Morphological findings in 192 surgically excised native mitral valves

Mitral valve disease (MVD) is a significant clinical problem that is becoming more common in the 21st century. The pathogenesis of MVD seems to be changing and is not well understood. The present study details the morphological findings in 192 native mitral valves excised over a one-year period at the Toronto General Hospital, Toronto, Ontario. The mean patient age was 59.7 ± 12.3 years at operation. There were 106 men (55.2%) and 86 women (44.8%) in the present study. The most frequent changes in the surgically excised valvular leaflets were fibrosis (78.6%) and thickening (66.2%). Fusion (32.3%) and calcification (25.2%) were common changes at the commissures. Chordae tendineae most often showed evidence of thickening (47.9%) and fibrosis (37.0%). In total, 110 valves showed mitral incompetence (57.3%), 72 showed mitral stenosis (37.5%), and 10 showed a combination of stenosis and incompetence (5.2%). In the present series, MVD was most frequently caused by postinflammatory (rheumatic) valve disease (RVD) (35.9%), followed by myxomatous degeneration (33.3%). Patients with RVD were usually female (66.7%), while those with myxomatous degeneration were more likely to be male (76.6%). RVD remains a significant problem even though the incidence of acute rheumatic fever with cardiac involvement has declined in Canada. This most likely reflects the current sociodemographic composition of the referral population. Les lésions de la valve mitrale (VM) constituent un problème clinique important, qui a pris de l’ampleur au cours du XXI e siècle. La pathogenèse semble évoluer et on n’en comprend pas très bien les causes. La présente étude donne une description morphologique détaillée de 192 valves mitrales naturelles, enlevées chirurgicalement, sur une période de un an, au Toronto General Hospital. L’âge moyen des patients était de 59,7 ± 12,3 ans au moment de l’opération. L’étude comptait 106 hommes (55,2 %) et 86 femmes (44,8 %). Les altérations les plus fréquentes étaient la fibrose (78,6 %) et l’épaississement (66,2 %) du tissu valvulaire. Autres observations courantes : la fusion (32,3 %) et la calcification (25,2 %) à la hauteur des commissures. Les cordons tendineux montraient le plus souvent des signes d’épaississement (47,9 %) ou de fibrose (37,0 %). Au total, 110 valves présentaient de l’insuffisance (57,3 %); 72, un rétrécissement mitral (37,5 %) et 10, de l’insuffisance et un rétrécissement (5,2 %). Dans la présente série, les lésions de la VM étaient le