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"Background. Spontaneous Echo Contrast (SEC) appears as a curling motion of echo in real lime and this indicates Wood stasis, ft is therefore predictive for thrombus formation and higher risk for thrombocmbolic phenomenon. Accumulating evidence showed higher incidence of (hrombus formation in mitral stenosis (MS) patients if they presented with positive SEC. Detection of left atrial thrombus is even more important before mitral valvuloplasty procedure to prevent .systemic and especially cerebral embolism. The aim of this study was to compare the utility of transthoracal eehocardiography (TIE) to transesophageal cchocardiography (TEE) in detecting SEC and thrombus in patients with MS.Method. Forty-eight patients with MS were studied with TEE and TTE. The diagnosis of MS was established by TTE.Result. With TTE, 15 patients (31,3%) had positive SEC, 33 patients (68, 7%) had negative SEC and 6 patients (12,5%) of the SEC positive patienls had thrombus in LA. On the other hand with TEE, SEC were positive in 36 (75%) patients, negative in 12 (25%) patients and 17 (35,4%) of the SEC positive patients showed LA thrombus. This study confirmed the strong association between SEC and thrombus formation, as thrombus was only observed in SEC positive patients.Conclusion. TEE is superior to TTB in detecting SEC and LA thrombus in patients with MS, because of the belter acoustic window of TEE. TEE should be considered in every patients with MS where thrombus formation has to be ruled out, particularly before baloon mitral valvuloplasly procedure."

"Mitral stenosis merupakan kelainan katup yang paling sering ditemukan di bagian Kardiologi RS. M. Hoesin, Palembang, dan bukti kuat menunjukkan adanya tromboemboli pada mitral stenosis. Banyak studi melihat kontras ekho spontan (KES) yang dianggap sebagai awal kejadian tromboemboli, namun terdapat kontroversi mengenai bagaimana mencapai regresi KES ini. Uji klinik tersamar ganda dilakukan untuk membandingkan aspirin 100 mg dengan acenocoumarol (sintrom) 1 mg yang diberikan selama 4 minggu pada 22 penderita mitral stenosis. Pada akhir penelitian diperoleh regresi 100 % pada KES kelompok acenocoumarol, 40% diantaranya regresi dari KES berat menjadi ringan, sedangkan 60 % mengalami resolusi sempurna. Pada kelompok aspirin tidak satupun KES mengalami regresi. Pada kelompok acenocoumarol, 2 di antara 4 trombus menghilang, sedangkan 2 sisanya ukurannya mengecil, sedangkan pada kelompok aspirin pada akhir minggu keempat, pasien dengan thrombus bertambah dari 3 menjadi 4. Kesimpulan: Pemakaian acenocoumarol 1 mg selama 4 minggu dapat secara efektif dan aman meregresi kontras echo spontan dan thrombus pada mitral stenosis tanpa perubahan hemodinamik yang berarti. (Med J Indones 2002; 11: 202-7)

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Mitral stenosis is one of the most often valvular disease in Division of Cardiology, M. Hoesin hospital, Palembang, and there was strong evidence of thromboembolic phenomenon in mitral stenosis (MS) patients. Many studies evaluated the spontaneous echo contrast (SEC) that was regarded as a precursor of thrombo embolic phenomenon. So far there were controversies regarding how to regress spontaneous echo contrast. A randomized double blind controlled study was done on 22 MS patients with positive SEC, receiving either aspirin 100 mg or acenocoumarol 1 mg and followed up after 4 weeks. There was 100 % regression of SEC in acenocoumarol group that consisted of 40% regression from severe SEC to mild, and 60% complete resolution. In aspirin group there was no resolution of SEC. In acenocoumarol group, 2 of 4 thrombus totally disappeared while the rest was reduced in size. On the other hand, in aspirin group, after 4 weeks, the patients with thrombus was increased from 3 to 4 patients. In conclusion, four week therapy with acenocoumarol 1 mg is effective and save in regressing spontaneous echo contrast and thrombus in mitral stenosis patients without any significant change in hemodynamics. (Med J Indones 2002; 11: 202-7)"

