Arrhythmia, An Indication for Valvotomy in Mitral Stenosis; Concomitant Lobectomy for Bronchiectasis

¹ The Department of Medicine, Beth Israel Hospital, New York, N. Y.
² The Department of Cardiovascular Surgery, Beth Israel Hospital, New York, N. Y.
³ The Department of Cardiographic Laboratory, Beth Israel Hospital, New York, N. Y.

1. A 55 year old woman with rheumatic mitral stenosis and chronic bronchiectasis developed atrial tachycardia (flutter) with rapid ventricular rate. This arrhythmia was uncontrollable though considerable treatment with antiarrhythmics, other cardiac drugs, therapy for digitalis intoxication, and antirheumatic treatment had been tried, over a period of three months.

2. On the possibility that distention of the left atrium due to tight mitral stenosis might be contributory in production of arrhythmia, probably through stimulation of stretch receptors and reflex vagal action, reduction of this distention by mitral valvotomy was recommended.

3. The three month old arrhythmia stopped suddenly during surgery, while cardiac neural structures were manipulated just prior to the dilatation of the tight mitral valve.

4. Arrhythmia has remained absent up to the present time, five months after surgery, and the patient improved greatly and has been working regularly for the past two months.

5. Concomitant lobectomy of the left lower lobe, for chronic bronchiectasis, was performed with the valvotomy.

6. This experience would suggest that an uncontrollable arrhythmia need not be a contraindication to mitral valvotomy, and in a suitable case may be an additional indication for it.