Rheumatic mitral stenosis at Siriraj Hospital

Abstract

Right heart catheterization was performed on 28 patients suffering from severe rheumatic mitral stenosis. 10 were male and 18 female. The ages of the patients ranged from 12 to 45 years. 21 of them had a normal sinus rhythm and the other 7 had atrial fibrillation. Information about the severity of symptoms was available in only 16 of these patients. 2 of them were in function class II, 12 were in class III and one was in class IV. About three-fourths of the patients had a reduction of the cardiac index and the other one-fourth had a low normal value. We found no correlation between the cardiac index and the size of the mitral valve at the time of surgery. Systolic pressure in the pulmonary artery ranged from 25 to 130 mm.Hg. The cardiac index tended to be lower as the pulmonary artery pressure became higher, but there was no close correlation between these two parameters. The pulmonary artery pressure was fairly well correlated with the pulmonary "wedge" pressure (left atrial pressure). Pulmonary hypertension was more severe in patients with a small mitral orifice. All of our 12 patients who had systolic pressure in the pulmonary artery of more than 50 mm.Hg. had an electrical axis in the E.K.G. of 90 degrees or more. Our data do not permit us to evaluate the relationship between the degree of disability and the disturbance of haemodynamics nor to assess the effect of atrial fibrillation on cardiac output.