A Long-Term Follow-up of Operated and Medically Treated Patients with Acquired Valvular Diseases

Abstract

A report has been made of the comparison of the clinical results in 448 cases of acquired valvular disease treated surgically or medically. The superiority of the prognosis in patients with mitral stenosis who underwent valvulo-plasty over that in medically treated patients with mitral stenosis or other types of acquired valvular disease was shown in the comparison of survival rates of the patients with same severity of disease according to the NYHA classification at the time of discharge. The better prognosis was also proved by the degree of improvement in cardiac, pulmonary, renal and liver functions etc. The incidence of embolization, which causes no immediate death but makes a patient's life dismal in the majority of cases, has been significantly lower in operated than in medically treated mitral stenosis. But the conclusion as to whether valvuloplasty can prevent recurrence of embolism in patients with previous emboli was reserved in this series because of lack of a sufficient number of the cases. It was statistically indicated that the prognosis is best in operated mitral stenosis with sinus rhythm, next in that with auricular fibrillation, then in medically treated mitral stenosis with sinus rhythm, and worst in that with auricular fibrillation. Many pregnant cardiac patients who developed decompensation during pregnancy continued to be decompensated after delivery, but adequate treatment prevented death for at least one year after the onset of decompensation. No significant differences were noted in duration between onset of the cardiac symptoms and death among groups with different ages of onset. Combined valvular disease was most frequently complicated by subacute bacterial endocarditis, and the prognosis was poor in more than half of the patients with this complication. The authors have considered the pulmonary artery wedge pressure as a reliable and rather easily obtainable index in determining indications for valvuloplasty. It was ascertained again in this series that for the patient with mitral stenosis whose pulmonary artery wedge pressure exceeds 20 mm.Hg valvuloplasty is absolutely indicated. Moreover, it was asserted that the level of the pressure should be lowered to 15 mm.Hg, especially in young patients with mitral stenosis.