[Acquired valvular cardiopathies in Italy: the dimensions of the problem and variations in etiology]

In order to get information on the number of patients with acquired valvular heart disease in Italy and about changes in the etiology of valvular involvement, we have examined death certificates regarding chronic endocardial and rheumatic heart disease; epidemiologic data of some congenital-degenerative valve disease; the results of a survey of valvular replacements in 40 Italian cardiac surgery centres in the periods 1970-1979 and 1980-1988. Deaths due to chronic endocardial and rheumatic heart disease (ISTAT source) were 8,129 in 1958 and 3,547 in 1986. These data suggest the presence of about 70,000 patients with acquired valvular heart disease due to chronic and rheumatic heart disease in Italy. Mitral valve prolapse and bicuspid aortic valve, complicated by degenerative changes, defined as congenital-degenerative valve diseases with clinical expression in adulthood, may be included in the group of acquired valvular heart disease. By extrapolation from epidemiological data the number of patients with acquired mitral insufficiency due to mitral valve prolapse might be about 28,000 and patients with aortic valve disease about 30,000 with an incidence of 1,500 per year. The survey performed in 45 Italian cardiac surgery centres revealed that the overall number of prosthetic valvular replacements was 7,695 in the period 1970-1979 and 25,467 in the period 1980-1988; the increase was maximal for aortic valve replacement (ratio 2.5:1 between the 2 periods) and and minimum for the combined mitral and aortic valve replacement (1.1:1). These data indicate that valvular heart disease of rheumatic origin is declining in Italy while degenerative valvular disease is increasing.