"Introduksi: Belum banyak studi yang meneliti parameter laboratorium sederhana sebagai prediktor trombus di atrium kiri pada subset stenosis mitral rematik. Selain itu, saat ini masih sangat sedikit studi yang menjelaskan patomekanisme trombus atrium kiri yang berkaitan dengan komponen hemorheologi pada pasien dengan mitral stenosis rematik. Tujuan: menilai hubungan parameter hemorheologi dari laboratorium sederhana Red Cell Distribution Width, Mean Platelet Volume, hematokrit, dan jumlah trombosit dengan kejadian trombus atrium kiri pada stenosis mitral rematik. Metode: Dilakukan studi potong lintang analitik LAMIA Study dengan pengumpulan data terhadap pasien stenosis rematik yang signifikan dimulai dari tanggal 1 Januari 2018 hingga 31 Juli 2021. Evaluasi trombus ditegakkan dari ekokardiografi transtorasik atau transesofagus. Pemeriksaan lab diperiksa dalam waktu 10 hari sebelum evaluasi ekokardiografi. Subjek dengan regurgitasi mitral yang signifikan akan dieksklusi. Hasil: Dari 318 subjek dengan stenosis mitral rematik signifikan yang diikutsertakan dalam penelitian, didapatkan sebanyak 102 pasien (32%) memiliki trombus di atrium kiri. Dari seluruh pasien, diketahui subjek dengan ritme atrial fibrilasi sebanyak 63.8% dan ritme sinus 36.2%. Hematokrit ≥ 45.15 % (OR 2.98; IK 95% 1.27 - 6.98, p = 0.012), Irama atrial fibrilasi (OR 2.39; IK 95% 1.10-5.20, p = 0.028), fraksi ejeksi ventrikel kiri ≥ 56.68 % (OR 0.42; IK 95% 0.23 - 0.77, p = 0.005), dan TAPSE ≥ 18.10 mm (OR 0.44; IK 95% 0.230 - 0.83, p = 0.011) berhubungan secara signifikan dengan kejadian trombus atrium kiri dari hasil analisis multivariat. Kesimpulan: Peningkatan hematokrit berhubungan secara signifikan dengan kejadian trombus atrium kiri, sedangkan nilai RDW dan jumlah platelet tidak berhubungan dengan kejadian trombus di atrium kiri pada stenosis mitral rematik. Kata kunci: LAMIA study, hematologi sederhana, trombus atrium kiri, stenosis mitral rematik

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Introduction: Only few studies have investigated simple laboratory parameters as predictors of left atrial thrombus in subset of rheumatic mitral stenosis. In addition, there are currently very few studies describing the pathomechanism of left atrial thrombus related to the hemorheological component in patients with rheumatic mitral stenosis. Objective: A study was conducted to assess the causal relationship of hemorheological parameters from a simple laboratory Red Cell Distribution Width (RDW), Mean Platelet Volume (MPV), hematocrit, and platelet count with the incidence of left atrial thrombus in rheumatic mitral stenosis. Methods: A cross-sectional analytical, LAMIA Study, was conducted with data collection on patients with significant rheumatic stenosis starting from 1 January 2018 to 31 July 2021. Thrombus evaluation was established by transthoracic or transesophageal echocardiography. Lab tests were performed within 10 days prior to the echocardiographic evaluation. Subjects with significant mitral regurgitation will be excluded. Results: Of the 318 subjects with significant rheumatic mitral stenosis included in the study, 102 patients (32%) had a thrombus in the left atrium. Of all the patients, it was known that subjects with atrial fibrillation rhythm as much as 63.8% and sinus rhythm 36.2%. Atrial fibrillation rhythm (OR 2.39; 95% CI 1.10-5.20, p = 0.028), left ventricular ejection fraction ≥56.68 % (OR 0.42; 95% CI 0.23 - 0.77, p = 0.005), TAPSE ≥18.10 mm (OR 0.44; 95% CI 0.230 - 0.83, p = 0.011), and hematocrit ≥45.15% (OR 2.98; 95% CI 1.27 - 6.98, p = 0.012). Conclusion: Increased hematocrit was significantly associated with the incidence of left atrial thrombus, whereas RDW and platelet count were not associated with the incidence of left atrial thrombus in rheumatic mitral stenosis. "

