Mitral Stenosis with Exertional Cyanosis and Pulmonary Hemosiderosis

A patient with mitral stenosis is reported who suffered from exertional cyanosis for the last eight years of his life. Radiologic examination of his chest demonstrated a diffuse pulmonary hemosid-erosis, which was confirmed at autopsy. Physiologic studies in the last few weeks of life showed that the cyanosis was not due to impairment of oxygenation of the blood in the lungs but rather to slowed circulation, possibly augmented by local changes in the anatomy of the vessels of the skin. T HE OCCURRENCE of cyanosis in pa-tients with mitral stenosis has long been noted, and cyanosis of the lips, ears and cheeks, the "mitral facies, " has been considered typical of that lesion. The subject has been re-viewed by Cossio and Berkonsky, ' who reported clinical and physiologic studies in 20 cases of mitral stenosis with cyanosis. In six of these patients they attributed the cyanosis to stasis of the circulation, as indicated by a high arterio-venous difference in the oxygen content of blood in peripheral arteries and veins. In 10 other patients they found both stasis and ar-terial oxygen unsaturation. In the remain-ing four patients the data did not explain the cyanosis but the authors postulated the presence of dilated venous capillaries in the skin. In no patient was arterial oxygen un-saturation the only cause of the cyanosis. Conspicuous granular hemosiderosis of the lungs, an uncommon complication of mitral stenosis, is usually discovered radiographically and is sometimes confused with other causes of miliary densities or calcification in the lungs. Pendergrass, Lame and Ostrum2 were able to find only 17 cases with autopsy. Reports based on radiographic studies alone would increase this total.3 ' ' No report of pulmonary func-tioil or arterial oxygen saturation studies in such cases has been found. Cyaniosis has no