Neurohormones in Mitral Stenosis before and after Percutaneous Balloon Mitral Valvotomy
Renato Razzolini MA, Ioira Ieoni MA, Francesca Cafiero MD, Silvia Liva MD,
Diego Faggian MD, Angelo Ramondo MD, Raffaello Chioin MD

The hormonal response to percutaneous balloon mitral valvotomy (PBMV) has been described in patients with sinus rhythm (SR) and atrial fibrillation (AF). The effect of hemodynamic parameters and PBMV on atrial natriuretic factor (ANF) secretion and plasma renin activity (PRA) in mitral stenosis (MS) in SR and AF was evaluated. Thirty-one patients (26 females, five males; mean age 50.5 ± 14 years) with rheumatic MS underwent PBMV. Fourteen patients had AF, and 17 were in SR. PRA and ANF were measured 24 h before, and at 30 and 60 min, 24 h and one month after PBMV, after resting for Ž2 h. Digitalis and diuretics were withdrawn 48 h before sampling; patients had not received ACE inhibitors or beta-blockers during the previous month. PBMV was successful in all cases, without complication. Mitral valve area was increased and wedge pressure decreased in both groups after PBMV. In AF patients, neither PRA nor ANF were significantly affected before and after PBMV; in SR patients, ANF was decreased and PRA increased significantly, notably 24 h after PBMV. The cardiac index (CI) was increased in both groups, but was distinctly lower in AF patients, before and after PBMV. Despite similar hemodynamic results, reversal of the hormonal pattern after PBMV occurred only in SR patients, probably because in AF patients a low CI elicits a hormonal response similar to heart failure. This abnormal hormonal pattern may limit functional recovery after PBMV; hence, PBMV is best attempted while patients are still in SR.