"Latar belakang: Stenosis mitral (SM) merupakan peyempitan dari orifisium katup mitral, dimana SM berat didefinisikan sebagai area katup mitral (AKM) <1 cm² dan biasanya berhubungan dengan gradien transmitral >10 mmHg. Pada praktik klinis, ketidaksesuaian antara hasil pengukuran AKM dan gradien transmitral sering ditemukan. Pasien SM berat dengan gradien transmitral rendah (≤10 mmHg) memiliki kecenderungan menetapnya gejala klinis paska tindakan pembedahan katup mitral dan kurangnya perbaikan klinis paska tindakan komisurotomi mitral transkateter perkutan (KMTP). Namun hingga saat ini, belum banyak studi mengenai faktor yang berhubungan dengan gradien transmitral rendah pada SM berat. Tujuan:Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan gradien transmitral rendah pada SM berat. Metode: Studi potong lintang pada 322 pasien SM berat. Dilakukan evaluasi catatan rekam medik dan hasil pemeriksaan ekokardiografi transtorakal. SM berat didefinisikan sebagai SM dengan AKM <1 cm² yang diukur secara planimetri dan gradien transmitral rendah didefinisikan sebagai gradien transmitral ≤10 mmHg. Hasil: Dari 322 subjek penelitian, sebanyak 36% memiliki gradien transmitral ≤10 mmHg, 68,9% perempuan dan 72% memiliki irama fibrilasi atrium (FA). Berdasarkan analisis multivariat, didapatkan faktor independen gradien transmitral rendah pada SM berat adalah net atrioventricular compliance (IK 95% 3,57–11,02, OR 6,27), maximal tricuspid regurgitation velocity (IK 95% 0,14–0,45, OR 0,26), irama fibrilasi atrium (IK 95% 1,20–4,91, OR 2,43) dan jenis kelamin perempuan (IK 95% 1,07–3,69, OR 1,99). Kesimpulan: Net atrioventricular compliance, maximal tricuspid regurgitation velocity, irama fibrilasi atrium dan jenis kelamin perempuan berhubungan dengan gradien transmitral rendah pada stenosis katup mitral berat.

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Background: Mitral stenosis (MS) is the narrowing of mitral valve orifice, in which severe MS is defined as planimetered mitral valve area (MVA) <1 cm² with transmitral gradient >10 mmHg. However, discrepancy between planimetered MVA and transmitral gradient is not uncommon in patients with severe MS, suggesting the presence of low gradient (LG) severe MS. Patients in this group display less benefit from valvuloplasty and a greater risk for persistent symptoms after mitral valve replacement (MVR). Yet, factors associated with LG severe MS has not been studied extensively. Objective: Aim of this study is to determine factors associated with LG severe MS. Methods: This is a cross-sectional study in 322 patients with severe MS. Medical records and transthoracic echocardiography examination results were evaluated. Severe MS was defined as planimetered MVA <1 cm² and LG was defined as transmitral gradient ≤10 mmHg. Results: Of 322 subjects, 36% had transmitral gradient ≤10 mmHg, 68,9% were women, and 72% had atrial fibrillation. According to multivariate analysis, several independent factors to LG severe MS were net atrioventricular compliance (95% CI 3,57–11,02, OR 6,27), maximal tricuspid regurgitation velocity (95% CI 0,14–0,45, OR 0,26), atrial fibrillation (95% CI 1,20–4,91, OR 2,43) and women (95% CI 1,07–3,69, OR 1,99). Conclusion: Net atrioventricular compliance, maximal tricuspid regurgitation velocity, AF and women were associated with LG severe MS."

