Left atrial pulmonary capillary, and oesophageal balloon pressure tracings in mitral valve disease.

In selecting patients for mitral valvotomy, the exclusion of mitral insufficiency by common clinical methods has proven unreliable. We endeavoured to determine whether preoperative " pulmonary capillary " pressures and tracings taken by means of a balloon in the aesophagus at the left atrial level would be of value in the diagnosis of mitral insufficiency. Pressure pulses were also obtained directly from the left atrium at operation; their characteristics in mitral stenosis and mitral insufficiency were studied, and they were correlated with the " P.C." and oesophageal balloon tracings, since the latter two are of value only in so far as they reflect hemodynamic events within the left atrium. To accomplish these aims, we set out to obtain all three types of tracing in each of a series of 30 patients who were operated upon for the relief of mitral stenosis. We relied upon the surgeon's finger to detect insufficiency. Both the size of the mitral orifice and the presence of a regurgitant jet were taken into consideration (Wynn et al., 1952). These criteria may be inadequate but must serve until better ones are devised.