RESUMEN
Mitral stenosis (MS) is a consequence of rheumatic heart disease that leads to heart failure requiring mechanical intervention. Percutaneous mitral commissurotomy (PMC) is the treatment of choice for the intervention, and currently there are no soluble markers associated with hemodynamic improvement after PMC. This study aims to determine the changes in cytokine/chemokine plasma levels, as well as T cell activation after PMC, and to investigate their association with immediate hemodynamic improvement and clinical outcomes. Plasma samples from eighteen patients with well-defined MS who underwent PMC and 12 healthy controls were analyzed using BioPlex immunoassay. We observed that 16 out of the 27 (60%) molecules assessed were altered in patients' plasma pre-PMC as compared to control group. Of those, IL-1ß, IL-12, IL-6, IL-4, PDGF, and CCL11 showed significant decrease after PMC. Stratifying the patients according to adverse outcome after a 28-month median follow up, we detected a significant reduction of IL-1ß, IL-12, IL-6, IL-4, IFN-γ, CXCL-10, VEGF, FGF and PDGF post-PMC in patients without events, but not in those who presented adverse events during the follow-up. Patients with adverse outcomes had lower IL-10 pre-PMC, as compared to the ones without adverse events. In addition, the frequency of CD8+ activated memory cells was increased after PMC, while the frequency of CD4+ activated memory cells did not change. Our results show an association between the decrease of specific cytokines and changes in T cell activation with hemodynamic improvement post-PMC, as well as with long-term outcomes, suggesting their possible use as soluble markers for hemodynamic recovery after MS intervention.
RESUMEN
Objetivo - Analisar os reultados da valvoplastia mitral por cateter-baläo (VMCB) em pacientes de alto risco operatório. Métodos - Vinte (12// pacientes dentre 172 comsecutivos submetidos a VMCB foram considerados de alto risco operatório. Dezessete (85//) eram mulheres e a média etária de 43(18-69) anos. Treze (65//) encontravam-se em edema agudo dos pulmöes (3 gestantes, 2 com acidente vascular cerebral (AVC) prévio, 1 com tromboembolismo pulmonar e outro com insuficiência renal crônica) e 7 (35//) em classe funcional (CF) III (2 com insuficiência coronariana crônica, 2 com obesidade maligna, 1 com neoplasia de pulmäo, 1 com caquexia cardíaca e outro com AVC prévio). Realizaram VMCB pela técnica transeptal sendo utilizado duplo baläo em 10(45//), baläo Inoue em 5(25//), monofoíl em 3(15//) e bifoil em 2(10//) pacientes. Resultados - Dezessete (85//) pacientes com sucesso e 2 (10//) com melhora clínica expressiva. Os resultados hemodinâmicos pré x pós-VMCB foram: pressäo de átrio esquerdo (PAE) em mmHg 28,2 ñ 10,0 x 15,2 ñ 9,2 (n = 20) (p < 0,001); gradiente transvalvar mitral médio (G) em mmHg 21,2 ñ 10,7 x 10,7 ñ 6,7 (n = 18) ( , 0,001); área valvar mitral (AVM) em cm² 0,73 ñ 0,6 (n = 11) (p < 0,001); pressäo média de artéria pulmonar em mmHg 52,0 ñ 18,2 x 40,1 ñ 14,7 (n = 18) (p < 0,001); índice cardíaco em L/min/m² 2,1 ñ 0,4 x 2,5 ñ 0,6 (n = 14) (p < 0,001). No ecocardiograma os resultados comparativos pré, pós e após 6 meses da VMCB foram: área valvar mitral (cm²) 1,06 ñ 0,39 x 1,92 ñ 0,51 x 1,65 ñ 0,5 e gradientes transvalvar mitral (mmHg) 13,8 ñ 4,7 x 7,3 ñ 3,6 x 7,3 ñ 4,4. Houve 2 óbitos imediatos (tromboembolismo pulmonar e falência de multiplos órgäos) e 1 extra-hospitalar. As complicaçöes foram: 2(10//) pacientes com complicaçöes neurológicas, 1(5//) com comunicaçäo interatrial e outro com perfuraçäo da átrio direito (5//). Conclusäo - A VMCB oferece alternativa ao tratamento cirurgico em pacientes considerados de alto risco operatório e manutençäo do sucesso em seis meses de seguimento
Purpose - To evaluate percutaneous mitral balloon valvuloplasty (PMBV) in surgical high risk patients. Methods - Twenty (12%) patients out of 172 submitted to a PMBV were considered high surgical risk cases; 17 (85%) were women and mean age was 43 (18- 69). Thirteen (65%) were in acute pulmonary edema (3 were pregnant, 2 had previous cerebrovascular event, 1 had pulmonar thromboembolism and other had chronic renal failure), and 7 (35%) were in functional class (CF) III (2 had coronary artery disease, 2 severe obesity, 1 pulmonar neoplasy, 1 cardiac cachexia and one with previous cerebrovascular event). All patients underwent PMBV through transeptal technique. Double balloon was used in 10 (50%) patients; Inoue balloon in 5 (25%), monofoil in 3 (15%) and bifoil in 2 (10%). Results - Seventeen (85%) obtained success and 2 (10%) had clinical improvement. The hemodinamic results pre versus post-PMBV showed: left atrium pressure (LAP) mmHg 28.2±10,0 x 15.2±9.2 (n=20) (p<0.001), mitral mediam gradient (G) mmHg 21.2±10.7 x 10.7±.7 (n=18)(p<0.001), mitral valve area (MVA) cm2 0.73±0.3 x 1.73±0.6 (n=11) (p<0.001), pulmonary artery pressure mmHg 52.0±18.2 x 40.1±14.7 (n=18) (p<0.001) and cardiac index L/min/m2 2.1±0.4 x 2.5±0.6(n=14) (p<0.001). Comparative echocardiography results pre, post and 6 months after PMBV showed: MVA 1.06±0.39 x 1.92±0.51 x 1.65±0.5 and G 13.8±4.7 x 7.3±3.6 x 7.3±4.4. There were two immediate deaths (pulmonary thromboembolism and multiple organs failure) and other after hospital discharge. The complications were: 2 (10%) patients with neurological complications, 1 (5%) atrial septal deffect and other right atrium perforation (5%). Conclusion - PMBV offers an alternative to surgical treatment in high risk surgical patients and the results are maintained in the 6 month follow-up