ARTHuR KITCHIN

نویسندگان

  • RICHARD TURNER
  • ANDREw LOGAN
  • ARTHuR KITCHIN
چکیده

Surely the essential feature is the presence of a significant degree of mitral stenosis -that is to say, enough to raise left atrial pressure under various conditions such as exercise, emotion, pregnancy, or tachycardia from any cause. Operation for removal of clot is not an accepted procedure apart from valvotomy. The statement that valvotomy is indicated "provided the valve is suitable for it" is in our experience meaningless because what the surgeon will be able to achieve cannot by any method be predicted preoperatively. The unreliability of the signs of a so-called pliant valve have been previously stressed.5 An excellent valvotomy may be achieved in a patient without the signs of a pliant valve, and it may be difficult to make a good valvotomy in a patient in whom the signs are clear. It will be apparent that we do not believe the case has been made for a greater role of long-term anticoagulant treatment in mitral disease, but we do consider that multicentre controlled trials are long overdue. In Britain the difficulty increases each year with the decreasing number of patients who require a first valvotomy. The opportunity lies in such countries as India and Pakistan. If young patients in sinus rhythm are to be put on long-term anticoagulants not only will the task be formidable but there will be many complications. Apart from the difficulties inherent in laboratory techniques, drug interference with anticoagulant control is an increasing hazard. We do not at present believe that there is any eviden-e for permanent, long-term treatment of patients with anticoagulants after valvotomy. In conclusion, we consider that possibly anticoagulants could, at a price, make a modest contribution to decreasing the incidence of systemic embolism, but as yet there is inadequate evidence because appropriate trials have not been carried out. It must be remembered that oral anticoagulants have no effect on platelet aggregation, and in other situations at least little effect on the systemic side of the circulation in comparison with that on the venous side. Once again, multicentre controlled trials are long overdue.-We are, etc.,

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تاریخ انتشار 2006