Surgical Pathology of the Mitral Valve: A Study of 712 Cases Spanning 21 Years

doi:10.1016/S0025-6196(12)61522-5

Mayo Clinic Proceedings

Volume 62, Issue 1, January 1987, Pages 22-34

https://doi.org/10.1016/S0025-6196(12)61522-5 Get rights and content

The gross surgical pathologic features of the mitral valve were reviewed in 712 patients who had undergone mitral valve replacement at our institution during 1965, 1970, 1975, 1980, and 1985. Among the 452 cases of mitral stenosis, either with or without mitral insufficiency, 99% were attributable to postinflammatory disease and 1% were related to congenital mitral stenosis. Among the 260 cases of pure mitral regurgitation, the two most common causes were a floppy valve (38%) and postinflammatory disease (31%). Moreover, a floppy valve was observed in 73% of the 59 examples of chordal rupture and in 38% of the 16 cases of infective endocarditis. Women accounted for 73% of the 452 cases of mitral stenosis and for 72% of the 530 cases of postinflammatory disease. In contrast, men accounted for 58% of the 260 cases of pure mitral regurgitation, including 76% of the floppy valves and 69% of the infected valves. During the 21 years spanned by the study, the relative frequency of postinflammatory mitral insufficiency progressively decreased, whereas that of floppy mitral valves increased. It is unclear whether aging, heredity, environmental factors, changes in the frequency of acute rheumatic fever, or changes in patient referral practices may account for this observation.

Section snippets

METHODS

From the tissue registry at our institution, we reviewed 712 mitral valves that had been surgically excised during the 5 years of 1965, 1970, 1975, 1980, and 1985. Valves were evaluated grossly, as recommended by Davies,¹⁷ Roberts and Morrow,¹⁸ and van der Bel-Kahn and Becker;¹⁹ only infected or insufficient valves associated with infarction were studied histologically. Subjects in this study may have had coexistent aortic or right-sided valvular disease that may have necessitated operative

Clinical Classification.

Of the 712 mitral valves reviewed (Table 1, Table 2), the functional status was pure stenosis in 175 (25%), stenosis and insufficiency in 277 (39%), and pure insufficiency in 260 (37%). From 1965 to 1985, the relative frequency of combined disease decreased, whereas that of pure stenosis or insufficiency tended to increase. During the same time, the surgeons repaired (rather than replaced) the mitral valves of an additional 148 patients (Table 3).²⁴

Morphologic Classification.

Among the 712 valves, 618 (87%) were excised

Postinflammatory Disease.

Postinflammatory disease is the most common cause of mitral valve dysfunction among patients who undergo mitral valve replacement and presumably is a manifestation of chronic rheumatic disease in most instances. It accounted for 83% of 470 clinical cases reported by Selzer and Katayama,⁴ 74% of the 712 cases in the present study, 61% of the 139 surgical cases of Allen and associates,¹⁰ and 54% of the 100 surgical specimens reviewed by Hanson and colleagues.¹² Postinflammatory disease has a

ACKNOWLEDGMENT

We thank Kenneth P. Off ord, Department of Medical Statistics and Epidemiology, for performing the statistical analyses in this study.

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: Present address: Middleton Memorial Veterans Hospital, Madison, Wisconsin.

^*: Mayo Graduate School of Medicine, Rochester, Minnesota.

^†: Mayo Graduate School of Medicine, Rochester, Minnesota.

^‡: Mayo Graduate School of Medicine, Rochester, Minnesota. Present address: University of Louisville, Louisville, Kentucky.

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Surgical Pathology of the Mitral Valve: A Study of 712 Cases Spanning 21 Years

Section snippets

METHODS

Clinical Classification.

Morphologic Classification.

Postinflammatory Disease.

ACKNOWLEDGMENT

Prog Cardiovasc Dis

Semin Roentgenol

Curr Prob Cardiol

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