Search

A case is reported of a 27-year-old man who presented to an inner city trauma center after he had experienced several seizure-like episodes. He was diagnosed with Lyme carditis and required 6 weeks of treatment with intravenous ceftriaxone for complete resolution of his symptoms. The case is discussed along with a review of the literature.

CONCLUSION The large majority of carefully selected cases of mitral stenosis with functional impairment submitted to commissurotomy benefit from the procedure and in many cases this benefit persists for at least one to three years. A greater degree of benefit can be anticipated in otherwise satisfactory cases when the right ventricular pressure is markedly elevated. Such elevation can usually be predicted when evidence of right ventricular strain is present on the electrocardiogram. In addition to evidence of improvement in respect to functional capacity, hemoptysis, and paroxysmal dyspnea, a large proportion of cases had objectively demonstrable improvement. This is evident in reduction of right ventricular pressure and decrease of right ventricular force on the electrocardiogram. Decrease in heart size by x-ray is an exceptional finding. Mitral commissurotomy with auricular appendectomy is an effective method for controlling peripheral emboli in patients with mitral stenosis. The presence of a calcified valve may not necessarily prevent lasting or significant benefit from the procedure.

SUMMARY 1) The resting cardiac output of patients with mitral stenosis is normal, and does not decrease until the onset of heart failure. 2) Pressure levels are more critical than flow levels in estimating the function of the right heart. 3) The most adequate picture of the right ventricular function is obtained from an analysis of pulmonary resistance and of the work of the right ventricle. 4) Patients who are most likely to benefit from mitral commissurotomy are those with high pulmonary artery pressures. 5) The degree of fall of the pulmonary artery pressure following commissurotomy is roughly parallel to the degree of clinical improvement in the few cases studied. 6) Patients with very low pulmonary artery pressures are not benefited by mitral commissurotomy and such low initial pressures may be present in patients with low grade rheumatic myocarditis. 7) Comparison of pre- and postoperative catheterization findings is the only critical method of evaluating results of mitral commissurotomy and should be further pursued. We wish to acknowledge the technical assistance of Mrs. Helen Obernolte, Dr. Andrew Farr, Miss Mary Mayo and Mr. Lucius Collier.