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Thus, elevated PCWP in patients with a severely enlarged left atrium may reflect impaired compliance as a late stage of MR with long-standing volume overload. We could demonstrate a significant difference in mean baseline PCWP levels in patients with severe preoperative LA enlargement, compared to those without. This is in contrast to previous studies from the 80s [19, 20], who could not show a relationship between LA size and PCWP. This is probably due to heterogeneous study populations and different methods to estimate LA Quinapyramine size in their studies. Normalization of mean PCWP following MVS in patients with severe preoperative LA enlargement occurred rapidly in response to relief of volume overload on the left atrium. These changes may facilitate postoperative left sided reverse remodeling. However, the process of postoperative LARR was not initiated in all patients and the reason for this is not fully understood, but may be related www.selleckchem.com/products/MS-275.html to myocardial fibrosis. In chronic MR, preload might be increased by the volume overload of the left ventricle, while afterload is decreased in the later part of systole. These adaptive changes tend to normalize the LVEF, even in the presence of left ventricular dysfunction which may be reflected in a high PCWP [21]. In the present study, the majority of the patients had normal or hyperdynamic left ventricular function, as assessed by preoperative echocardiography. Simultaneously, invasive hemodynamic measurements demonstrated impaired cardiac output at baseline in the same population. Following MVS, the volume and pressure overload was relieved to the left sided chambers and the PCWP decreased together with an increase in cardiac output (Table 3). At six months follow-up the echocardiographic data demonstrated a postoperative left sided reverse remodeling with a significant reduction Smoothened inhibitor in LA volume as previously described [5]. Furthermore, the left ventricular end-diastolic dimension decreased and the hyperdynamic LVEF was normalized in analogy with previously published data [22, 23]. The variability in natriuretic peptide release (NT-proBNP or protype-B natriuretic peptide) following cardiac surgery has been extensively investigated previously [24]. Hormonal activation, with the release of natriuretic peptides, has been used to identify asymptomatic patients with MR at high risk of left ventricular dysfunction or death [2] suggesting that hormonal activation in MR is a predictor of poor outcome [3, 4]. However, to date, there have been no reports of changes of NT-proBNP in relation to LA enlargement and reverse remodeling. The present study confirms preoperative NT-proBNP activation, especially in patients with severe preoperative LA enlargement.