Surgical Pathology of the Mitral Valve: A Study of 712 Cases Spanning 21 Years
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.
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Mayo Graduate School of Medicine, Rochester, Minnesota.
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Mayo Graduate School of Medicine, Rochester, Minnesota.
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Mayo Graduate School of Medicine, Rochester, Minnesota. Present address: University of Louisville, Louisville, Kentucky.