Systemic arterial embolism in rheumatic heart disease

Abstract Rheumatic heart disease is an important cause of systemic arterial embolism. In 1933, Weiss and Davis 76 published a report on embolic episodes in rheumatic heart disease, using autopsy material as their source of study. Harris and Levine 25 , in 1941, reported on a series of cerebral emboli complicating rheumatic heart disease. In 1950, Bourne 6 published a report on the relationship of exertion to embolism in mitral stenosis. Recent publications (Warren and Linton 75 , Haimovici 23 , and Andrus 3 ) on the general subject and the treatment of arterial embolism emphasized further the importance of rheumatic heart disease as an etiological factor. The considerable progress in the past few years with anticoagulant agents as a protection against embolism and the recent surgical obliteration of the left atrial appendage as a possible focus of thrombus formation in rheumatic heart disease were responsible for the present study. It was undertaken primarily to elucidate the factors favoring intracardiac thrombosis, to ascertain the relative frequency of the atrial appendage as the offending site, and to appraise the results of therapy. The records of 194 patients, including the autopsy findings in thirty-nine patients, were obtained from the Massachusetts General Hospital, the House of the Good Samaritan, and the private practice of two of the authors (E. F. B. and P. D. W.). The period covered was from 1923 to 1950. Patients suffering from bacterial endocarditis have been excluded.