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The fact that morphological changes occur in the lungs of patients with mitral stenosis has been generally accepted since 1936 when Parker and Weiss described thickening of the capillary basement membrane, scarring and probable loss of capillaries (1). These findings have been confirmed and extended by others (2, 3), yet there is no agreement regarding the physiological and clinical significance of the pulmonary lesions. Because of their location in relation to vascular structures, one would expect that such lesions might interfere with the flow of blood through the lungs or with the diffusion of gases across the pulmonary membrane. Hemodynamic studies by a number of different workers have demonstrated an increase in pulmonary vascular resistance in patients with mitral stenosis (4-10). This paper deals with studies of the diffusion of gases across the pulmonary membrane in a group of patients on whom mitral valvulotomy had been performed. The diffusing capacity for oxygen is the number of ml. of oxygen diffusing across the pulmonary membrane per minute in response to a mean difference of 1 mm. Hg in the partial pressure of oxygen on the two sides of the membrane. It is a function of the thickness, physicochemical structure and area of the surface across which diffusion takes place. The area is related to the area of the walls of all capillaries which are actively involved in gas exchange. Capillaries are not included if

THE DIFFUSING CAPACITY OF THE LUNGS IN PATIENTS WITH MITRAL STENOSIS STUDIED POST-OPERATIVELY 1