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Pengaruh Tingkat Keparahan Stenosis Mitral Terhadap Kadar Soluble Vascular Cell Adhesion Molecule-1 dan Soluble Intercellular Adhesion Molecule-1 Pramono Sigit; Yoga Yuniadi; Indriwanto Sakidjan
Jurnal Kardiologi Indonesia Vol. 35, No. 1 Januari - Maret 2014
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v35i1.371

Abstract

Background: Blood Soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) and Soluble Intercellular Adhesion Molecule-1 (sICAM-1) levels are increased in Mitral Stenosis (MS) patients, but whether this phenomenon is due to chronic rheumatic inflammation process or because of hemodynamic effect of mitral stenosis severity is not clear yet.Objective: This research aims to study the effect of mitral stenosis severity on blood sVCAM-1 and sICAM-1 levels.Method: This study is a cross sectional study. Research subjects were divided into 3 groups: control patients, pre BMV (Baloon Mitral Valvulotomy) group, and post BMV group (patients who have already undergone BMV for ? 1year). Blood sVCAM-1 and sICAM-1 were measured using quantitative sandwich immunoassay method in all groups, and echocardiographic study to evaluate MS severity (MVA (Mitral Valve Area), mMVG (mean Mitral Valve gradient), TVG (Tricuspid Valve Gradient), mPAP (mean Pulmonary Artery Pressure), and LAVI (Left Atrial Volume Index) were performed to pre BMV and post BMV group at the same day with the blood sample collections.Results: There were 23 normal subjects, 26 patients in pre BMV group, and 27 patients in post BMV group. The sVCAM-1 and sICAM-1 levels in patients with MS (pre BMV and post BMV group) were higher than normal control subjects (536,87 ± 251,68 ng/ml vs 536,87 ± 149,22 ng/ml; p<0,001 and 270,04 ± 111,67 ng/ml vs 216,43 ± 50,60 ng/ml; p=0,006), meanwhile there were no differences of sVCAM-1 and sICAM-1 levels between pre BMV and post BMV group (854,67 ± 227,26 ng/ml vs 809,22 ± 275,63 ng/ml; p=0,515 dan 279,98 ± 114,39 ng/ml vs 260,49 ± 110,38 ng/ml; p=0,539). There were also no significant correlation between mitral stenosis severity (MVA, mMVG, TVG, mPAP dan LAVI) with sVCAM-1 and sICAM-1 levels (p>0,05).Conclusion: There were no correlation between mitral stenosis severity with blood sVCAM-1 and sICAM-1 levels
Preoperative and predischarge predictors for persistent pulmonary hypertension after mitral valve surgery in patients with chronic organic mitral regurgitation Rina Ariani; Indriwanto Sakidjan; Budhi Setianto
Jurnal Kardiologi Indonesia Vol. 35, No. 2 April - Juni 2014
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v35i2.394

Abstract

Objectives. This study sought to evaluate the prevalence of pulmonary hypertension after mitral valve surgery ini patients with chronic organic mitral regurgitation and to determine preoperative and predischarge predictors for persistent pulmonary hypertension after surgeryMethods. This is a cohort retrospective study involving subjects with chronic organic mitral regurgitation with preoperative systolic PA pressure > 50 mmHg undergoing surgery. Demographic and echocardiography datas were collected prior to surgery, predischarge, and follow up datas were evaluated after minimal 6 months duration. Subjects were then devided into groups based on existence of persistent pulmonary hypertension after follow up. Bivariate and multivariate analysis was done to determine contributing factors.Results.There were 92 subjects with dominant mitral regurgitation included in this study with median age 40 (range 17-68) years with slight female predominance (55%). Persistent pulmonary hypertension was observed in 23 subjects (25%) predischarge and in 20 subjects (20.7%) after mean follow up of 11 + 5.5 months. Bivariate analysis revealed preoperative TAPSE, underlying etiology, severity of pulmonary hypertension preoperatively, postoperative atrial fibrilation, mean mitral valve gradient predischarge, and the presence of residual pulmonary hypertension predischarge were related with persistent pulmonary hypertension. From multivariate analysis, post operative atrial fibrillation [OR 7.3 (CI 95% 1.64-33.33, p=0.09)], mean mitral valve gradient predischarge [OR 1.67 (CI 95% 1,3-2.7, p=0.038)], and preoperative TAPSE [OR 0.143 (CI 95% 0.03-0.70, p=0.017)] were independent predictors for persistent pulmonary hypertension after mitral valve surgery.Conclusion. Persistent pulmonary hypertension was observed in 20.7% subjects after mitral valve surgery. Preoperative TAPSE, post operative atrial fibrillation, and predischarge mean mitral valve gradient were independent predictors.