{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T19:05:30Z","timestamp":1789239930168,"version":"build-2803163510"},"reference-count":48,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2019,6,12]],"date-time":"2019-06-12T00:00:00Z","timestamp":1560297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009700","name":"Fondazione Gigi e Pupa Ferrari","doi-asserted-by":"publisher","award":["FPF-14"],"award-info":[{"award-number":["FPF-14"]}],"id":[{"id":"10.13039\/501100009700","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009647","name":"Ministry of Health","doi-asserted-by":"publisher","award":["RC2015-BIO30-2613051"],"award-info":[{"award-number":["RC2015-BIO30-2613051"]}],"id":[{"id":"10.13039\/100009647","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Mitral valve prolapse (MVP) is the most common cause of severe mitral regurgitation. It has been reported that MVP patients\u2014candidates for mitral valve repair (MVRep)\u2014showed an alteration in the antioxidant defense systems as well as in the L-arginine metabolic pathway. In this study, we investigate if oxidative stress and endothelial dysfunction are an MVP consequence or driving factors. Forty-five patients undergoing MVRep were evaluated before and 6 months post surgery and compared to 29 controls. Oxidized (GSSG) and reduced (GSH) forms of glutathione, and L-arginine metabolic pathway were analyzed using liquid chromatography-tandem mass spectrometry methods while osteoprotegerin (OPG) through the ELISA kit and circulating endothelial microparticles (EMP) by flow cytometry. Six-month post surgery, in MVP patients, the GSSG\/GSH ratio decreased while symmetric and asymmetric dimethylarginines levels remained comparable to the baseline. Conversely, OPG levels significantly increased when compared to their baseline. Finally, pre-MVRep EMP levels were significantly higher in patients than in controls and did not change post surgery. Overall, these results highlight that MVRep completely restores the increased oxidative stress levels, as evidenced in MVP patients. Conversely, no amelioration of endothelial dysfunction was evidenced after surgery. Thus, therapies aimed to restore a proper endothelial function before and after surgical repair could benefit MVP patients.<\/jats:p>","DOI":"10.3390\/jcm8060835","type":"journal-article","created":{"date-parts":[[2019,6,12]],"date-time":"2019-06-12T10:55:19Z","timestamp":1560336919000},"page":"835","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Endothelial Dysfunction in Patients with Severe Mitral Regurgitation"],"prefix":"10.3390","volume":"8","author":[{"given":"Benedetta","family":"Porro","sequence":"first","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Songia","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-5300","authenticated-orcid":false,"given":"Veronika A.","family":"Myasoedova","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenza","family":"Valerio","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"},{"name":"Dipartimento di Medicina Clinica e Chirurgia, Universit\u00e0 degli Studi di Napoli Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7746-8539","authenticated-orcid":false,"given":"Donato","family":"Moschetta","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Gripari","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0309-6231","authenticated-orcid":false,"given":"Laura","family":"Fusini","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Cavallotti","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Canzano","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Turnu","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Alamanni","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Camera","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"},{"name":"Department of Pharmacological and Biomolecular Sciences, Universit\u00e0 degli Studi di Milano, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana","family":"Cavalca","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7225-3379","authenticated-orcid":false,"given":"Paolo","family":"Poggio","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1161\/CIRCULATIONAHA.113.006702","article-title":"Epidemiology and pathophysiology of mitral valve prolapse: New insights into disease progression, genetics, and molecular basis","volume":"129","author":"Delling","year":"2014","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM199907013410101","article-title":"Prevalence and clinical outcome of mitral-valve prolapse","volume":"341","author":"Freed","year":"1999","journal-title":"N. 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