Mitral Stenosis

Neeraj Parakh, Ravi S Math, Vivek Chaturvedi, Neeraj Parakh, Ravi S Math, Vivek Chaturvedi

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781351680868
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Comprehensive book on mitral stenosis not only compiles the existing published knowledge and literature about mitral stenosis in a succinct manner but also has input from experts having years of experience in this field. It will serve as an authentic reference and a ready reckoner for cardiology fellows, practicing cardiologists, academics and researchers

1Pathophysiology and clinical features

1The history of mitral stenosis

Balram Bhargava and Neeraj Parakh

2Epidemiology and the natural history of mitral stenosis

Anita Saxena

3The etiology of mitral stenosis

Anunay Gupta and Sandeep Singh

4The pathophysiology of mitral stenosis

Sudheer Arava, Kusuma Harisha, and Ruma Ray

5Clinical features of mitral stenosis

Jaganmohan A. Tharakan

6Complications of mitral stenosis

Senguttuvan Nagendra Boopathy and Ambuj Roy

1The history of mitral stenosis

Balram Bhargava and Neeraj Parakh

The mitral valve and mitral stenosis

The surgical era

The era of prosthetic mitral valves

The advent of echocardiography

The catheter era

References

The mitral valve and mitral stenosis

The existence of the mitral valve is as old as the human race, but its nomenclature and clinicopathological recognition are no older than five centuries. The anatomical left atrioventricular valve was named the “mitral valve” by the Father of modern anatomy—Andreas Vesalius. In the second edition of De Humani Corporis Fabrica, published in 1555, he wrote that the mitral valve, when turned upside down, resembles a bishop’s miter (a two-flapped angled hat) (Figure 1.1) and gave an accurate description of mitral valve anatomy.1 In 1668, John Mayow from the Oxford school described the first patient of mitral stenosis with detailed clinical and pathological findings and was able to correlate clinical features with autopsy findings. Further, in 1705, Raymond de Vieussens scientifically detailed the clinical findings of a 30-year-old male patient of mitral stenosis.2 Later, when this patient died, he documented various pathological findings of mitral stenosis in his magnificent engravings:

I opened the left ventricle and I discovered here first that which I have just pointed out: namely the substance of the mitral valves has become bony and that it had very markedly diminished, and indeed changed the natural appearance of the lumen.

Figure 1.1Bishop’s miter.

In 1806, Jean-Nicolas Corvisart described the thrill associated with mitral stenosis; he was the father of chest auscultation as well as the physician to Napoleon Bonaparte. Subsequently, in 1819, his pupil Rene H. T. Laennec, inventor of the stethoscope, described the murmur of mitral stenosis as “bruit de soufflet” (soft bellows).3 Many years later, Sulpice Antoine Fauvel, a French epidemiologist, described the precise timing and nature of the presystolic murmur in mitral stenosis.4 In 1862, Austin Flint provided precise and accurate descriptions of various cardiac murmurs,5 in particular a similar presystolic murmur at the apex in severe aortic regurgitation and a normal mitral valve, eponymously described as an Austin Flint murmur. In 1877, Paul Louis Duroziez described congenital mitral stenosis and made an etiological distinction between mitral stenosis of rheumatic and of congenital origin. He is also remembered for describing the Duroziez’s murmur in severe aortic regurgitation (Table 1.1).6

Table 1.1The history of mitral stenosis: The anatomical and clinical era

Contribution	Physician/surgeon/scientist	Year
Named mitral valve	Andreas Vesalius	1555
First description of mitral stenosis	John Mayow	1668
First scientific description of mitral stenosis	Raymond de Vieussens	1706
Described thrill of mitral stenosis	Jean Nicolas Corvisart	1806
Described murmur of mitral stenosis	Rene Theophile Hyacinthe Laennec	1819
Characterized presystolic timing of murmur in mitral stenosis	Sulpice Antoine Fauvel	1843
Described presystolic murmur of aortic regurgitation	Austin Flint	1862
Described congenital mitral stenosis	Paul Louis Duroziez	1877
Described juvenile mitral stenosis	Sujoy B. Roy	1963

The surgical era

The idea of surgically opening the mitral valve was first visualized by Frederick Alexander Samways in 1898 (Figure 1.2),7 supported by Sir Lauder Brunton in 1902.8 In Samways’ own words, for the surgical treatment of mitral stenosis:

Figure 1.2Samways’ landmark paper in The Lancet, 1896.

I anticipate that with the progress of cardiac surgery some of the severest cases of mitral stenosis will be relieved by slightly notching the mitral orifice and trusting the auricle to continue its defence.

However, strong disapproval from contemporary physicians enforced a hasty retreat from the idea of surgery, which remained in cold storage for nearly 20 years. In 1923, an 11-year-old girl with mitral stenosis was successfully operated on by partial valve excision. She survived for nearly 5 years after the operation; however, the next five patients operated on by th...