"ABSTRAKLatar belakang: Studi sebelumnya menyimpulkan bahwa mitral valve gradient (MVG) merupakan parameter selain area katup mitral (AKM) yang berhubungan dengan perbaikan gejala pasca komisurotomi mitral transkateter perkutan (KMTP). Oleh karena itu, studi diperlukan untuk menjelaskan hubungan MVG terhadap perbaikan gejala secara objektif, dalam bentuk kapasitas fungsional.Tujuan: Studi ini bertujuan untuk mengevaluasi hubungan MVG terhadap perubahan kapasitas fungsional pasca KMTP.Bahan dan Metode: Studi quasi experimental dengan one group pre-post design terhadap 78 subjek. Pemeriksaan ekokardiografi dan treadmill Bruce termodifikasi dilakukan 1-2 hari sebelum dan 1-2 minggu setelah KMTP. Data sebelum dan setelah KMTP dianalisis untuk mencari hubungan variabel terhadap perbaikan kapasitas fungsional pasca KMTP. Perbaikan kapasitas fungsional didefinisikan sebagai perubahan lama latihan > 180 detik pasca KMTP.Hasil: Rerata usia adalah 42 tahun, mayoritas perempuan (3,6:1) dengan rerata IMT 22,27 kg/m2. Sebesar 5,1% pasien merokok dengan komorbid stroke sebesar 14,1%. Sebelum KMTP, 53% memiliki irama sinus dengan mayoritas memiliki fungsi ventrikel kiri yang baik (rerata ejeksi fraksi 62%) dan fungsi ventrikal kanan yang baik (median tricuspid annular plane systolic excursion (TAPSE) 20 mm). Sebesar 97% pasien datang dengan kelas NYHA II sebelum KMTP dan mengalami perbaikan signifikan kapasitas fungsional pasca KMTP berupa perbaikan median lama latihan (241(18-1080) ke 603(30-1900) detik, p < 0,001) dan perbaikan median nilai VO2max estimasi (18,8(10,2-51,4) ke 32,8(10,6-83,2) mlO2/kg/menit, p<0,001). Dari uji korelasi, didapatkan variabel usia (r -0,23, adjusted R2=4,1%), pre-MVG (r 0,23, adjusted R2=4,2%), Δ MVG (r 0,31, adjusted R2= 9,0%) , dan pre-TR Vmax (r 0,3, adjusted R2=1,3%) berkorelasi terhadap perubahan kapasitas fungsional. Perbaikan kapasitas fungsional segera pasca KMTP tidak berhubungan dengan AKM pasca KMTP ≥ 1,5 cm2 (p= 0,14) dan perubahan AKM ≥ 200% pasca KMTP (p= 0,18). Penurunan MVG > 50 % pasca KMTP (OR 2,89, IK 95% 1,06-7,92; p = 0,038) dan TR Vmax sebelum KMTP > 3,4 m/s (OR 3,42, IK 95% 1,19-9,83; p = 0,023) merupakan prediktor perbaikan kapasitas fungsional segera pasca KMTP.Kesimpulan: Penurunan MVG lebih dari 50% pasca KMTP berhubungan dengan perbaikan kapasitas fungsional segera pasca KMTP.

