The clinical course of patients with severe “rheumatic” mitral insufficiency

Abstract

This study has been concerned chiefly with the clinical course of adult patients with predominant rheumatic mitral insufficiency under medical management. It is based on a series of 42 patients followed medically, and a group of 115 patients who underwent cardiac surgery. These have been compared with a group of 138 patients proven to have pure mitral stenosis at surgery. The patients were similar in age and sex. Rheumatic fever had been diagnosed in more than half the patients with insufficiency, and subacute bacterial endocarditis had occurred more frequently, but a history of systemic embolism was less frequent in insufficiency than in stenosis. Strikingly different was the tendency of patients with insufficiency to develop atrial fibrillation and enlargement of the left ventricles and left atria, the latter often very marked. It has been shown that mitral insufficiency may exist in the symptom-free stage for many years, and many of these patients may be in atrial fibrillation and have large and even gigantic left atria, and left ventricular enlargement. Deterioration may be very slow, although sudden death may occur occasionally. The more malignant course and the difference in clinical profile of patients with ruptured papillary muscles or chordae tendineae is described in a group of 13 such patients. The implications of this study in connection with the selection of patients for cardiac surgery have been discussed.