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(Circulation. 1971;44:381.)
© 1971 American Heart Association, Inc.

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Longitudinal Hemodynamic and Clinical Study of Mitral Stenosis

ALBERT A. DUBIN M.D.¹; HAROLD W. MARCH M.D.¹; KEITH COHN M.D.¹; ARTHUR SELZER M.D.¹

¹ From the Heart Research Institute, the Institute of Medical Sciences, and the Cardiology Unit, Presbyterian Hospital, Pacific Medical Center; and the Division of Cardiology, Veterans Administration Hospital, San Francisco, California.

Forty-two patients with pure mitral stenosis underwent a prospective, longitudinal study with two or more cardiac catheterizations 1 to 10 years apart and without intervening surgical treatment. The majority of patients had not previously had mitral valve surgery; in 16, the period of observation followed valvotomy. Twenty-seven patients showed evidence of progressive obstruction of the mitral valve; 15 showed no change in the calculated mitral valve area. In the group of patients with progressive disease (stenosis or restenosis) there was a consistent clinical and hemodynamic deterioration: 25 of the 27 showed increasing disability. In the nonprogressive group, seven of the 15 showed increasing symptomatology, most often related to the development of atrial fibrillation and a fall in cardiac output. Possible causes for the different course of mitral stenosis in the two groups are reviewed. The probability that trauma due to altered flow patterns through a stenotic valve produces progressive stenosis is suggested.

Key Words: Atrial fibrillation • Pulmonary hypertension • Cardiac catheterization • Pulmonary vascular resistance • Mitral valve area

Submitted on October 19, 1970
Accepted on April 28, 1971

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