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[Natural history of patients with severe mitral and double-valve disease under medical therapy (author's transl)].

55 patients with mitral valve disease (MV) and 30 patients with combined aortic and mitral valve lesions (DV) class III or IV (NYHA) were followed up to ten years on medical therapy. In all cases valve replacement was indicated but not done for different reasons. The prediction of late survival was analyzed by anamnestic, clinical and hemodynamic variables. The five-years survival rate in MV was 50% (stenosis 57%, incompetence 25%), in DV 28%. Those patients who refused operation had a high survival rate. Functional class IV, cardiothoracic ratio greater than 60%, mean pulmonary artery pressure greater than 30 mm Hg (MV) or greater than 25 mm Hg (DV), pulmonary vascular resistance greater than 400 dyn/s/cm5 (MV) or 300 dyn/s/cm5 (DV) were significantly negative factors influencing the survival curves. In addition, in patients with MV and incomplete right bundle branch block and a PEP/LVET ratio greater than 0.34 calculated from systolic time intervals indicated a serious prognosis. Comparing the survival curves after mitral valve replacement and conservative therapy, it is evident that in mitral and double valve disease class III or IV the operative therapy leads to life prolongation with the exception of mitral stenosis class III.