THE criteria for the diagnosis of mitral insufficiency, as set forth by the New York Heart Association,1 require the presence of enlargement of the heart in addition to a systolic murmur at the apex. In the opinion of some clinicians, this requirement of cardiac enlargement does not apply to children2 or young adults.3 The present paper reports further evidence on this matter from observations on 1,971 children seen in consultation during the first two years of operation of the Denver Area Rheumatic Fever Diagnostic Service (1944 to 1946).
The record of each child was coded, using the punch card method of the International Business Machine Corporation. Two hundred and twenty-six of the 1,971 children examined had rheumatic heart disease. One hundred and sixty-four of the 226 had mitral insufficiency; 58 of this group also had mitral stenosis, aortic stenosis, aortic insufficiency, tricuspid insufficiency or pericarditis. An