Chronic Valvular Disease of the Heart

Abstract

Chronic valvular disease is most commonly the result of rheumatic damage following single or repeated attacks of rheumatic fever. There is resulting rigidity or deformity of the valve cusps, with fusion of the commissures and shortening or fusion of the chordae tendineae of the mitral and tricuspid valves. This leads to valvular stenosis or incompetence, although both may coexist. Following rheumatic damage the mitral valve is affected alone in 50%-60% of cases; combined aortic and mitral involvement occurs in 20%, and aortic involvement in some 10%. The tricuspid valve is usually only affected in patients who also have aortic and mitral valve involvement (Reichek et al. 1973). Sixty per cent of patients who present with rheumatic valvular disease give a prior history of rheumatic fever. They may, however, present with cardiac murmurs found on routine examination. Follow-up is required by physical examination and serial X-rays, electrocardiograms and echocardiography. Cardiac catheterisation is indicated during assessment for surgery.