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European Heart Journal 1991 12(Supplement B):55-60; doi:10.1093/eurheartj/12.suppl_B.55
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Pathomorphological aspects, aetiology and natural history of acquired mitral valve stenosis

D. Horstkotte, R. Niehues and B. E. Strauer

Department of Medicine, Division of Cardiology, Pneumology and Angiology, Heine-Heine University Düsseldorf, Germany

Correspondence: D. Horstkotte, MD, FESC, Department of Medicine, Heinrich-Heine University, MoorenstraBe 5, D-4000 Düsseldorf 1, Germany.

Commissural fusion, leaflet thickening and alteration of the subvalvular apparatus are dominant mechanisms causing clinically important mitral stenosis (MS) of rhewnatic origin. Calcification and a consequent decrease in Ieaflet mobility are subsequent features in rheumatic MS and may be the primary mechansim in MS of degenerative origin.

In 1051 consecutive patients with pure or predominant MS requiring surgical intervention, aetiology was rheumatic in 76·9%, infective in 3·3%, degenerative (severe annular and leafkt calcecatwn) in 2·7% and congenital (Luternbacher syndrome) in 1·2% it was the result of systemic lupus erythematosus (n=4), carcinoid heart disease (n=2), endomymrdial fibrosis (n=2) and rheumatoid arthrih (n=2) in less than 1%, while in 14·5% of these patients aetiology remained unclassified.

The natural history of rheumatic MS is characterized by an asymptomatic latent period, following the initial rheumatic fever (RF). In a prospective study of MS (n=159) the mean interval between RF and the appearance of symptom was 16·3±5·2 years. Twenty five years after the initial RF 8% of the patients were still asymptomatic, 9% were class II (NYHA), 33% class III and 50% had been operated or were class IV. Progress from mild to severe disability took 9·2±4·3 years on average. When valve surgery was indicated but refused by the patients, sruvival with medical treatment was 0·44±0·06 afrer 5 years, 0·32±0·08 after 10 years and 0·19±0·09 after 15 years. In 84·3% of these patients death was cardiac-related and due to right heart failure (27·7%), lung oedema resistant to medical therapy (14·5%), thromboembolic (10·8%) or haemorrhagic complications (7·2%), myocardial infarction (9·3%) or infective endocardih (3·6%); 14·5% of the patients had a sudden death.

Key Words: Mitral stenosis • natural history of mitral stenosis • aetiology of mitral stenosis


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