Key result
Chronic rheumatic mitral stenosis was associated with significantly hypertrophied papillary muscles compared to normal hearts (mean tip circumference 2.2 cm vs 1.1 cm, p<0.001).
Observational (n=25)
No
Chronic rheumatic mitral stenosis is associated with significant papillary muscle hypertrophy and fibrosis, which may explain the small end-systolic left ventricular cavity and high frequency of chest pain in these patients.
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May link papillary hypertrophy to small LV cavity and chest pain in rheumatic MS; hypothesis-generating and requires prospective validation.
A quantitative pathologic study was performed on papillary muscles in 15 cases of chronic rheumatic mitral stenosis. The papillary muscles were grossly hypertrophied as compared with papillary muscles in 10 normal specimens. Hypertrophy of papillary muscles was associated with pronounced fibrosis. Angiographically, these hearts were remarkable in small left ventricular cavity with almost complete cavity elimination at end systole. Left ventricular wall dyskinesia was also present. It is probable that derangement of the mitral valve structure due to rheumatic process leads to more stress on the supporting elements, thus resulting in papillary muscle hypertrophy.
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Sheikhzadeh et al. (1981) conducted an observational in Chronic rheumatic mitral valve stenosis (n=25). Chronic rheumatic mitral valve stenosis vs. Normal mitral apparatus was evaluated on Papillary muscle circumference at the tip (cm) (p=<0.001). Chronic rheumatic mitral stenosis was associated with significantly hypertrophied papillary muscles compared to normal hearts (mean tip circumference 2.2 cm vs 1.1 cm, p<0.001).
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