Systemic Embolism in Mitral Stenosis Relation to the Size of the Left Atrial Appendix

Abstract

Systemic embolism in patients with mitral stenosis was more than three times commoner when the left atrial appendix was large than when small. Conversely, the left atrial appendix was larger in patients with a history of embolism than in those without it. The occurrence of embolism rose steeply in successive decades when the appendix was large but not when it was small. The left atrial appendix should be amputated at mitral valvotomy as an extra precaution against embolism. A number of patients presenting with systemic embolism and only slight rheumatic mitral-valve involvement have disproportionate enlargement of the left atrial appendix. Amputation of the appendix and relief of mitral stenosis, however slight, is recommended here as a protection against further emboli. © 1964, British Medical Journal Publishing Group. All rights reserved.