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Objective To explore the effect of mitral valve morphology on short-term and long-term outcomes in elderly patients with rheumatic mitral stenosis(MS)undergoing percutaneous balloon mitral valvuloplasty(PBMV).Methods In the prospective study,elderly patients with rheumatic mitral stenosis undergoing PBMV between February 1996 and June 2007 were followed up for 10 years.One hundred and twenty-four patients with full follow-up data were included in the study.According to echocardiography Wilkins score,83 cases of patients (Wilkins score ≤ 8)were selected as Wilkins score ≤ 8 group,and 41 cases were selected as Wilkins score＞ 8 group.The pressure gradient in mitral valve(MV△P),mitral valve area(MVA),left atrial diameter(LAD),left ventricular end-systolic diameter(LVESd),left ventricular end-diastolic diameter(LVEDd),pulmonary artery systolic blood pressure(sPAP),ejection fraction(EF)and mitral regurgitation were measured before and after the operation.Results In both Wilkins score ≤ 8 group and Wilkins score＞ 8 groups,MVA and EF were increased immediately after PBMV operation versus before PBMV operation,and MV△P,LAD,LVEDd,LVEDs and PAPs were decreased immediately after PBMV operation versus before PBMV operation(all P ＜0.05).Severe mitral regurgitation was not found in both two groups.The clinical effects of the Wilkins score≤8 group were stable after 10 years,which had no significant difference in the indexes compared with those in the Wilkins score≤ 8 group immediately after PBMV(P＞0.05).MVA and EF in the Wilkins score＞8 group were decreased,and MV△P,LAD,LVEDd,LVEDs and PAPS were increased after 10 years as compared with those immediately after PBMV(P＜0.05).The incidence of NYHA functional class Ⅲ or Ⅳ was lower in the Wilkins score ≤8 group than in the Wilkins score＞8 group(26.5％ or 22/83 vs.46.3％ or 19/41,x2 =4.879,P=0.027).And the incidence of mitral restenosis was lower in the ≤8 group than in the Wilkins score＞8 group(34.9％ or 29/83 vs.61.0％ or 25/41,x2 =7.567,P=0.006).There was no significant difference in the incidence of moderate or severe mitral regurgitation between the two groups(10.8％ or 9/83 vs.12.3％ or 5/41,x2=1.278,P=0.258).Conclusions The short-term and long-term outcomes are good in elderly individuals with rheumatic mitral stenosis undergoing PBMV operation,and the curative effect of PBMV operation is better in patients with Wilkins score ≤8 than in patients with Wilkins score ＞8.
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<p><b>OBJECTIVE</b>To study the correlation between the expression levels of phagocytic NADPH oxidase p22phox subunit and left ventricular mass index (LVMI) in patients with non-valvular chronic heart failure and explore the role of oxidative stress caused by NADPH oxidase p22phox subunit in left ventricular remodeling.</p><p><b>METHODS</b>Semi-quantitative RT-PCR was used to examine the expression levels of phagocytic NADPH oxidase p22phox in 59 patients with non-valvular chronic heart failure and 20 control subjects. All the subjects underwent ultrasonic cardiography to record their IVST, LVPWT, LVEDd, LVEDs, and EF. Based on the calculated LVMI, the patients were divided into heart failure without LV hypertrophy (LVH) group and heart failure with LVH group.</p><p><b>RESULTS</b>The patients with heart failure showed significantly higher expression of phagocytic NADPH oxidase p22phox than the control subjects (0.91∓0.37 vs 0.68∓0.33, P=0.039), and the patients with LVH had significantly higher p22phox expression than those without LVH (1.58∓0.20 vs 0.71∓0.24, P=0.026). LVMI showed a positive correlation with the expression of p22phox in these patients (r=0.508, P<0.05).</p><p><b>CONCLUSION</b>NADPH oxidase p22phox expression level is positively correlated with LVMI and can be indicative of the level of left ventricular remodeling in patients with non-valvular chronic heart failure.</p>