The Clinical Recognition of "Silent" Mitral Stenosis

¹ Cardiovascular Section, Department of Medicine, Hahnemann Medical College and Hospital
² Assistant Professor of Medicine, Director, Auscultation Unit, Hahnemann Medical College and Hospital
³ Professor of Medicine, Director, Cardiovascular Section, Hahnemann Medical College and Hospital

This communication deals with the occurrence of "silent" mitral stenosis in two patients. Their remarkable similarity suggests a unique syndrome characterized by rapid deterioration and relative intractability following the onset of symptoms, severe pulmonary hypertension, a heavily calcified and "tightly" stenotic mitral valve, and the absence of auscultatory evidence of mitral stenosis. On physical examination, they had the findings of pulmonary hypertension and consequent right ventricular hypertrophy, tricuspid regurgitation and right ventricular failure. A diagnosis of mitral valve obstruction did not become apparent until a careful analysis of the electrocardiogram and the chest roentgenograms could be made.

The detection of dense valvular calcification with the image intensifier and combined heart catheterization firmly established the diagnosis. Replacement of the mitral valve with a prosthetic valve offered the only possible solution in view of the extensive valvular damage and heavy calcification found at surgery. This report focuses attention on patients with unexplained pulmonary hypertension, and indicates the necessity of excluding "silent" mitral stenosis in such individuals.