PURPOSE: Plasma levels of renin, angiotensin II and aldosterone are increased during normal pregnancy. However, these values in preeclampsia are decreased to nearly that of a nonpregnant subject, and vascular sensitivity to angiotensin II is increased. In preeclampsia, aldosterone is decreased less than rennin. Therefore current studies were undertaken to determine the relationship between aldosterone to renin ratio (ARR) and uterine artery perfusion via RI value. MATERIALS AND METHODS: In this study, the relationship between plasma aldosterone and renin concentration was determined in 27 preeclamptic women and 50 normal pregnant women, whose gestational weeks were matched. The aldosterone to renin ratio was calculated and compared between the two groups. Doppler velocimetry of the uterine artery, which was used to calculate resistance index (RI), was performed on all subjects. The relationship between ARR and RI value was reviewed. RESULTS: In the preeclampsia group, RI value of the uterine artery was significantly higher than that of normal pregnant women. Both plasma renin and aldosterone concentrations were lower in the preeclampsia group. However, the ratio of these two parameters was significantly higher (38.3 vs. 16.1, p < 0.001); the greater ARR, the higher the RI of the uterine artery (r(2)=0.053, p=0.048). CONCLUSION: This study demonstrates that a high aldosterone to renin ratio may have a negative effect on perfusion of the uterine artery and play an important role in the pathophysiology of preeclampsia.
Adult ; Aldosterone/*blood ; Arteries/metabolism ; Case-Control Studies ; Female ; Gestational Age ; Health ; Humans ; Pre-Eclampsia/*blood ; Pregnancy ; Renin/*blood ; Uterus/*blood supply/*metabolism

BACKGROUND AND OBJECTIVES: Recently, in mitral valve surgery, valvuloplasty or valve repair was successfully introduced to improve postoperative left ventricular function and to decrease operative mortality. However, the real impact of this technique on daily practice in Korea was not systematically assessed. MATERIALS AND METHOD: The operative methods, postoperative death, follow-up results and their contributing factors were analysed among patients who underwent mitral valve surgery at our institution. RESULTS: 1) From June 1989 to December 1996, 416 patients (186 males, mean age 48+/-13 years) underwent mitral valve surgery. Dominant mitral stenosis (MS) was the main pathology in 167 patients; dominant mitral regurgitation (MR) and balanced mitral stenoinsufficiency (MSR) in 197 and 52 respectively. 2) In MS, valve replacement was performed in 91% whereas commissurotomy in 9%. However, in MR, the rates of valve repair surgery has increased up to 60% of the total surgical procedures for the past three years. 3) The overall operative mortality was 4% (18/416). It was significantly lower in valve repair compaired with valve replacement (0% vs. 6%; p=0.003). In MS, factors associated with high mortality were longer cardiopulmonary bypass and aortic cross clamp time. In MR, high mortality was associated with diabetes, endocarditis, valve replacement and longer cardiopulmonary bypass time. 4) The 7-year late survival among operative survivors was 95+/-2% in MS, which was singnificantly higher than that in MR (80+/-6%, p=0.04). 5) In MR, the 4-year cardiac event-free survival among operative survivors (absence of cardiac death, reoperation, bleeding, endocarditis, thromboembolism, or development of heart failure) was significantly higher in valve repair group than in valve replacement (84+/-7 vs. 76+/-5%; p=0.03). CONCLUSION: The overall outcomes of recent mitral valve surgery were satisfactory. In MR, valve repair surgery seemed to be an established method to decrease operative mortality and long-term complications.
Cardiopulmonary Bypass ; Death ; Disease-Free Survival ; Endocarditis ; Follow-Up Studies ; Heart ; Hemorrhage ; Humans ; Korea ; Male ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Mortality ; Pathology ; Reoperation ; Survivors ; Thromboembolism ; Ventricular Function, Left