Clinical and hemodynamic features of advanced rheumatic mitral regurgitation
| Autor: | Harry Goldberg, Joseph F. Uricchio, Lamberto G. Bentivoglio |
|---|---|
| Rok vydání: | 1961 |
| Předmět: |
Mitral regurgitation
medicine.medical_specialty business.industry Diastole Cardiac index Atrial fibrillation General Medicine Left ventricular hypertrophy medicine.disease medicine.anatomical_structure Right ventricular hypertrophy Ventricle Internal medicine cardiovascular system Cardiology Medicine cardiovascular diseases business Pulmonary wedge pressure |
| Zdroj: | The American Journal of Medicine. 30:372-381 |
| ISSN: | 0002-9343 |
| DOI: | 10.1016/0002-9343(61)90047-x |
| Popis: | The clinical and physiologic features of sixty-five patients with mitral regurgitation of rheumatic origin were studied. 1.1. A long asymptomatic period averaging 10.6 years was observed. Contrary to previous reports dyspnea, as well as fatigue, was found to be an early and constant symptom present in over 90 per cent of the patients. 2.2. In addition to the pansystolic murmur constantly present, a mid-late diastolic murmur was heard in forty-one patients (63 per cent) despite little or no mitral obstruction. A diastolic gallop sound was a very frequent finding. 3.3. Electrocardiographic evidence of left ventricular hypertrophy was found in only onethird of the patients. A normal ventricular complex was present in 50 per cent, while right ventricular hypertrophy was observed in 15 per cent of the cases. 4.4. The typical roentgenographic rinding was an enlarged left atrium with a wide sweep of barium esophagram contrasted to the localized posterior displacement seen in pure mitral stenosis. 5.5. The cardiac index was low in the group with atrial fibrillation and normal in patients with normal sinus rhythm. A large C-V wave (ventricularization) was found in the left atrial (93 per cent of the patients) and pulmonary wedge pressure curves (83 per cent of the patients). A ventricular filling gradient, when present, is confined to early diastole. In the present series, the most reliable method for the qualitative and quantitative estimation of the degree of mitral regurgitation was ventriculography employing injection of radiopaque material into the left ventricle with simultaneous serial roentgenography of the cardiac silhouette. 6.6. Sixty-four patients were operated upon for correction of the regurgitation. At surgery, the regurgitation was found to be almost invariably posterior. Calcification of the valve was noted in 31 per cent of the patients operated upon. In approximately 12 per cent of the cases Ashoff bodies in various stages of evolution were found in the biopsy specimens of the left atrium. |
| Databáze: | OpenAIRE |
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