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ABSTRACTIntroduction: Previous studies had shown that mitral valve gradient (MVG) was other parameter than mitral valve area (MVA) which had correlation with symptom improvement post baloon mitral valvuloplasty (BMV). However, further study is needed to illuminate the assocation of MVG with clinical improvement objectively, in term of functional capacity.Objective: This study aimed to determine the association between MVG and functional capacity alteration after BMV.Material and Methods: Quasi exsperimental study with one group pre-post design was applied in 78 subjects. Echocardiography and Modified Bruce Protocol assessment were done 1-2 days before and 1-2 weeks after BMV. Pre and post data were analized to obtain association of variables with functional capacity alteration immediately after BMV. Improvement of functional capacity was defined as alteration of exercise time more than 180 seconds after KMTP.Results: The mean age was 42 y.o, female dominant (3,6:1), mean BMI was 22,27 kg/m2. Of 5,1% patient were smoker with most commonly observed comorbidities include stroke (14,1%). Majority 53% had sinus rhythm with dominant good left ventricular function (mean ejection fraction 62%) and good right ventricular function (median tricuspid annular plane systolic excursion (TAPSE) 20 mm). Of 97% patients presented with NYHA class II before BMV with significant improvement of functional capacity after BMV such as median exercise time alteration (241(18-1080) to 603(30-1900) s, p < 0,001) and median estimate VO2 max value alteration (18,8(10,2-51,4) to 32,8(10,6-83,2) mlO2/kg/minute, p<0,001). From correlation test, age (r -0,23, adjusted R2=4,1%), pre-MVG (r 0,23, adjusted R2=4,2%), Δ MVG (r 0,31, adjusted R2= 9,0%), and pre-TR Vmax (r 0,3, adjusted R2=1,3%) were corelated with functional capacity alteration. Improvement of functional capacity did not significantly associate with post MVA>1,5 cm2 (p= 0,14) and AKM alteration after BMV ≥ 200% (p= 0,18). Reduction of MVG > 50 % after BMV (OR 2,89, 95% CI 1,06-7,92; p = 0,038) and TR Vmax before BMV > 3,4 m/s (OR 3,42, 95% CI 1,19-9,83; p = 0,023) were predictor of functional capacity improvement immediately after BMV.Conclusions: Reduction of MVG more than 50% had association with immediate improvement of functional capacity post BMV."

"Latar belakang: Demam rematik dan komplikasinya masih merupakan masalahkesehatan pada banyak negara berkembang. Katup mitral merupakan katup yang palingsering terlibat oleh proses rematik, dengan derajat keparahan yang tinggi (60-70%pasien), baik stenosis dan/atau regurgitasi. Tatalaksana pada pasien dengan stenosis katupmitral berat telah digunakan sebagai modalitas terapi sejak hampir tiga dekade terakhir.Pemilihan kandidat KMTP yang telah umum digunakan adalah dengan Skor Wilkins.Skor Wilkins yang dinilai dari TTE memiliki beberapa kelemahan dibandingkanmodalitas TEE. Keterbatasan lain Skor Wilkins adalah terdapat variabel morfologi katupmitral yang tidak dimasukkan dalam Skor Wilkins antara lain area katup mitral, morfologikomisura, kalsifikasi komisura, dan area katup mitral awal. Selain itu angka keberhasilandini KMTP di Indonesia masih tergolong rendah dibandingkan dengan negara lain didunia.Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan morfologi katup mitral(area katup mitral, ketebalan katup, tebal fusi komisura, tebal kalsifikasi komisura, fusikorda) terhadap luaran keberhasilan dini KMTP.Metode: Penelitian ini merupakan studi potong lintang pada pasien stenosis mitral beratakibat penyakit jantung rematik yang menjalani tindakan KMTP. Luaran keberhasilandini yang optimal adalah tercapainya ukuran area katup mitral ≥ 1,5 cm2 tanpa disertairegurgitasi mitral sedang atau lebih yang dievaluasi paska tindakan KMTP denganekokardiografi. Penilaian katup mitral dilakukan secara detil dengan TEE meliputi SkorWilkins dari TEE (pliabilitas, ketebalan ketup, kalsifikasi, fusi korda), area katup mitral(AKM) 3D pra tindakan, tebal fusi komisura anterolateral dan posteromedial, tebalmaksimal kalsifikasi komisura. Semua variabel dilakukan uji statistik bivariat, danselanjutnya dilakukan analisis multivariat.Hasil: Total terdapat 41 pasien yang menjalani KMTP. Sebanyak 18 (43,9%) pasienmencapai hasil luaran dini optimal. Didapatkan rerata AKM 3D pra 0,6 cm2 pada sampel.Dari uji analisis multivariat didapatkan AKM 3D pra dan tebal fusi komisura anteriormerupakan faktor morfolgi katup yang secara independen berhubungan dengankeberhasilan dini KMTP.Kesimpulan: Pada populasi dengan Skor Wilkins yang rendah, AKM pra KMTP danketebalan komisura anterolateral berhubungan dengan keberhasilan dini KMTP.Sedangkan Skor Wilkins yang rendah itu sendiri tidak lagi berhubungan dengankeberhasilan dini KMTP.

