Adolescent ; Adult ; Atrial Appendage ; diagnostic imaging ; Blood Flow Velocity ; Echocardiography, Transesophageal ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve Stenosis ; physiopathology ; Rheumatic Heart Disease ; physiopathology ; Thromboembolism ; etiology

OBJECTIVETo investigate the pathogenesis of thromboembolism in patients with mitral stenosis in a pre-thrombotic state.

METHODSThe biochemical markers' levels in plasma for platelet activity [soluble P-selectin (GMP-140)], states of thrombin generation [antithrombin III (AT III) and protein C (PC)], fibrinolysis [D-dimer (DD), plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (t-PA) and FDP] and von Willebrand factor (vWF) were determined from blood specimens obtained from the femoral veins and arteries and the right and left atria of 43 consecutive patients (20 with atrial fibrillation and 23 with sinus rhythm) with mitral stenosis (MS), undergoing percutaneous mitral valvuloplasty. The same parameters were compared with those of 15 control subjects, who had no detectable heart disease, but with paroxysmal supraventricular tachycardia undergoing radiofrequency catheter ablation of the left accessory pathway through a transseptal passage.

RESULTSBlood from the left atrium contained an excessive amount of platelet activity, thrombin generation and fibrinolysis compared with the blood from the right atrium, and the femoral veins and arteries. However blood from the right atrium was much lower in these activities when compared with those from the left atrium, and the femoral veins and arteries in both groups. Compared with those in the control subjects, GMP-140 in the left atrium was significantly higher (P < 0.05) and AT III was significantly lower (P < 0.05) in patients with MS. Compared with the patients with MS and spontaneous left atrial echocontrast (LASEC) /= 2 had significantly higher levels of GMP-140 in plasma (P < 0.05), and significantly lower levels of AT III (P < 0.05) and PC (P < 0.01) levels in the left atrium. However, there were no significant differences between patients with atrial fibrillation and those with sinus rhythm regarding amounts of plasma coagulation markers in the left atrium. Univariate regression analysis revealed that LASEC was negatively correlated with plasma levels of blood from the left atria in the patients with MS.

CONCLUSIONCoagulability is increased in the left atria of patients with MS and is positively correlated with LASEC.

Adult ; Antithrombin III ; analysis ; Female ; Fibrin Fibrinogen Degradation Products ; analysis ; Heart Atria ; chemistry ; Humans ; Male ; Mitral Valve Stenosis ; complications ; P-Selectin ; blood ; Plasminogen Activator Inhibitor 1 ; blood ; Protein C ; analysis ; Regression Analysis ; Thromboembolism ; etiology ; Thrombophilia ; blood ; complications ; von Willebrand Factor ; analysis