ABSTRACT
SYSTEMIC arterial embolization is a recognized complication of mitral-valve surgery. These emboli generally consist of fibrin material, which had been dislodged from a clot in the left atrium at the time of commissurotomy. Less commonly, calcium is dislodged from the mitral valve during the procedure and forms the embolus. Rarely, other material may be embolized, as in a forty-four-year-old woman who underwent a second mitral commissurotomy for recurrent stenosis. At operation, finger fracture of the mitral valve was attempted, but believed inadequate, and the valve was further widened by a Tubbs dilator inserted from the left ventricle. Massive mitral regurgitation resulted (V waves in the left atrium rising to 50 mm. of mercury, and the mean pressure rising to 30 mm. from a preoperative valve of 22 mm. of mercury), and on return to the recovery room the patient’s pupils were dilated and nonreactive to light. She never regained consciousness and died twelve hours after operation in acute pulmonary edema and shock. Before operation the patient had normal sinus rhythm, an end-diastolic mitral-valve gradient of 20 mm. of mercury and severe pulmonary hypertension (pulmonary arterial pressure of 100 systolic, 40 diastolic). At autopsy the anterolateral mitral commissure was found to have been opened from the free margin to the mitral annulus, and also the anterolateral papillary muscle had been split. No clot was present in the left atrium or ventricle. A fresh infarct was seen in the brain (Figure 1), and histologically a large fragment of myocardium was found in a cerebral artery leading to the area of encephalomalacia (Figure 2).
