THE NATURAL HISTORY OF 271 PATIENTS WITH MITRAL STENOSIS UNDER MEDICAL TREATMENT

Abstract

This report is a follow-up of 271 patients with isolated mitral stenosis under medical treatment.The material comprises patients who came under medical care for cardiac symptoms during the years 1933-49.A first report of this series has already been published (Olesen, 1955).By 1959, 83 per cent of the patients had died, and the majority of survivors showed symptoms and signs of progression of the disease.On this background an analysis of the last follow-up data is presented as a contribution to the description of the natural history of mitral stenosis. MATERIAL AND METHODSThe material comprises 271 patients with isolated mitral stenosis derived from the following sources: (1) 213 patients who were admitted to the Medical Department B, Rigshospitalet, University Hospital of Copenhagen, Denmark, under the care of Professor Erik Warburg during the years 1933-49, and (2) 58 who saw Professor Warburg in private consultation during the same period.The clinical diagnosis of mitral stenosis was based upon the presence of a rough, rolling, or rasping diastolic or presystolic apical murmur.Patients with definite auscultatory signs of aortic valvular lesions were excluded.The material includes 261 patients with a sure clinical diagnosis and 10 patients with autopsy diagnosis.The validity of the clinical diagnosis of mitral stenosis was checked in several ways: (1) 91 patients eventually came to autopsy, and mitral stenosis was verified in all instances, (2) at the clinical follow-up 78 patients were examined by the author in 1951-53, and 31 were re-examined in 1959, and the characteristic diastolic or presystolic murmurs were heard in all cases (in one patient an additional atrial septal defect was diagnosed), (3) 12 patients were subjected to mitral valvotomy during the period of observation and mitral stenosis was corroborated in all cases.Complicating aortic valvular disease which had not been previously diagnosed was found at autopsy in 4 out of 91 cases and at clinical follow-up in 12 out of 78 patients.Tricuspid valvular stenosis occurred at autopsy in 5 out of 91 patients.Apparently the frequency of complicating aortic and tricuspid valvular lesions was low.At the selection of the series all patients with a characteristic diastolic or presystolic apical murmur were grouped as mitral stenosis whether an apical systolic murmur had been present or not, since mitral regurgitation in the presence of signs of mitral stenosis traditionally had not been evalu- ated at the time of first observation.A total of 43 per cent of the series had an apical systolic murmur recorded, and this group may be assumed to comprise many patients with some degree of 349 on July 11,