"Silent" Mitral Stenosis

Patho-anatomical Basis of the Absence of Diastolic Rumble

Abstract

Patho-anatomical study was carried on 5 cases with "silent" mitral stenosis to search any responsible factors for a disappearance of pathognomonic apical diastolic rumble.
Compared with 15 control cases with mitral stenosis, the following pathoanatomical determinants were thought to be responsible.
(1) Marked restriction of mitral valve movement, especially of mobile "trigone" of anterior leaflet.
(2) Adhesion, thickening and shortening of chordae tendineae causing the formation of the second point of stenosis below the valve.
(3) Postero-medially deviated mitral valve orifice.
(4) Left atrial huge thrombi.
(5) Combination of these factors.
The meaning of these patho-anatomical factors was discussed.