Influence of surgery on the natural history of rheumatic mitral and aortic valve disease.
The rate of survival, the evolution of functional cardiac status and the incidence of major complications during a 5 year period were studied in 410 patients with rheumatic mitral or aortic valve disease, of whom 200 were treated medically and 210 by surgery. The 5 year survival rates in patients with various types of rheumatic mitral valve disease were similar (45 percent for those with mitral stenosis and 46 percent for those with mitral insufficiency or mixed mitral insufficiency and stenosis). The survival rate in patients with aortic valve disease was somewhat more favorable (64 percent). Mitral valvulotomy had the most positive influence on mortality. The 85 percent 5 year survival rate of patients who underwent this procedure was significantly higher than that of patients with medically treated mitral stenosis. In patients submitted to mitral and aortic valve replacement, the survival rate was also improved in comparison with data in the corresponding medically treated group, but to a lesser degree (70 percent for aortic valve replacement and 60 percent for mitral valve replacement). In all surgically treated groups, initial operative mortality was the primary determinant of the rate of survival at the end of 5 years. Survivors of all surgical groups had appreciable improvement in cardiac functional classification and a remarkable reduction in the incidence of heart failure and atrial fibrillation. The incidence of infectious endocarditis was significantly reduced after mitral valvulotomy, as compared with the incidence in patients with medically treated mitral stenosis. Mitral and aortic valve replacement did not reduce the incidence of infectious endocarditis. The incidence of thromboembolic phenomena was favorably influenced by mitral valvulotomy and aortic valve replacement, but not by mitral valve replacement.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology; D002648:Child; D004696:Endocarditis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology; D006333:Heart Failure / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012214:Rheumatic Heart Disease / Q000150:complications*; D014687:Venezuela