International Journal of Cardiology 91 (2003) 221–225 www.elsevier.com / locate / ijcard Decreased platelet activation and endothelial dysfunction after percutaneous mitral balloon valvuloplasty a b b, b c b * Ertan Yetkin , A. Riza Erbay , Hasan Turhan , Mehmet Ileri , Selime Ayaz , Ramazan Atak , b a Kubilay Senen , Sengul Cehreli a Inonu University Faculty of Medicine, Department of Cardiology, Malatya, Turkey b Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey c Turkiye Yuksek Ihtisas Hospital, Department of Biochemistry, Ankara, Turkey Received 25 May 2002; received in revised form 14 January 2003; accepted 21 January 2003 Abstract Objective: This study was conducted to assess the changes in platelet activation and endothelial dysfunction in patients with mitral stenosis (MS) and sinus rhythm (SR) following percutaneous mitral balloon valvuloplasty (PMBV). Background: Systemic thromboem- bolism is a serious complication in patients with valvular heart disease, and its incidence is highest in those with mitral stenosis. A hypercoagulable state has also been reported in patients with mitral stenosis and sinus rhythm. A recent study has shown that patients with previous PMBV had a lower incidence of thromboembolism. Methods and results: The study was conducted in 21 patients (two men, 19 women, mean age53466 years) with mitral stenosis and sinus rhythm (SR) who underwent percutaneous mitral balloon valvuloplasty and 17 healthy control subjects (two men, 15 women, mean age53366 years). Biochemical markers of platelet activity (beta thromboglobulin, BTG, and soluble P-selectin, sPsel) and endothelial dysfunction (von Willebrand Factor, vWF) were measured in both control subjects’ and patients’ serum samples taken immediately before PMBV and 24 h after PMBV procedure. All patients underwent successful PMBV. Significant improvement of mitral valve area, pulmonary artery pressure, mean mitral gradients, and left atrial diameter were achieved in all patients after PMBV. Compared with control subjects, patients with MS had higher plasma levels of BTG (66626 ng/ml vs. 1466 ng/ml, P,0.001), vWF (177667 units/dl vs. 99637 units / dl, P,0.0001), sPsel (226674 ng/ml vs. 155666 ng/ml, P,0.001). There was a significant reduction of plasma levels of BTG (66626 ng/ml vs. 48620 ng/ml, P50.002), vWF (177667 units / dl vs. 134660 units / dl, P50.001) and P-selectin (226674 ng/ml vs. 173671 ng/ml, P50.008,) 24 h after PMBV. Conclusion: We have shown that patients with severe MS and SR have increased platelet activation and endothelial dysfunction compared with control subjects and PMBV results in decreased platelet activity and improvement of endothelial injury.  2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Endothelial dysfunction; Platelet activation; Mitral stenosis; Mitral balloon valvuloplasty 1. Introduction incidence is highest in those with mitral stenosis [1,2]. Mitral stenosis is a well recognised risk factor Systemic thromboembolism is a serious complica- for stroke especially if an enlarged left atrium, atrial tion in patients with valvular heart disease, and its fibrillation and impaired left ventricular function are present. A hypercoagulable state has also been re- ported in patients with mitral stenosis and sinus *Corresponding author. Turkocagi caddesi 20 Sokak, No: 2 / 2 Balgat, rhythm [3–5]. Previous studies have confirmed that 06520 Ankara, Turkey. Tel.: 190-312-286-7658. E-mail address: drhturhan@yahoo.com (H. Turhan). percutaneous mitral balloon valvuloplasty (PMBV) is 0167-5273 / 03 / $ – see front matter  2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016 / S0167-5273(03)00027-5