Does Chronic Inflammation Play a Role in Rheumatic Mitral Valve Restenosis after Percutaneous Transvenous Mitral Commissurotomy?

Not available

  • Amiliana M Soesanto Dept. Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia/ National Cardiovascular Center Harapan Kita
Keywords: Mitral valve restenosis, PTMC, chronic inflammation



Background: Mitral valve restenosis is defined as decreased mitral valve area (MVA) <1.5 cm2 or decreased MVA >50% after PTMC. It is time-dependent and associated with major adverse cardiovascular events (MACE), such as congestive heart failure, cardiac death, mitral valve replacement, and redo PTMC. The mechanism is not yet known; however, chronic inflammation may have a role. Objective: To know the association between chronic inflammation and mitral valve restenosis after PTMC. Methods: A total of 40 patients with mitral valve stenosis who underwent successful PTMC were matched and classified into restenosis/case group (n=20) and no restenosis/control group (n=20). Secondary data was taken from electronic medical records such as patient characteristics (gender, age & 2nd prophylaxis), echocardiography data before PTMC (Wilkins’ score and MVA before PTMC), and echocardiography data after PTMC (MVA after PTMC). Follow-up echocardiography examination (follow-up MVA) and laboratory assessment of chronic inflammation marker (IL-6) were done on all patients. Statistical analyses were done to look for an association between the level of chronic inflammation marker & other independent variables with mitral valve restenosis. Results: Median IL-6 concentration was 2.39 (0.03 – 11.4) pg/mL. There was no statistically significant difference in IL-6 levels between both groups (p-value >0.05). MVA decrement was 0.13 (0 – 0.62) cm2/year with rate of MVA decrement ≥0.155 cm2/year was predictor of mitral valve restenosis (p-value <0.001, OR = 46.72, 95% CI 6.69 – 326.19). Conclusion: Chronic inflammation assessed by IL-6 was not associated with mitral valve restenosis.


Download data is not yet available.


1. Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, et al. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015. N Engl J Med. 2017;377(8):713–22.
2. Watkins DA, Beaton AZ, Carapetis JR, et al. Rheumatic Heart Disease Worldwide: JACC Scientific Expert Panel. J Am Coll Cardiol. 2018;72(12):1397–416.
3. Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Prim. 2016;2.
4. Remenyi B, Elguindy A, Smith SC, Yacoub M, Holmes DR. Valvular aspects of rheumatic heart disease. Lancet [Internet]. 2016;387(10025):1335–46. Available from:
5. Nobuyoshi M, Arita T, Shirai S, et al. Percutaneous balloon mitral valvuloplasty: a review. Circulation. 2009;119(8).
6. Song JK, Song JM, Kang DH, et al. Restenosis and adverse clinical events after successful percutaneous mitral valvuloplasty: Immediate post-procedural mitral valve area as an important prognosticator. Eur Heart J. 2009;30(10):1254–62.
7. Rifaie O, Omar AMS, Abdel-Rahman MA, Raslan H. Does a chronic inflammatory state have a role in the development of mitral restenosis after balloon mitral valvuloplasty? Int J Cardiol [Internet]. 2014;172(3):e417–8. Available from:
8. Mechmeche R, Zaroui A, Aloui S, et al. Late mitral restenosis after percutaneous commissurotomy: Predictive value of inflammation and extracellular matrix remodeling biomarkers. Hear Lung J Acute Crit Care [Internet]. 2017;46(4):258–64. Available from:
9. Toor D, Sharma N. T cell subsets: an integral component in pathogenesis of rheumatic heart disease. Immunol Res. 2018;66(1):18–30.
10. Liu AC, Joag VR, Gotlieb AI. The emerging role of valve interstitial cell phenotypes in regulating heart valve pathobiology. Am J Pathol. 2007;171(5):1407–18.
11. Passos LSA, Nunes MCP, Aikawa E. Rheumatic Heart Valve Disease Pathophysiology and Underlying Mechanisms. Front Cardiovasc Med. 2021;7(January):1–10.
12. Hernandez R, Banuelos C, Alfonso F, et al. Long-term clinical and echocardiographic follow-up after percutaneous mitral valvuloplasty with the Inoue balloon. Ci. 1999;99:1580–6.
13. Fawzy ME. Mitral balloon valvuloplasty. J Saudi Hear Assoc [Internet]. 2010;22(3):125–32. Available from:
14. Gordon SPF, Douglas PS, Come PC, Manning WJ. Two-dimensional and Doppler echocardiographic determinants of the natural history of mitral valve narrowing in patients with rheumatic mitral stenosis: Implications for follow-up. J Am Coll Cardiol. 1992;19(5):968–73.
15. Nunes MCP, Tan TC, Elmariah S, et al. The echo score revisited: Impact of incorporating commissural morphology and leaflet displacement to the prediction of outcome for patients undergoing percutaneous mitral valvuloplasty. Circulation. 2014;129(8):886–95.
16. Sika-Paotonu D, Beaton A, Raghu A, Steer A, Carapetis J. Acute rheumatic fever and rheumatic heart disease. In: Ferretti J, Sevens D, Fischetti V, editors. Streptococcus pyogenes : Basic Biology to Clinical Manifestations [Internet]. Oklahoma City; 2017. Available from:
17. Ralph AP, Noonan S, Wade V, Currie BJ. The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. Vol. 214, Medical Journal of Australia. 2021. 220–227 p.
18. Vannice KS, Ricaldi J, Nanduri S, et al. Streptococcus pyogenes pbp2x mutation confers reduced susceptibility to ß-lactam antibiotics. Clin Infect Dis. 2020;71(1):201–4.
Views & Downloads
Abstract views: 993   
Full Text (PDF) downloads: 715   
How to Cite
Soesanto, A. (2022). Does Chronic Inflammation Play a Role in Rheumatic Mitral Valve Restenosis after Percutaneous Transvenous Mitral Commissurotomy?. Indonesian Journal of Cardiology, 43(3), 101-107.