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THE problem of systemic arterial embolism in rheumatic heart disease does not end after the patient has survived the acute episode. As protection from re-embolism, which threatens in some 45 per cent of cases,1 programs based on the use of Dicumarol with ambulatory patients leave much to be desired. Irregular anticoagulant control, further embolism despite adequate control, major hemorrhage and death are recognized complications of this prophylactic method.Dock in 1946 originally suggested to Madden2 the possibilities of left-atrial-appendage resection, but the seven reported surgical attempts1 , 3 , 4 made since that time to prevent recurrent embolism into the greater circulation have been . . .
Leonard et al. (1952) studied this question.