Fifteen adult patients (ages 32 to 59 years) with significant valvular aortic stenosis in whom the severity of obstruction was documented by haemodynamic measurement and in whom the natural history was not interrupted by operation were followed for up to II 7 years, or until death. The overall prognosis was poor, two-thirds of the group being dead at last follow-up. The percentage mortality, corrected for the number of patients followed, was 36 per cent at 3 years, and 52 per cent at 5 years; of those who were followed for IO years, go per cent had died. The age at the onset of symptoms was not related to duration of survival, there was no clear relation between the type of symptom and survival, and haemodynamic parameters could not be correlated with symptoms or survival. Patients with a combination of symptoms tended to have the worst prognosis. Three patients were asymptomatic, one of whom died suddenly. These data provide a basis for predicting the natural history of isolated valvular aortic stenosis in adult patients, and indicate that significant obstruction together with symptoms portends an extremely poor prognosis.

No abstract

While considerable information concerning the hemodynamic and angiographic features of idiopathic hypertrophic subaortic stenosis (IHSS) is available, data concerning the natural history of the disease are limited. The clinical courses of 126 patients with hemodynamically documented IHSS, examined repeatedly for up to 12 years, were analyzed. The older patients tended to be more severely symptomatic. Although the course was extremely variable, the patients who were asymptomatic initially tended to remain so, while those who were more disabled generally deteriorated, died, or improved spontaneously. Bacterial endocarditis occurred in three patients. Ten patients died as a consequence of the natural history of IHSS; six of these deaths were unexpected. Sudden deaths occurred usually in patients with no or mild obstruction, and in patients with both the familial and sporadic forms of the disease. Atrial fibrillation was observed in 8% of the patients, and abnormalities of atrioventricular conduction, in 30%. Absence of voltage criteria for left ventricular hypertrophy occurred more frequently in asymptomatic patients, those with mild obstruction, and those with familial IHSS. Pulmonary hypertension occurred in one third of the patients, and was associated with considerable clinical disability. Obstruction to right ventricular outflow occurred in eight patients (15%), two of whom had no associated obstruction to left ventricular outflow.

No abstract

SUMMARY Sixty-five consecutive patients with recent unequivocal TIA (33) or stroke (32), but nondiagnostic arteriograms, had two-dimensional echocardiograms (2DE) and electrocardiograms (ECG) to determine the incidence of cardiac abnormalities which could cause embolic stroke. Abnormalities were classified according to increasing probability of causing an embolic event: non-specific, possible emboligenic abnormality (PEA) or definite emboligenic abnormality (EA).Although 2DE was abnormal in 33 patients (51%), and ECG in 38 (59%), many abnormalities were nonspecific. Only four patients (6%) had EA on ECG and two (3%) on 2DE. Since one patient had EA on both tests, 2DE identified only one patient (mitral valve prolapse) not already identified by ECG. All patients with EA had a prior history of cardiac disease. PEA was present on ECG in 11 patients (17%), and on 2DE in 25 (38%). There was no correlation between age, CT results, or neurologic symptoms commonly associated with embolic stroke and the presence of EA or PEA on ECG or 2DE.Although TIA and stroke patients with negative arteriograms have a high incidence of abnormalities on ECG and 2DE, the percentage of patients with EA is low, and cardiac history and ECG identify most patients. 2DE provides little additional information.