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Background: Rheumatic fever and its complication is still a major health problem indeveloping countries. The mitral valve is the most commonly and severely affected (65%-70% of patients) by rheumatic process by stenosis and/or regurgitation. PercutaneousTranscatheter Mitral Comisurotomy (PTMC) has been used for almost 3 last decades.Wilkins Score has been used for choosing candidates for PTMC. There are several mitralvalve features that is not included in the Wilkins score. Nevertheless, the success rate ofPTMC in Indonesia still considered lower than other countries.Aim: This study aims to know the association of mitral valve morphology (mitral valvearea, valve thickness, thickness of commissural fusion, thickness of commisurecalsification, subvalvar involvement) with immediate success of PTMC.Methods: This is a cross-sectional study, data was taken procpectively in patients withrheumatic heart disease whom undergone PTMC. Optimal immediate success wasdefined as mitral valve area ≥ 1,5 cm2 without mitral regurgitation moderate or more,which was evaluated after PTMC using echocardiography. Detailed assessment of mitralvalve using TEE including Wilkins Score from TEE (pliability, valve thickness,calsification, chordal fusion), mitral valve area (MVA) 3D, thickness of anterolateral andposteromedial commissural fusion, maximum thickness of commissural calsificationwere taken before the PTMC procedure. All morphological variables undergone bivariateanalysis and whichever is eligible to multivariate analysis.Results: Forty-one patients undergone PTMC procedure. Eighteen patients (43,9%)achieved optimal immediate result. Mean MVA by 3D echo before PTMC was 0,6 cm2.After multivariate analysis, MVA 3D and thickness of anterolateral commisure were theonly morphological features which independently associated with early success ofPTMC.Kesimpulan: In population with low Wilkins score, the score is no longer associatedwith the immediate optimal outcome of PTMC. Instead, MVA 3D pre-PTMC andthickness of anterolateral commissure are associated with immediate optimal outcome ofPTMC."

