THE NATURAL HISTORY OF 271 PATIENTS WITH MITRAL STENOSIS UNDER MEDICAL TREATMENT

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Abstract
Two hundred and seventy-one patients with symptomatic mitral stenosis who were first seen during the years 1933-49 were followed up in 1951-53 and again in 1959. The average age at the first observation was 41.5 years. A large number were in an advanced stage of the disease. Fifty-seven % had chronic atrial fibrillation and 62% enlargement of the heart, L e. a cardiothoracic index of 55 or more. Right axis deviation was present in 29%. Increased hilar markings were noted in 35% of those with adequate radiological examination. At the follow-up-after an average period of 11 years[long dash]a total of 70% of the series were dead, 18% had deteriorated, and 11% were unchanged, 1% having incomplete data. At the second follow-up-after 18 years[long dash]a total of 83% were dead, 12% had deteriorated, and 3% were unchanged, 2% having incomplete data. Sixty-two% died from cardiac failure, 22% from thrombo-embolic complications, 8% from infections, and 8% from unrelated causes. For the total series the survival rates were 34% after 10 years and 14% after 20 years. These results were similar whether an apical systolic murmur had been present or absent. Women had a slightly higher survival than men, and younger patients did better than those over the age of 50 years. Patients with atrial fibrillation and with enlarged hearts had a lower survival than found in the absence of these signs. Decreasing functional capacity was associated with decreasing survival rate. Patients with right axis deviation or with increased hilar markings had a lower survival than patients without these signs. The continued tendency to progression of mitral stenosis giving rise to symptoms is stressed and the advisability of operation is discussed.