The Association between B-type Natriuretic Peptide Family and Successful Percutaneous Transvenous Mitral Commissurotomy: A Systematic Review

Document Type : Systematic review


Cardiologist, Preventive Cardiovascular Care Research center, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


B-type natriuretic peptide (BNP) level is known to increase in patients with rheumatic mitral stenosis. In this systematic review, we aimed to discuss the possible association between plasma BNP level and the success rate of percutaneous transvenous mitral commissurotomy. PubMed and Scopus databases were searched systematically, using the following key terms: “B-type natriuretic peptide” OR “BNP” AND “percutaneous transvenous mitral commissurotomy” OR “percutaneous transluminal mitral commissurotomy” OR “PTMC” OR “percutaneous balloon mitral valvotomy” OR “PBMV”. The title, keywords and abstract of relevant articles were searched thoroughly. Among 27 articles found in these databases, 18 studies were excluded during different stages of article selection, based on the inclusion and exclusion criteria. A total of 333 patients were evaluated in the selected studies. Overall, 75 and 191 cases were male and female, respectively. Sex ratio was not specified in two studies, evaluating a total of 67 patients. The obtained results showed that BNP level may decrease after a successful PTMC. Furthermore, post-operative plasma levels of BNP and N-terminal proBNP could be considered as predictors of the success rate of PTMC. Based on the results reported in the evaluated articles, there may be an association between post-operative plasma levels of BNP family and the success rate of PTMC.


1. Boudoulas H. Etiology of valvular heart disease in the 21st century. Hellenic J Cardiol. 2002; 43:183-8. Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. Lancet. 2003; 362:316-22.
3.Nishikimi T, Nagata S, Sasaki T, Tomimoto S, Matsuoka H, Takishita S, et al. Plasma concentrations of adrenomedullin correlate with the extent of pulmonary hypertension in patients with mitral stenosis. Heart. 1997; 78:390-5.
4.Goetze JP, Friis-Hansen L, Rehfeld JF, Nilsson B, Svendsen JH. Atrial secretion of B-type natriuretic peptide. Eur Heart J. 2006; 27:1648-50.
5.Golbasy Z, Ucar O, Yuksel AG, Gulel O, Aydogdu S, Ulusoy V. Plasma brain natriuretic peptide levels in patients with rheumatic heart disease. Eur J Heart Fail. 2004; 6:757-60.
6.Arat-Ozkan A, Kaya A, Yigit Z, Balci H, Okcun B, Yazicioglu N, et al. Serum N-terminal pro-BNP levels correlate with symptoms and echocardiographic findings in patients with mitral stenosis. Echocardiography. 2005; 22:473-8.
7.Ucar O, Bayar N, Karagoz A, Aydogdu S. Valvular heart disease: plasma B-type natriuretic peptide levels in patients with pure rheumatic mitral stenosis. Acta Cardiol. 2012; 67:59-64.
8.Iltumur K, Karabulut A, Yokus B, Yavuzkir M, Taskesen T, Toprak N. N-terminal proBNP plasma levels correlate with severity of mitral stenosis. J Heart Valve Dis. 2005; 14:735-41.
9.Adhikari CM, Malla R, Rajbhandari R, Bhatta YK, Maskey A, Thapaliya S, et al. Percutaneous transvenous mitral commissurotomy in elderly mitral stenosis patients. A retrospective study at shahid gangalal national heart centre, bansbari, kathmandu, Nepal. Maedica. 2013; 8:333-7.
10. Joseph PK, Bhat A, Francis B, Sivasankaran S, Kumar A, Pillai VR, et al. Percutaneous transvenous mitral commissurotomy using an Inoue balloon in children with rheumatic mitral stenosis. Int J Cardiol. 1997; 62:19-22.
11. Harrison JK, Wilson JS, Hearne SE, Bashore TM. Complications related to percutaneous transvenous mitral commissurotomy. Cathet Cardiovasc Diagn. 1994; (Suppl 2):52-60.
12. Bahl VK, Chandra S, Talwar KK, Kaul U, Manchanda SC, Sharma S, et al. Influence of subvalvular fibrosis on results and complications of percutaneous mitral commissurotomy with use of the Inoue balloon. Am Heart J. 1994; 127:1554-8.
13. Kothari SS, Kamath P, Juneja R, Bahl VK, Airan B. Percutaneous transvenous mitral commissurotomy using Inoue balloon in children less than 12 years. Cathet Cardiovasc Diagn. 1998; 43:408-11.
14. Lopez-Meneses M, Martinez Rios MA, Vargas Barron J, Reyes Corona J, Sanchez F. Ten-year clinical and echocardiographic follow-up of patients undergoing percutaneous mitral commissurotomy with Inoue balloon. Arch Cardiol Mex. 2009; 79:5-10.
15. Sadeghian H, Salarifar M, Rezvanfard M, Nematipour E, Lotfi Tokaldany M, Safir Mardanloo A, et al. Percutaneous transvenous mitral commissurotomy: significance of echocardiographic assessment in prediction of immediate result. Arch Iran Med. 2012; 15:629-34.
16. Razzolini R, Leoni L, Cafiero F, Liva S, Faggian D, Ramondo A, et al. Neurohormones in mitral stenosis before and after percutaneous balloon mitral valvotomy. J Heart Valve Dis. 2002; 11:185-90.
17. Shang Y, Lai L, Chen J, Zhang F, Wang X. Effects of percutaneous balloon mitral valvuloplasty on plasma B-type natriuretic peptide in rheumatic mitral stenosis with and without atrial fibrillation. J Heart Valve Dis. 2005; 14:453-9.
18. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals Intern Med. 2009; 151:W-65-W-94.
19. El Zayat A. Potential use of Brain Natriuretic Peptide in patients with asymptomatic significant mitral stenosis. Egypt Heart J. 2014; 66:269-75.
20. Wilson V, Gupta N, Prabhakar P, Ramakrishnan L, Seth S, Maulik SK. Effect of Percutaneous Transvenous Mitral Commissurotomy on Plasma Apelin Level in Mitral Stenosis Patients. J Clin Exp Cardiolog. 2014; 5:2.
21. Pourafkari L, Seyedhosseini S, Kazemi B, Esmaili H, Aslanabadi N. Changes in Serum NT-Pro BNP and Left Atrial BNP Levels after Percutaneous Transvenous Mitral Commissurotomy in Sinus Rhythm Versus Atrial Firilation. J Cardiovasc Thorac Res. 2014; 6:175-9.
22. Ramakrishnan S, Agarwal A, Singh S, Karthikeyan G, Seth S, Narang R, et al. NT-pro-BNP levels as a marker of success of percutaneous transvenous mitral commissurotomy. Indian Heart J. 2010; 62:35-8.
23. Chadha DS, Karthikeyan G, Goel K, Malani SK, Seth S, Singh S, et al. N-terminal pro-BNP plasma levels before and after percutaneous transvenous mitral commissurotomy for mitral stenosis. Int J Cardiol. 2010; 144:238-40.
24. Selcuk MT, Selcuk H, Maden O, Erbay AR, Temizhan A, Aksu T, et al. The effect of percutaneous balloon mitral valvuloplasty on N-terminal- pro B- type natriuretic peptide plasma levels in mitral stenosis. Int Heart J. 2007; 48:579-90.
25. Nakamura M, Kawata Y, Yoshida H, Arakawa N, Koeda T, Ichikawa T, et al. Relationship between plasma atrial and brain natriuretic peptide concentration and hemodynamic parameters during percutaneous transvenous mitral valvulotomy in patients with mitral stenosis. Am Heart J. 1992; 124:1283-8.