A clinical study was made on 352 cases of valvular heart diseases admitted to the Kyungpook National University Hospital for the last 11, years, from January 1965 to December 1975.
The most common valvular heart disease was mitral stenoinsufficiency followed by mitral stenosis, combined mitral and aortic valve disease, mitral insufficiency, aortic insufficiency and aortic steno-insufficiency in the order of frequency. Aortic, and combined mitral and aortic valve diseases -were more common in males and mitral valve disease in females. The ages on admission were between 20 to 49 years in about 70 percent of the patients with mitral stenosis, mitral steno-insufficiency or combined mitral and aortic valve disease, and in about half of the cases with mitral insufficiency. However, all cases with aortic steno-insufficiency were 30 years or more. The etiology of the diseases was considered to be rheumatic in origin in 340 cases out of 352. In the remaining 12 cases, eight were thought to be syphilitic and in four the etiology was undetermined.
Cardinal symptoms on admission in the order of frequency were dyspnea, palpiation, cough, sputum, weakness,
abdominal pain, hemoptysis and chest pain and/or discomfort. Major physica1 f findings were hepatomegaly, distension of the neck veins, peripheral edema, cardiac cachexia and hydrothorax in that order. Thus the majority of the patients were in both right and left heart failure on admission. Among 58 cases with hydrothorax, it was right-sided in 46.6 per cent of th cases, bilateral in 37.9 per cent and left-sided in only 15.5 percent.
Precipitating factors of heart failure were uncertain in just under half of the cases. In th remainder, where they were known, various in infections including upper respiratory infection and/or rheumatic activity, bacterial endocarditis were the most common precipitating factors, being responsible in more than half of the patients. Overe xertion, discontinuation of digitalis diuretics and severe anemia were also frequently responsible. In females, pregnancy, abortion and miscarriage not infrequently precipitated heart failure.
On electrocardiographic examination atrial fibrillation was present in about 40 percent of a11 cases and approximately 80 percent of this arrhythmia was seen in mitral valve disease. The other ectopic arrhythmias were less common but were also more frequent in mitral valve disease. Various types of bundle branch block were noted in about 10 per cent of the cases and nearly 70 per cent of them were incomplete right bundle branch block. The latter was seen only in mitral or combined mitral and aortic valve diseases, particularly in mitral stenosis. Right atrial enlargement was quite infrequent, being seen only in mitral valve disease, whereas left atrial enlargement was noted in about one quarter of all cases and approximately 80 percent of the cases with this finding were mitral or combined mitral and aortic valve diseases. Right ventricular-hypertrophy and left ventricular hypertrophy were not infrequent even in mitral insufficiency and mitral stenosis, respectively, and such unexpected results were thought to be brought about by the high false positivity of voltage criteria of ventricular hypertrophy currently in use.
Proteinuria was noted in about half of the cases and the incidence was higher in those with severe heart failure. Leukocytosis was more common in patients with complication, as expected. Incidences of low hemoglobin level and elevated erythrocyte sedimentation rate, however, showed no significant difference between those with and without complications.
Bacterial endocarditis and systemic embolism were two most common complications, each of them occurring in approximately 10 per cent of all cases. Pneumonia, severe anemia, and digitalis intoxication were also not infrequent. The systemic, embolisms were almost exclusively in the brain and about half of them occurred in mitral stenosis. The incidence of atrial fibrillation complicating systemic embolism in mitral stenosis and in the other valvular heart diseases was approximately 70 and 60 per cent, respectively.
More than 70 per cent of the cases were improved, mostly within two weeks. Approximately two fifths of the unimproved cases were dead. Most common cause of death was systemic, embolism, being responsible for little more than one quarter. This was followed in the order of frequency by renal insufficiency, digitalis intoxication, bacterial endocarditis, and progressive failure.
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