title: [The acute and 24-hour modifications to the atrial natriuretic factor in patients who have undergone mitral valvuloplasty. The hemodynamic and echocardiographic correlations].
abstract: BACKGROUND
  The recent introduction of percutaneous transvenous mitral valvuloplasty (PTMV) for the treatment of mitral stenosis (MS) has provided a unique human model for the study of short-term changes in ANF secretion before and after a reduction in left atrial pressure. This study was designed to investigate the effect of a short-term reduction in left atrial pressure and volume, as determined by echocardiographic study, on ANF and other neurohumoral factor plasma levels (renin and aldosterone).
  
  
  METHODS
  10 patients in III FC NYHA, with normal sinus rhythm and MS underwent PTMV. Hemodynamic parameters were measured immediately before and after (20-30 minutes) PTMV. Plasma levels of ANF, aldosterone and plasma renin activity (PRA) were obtained before (24 h) and after (2 h and 24 h) valvuloplasty; echocardiographic left atrial size before (24 h) and 24 h after PTMV.
  
  
  RESULTS
  Immediately after PTMV mean left atrial (LA) pressure decreased from 22.3 +/- 6.8 mmHg to 10.0 +/- 2.4 mmHg (p < 0.01); mitral valve area (MVA) increased from 0.99 +/- 0.28 cm2 to 2.17 +/- 0.26 cm2 (p < 0.01). 24 hours after PTMV on echocardiography, LA systolic volume decreased from 59.5 +/- 16.9 cm3 to 42.3 +/- 8.3 cm3 (p < 0.01), LA diastolic volume from 82.6 +/- 15.8 cm3 to 66.5 +/- 12.6 cm3 (p < 0.01), and LA diameter from 48.1 +/- 7.5 mm to 39.2 +/- 4.4 mm (p < 0.01). ANF plasma levels before PTMV were 64.0 +/- 36.9 fmol/ml; 2 and 24 hours after PTMV they fell to 34.2 +/- 21.6 fmol/ml (p < 0.01) and to 20.3 +/- 21.0 fmol/ml (p < 0.01), respectively. PRA values were 15.7 +/- 13.2 ng/ml/h before PTMV; 2 and 24 hours after PTMV they increased to 17.5 +/- 23.2 ng/ml/h (NS) and to 22.3 +/- 16.8 ng/ml/h (p < 0.01). The aldosterone plasma levels were 43.2 +/- 27.9 ng/dl before PTMV and 47.3 +/- 35.8 ng/dl (NS) and 45.3 +/- 28.0 ng/dl (NS) 2 and 24 hours after PTMV.
  
  
  CONCLUSIONS
  These results indicate that LA "de-stretching" due to the MVA increase and LA pressure decrease, leads to an abrupt reduction of ANF secretion. According to other studies, PRA increases immediately after PTMV, with a further increase 24 hours after PTMV.
authors.affiliation: Istituto di Chirurgia del Cuore e dei Grossi Vasi, Policlinico Umberto I, Università La Sapienza, Roma.
authors.forename: E
authors.initials: E
authors.lastname: Mangieri
authors.forename: C
authors.initials: C
authors.lastname: Tosti Croce
authors.forename: G
authors.initials: G
authors.lastname: Tanzilli
authors.forename: N
authors.initials: N
authors.lastname: Alessandri
authors.forename: R
authors.initials: R
authors.lastname: D'Agostino
authors.forename: A
authors.initials: A
authors.lastname: Pignatelli
authors.forename: A
authors.initials: A
authors.lastname: Lomurno
authors.forename: G M
authors.initials: GM
authors.lastname: Sardella
authors.forename: M
authors.initials: M
authors.lastname: Nardi
authors.forename: G
authors.initials: G
authors.lastname: Scibilia
mesh_terms: D000328:Adult; D009320:Atrial Natriuretic Factor / Q000097:blood*; D006328:Cardiac Catheterization; D002404:Catheterization / Q000706:statistics & numerical data; D002940:Circadian Rhythm; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008946:Mitral Valve Stenosis / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D012214:Rheumatic Heart Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors
chemical_list: D009320:Atrial Natriuretic Factor
vernacular_title: Modificazioni acute ed a 24 ore del fattore natriuretico atriale in pazienti sottoposti a valvuloplastica mitralica. Correlazioni emodinamiche ed ecocardiografiche.