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Ramakrishna CD, Khadar SA, George R, Jayaprakash VL, Sudhayakumar N, Jayaprakash K, Pappachan JM
Correspondence: Dr Joseph M Pappachan, email@example.com
Introduction This cross-sectional study on the age-specific clinical and anatomical characteristics of mitral stenosis was conducted at the Department of Cardiology at Kottayam Medical College, South India.
Methods The clinical profile, laboratory details and transthoracic echocardiographical features of 203 consecutive patients with mitral stenosis were studied. Wilkins score was used to assess the valve morphology and the feasibility of balloon mitral valvotomy (BMV)/closed mitral valvotomy (CMV). Patients were grouped according to age, into Group I (younger than 40 years; 68 cases), Group II (40–65 years; 78 cases) and Group III (older than 65 years; 57 cases) for analysis.
Results The mean age of the patients was 53 years. History of rheumatic fever was less common in Group III (37 percent in Group I vs. 20 percent in Group III, p-value is equal to 0.05). Acute pulmonary oedema occurred commonly in Group III (six percent in Group I vs. 36 percent in Group III, p-value is less than 0.001). Incidence of ischaemic strokes increased with increasing age (three percent in Group I vs. 12 percent in Group II, p-value is equal to 0.05; 12 percent in Group II vs. 25 percent in Group III, p-value is equal to 0.05; and three percent in Group I vs. 25 percent in Group III, p-value is less than 0.001). Prevalence of atrial fibrillation (AF) increased progressively with increasing age (nine percent in Group I vs. 30 percent in Group II, p-value is less than 0.001; 30 percent in Group II vs. 64 percent in Group III, p-value equal to 0.003). Clinical features of pulmonary hypertension was highest among Group I (66 percent in Group I vs. 42 percent and 43 percent in Groups II and III, respectively, p-value is equal to 0.01). The mean duration of exertional dyspnoea, history of paroxysmal nocturnal dyspnoea, mean NYHA class, mean left atrial sizes, mean mitral valve areas and mean mitral valve gradients did not vary significantly among the three groups. Mitral valve scores were prohibitive for BMV/CMV in significant numbers of older patients (seven percent in Group I vs. 38 percent in Group II vs. 80 percent in Group III; p-value is less than 0.001).
Conclusion When compared to the trends in developed countries, the mean age at presentation of mitral stenosis is similar, but the degree of valve deformity is higher. Incidence of pulmonary oedema, AF and stroke increases with advancing age in mitral stenosis.
Keywords: atrial fibrillation, mitral stenosis, mitral valvotomy, pulmonary oedema, rheumatic heart disease, stroke
Singapore Med J 2009; 50(7): 680-685