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Article
July 19, 1952

COMMISSUROTOMY FOR MITRAL STENOSIS: TECHNIQUE FOR PREVENTION OF CEREBRAL COMPLICATIONS

Author Affiliations

Philadelphia

JAMA. 1952;149(12):1085-1091. doi:10.1001/jama.1952.02930290007002
Abstract

One of the most tragic complications occurring in a case of mitral stenosis is cerebral embolization. In those cases in which the condition does not prove fatal, there is usually a long period of invalidism and not infrequently a permanent residual paralysis or personality change. With present generally accepted medical management, such vascular accidents are not completely avoidable, especially in cases with associated auricular fibrillation. The daily use of anticoagulants such as bishydroxycoumarin (dicumarol®) to maintain a persistent state of relative incoagulability of the circulating blood is an incomplete and none too satisfactory method of protection against embolization in cases of mitral stenosis. The patient is thereby converted into a "bleeder," with the constant risk of serious hemorrhage should he sustain a slight wound from any cause.

Logically, the best protective measure against the formation of auricular thrombi and the occurrence of embolization is the early surgical attack on the

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