Etiology of acquired valvular heart disease in adults. A survey of 18,132 autopsies and 100 consecutive valve-replacement operations

The cardiac valve pathology in 18,132 autopsies was analyzed. A total of 1,136 patients (6.3%) had acquired valvular disease. The most commonly diseased cardiac valve was the mitral valve (49%), followed by the aortic valve (42%) and the tricuspid (9%) and pulmonary valves (0.3%). Rheumatic fever accounted for 99.7% of cases of mitral stenosis and 68.4% of mitral incompetence. The autopsy incidence of mitral stenosis remained constant over 30 years (1950 to 1979). Only 44.4% of the cases of acquired aortic stenosis were due to rheumatic fever. Review of 100 consecutive, surgically excised native valves revealed that if the pathologist is given adequate information regarding the macroscopic appearance of the intact valve prior to excision, an accurate etiopathologic diagnosis can be made in 81% of cases compared with only 35% of cases without such information.