Right Coronary Arterial Spasm Causing Prinzmetal ' s Variant ~ n ~ i n a *

percent had systemic emboli. Conclusions from this large series were: 1) atrial fibrillation is the main cause of systemic embolism; 2) embolism is as common with mitral regurgitation as with mitral stenosis; 3) mitral valve calcification predisposes to operative emboli; 4 ) atrial appendage size has no influence on the occurrence of systemic embolism. Review of the literature has not revealed a reported case of peripheral migration of the mitral valve. That this may occur with endocarditis and aneurysm formation of the mitral valve is easily appreciated when the pathogenesis of valve aneurysm formation is r e ~ i e w e d . ~ As a result of valvulitis, granulation and scar tissue are exposed to a constantly maintained intraventricular pressure with dilatation and protrusion of the valve into the left atrium. The aneurysm may obstruct the mitral orifice producing mitral stenosis or perforate, causing incompetence. Perforation of the aneurysm allows embolization of valve fragments, vegetations and clots. The aneurysms characteristically involve the anterior leaflet of the mitral valve, particularly in the presence of aortic reg~rgitation.~ The serious hemodynamic changes attendant with acute mitral regurgitation due to bacterial endocarditis demand judicious medical management directed to control of congestive heart failure and sterilization of the infective process. Prompt surgical intervention must be considered if response to the measures is not achieved. The prudence of removing the nidus of infection as well as hemodynamic correction by surgical means is well documented.7-0