Plasma level of soluble P-selectin in patients with rheumatic mitral stenosis and sinus rhythm undergoing percutaneous mitral balloon valvuloplasty

Objective To determine whether plasma level of soluble P-selectin (sP-selectin) increases in rheumatic mitral stenosis ( MS) patients with sinus rhythm, who have scheduled for percutaneous mitral balloon valvuloplasty (PMBV), and to examine the effect of PMBV on sP-selectin level. Methods Twenty-six patients with MS and sinus rhythm ( study group, 20 female, mean age 33 +/- 8 years) and a well-matched control group composed of 21 healthy volunteers ( 15 female, mean age 35 +/- 6 years) were enrolled in the study. In each patient left atrial ( LA) thrombus was excluded by transesophageal echocardiography. sP-selectin levels were compared between study patients and controls, and between peripheral and LA blood. Changes in sP-selectin level 24 h and 4 weeks after PMBV were also analyzed. Results A significantly higher basal sP-selectin level was noted in study group. After PMBV, the mitral valve area (MVA) increased and the transmitral mean gradient decreased significantly. At 24th hour after PMBV, sP-selectin level decreased from 1080.38 +/- 143.87 ng/ml to 960.00 +/- 103.26 ng/ml ( p < 0.0001) and at 4th-week follow-up it was decreased from 960.00 +/- 103.26 ng/ml to 879.61 +/- 98.16 ng/ml ( p < 0.0001). No significant difference was found between peripheral and LA blood regarding the sP-selectin level. Correlation analysis between the difference in MVA measured 24-hour after and before PMBV and the difference in sP-selectin level measured 24-hour after and before PMBV showed a significant direct relationship between these variables. Conclusion This study suggests that in patients with MS and sinus rhythm sP-selectin level increases probably due to turbulent flow across the stenotic valve. After PMBV sP-selectin shows a progessive decline, which is directly correlated with the increase in MVA.