Relationship of Pulmonary Functional and Pathological Changes in Mitral Stenosis

OCCLUSIVE vascular changes in the lung accompanying the pulmonary hypertension of mitral stenosis have been known to occur since their description by Brenner in 19351and by Parker and Weiss in 1936.2What part the pulmonary arteriolar and capillary changes may play in the distressing respiratory symptoms of mitral stenosis is a matter of concern. So, too, is their effect on the results of operations which restore relatively normal function to the stenotic valve. Larrabee, Parker, and Edwards3believed that patients with intimal or medial fibrosis of the arterioles would not benefit from the operation because of irreversible changes which would increase the resistance to blood flow through the lung. Our studies do not lead us to support this point of view. Physiological observations and study of biopsy specimens of lungs obtained from a series of patients who underwent mitral commissurotomy suggest that the ultimate clinical result