Regression of multiple pulmonary varices after mitral valve replacement.

A 30-year-old woman with severe mitral insufficiency had large, rounded opacities at the right hilus as seen on her chest x-ray film. These were shown to be varicosities of the right pulmonary veins by pulmonary angiography and by direct injection of contrast medium from a Brockenbrough catheter, which entered the varices from the left atrium. A year after mitral valve replacement there was complete regression of the venous dilatations. When a pulmonary varix is detected there is associated heart disease in 40% of cases. Mitral valve disease (usually mitral insufficiency) is the cardiac abnormality in 27%. This would indicate that pulmonary varix is a complication of mitral insufficiency. Four patients who have undergone valve replacement for mitral reflux have shown regression of the caricosities, suggesting that relief of mitral insufficiency will reduce or eliminate the risk of varix rupture.