"[ABSTRAKLatar belakang : Stenosis mitral (SM) masih merupakan masalah kesehatan yang penting di Indonesia. Pada SM terjadi peningkatan kadar P selectin karena disfungsi endotel dan aktivasi platelet. Komisurotomi mitral transvena perkutan (KMTP) merupakan tatalaksana baku untuk penderita SM yang dapat memperbaiki kemampuan aktivitas fisik yang pada akhirnya akan mempengaruhi kadar P selectin. Belum ada penelitian yang menghubungkan antara tingkat aktifitas fisik dengan kadar P Selectin 3 bulan pasca KMTP pada SM rematik.Metode : Penelitian ini merupakan penelitian potong lintang. Dari 56 subyek penelitian yang menjalani KMTP sejak bulan Mei 2013 sampai Februari 2014 di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, didapatkan 35 sampel yang memenuhi kriteria penerimaan . Data klinis dan data ekokardiografi sebelum dan 3 bulan pasca KMTP diambil dari catatan medis. Dilakukan wawancara 3 bulan pasca KMTP. Tingkat aktivitas fisik dibagi menjadi 2 kelompok: kelompok 1 1-4 METs, kelompok 2 > 4 METs. Kadar P selectin diambil 3 bulan pasca KMTP. Selanjutnya dilakukan analisa statistik untuk mengetahui hubungan antara tingkat aktivitas fisik dengan kadar P Selectin 3 bulan pasca KMTP pada SM rematikHasil : Pasien yang akan menjalani KMTP memiliki rerata usia 40,00±11,58 tahun dengan proporsi perempuan lebih tinggi daripada laki-laki (74,3%) dan dengan proporsi irama sinus yang lebih tinggi daripada irama atrial (57,1%). Dari uji T didapatkan ada perbedaan bermakna rata-rata kadar P selectin 3 bulan pasca KMTP pada tingkat aktivitas fisik 1-4 METs dan > 4 METs, dimana rerata kadar P selectin 3 bulan pasca KMTP pada tingkat aktivitas fisik > 4 METs lebih rendah secara bermakna dibandingkan 1-4 METs (p=0,003). Setelah dilakukan analisa multivariat terlihat tingkat aktivitas fisik pasca KMTP tetap berpengaruh terhadap kadar P Selectin 3 bulan pasca KMTP (p=0,001). Area Katup Mitral (AKM) pasca KMTP berpengaruh terhadap kadar P selectin 3 bulan pasca KMTP (p=0,018), namun tingkat aktivitas fisik pasca KMTP lebih besar pengaruhnya dibandingkan AKM.Kesimpulan : Terdapat hubungan antara tingkat aktivitas fisik dengan kadar P selectin 3 bulan pasca KMTP dimana pada tingkat aktivitas yang lebih tinggi ( > 4 METs) kadar P selectin lebih rendah 10,489 ug/ml dibandingkan tingkatan aktivitas fisik 1-4 METs.

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ABSTRACTBackground: Mitral stenosis (MS) is an important health problem in Indonesia. P selectin level in MS increases due to endothelial dysfunction and platelet activation. Percutaneous transvenous mitral commissurotomy (PTMC) is one of the management for MS patients. Thus, the physical activity can improve and in turn affect the level of P selectin. There has been no study link the level of physical activity with the level of P Selectin 3 months after of PTMC.Method: This is a cross sectional study with 56 subjects who underwent PTMC from May 2013 to February 2014 at the Hospital of National Heart Centre Harapan Kita. Then, 35 samples met the inclusion criteria. Clinical and echocardiography data before and 3 months after PTMC were taken from medical records. Interviews were conducted 3 months after PTMC. Physical activity levels were divided into 2 groups: group 1 (1-4 METs) and group 2 (> 4 METs). Sample for P selectin was taken 3 months after PTMC. Further statistical analysis was done to determine the relationship between physical activity level with level of P Selectin 3 months after PTMC in rheumatic MS.Result: Patients who will undergo PTMC have the mean age of 40.00 ± 11.58 years with a higher proportion of women than men (74.3%) and the proportion of sinus rhythm is higher than atrial rhythm (57.1%) . T-test analysis result showed significant difference in the average levels of P selectin 3 months after PTMC on the level of physical activity 1-4 METs and > 4 METs. The average P selectin levels on the level of physical activity in group with > 4 METs was significantly lower compared with group 1-4 METs (p = 0.003). After multivariate analysis, the physical activity level still has an effect on the P selectin levels 3 months after PTMC (p = 0.001). The Mitral Valve Area (MVA) after PTMC also has an effect on P selectin levels (p = 0.018). However, the level of physical activity after PTMC has a greater effect than MVA.Conclusion: There is a relationship between the level of physical activity with P selectin levels 3 months after PTMC.Group with higher activity level (> 4 