[Clinicopathological analysis of rheumatic heart disease]

Autopsy cases of rheumatic heart disease which took natural courses without surgery were clinicopathologically analyzed. The patients had pancarditis (2 patients), mitral stenosis (MS; 12), mitral regurgitation (MR; 8), aortic stenosis and regurgitation (ASR; 5) and combined valvular disease (CVD; 30). The patients with pancarditis (mean age 15 years) showed high rheumatic activity, short clinical course, enlargement of the heart, edematous swelling and inflammation of the valves, myocardium and pericardium with multiple Aschoff nodules. Patients with MS (mean age 42 years) showed low rheumatic activity, enlarged left atrium and right ventricle, thickening and calcification of the valve edge which was categorized into oval shape and slit shape ostial narrowing, and fibromuscular thickening of the small coronary artery wall. Patients with MR (mean age 32 years) showed moderate rheumatic activity, enlarged left ventricle, left atrium and right ventricle, diffuse thickening of the valve, contraction of the posterior leaflet and healing Aschoff nodules. Patients with ASR (mean age 36 years) showed moderate rheumatic activity, elongated enlargement of the left ventricle, adhesion of the commissures, thickening with contraction and calcification of the cusps, hypertrophy and fibrosis of the myocardium. Patients with CVD were divided into the left-sided double stenosis group (CVD-S; 16 patients) and double regurgitation or triple valve disease group (CVD-R; 14). The CVD-S group (mean age 51 years) showed low rheumatic activity, female predominance and similar morphology to MS. The CVD-R group (mean age 32 years) showed moderate rheumatic activity, relatively short clinical course, male predominance and similar pathology to pancarditis and/or MR. The valvular pathology in rheumatic fever was modified by connective tissue matrix of the valves, especially of acid-mucopolysaccharides.