Source of Emboli in Rheumatic Heart Disease

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Abstract
Embolism is responsible for death in 30% of patients who die of rheumatic heart disease. 509 patients with rheumatic heart disease were studied post-mortem at the Queens General Hospital, for underlying causes and contributory factors. Of 113 persons with infarction of the kidney, spleen, or brain, thrombi were present in the chambers of the left side of the heart in 68, 19 of whom (28%) also had associated nonbacterial thrombotic lesions. Thrombi were absent in 45 persons, 23 of whom (51%) showed concomitant nonbacterial thrombotic endocarditis as the likely source of emboli. In addition, nonbacterial thrombotic endocarditis could have been the source of emboli in 11 of 49 persons with bacterial endocarditis and visceral infarction. Some of the relevant literature is reviewed and other series of patients are compared with the present group. The significance of this source of emboli has not been emphasized adequately heretofore. The diminishing frequency of other complications of rheumatic fever, such as bacterial endocarditis gives increasing importance to the complication of embolization. The common occurrence of embolism during cardiac surgery, now being employed with benefit more frequently in rheumatic heart disease, makes the full elucidation of this problem imperative at the moment. Prevention of this complication depends upon proper recognition of the source and the mechanism of the formation of such emboli.