Clinical features, problems in medical management and therapeutic planning in severe valvular heart disease.

Clinical features and pathological findings were reviewed in 90 postmortem cases of valvular heart disease (VHD) to clarify the problems and limitations of medical management. The clinical features of severe mitral valve disease included congestive heart failure (CHF), with tricuspid regurgitation in many cases, atrial fibrillation, frequent ventricular premature beats, ventricular hypertrophy, cardiomegaly, increased pulmonary arterial pressure and abnormal hepatorenal function. The most common causes of aortic valve disease (AVD) were rheumatic fever and infective endocarditis, and the major causes of death were sudden death and intractable CHF. Autopsy in cases of AVD revealed marked left ventricular hypertrophy and dilatation, vegetations, thickening, adhesion and calcification in the aortic valve. Some patients died of cardiogenic shock due either to severely impaired cardiac function or to associated myocardial or pulmonary infarction. Abrupt onset of embolism was also related to death of the patients. The management of VHD must include the treatment of CHF and arrhythmias and the prevention of embolism. Appropriate timing for surgery and close follow-up by cardiologists is mandatory.