METs) have lower level of P selectin (with the mean difference levels of P Selectin 10,489 ug/ml);Background: Mitral stenosis (MS) is an important health problem in Indonesia. P selectin level in MS increases due to endothelial dysfunction and platelet activation. Percutaneous transvenous mitral commissurotomy (PTMC) is one of the management for MS patients. Thus, the physical activity can improve and in turn affect the level of P selectin. There has been no study link the level of physical activity with the level of P Selectin 3 months after of PTMC.Method: This is a cross sectional study with 56 subjects who underwent PTMC from May 2013 to February 2014 at the Hospital of National Heart Centre Harapan Kita. Then, 35 samples met the inclusion criteria. Clinical and echocardiography data before and 3 months after PTMC were taken from medical records. Interviews were conducted 3 months after PTMC. Physical activity levels were divided into 2 groups: group 1 (1-4 METs) and group 2 (> 4 METs). Sample for P selectin was taken 3 months after PTMC. Further statistical analysis was done to determine the relationship between physical activity level with level of P Selectin 3 months after PTMC in rheumatic MS.Result: Patients who will undergo PTMC have the mean age of 40.00 ± 11.58 years with a higher proportion of women than men (74.3%) and the proportion of sinus rhythm is higher than atrial rhythm (57.1%) . T-test analysis result showed significant difference in the average levels of P selectin 3 months after PTMC on the level of physical activity 1-4 METs and > 4 METs. The average P selectin levels on the level of physical activity in group with > 4 METs was significantly lower compared with group 1-4 METs (p = 0.003). After multivariate analysis, the physical activity level still has an effect on the P selectin levels 3 months after PTMC (p = 0.001). The Mitral Valve Area (MVA) after PTMC also has an effect on P selectin levels (p = 0.018). However, the level of physical activity after PTMC has a greater effect than MVA.Conclusion: There is a relationship between the level of physical activity with P selectin levels 3 months after PTMC.Group with higher activity level (> 4 METs) have lower level of P selectin (with the mean difference levels of P Selectin 10,489 ug/ml), Background: Mitral stenosis (MS) is an important health problem in Indonesia. P selectin level in MS increases due to endothelial dysfunction and platelet activation. Percutaneous transvenous mitral commissurotomy (PTMC) is one of the management for MS patients. Thus, the physical activity can improve and in turn affect the level of P selectin. There has been no study link the level of physical activity with the level of P Selectin 3 months after of PTMC.Method: This is a cross sectional study with 56 subjects who underwent PTMC from May 2013 to February 2014 at the Hospital of National Heart Centre Harapan Kita. Then, 35 samples met the inclusion criteria. Clinical and echocardiography data before and 3 months after PTMC were taken from medical records. Interviews were conducted 3 months after PTMC. Physical activity levels were divided into 2 groups: group 1 (1-4 METs) and group 2 (> 4 METs). Sample for P selectin was taken 3 months after PTMC. Further statistical analysis was done to determine the relationship between physical activity level with level of P Selectin 3 months after PTMC in rheumatic MS.Result: Patients who will undergo PTMC have the mean age of 40.00 ± 11.58 years with a higher proportion of women than men (74.3%) and the proportion of sinus rhythm is higher than atrial rhythm (57.1%) . T-test analysis result showed significant difference in the average levels of P selectin 3 months after PTMC on the level of physical activity 1-4 METs and > 4 METs. The average P selectin levels on the level of physical activity in group with > 4 METs was significantly lower compared with group 1-4 METs (p = 0.003). After multivariate analysis, the physical activity level still has an effect on the P selectin levels 3 months after PTMC (p = 0.001). The Mitral Valve Area (MVA) after PTMC also has an effect on P selectin levels (p = 0.018). However, the level of physical activity after PTMC has a greater effect than MVA.Conclusion: There is a relationship between the level of physical activity with P selectin levels 3 months after PTMC.Group with higher activity level (> 4 METs) have lower level of P selectin (with the mean difference levels of P Selectin 10,489 ug/ml)]"