Comparative studies of mitral valves in rheumatic heart disease

Mitral valve tissues from 195 patients with rheumatic heart disease removed at the time of cardiac surgery were studied by conventional histologic techniques. One hundred seven patients from a five-year period at All-India Institute for Medical Sciences in New Delhi were studied in conjunction with 88 patients undergoing cardiac surgery in Albuquerque during a similar period. In Indian patients a correlation was noted between degree of moderate or severe valvular calcification and extent of adjacent valvular mononuclear cellular infiltration often consisting of striking lymphocytic-plasma cell collections. Similar distinct correlations were not observed among the mitral valves from the Albuquerque patients. It is possible that mitral valve mononuclear cell infiltrates among Indian patients may reflect a chronic immune reaction influencing the natural course of rheumatic heart disease in this latter population.