Lewin R F, Raff H, Findling J W, Dorros G
Department of Cardiology, St. Luke's Medical Center, Milwaukee, WI 53215.
Am Heart J. 1990 Dec;120(6 Pt 1):1305-10. doi: 10.1016/0002-8703(90)90240-x.
Acute mitral obstruction may lead to an increase in atrial natriuretic peptide (ANP) due to increased atrial pressure and a large increase in arginine vasopressin (AVP) due to simultaneous arterial and ventricular baroreceptor unloading. We measured ANP and AVP concentration after transseptal puncture and during percutaneous retrograde mitral balloon valvuloplasty (PRMV) in 11 patients (mean age 57 +/- 12 years; nine women) with mitral stenosis and congestive heart failure. Atrial septal puncture per se resulted in a significant increase in ANP and AVP without a significant change in aortic pressure. Subsequent PRMV led to a further increase in ANP, a transient decrease in aortic pressure from 89 +/- 7 to 45 +/- 4 mm Hg, and a large (fivefold) increase in AVP. ANP and AVP were no longer different from baseline values 18 to 24 after the procedure. This study suggests that transseptal puncture and acute mitral obstruction are major stimuli to ANP release and that combined unloading of arterial and left ventricular mechanoreceptors is a very potent vasopressinergic stimulus.
急性二尖瓣梗阻可能由于心房压力升高导致心钠素（ANP）增加，同时由于动脉和心室压力感受器负荷减轻导致精氨酸血管加压素（AVP）大幅增加。我们测量了11例二尖瓣狭窄合并充血性心力衰竭患者（平均年龄57±12岁；9名女性）经房间隔穿刺后及经皮逆行二尖瓣球囊成形术（PRMV）期间的ANP和AVP浓度。房间隔穿刺本身导致ANP和AVP显著增加，而主动脉压力无显著变化。随后的PRMV导致ANP进一步增加，主动脉压力从89±7 mmHg短暂降至45±4 mmHg，AVP大幅（五倍）增加。术后18至24小时，ANP和AVP不再与基线值有差异。本研究表明，经房间隔穿刺和急性二尖瓣梗阻是ANP释放的主要刺激因素，动脉和左心室机械感受器的联合负荷减轻是一种非常有效的血管加压素能刺激因素。
