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. 1968 Sep;23(5):530–536. doi: 10.1136/thx.23.5.530

Incidence of systemic embolism before and after mitral valvotomy

P B Deverall 1,1, P M Olley 1,2, D R Smith 1, D A Watson 1, W Whitaker 1
PMCID: PMC471843  PMID: 5680237

Abstract

Mitral valvotomy is of established value in improving the clinical condition and life expectancy of patients with rheumatic mitral stenosis. Its value in preventing or reducing the incidence of systemic arterial embolism is less certain. A comparison of pre- and post-operative embolic incidence can only be accepted if it is clear that the method of assessing the pre-operative figure is reliable. It is shown that the figure varies according to the length of the pre-operative study, and evidence is presented to show a changing incidence with increasing length of chronic rheumatic history. By studying patients in whom the time of onset of rheumatic heart disease is accurately known, a rising embolic incidence with the passage of time is shown. A comparison is made between groups of patients who have experienced the same length of chronic rheumatic history but who differ in respect of mitral valvotomy. We conclude from our comparison that this operation does not diminish the incidence of embolism, though only about a quarter of all our patients had atrial appendagectomy at the time of valvotomy. A reduction in the incidence of recurrent embolism in a given patient after mitral valvotomy is shown but may be more apparent than real. Operative embolism, defined here as that occurring either at or within 48 hours of operation, has an incidence of 3·8%. The factors related to pre-operative, operative, and post-operative embolism are presented.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BAKER C., BROCK R. C., CAMPBELL M., WOOD P. Valvotomy for mitral stenosis; a further report, on 100 cases. Br Med J. 1952 May 17;1(4767):1043–1055. doi: 10.1136/bmj.1.4767.1043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BAKER C., HANCOCK W. E. Deterioration after mitral valvotomy. Br Heart J. 1960 Apr;22:281–294. doi: 10.1136/hrt.22.2.281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BANNISTER R. G. The risks of deferring valvotomy in patients with moderate mitral stenosis. Lancet. 1960 Aug 13;2(7146):329–333. doi: 10.1016/s0140-6736(60)91479-3. [DOI] [PubMed] [Google Scholar]
  4. BELCHER J. R., SOMERVILLE W. Systemic embolism and left auricular thrombosis in relation to mitral valvotomy. Br Med J. 1955 Oct 22;2(4946):1000–1003. doi: 10.1136/bmj.2.4946.1000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bakoulas G., Mullard K. Mitral valvotomy and embolism. Thorax. 1966 Jan;21(1):43–46. doi: 10.1136/thx.21.1.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. COULSHED N., EPSTEIN E. J., WALKER E., GALLOWAY R. W. SYSTEMIC EMBOLISM IN MITRAL STENOSIS. Br Med J. 1964 Nov 28;2(5421):1393–1394. doi: 10.1136/bmj.2.5421.1393-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. ELLIS F. H., Jr, CONNOLLY D. C., KIRKLIN J. W., PARKER R. L. Results of mitral commissurotomy; follow-up of three and one-half to seven years. AMA Arch Intern Med. 1958 Dec;102(6):928–935. doi: 10.1001/archinte.1958.00260230074010. [DOI] [PubMed] [Google Scholar]
  8. ELLIS L. B., ABELMANN W. H., HARKEN D. E. Selection of patients for mitral and aortic valvuloplasty. Circulation. 1957 Jun;15(6):924–935. doi: 10.1161/01.cir.15.6.924. [DOI] [PubMed] [Google Scholar]
  9. ELLIS L. B., HARKEN D. E. Arterial embolization in relation to mitral valvuloplasty. Am Heart J. 1961 Nov;62:611–620. doi: 10.1016/0002-8703(61)90369-6. [DOI] [PubMed] [Google Scholar]
  10. ELLIS L. B., HARKEN D. E., BLACK H. A clinical study of 1,000 consecutive cases of mitral stenosis two to nine years after mitral valvuloplasty. Circulation. 1959 Jun;19(6):803–820. doi: 10.1161/01.cir.19.6.803. [DOI] [PubMed] [Google Scholar]
  11. GLENN W. W., MCNEILL T. M. Aortic embolism complicating mitral stenosis; with particular reference to emergency valvulotomy before embolectomy. N Engl J Med. 1957 Feb 14;256(7):295–297. doi: 10.1056/NEJM195702142560704. [DOI] [PubMed] [Google Scholar]
  12. KELLOGG F., LIU C. K., FISHMAN I. W., LARSON R. Systemic and pulmonary emboli before and after mitral commissurotomy. Circulation. 1961 Aug;24:263–266. doi: 10.1161/01.cir.24.2.263. [DOI] [PubMed] [Google Scholar]
  13. LIKOFF W., URICCHIO J. F. Results of mitral commissurotomy; clinical status of two hundred patients five to eight years after operation. J Am Med Assoc. 1958 Feb 15;166(7):737–740. doi: 10.1001/jama.1958.02990070023006. [DOI] [PubMed] [Google Scholar]
  14. LOWTHER C. P., TURNER R. W. Deterioration after mitral valvotomy. Br Med J. 1962 Apr 14;1(5284):1027–contd. doi: 10.1136/bmj.1.5284.1027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. OLESEN K. H., BADEN H. Survival in mitral stenosis with and without operation. A nine year follow-up. Acta Chir Scand Suppl. 1961;Suppl 283:116–122. [PubMed] [Google Scholar]
  16. ROWE J. C., BLAND E. F., SPRAGUE H. B., WHITE P. D. The course of mitral stenosis without surgery: ten- and twenty-year perspectives. Ann Intern Med. 1960 Apr;52:741–749. doi: 10.7326/0003-4819-52-4-741. [DOI] [PubMed] [Google Scholar]
  17. SMITH B., UMAPATHY A., BENTALL H. H., CLELAND W. P. ANTICOAGULANTS AND MITRAL VALVOTOMY. Br Heart J. 1965 Jul;27:618–624. doi: 10.1136/hrt.27.4.618. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. SOMERVILLE W., CHAMBERS R. J. SYSTEMIC EMBOLISM IN MITRAL STENOSIS: RELATION TO THE SIZE OF THE LEFT ATRIAL APPENDIX. Br Med J. 1964 Nov 7;2(5418):1167–1169. doi: 10.1136/bmj.2.5418.1167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. SZEKELY P. SYSTEMIC EMBOLISM AND ANTICOAGULANT PROPHYLAXIS IN RHEUMATIC HEART DISEASE. Br Med J. 1964 May 9;1(5392):1209–1212. doi: 10.1136/bmj.1.5392.1209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Stephenson S. F. Anticoagulants and mitral valvotomy: a nine-year survey. Thorax. 1966 Jan;21(1):38–42. doi: 10.1136/thx.21.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. WOOD P. An appreciation of mitral stenosis. I. Clinical features. Br Med J. 1954 May 8;1(4870):1051–contd. doi: 10.1136/bmj.1.4870.1051. [DOI] [PMC free article] [PubMed] [Google Scholar]

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