusion, successful PBMV can reduce the prethrombotic state in patients with mitral stenosis. In addition, it may improve endocardial function of the left atrium in those without atrial fibrillation.

Comparison between two different modes of oxygen therapy during immediate postoperative period following mitral commisurotomy.

Hypoxaemia is a common postoperative problem after thoracotomy. Oxygen therapy with continuous monitoring by pulse oximetry should be a routine practice. This study was conducted to compare the efficacy between nasal cannula and ventimask for post-thoracotomy oxygen supplementation on 20 patients divided into 2 groups of 10 each undergoing closed mitral commisurotomy. The study period was of 5 months duration from March to July, 1996. The mean oxygen saturation remained above 98% in both the groups receiving oxygen either by nasal cannula or ventimask. As there was adequate oxygenation, the cost benefit ratio favours the use of nasal cannula for routine postoperative oxygen supplementation in the closed mitral commisurotomy patients.

Non-surgical mitral valvuloplasty for rheumatic mitral stenosis.

One hundred and twenty-six patients of rheumatic mitral stenosis (MS), aged 10-30 (mean 19.5 +/- 5.9) years underwent balloon mitral valvuloplasty (BMV). All valvuloplasties were done by the anterograde transvenous, transatrial route. The procedure was successful in 120 (95%) cases. Single balloon was used in 10 patients early in the series and double balloon was used in the other 110 patients. BMV resulted in a significant increase in the mitral valve area (MVA) from 0.96 +/- 0.35 to 2.3 +/- 0.8 cm2 (p less than 0.0001) and a significant fall in the transmitral pressure gradient (TMG) from 28.2 +/- 3.2 to 7.4 +/- 4.8 mmHg (p less than 0.001). The MVA achieved by BMV was found to have a significant positive correlation with the balloon diameter to body surface area ratio (BD/BSA) (r = 0.69, p less than 0.001). New mitral regurgitation (MR) developed in 15 patients--trivial in 11, 2+ in 2 and 3+ in 2. One patient required emergency mitral valve replacement. Procedure induced MR did not have a significant relation to the balloon size, degree of mitral sub-valvular pathology or the severity of mitral stenosis. Iatrogenic atrial septal defect was detected by oximetry in none, by angiography in one patient, and by Doppler color flow imaging in 5 patients. Cardiac tamponade was the most frequent serious complication, occurring in 6 patients, 4 of whom died following emergency surgery. Sixty-five patients have been followed up for at least 6 months (range 6-30, mean 16.3 +/- 6.3 months) following BMV.(ABSTRACT TRUNCATED AT 250 WORDS)