Systemic and Pulmonary Emboli before and after Mitral Commissurotomy

SYSTEMIC AND PULMONARY emboli are frequent and serious complications1-3 in mitral stenosis. It has been stated4' 5 that systemic embolism occurring in patients with mitral stenosis is an indication for mitral commissurotomy, and surgery has been recommended6' 7 as an urgent or emergency procedure in patients with recent systemic embolism to prevent more episodes. In one series8 of 50 patients followed for 41/2 to 7 years after commissurotomy no postoperative emboli were encountered. Others have noted systemic emboli during the first 2 years after commissurotomy" 6, 9, 10 but some6' 10 have thought that the incidence was less than the preoperative occurrence. In contrast to these reports, we have been impressed with the frequency of embolic phenomena following mitral commissurotomy; so we were prompted to investigate the relation of mitral commissurotomy to postoperative emboli. Material and Methods This study includes 149 patients who had mitral commissurotomy from 1950 to 1959 at Los Angeles County Harbor General Hospital, Torrance, and Long Beach Veterans Administration Hospital. It includes all the 75 patients operated upon at the Harbor General Hospital and 74 of 80 patients at the Veterans Hospital.* There were 91 male and 58 female patients. Four were in the second decade, 18 in the third, 53 in the fourth, 53 in the fifth, and 21 in the