A Clinical study was made on 189 cases with mitral valvular heart disease, who were admitted to the National Medical Center between January 1970 and July 1977, and the following results were obtained.
1. The , incidence of each modality of. mitral valvular disease was as follows: mitral stenoinsufficiency 44.4%, mitral stenosis 34.4%, and mitrall insufficiency 21. 2%. The peak age ir-cidence of mitral heart disease was in 5th decade.
2. Of 189 cases, definite or probable history of rheumatic fever was obtained only in 54.0 and in the remainders, no clue of history of rheumatic fever was indentifiable.
3. Among 36 cases with definite past history of rhematic fever, two thirds of the patients experienced rheumatic fever between the age of 5 aLd 14. The mean duration from past episode of rheumatic fever to the onset of cardiac symptom was 13. 9 years.
4. Predominent symptoms of the disease were dyspnea, palpitation, cough and sputum,. chest pain, orthopnea, abdominal pain and hemoptysis in the order of frequency. Major physical finlings were hepatomegaly, pulmonary congestion,´. thrill, leg edema,. jugular venous distention, cardiomegaly and cyanosis in the order´of-frequency.
5. Precipitating factors of congestive failure were detected in two thirds of 189 cases, of which URI or rheumatic activity´ was most prevalent,fo flowed by physical exertion, pregnancy and delivery, discontinuation of medication, excitement and pneumonia in order.
6. Major electrocardiographic findings of"mitral heart disease we?e as follows: atrial fibrillation was found in 43.4%, right ventricular hypertrophy in 27.0%, left ventricular hypertrophy in 30.7% and left atrial enlargement in 28.6%.
7. Concerning laboratory data, hemoglobin was below 12gm% in 39.4%, erythrocyte sedimentation rate was above 15mm/hr in 40.1% and ASO titer was found to be increased over 250 Todd units in 43. 1%.
8. Important complications of mitral heart disease were pneumonia, systemic embolism, digitalis poisoning and bacterial endocarditis. The loci of clinical systemic embolism were found to be almost exclusively in the brain and the incidence was highest in mitral senosis.
9. Important causes of death in 20 cases were systemic embolism, progressive heart failure and becterial endocarditis, but no definite cause of death could be identified in 2 cases.
10. Phonocardiographic study was done on 14 patients. Q-S1 interval, seemed to be prolonged in MS, MSI and MI alike. Mean Q-Si interval in patients with MS was 98 msec, and S2-OS interval was 80 msec. Well´s index was calculated in 7 cases, and proved to be higher than +2 in all cases except one patient, which seemed to imply the tendency of severity of mitral heart diseases treated.
|