`Bronchitis' in Patients with Mitral Stenosis

Episodes of 'recurrent bronchitis' following minor upper respiratory tract infections are common in patients with mitral stenosis. The first incident of this type is often found in retrospect to mark the onset of progressive deterioration in exercise tolerance. The clinical features of 'bronchitis' in these patients, however, frequently differ from those of true purulent bronchitis. There may be little, if any, infection of the sputum, and pyrexia is either absent or unimpressive. Orthopnoea is commonly present, and the response to routine therapy with antibiotics and bronchodilator drugs is slow and incomplete, leaving a wheezy chest for several weeks. On the other hand, there is no doubt that purulent bronchitis and emphysema do occur in patients with mitral stenosis. It is of the utmost importance, therefore, when assessing patients for mitral valvotomy to be able to separate these two groups since it is essential to know how much respiratory disability is due to the pulmonary consequences of mitral valve obstruction and how much is caused by true bronchitis and/or emphysema. In this way, both the operative risks and the likelihood of being able to provide maximum benefit from this type of operation can be assessed more accurately. Similarly, physiological information that separates these two groups of 'bronchitic cardiac patients' can guide the post-operative management of patients in the true bronchitic and emphysematous group where elective tracheostomy and/or assisted ventilation may save a life (Temple, 1961). The present investigation was designed to compare the pulmonary !function of patients with mitral stenosis who had experienced recurrent bronchitis with that of patients with mitral stenosis who had never experienced symptoms of this nature.