Valvular heart disease: Undiagnosed valvular involvement, concomitant coronary artery disease and systemic embolization

Abstract

The clinical and operative findings were correlated with postmortem findings in 259 patients who died during or shortly after open heart surgery for valvular disease. In 114 patients with clinically diagnosed isolated aortic valve disease, 72 had morphologic abnormalities of the mitral valve, and in 13 these changes were hemodynamically significant. In 28 of 81 patients with clinically diagnosed isolated mitral valve disease, 28 showed aortic valve abnormalities, but the changes were significant in only 1. Fifty-five patients showed abnormalities of the tricuspid valve. All had concomitant mitral valve disease, 44 had aortic valve disease and 2 had changes of the pulmonic valve as well. In 8 the tricuspid valve disease was hemodynamically significant; in 4 of the 8, the lesion was clinically recognized. Evidence is presented indicating that rheumatic stigmata are rare in aortic valve disease. The prevalence of other etiologic factors in both aortic and mitral valve disease is discussed. The prevalence and severity of coronary artery disease is the same regardless of the valve or valves involved. Angina pectoris occurred in 57 percent of patients with aortic valve disease. In 50 percent of these patients with angina pectoris, trivial or no coronary artery disease was present. However, angina pectoris occurred in 10 of 11 patients with aortic valve disease who had severe coronary artery disease. Eight percent of patients with mitral valve disease had angina pectoris, and all showed 2+ to 3+ coronary artery disease. Of 41 patients who showed evidence of old systemic embolization, 39 had mitral valve disease. The frequency of such embolization was the same in patients with predominant mitral insufficiency as in those with stenosis.