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Patients with chronic congestive heart failure operated upon for the surgical correction of mitral stenosis have been observed repeatedly to have low plasma sodium concentrations and elevated plasma potassium concentrations after operation. This study was primarily directed at an understanding of these abnormalities. The authors have shown that the preoperative patient has a characteristic disorder of body composition noteworthy for a high total body water, a high total body sodium, a low total exchangeable potassium and a low plasma sodium concentration. Fellow, Canadian National Research Council. 199 passes. These methods are particularly valuable in investigating the complex problems that are seen after operations on the mitral valve.In patients with mitral stenosis of such severity as to warrant surgical intervention, abnormalities in the metabolism of water and electrolytes are already present and the nutritional state has frequently considerably deteriorated as the result of longstanding heart failure. The stress of operation is then superimposed, and it is not surprising that in the postoperative period gross biochemical disturbances may become apparent. The present study is an attempt to elucidate the nature and mechanisms of some of these disturbances.METHODS AND MATERIAL The metabolic balance studies were carried out following the principles described by Moore and Ball.' The intake of sodium, potassium and nitrogen in the diet has been calculated from food analyses carried out in this laboratory. The intravenous intake given therapeutically or for the performance of various investigations has also been measured. In the case of blood transfusions, which were frequently large, only the readily available nitrogen, sodium and potassium in the plasma have been entered in the balance chart. Similarly only the plasma fractions of these constituents in the operative blood loss have been entered. The total amount of whole blood transfusions and blood loss have been indicated, however, in the legends of the charts. In calculating the total excretion, account has been taken of loss in the urine, feces, wound exudate and fluid drained from the chest. The balance of nitrogen demonstrated a transient negative phase with high excretion on one day and a rapid return to positive balance as her intake improved with resumption of caloric intake. Potassium followed a similar pattern. Sodium intake was restricted throughout, but the balance was consistently positive except for the first day after operation. Body weight showed an increase for three days postoperatively, then a sharp reduction followed by a later rise. Eosinophile count was near zero for two days after operation, then returned sharply to normal or above normal values save for two days immediately preceding her pulmonary embolus. Urinary steroid analyses showed elevation of the 17-ketosteroids on the first postoperative day; there was an increase in 17-hydroxycorticoids persisting three days and then falling slowly to the subnormal starting values.Inta...