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A febrile syndrome following mitral commissurotomy is described. This syndrome consists of the episodic recurrence of a combination of events first occurring after a variable latent phase following mitral commissurotomy and is uniformly characterized by precordial pain and fever, is commonly featured by the precipitation or intensification of pre-existing heart failure, is variably accompanied by migratory joint pains, arrhythmias, hemoptysis or psychosis and sometimes terminates in death. The syndrome was found to occur in 43 (24.0 per cent) of 179 consecutive individuals subjected to mitral commissurotomy. Because we have never encountered such a syndrome following any other type of nonrheumatic cardiac or pulmonary surgery and for other reasons we are compelled to regard it as a reactivation of rheumatic fever.