[Respiratory failure sometimes is due to a cardiac cause].

In two women aged 65 and 49 years and a man aged 64 years, severe respiratory failure developed and a pulmonary disease was suspected. They also had a minor systolic murmur. At further investigation no pulmonary cause for the disease could be established. Pulmonary artery catheterization revealed increased pulmonary artery and wedge pressures and transthoracic and transoesophageal echocardiography revealed mitral valve insufficiency. Two patients had valve surgery, the third received medication. Respiratory failure is a common problem in an intensive care unit. If this condition is caused by mitral valve insufficiency the clinical picture is not always that of acute left ventricular failure with hydrostatic pulmonary oedema due to backward failure. In patients with respiratory failure due to mitral valve pathology initial diagnostic problems may be overcome by combining the findings of pulmonary artery catheterization and transthoracic and transoesophageal echocardiography.