Clinical Observation |

Severe Rheumatic Mitral Stenosis:  A 21st Century Medusa

Pedro Carrilho-Ferreira, MD; Monica Mendes Pedro, MD; Manuel Gato Varela, MD; Antonio Nunes Diogo, MD, PhD
Arch Intern Med. 2011;171(16):1498-1499. doi:10.1001/archinternmed.2011.368.
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Although the prevalence of rheumatic fever has greatly decreased in developed countries, rheumatic mitral stenosis still causes significant morbidity and mortality. Symptomatic patients have a poor prognosis, with a 0 to 15% 10-year survival rate, particularly if percutaneous or surgical intervention are contraindicated or considered high risk. We present a case of severe rheumatic mitral stenosis with an evolution over 4 decades, in which exceptional venous distention has established.

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Figure 1. A 74-year-old female patient with a history of rheumatic mitral valve disease with severe stenosis. A, Jugular venous distention. B, Superficial venous circulation in the anterior chest and abdomen wall. C, Superficial venous circulation in the anterior chest, abdomen, and lower limbs. D, Superficial venous circulation on the lower limbs.

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Figure 2. Echocardiogram showing rheumatic valve disease with mitral stenosis and left atrial dilatation.




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