The clinicopathologic correlation of lung biopsies in mitral stenosis

Abstract 1. 1. A pathologic study of lung biopsies from fifteen cases of well-established mitral stenosis was made with the purpose of correlation of the alveolar and pulmonary vessel changes with the clinical and laboratory findings. A control group of ten autopsy cases without cardiac or pulmonary disease was also studied. 2. 2. The changes in the alveolar walls consisted of capillary dilatation, thickening of the capillary basement membrane, increase in the interstitial tissue, pericapillary edema, and a transition to cuboidal epithelium. 3. 3. The lesions in the pulmonary vessels consisted of intimal thickening, medial hypertrophy, and scarring with narrowed lumens. 4. 4. Such changes were more commonly found in older patients with more advanced disease, in those with roentenographic evidence of pulmonary fibrosis or hemosiderosis, electrocardiographic evidence of right ventricular hypertrophy, high pulmonary artery pressures, and increased pulmonary and pulmonary arteriolar resistance. Pulmonary vessel changes could not be consistently predicted by any clinical or laboratory finding. 5. 5. Patients with marked pulmonary changes tend to derive less benefit from mitral valvulotomy, but there are noteworthy exceptions. 6. 6. No single feature or group of features is completely reliable in determining the degree of pulmonary changes present prior to operation nor do the pulmonary changes as determined by lung biopsy necessarily predict the degree of benefit to be obtained from valvulotomy.