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.

An analysis of the first 100 consecutive cases of mitral stenosis treated by commissurotomy is presented. Frank hemoptysis was noted in 25 individuals and systemic arterial emboli in 22 others; no recurrence of these complications was found one to three and one-half years after surgery. "Pure" mitral stenosis was present in 64, and an associated insufficiency in 27; in nine others there was an associated aortic insufficiency.. A sinus rhythm changed to auricular fibrillation after surgery in 15; in nine the change was permanent. In one instance auricular fibrillation changed to sinus rhythm postoperatively. A rough correlation was found between the extremes of pulmonary artery systolic pressure and the clinical, roentgen and electrocardiographic findings Calcium was found in the mitral valves in 52 patients and did not, per se, predicate a poor functional result. No instance of rheumatic fever occurred postoperatively, even though 14 of 78 biopsied auricular appendages indicated rheumatic infection. Functional improvement occurred in 78 patients, and there were nine unimproved. There were 11 deaths due to surgery and two who died during this three-year follow-up from intercurrent infection.

The ultimate fate of the incised commissure following surgery for mitral stenosis will remain unknown for years to come

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