Studies in cardiac pathology . 23 cases dying surgical deaths, only 4 had dilated leftauricles. Pericarditis was present in nearly one-third of the cases,and sudden death occurred in 7. Sixty per cent, of the casesgave a history of rheumatic infection. Nineteen cases were ad-vanced in life and gave no such history, showing that this lesionTCiSLy have a sclerotic as well as an infectious origin. Nearly allstatistics show that mitral obstruction, especially the form whichoccurs in early life and results from an infectious valvulitis, isvery much more common in the female sex. Various explanation
Studies in cardiac pathology . 23 cases dying surgical deaths, only 4 had dilated leftauricles. Pericarditis was present in nearly one-third of the cases,and sudden death occurred in 7. Sixty per cent, of the casesgave a history of rheumatic infection. Nineteen cases were ad-vanced in life and gave no such history, showing that this lesionTCiSLy have a sclerotic as well as an infectious origin. Nearly allstatistics show that mitral obstruction, especially the form whichoccurs in early life and results from an infectious valvulitis, isvery much more common in the female sex. Various explanationshave been offered, such as, for instance, that prolonged subacuteinfections are more frequent in women, also that, owing tolessened cardiac activity and intracardiac pressure, the mitralvalve makes less extensive excursions, and is hence more proneto adhesive changes. Congenital structural differences have alsobeen suggested. It must be admitted, however, that none ofthese explanations are satisfactory. Among 50 autopsies of. Fig. 22.—Mitral |jccimen .showing mitral stenosis viewed from the ventricular side. The valvular end<i-cardium is thickened and has lost much of its flexibility; the chorda; tendinea; are thickened,indurated, contracted, and more or less fused together. Small verrucose vegetations are seenon the ventricular endocardium just to the left of the mitral valve. 74 STUDIES IN CARDIAC PATHOLOGY mitral stenosis cases Sears found in 25 a mitral lesion only (19admitted only one finger). In 7 other cases the mitral lesion wasthe principal one (2 fibrous pericarditis, 5 aortic disease). Sothat in 27 cases there was mitral disease alone, in 17 mitral andaortic, in 1 mitral and tricuspid, in 5 mitral, aortic, and tricuspid,in 4 fibrous pericarditis. Pathologic Physiology.—The presence of mitral stenosis atfirst tends to produce left auricular hypertrophy, owing to obstruc-tion to outflow offered by the constricted orifice. Hirschfelder ^and Wolfsohn ha
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