Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UNIPROT:P00750 (PLA)
 16,800 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 34 patients with mitral stenosis or combined mitral valve disease class II, III or IV (NYHA), the mitral valve closure index (MVCI, Shiu et al. 1977), based on the rate of diastolic apposition of the anterior and posterior mitral leaflet echos, and the diastolic closure rate (EF-slope) were determined and compared with hemodynamic data such as mean left atrial pressure (PLA), mean diastolic pressure gradient across the stenotic valve (DP) and mitral valve orifice area (Q), calculated by the Gorlin formula. MVCI and EF-slope correlated more favorably with DP (MVCIr = -0.71, EF-sloper = -0.53) than with Q and PLA. The results were not different in patients with sinus rhythm or atrial fibrillation. Using MVCI or EF-slope thie discrimination between severe and moderate or between moderate and light mitral stenosis was uncertain. Nevertheless, MVCI below 30 was associated with light, above 50 with severe mitral stenosis. In spite of the relationship between MVCI or EF-slope and the severity of mitral stenosis, in the individual case an exact quantification of mitral stenosis is not possible due to the great variability of echocardiographic data. For the assessment of the severity of mitral stenosis the mitral valve closure index is not superior to the EF-slope.
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PMID:[Echocardiographic determination of the severity of mitral stenosis by the mitral valve closure index (author's transl)]. 50 63

The purpose of this study was to evaluate the solubility of left atrial thrombi to thrombolytics after failure of long-term anticoagulant therapy in patient with mitral stenosis. One hundred and eighty-one consecutive patients with mitral valve area < or = 1.5 cm(2) and without severe mitral regurgitation were screened with echocardiography; 30 were found to have left atrial thrombi. Follow-up echocardiography performed 7.4 +/- 5.6 months after warfarin therapy revealed that 8/30 of patients had complete dissolution and 3/30 had partial dissolution of the thrombi. Thirteen patients with residual isolated appendageal thrombi underwent balloon mitral commissurotomy and were randomized into four groups at the end of balloon mitral commissurotomy: group A, receiving intra-atrial infusion of heparin and tissue plasminogen activator (t-PA; n = 4); group B, heparin and streptokinase (n = 3); group C, heparin (n = 3); and group D, acting as control (n = 3). It was found that only two patients in the t-PA group had their thrombi either completely or partially dissolved within 48 hr. Thus, this study suggests that t-PA may have the potential of dissolving chronic left atrial thrombi.
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PMID:Intra-atrial thrombolytic therapy for dissolution of chronic left atrial thrombi in patients undergoing balloon mitral commissurotomy. 1212 52

Mitral stenosis still remains a major problem in Southeast Asia including Thailand. It contributes to the morbidity and mortality related to thromboembolism which was associated with the left atrial thrombus. However, the pathogenesis of left atrial thrombus in these patients is not completely understood. Therefore, the objective of this study was to investigate the coagulation and platelet activity including the function of the endocardium in the left atrium and peripheral circulation in patients with mitral stenosis who were free of left atrial thrombus and to compare those hematologic markers activity in the peripheral venous blood between the patients with mitral stenosis and the control. Thirty-six patients with moderate to severe mitral stenosis were included in the study. Most of the patients were in functional class II and 50 per cent had atrial fibrillation. Blood was obtained from the femoral vein, femoral artery, pulmonary artery and left atrium of these patients before heparin was administered to determine the value of various hematologic markers. In the control group, blood for determining the hematologic markers was collected only from the antecubital vein. The results of this study demonstrated that the levels of prothrombin activation fragment 1+2 (F1+2), thrombin-antithrombin III complex (TAT) and Beta-thromboglobulin (beta-TG) in the left atrium of the patients with mitral stenosis were significantly higher than those in the femoral vein and femoral artery, whereas the level of thrombomodulin was significantly lower in the left atrium compared with the femoral artery and vein. When comparing with the control group, the levels of TAT, plasminogen activator inhibitors-1 (PAI-1) from the peripheral vein were significantly higher and the level of thrombomodulin was also significantly lower in the patients with mitral stenosis. In conclusion, the present study demonstrated an abnormal hypercoagulable state of the left atrium and systemic circulation related to the abnormalities of coagulation, platelets and the endocardium which may cause the formation of left atrial thrombus in patients with mitral stenosis.
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PMID:An abnormal systemic and regional hypercoagulable state in patients with mitral stenosis. 1506 Dec 99

Anticoagulation treatment can prevent systemic embolism in patients with mitral stenosis (MS) and atrial fibrillation (AF), but this treatment is under debate if patients are in sinus rhythm. The authors aimed to determine the hemostatic changes in patients with MS and sinus rhythm. Forty-six patients (28 in sinus rhythm and 18 in AF) with mitral stenosis were enrolled in this study. They studied systemic venous fibrinogen, D-dimer, antithrombin-III, tissue plasminogen activator (tPA), plasminogen activator inhibitor-I (PAI-I), von Willebrand factor (vWF), and platelet factor 4 (PF 4) in these patients. The patients were first classified according to their rhythm as sinusal and AF, and then according to the presence of left atrial spontaneous echo contrast (LASEC). Fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly greater in patients with MS and sinus rhythm or atrial fibrillation compared to the control group (p < 0.05). Whether the rhythm was sinus or AF, fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly higher in patients with LASEC than in the control group (p < 0.05). Only PF 4 was higher in the AF group than in those with sinus rhythm (p < 0.05). As to plasminogen activator and PAI-I levels, only tissue plasminogen activator levels were found to be higher in the AF group than in those with sinus rhythm and the control group (p < 0.05). In patients with mitral stenosis and sinus rhythm, if LASEC is present, coagulation activation, platelet activation, and endothelial dysfunction are similar in patients with AF, and anticoagulation should be considered in these patients.
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PMID:Coagulation, fibrinolytic system activation and endothelial dysfunction in patients with mitral stenosis and sinus rhythm. 1735 Nov 62

Severe thrombosis of a mechanical valve is a rare complication in pediatric patients. Thrombolytic therapy as treatment of mechanical mitral valve thrombosis has rarely been reported in young infants. We report the successful treatment with recombinant tissue-type plasminogen activator of a mechanical mitral valve thrombus in a 7 month-old patient with trisomy 21, complete atrioventricular canal defect and pulmonary hypertension status post complete atrioventricular canal repair and subsequent prosthetic mitral valve replacement. He presented with respiratory decompensation and shock secondary to severe mechanical mitral valve stenosis. Serial echocardiograms showed significant resolution of the thrombus within 18 h of infusion with no major bleeding complications during the treatment course. Although a rare complication of mechanical valve placement in pediatrics, thrombosis of mechanical valves may result in severe hemodynamic and respiratory compromise. This case demonstrates that thrombolytic therapy is a feasible option for the treatment of critical thrombosis in pediatric patients after MVR.
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PMID:Successful treatment of severe mechanical mitral valve thrombosis with tissue plasminogen activator in a 7-month-old infant. 2288 63