The Postcommissurotomy Syndrome

The term " postcommissurotomy syndrome " (P.C.S.) was first used by Soloff et al. (1953) to define an illness with a " distressingly high incidence " (43 out of 183 cases) after mitral valvotomy. The main symptoms were sternal pain with radiation to the left chest and pyrexia, the onset was mostly abrupt either days or weeks after operation and the duration varied from ten days to four weeks with frequent further relapses. The syndrome occurred either alone or in various com- binations with other postoperative complications ; though the mortality was low (3 out of 43) there was an adverse influence on the outcome of the operation in more than one-third of the cases. Among the many hypotheses advanced for the pathogenesis they favoured the idea of rheumatic reactivation induced by surgical trauma. Bercu (1953), who observed the P.C.S. in 10 per cent of his patients, agreed that it may suggest rheumatic activity though trauma to the heart may be more important; the prognosis in his cases was not different from that of the uncomplicated cases. January et al. (1954) with a similar incidence used the term " postvalvotomy syndrome "; they did not consider the symptoms as wholly characteristic of rheumatic fever. McAllister (1953) sus- pected a low-grade infection of the lingula as its cause. Dressler (1954) for whom the syndrome consists of the triad, pericarditis, pleurisy, and pneumonitis, compared the P.C.S. with idiopathic recurrent pericarditis and tried to establish a rheumatic etiology for both. Verheugt et al. (1954) did not mention the syndrome by name, but described its signs as temporary rheumatic activity because of its successful treatment with amidopyrine and the rise in antistreptolysin titre in some of their patients.