The value of left heart catheterization in patients with rheumatic mitral valve disease.

Diagnostic and therapeutic problems commonly arise in patients with rheumatic heart disease despite the use of all available clinical data, including electrocardiographic and roentgenographic studies. The deficiencies of the conventional aids have become more apparent with attempts to define the physiological significance of mitral valve lesions. Since its introduction by Cournand and associate’ in 1941, right heart catheterization has been employed with singular success. Its primary contribution has been in the patient with congenital heart disease, although it has served to clarify much of the altered physiology in patients with rheumatic mitral and tricuspid stenosis. In aortic stenosis and mitral and tricuspid insufficiency, the procedure has been of little value. In contrast, left heart catheterization enables pressure measurements to be recorded across the aortic valve during systolic ejection and across the mitral valve during ventricular filling.2 3 The present report illustrates the importance of left heart catheterization in the study of patients with rheumatic mitral valve disease. The material is presented in the form of the five most common problems encountered. In each instance, the diagnostic and therapeutic enigma was resolved by left heart catheterization. All patients were studied by the Fisher4 modification of the BjSrk3 technique. Problem 1. Objective evidence of mitral stenosis combined with equivocal symptoms and a normal roentgenogram and electrocardiogram.