Patients With Mitral Stenosis and Systemic Emboli: Hemodynamic and Clinical Observations

Introduction  In 1933, Weiss and Davis analyzed 164 cases of fatal rheumatic heart disease that came to postmortem examination at the Boston City Hospital and reported that death was caused by systemic emboli in 25 instances or 15%.¹ In a clinicopathologic study of 101 cases of mitral stenosis examined at the Boston City Hospital between 1945 and 1949, peripheral infarcts were found in 49 cases; ten of these were associated with subacute bacterial endocarditis.² In 33 patients of this series systemic emboli were the cause of death.In the intervening years, the clinical course of rheumatic mitral stenosis has been markedly altered by advances in the surgical treatment of obstruction at the mitral valve, in the medical treatment of congestive heart failure and of subacute bacterial endocarditis, and in the chemotherapeutic prevention of recurrences of active rheumatic fever. On the other hand, there is no evidence that