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To the Editor:—
Lamkin et al (194: 1019, 1965) have done a service in calling attention to the commonest late complication of heart-valve replacement, namely, thromboembolism. In discussing the genesis of the thromboemboli in their patient, the authors did not consider the loud apical holosystolic murmur. Such a finding in the presence of a Starr-Edwards mitral prosthesis usually means regurgitation through a break in the suture line about the valve. After angiographic confirmation, closure of the defect is indicated, because this will probably reduce the likelihood of thromboembolism.
Rogers WR. A Complication of Heart-Valve Replacement. JAMA. 1966;195(3):228. doi:10.1001/jama.1966.03100030122042
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