Mitral Stenosis: Selection of Cases for Mitral Valvotomy

for prompt treatment of sore throats or recurrences of limb or joint pains and on the importance of penicillin cover for dental extractions if heart lesions persist. If sulphonamide prophylaxis has been started in hospital it should be continued for at least another two years. Patients should attend after-care clinics at regular intervals. Our own are seen at the third, sixth and twelfth month after discharge and then once each year. These examinations are of value for the following reasons. First, to establish as far as possible whether there has been any fresh rheumatic activity; the occurrence of sore throats or limb and joint pains is noted; the haemoglobin, blood sedimentation rate and weight are recorded and a search is made for nodules. If there is any question of present activity the patients are re-admitted for assessment and treatment. Secondly, to ensure an adequate check on any change in the cardiac status they may have occurred; at follow-up clinical and radiological signs in the heart may be either more or less marked than they were in hospital and further advice on physical activity must be given. Thirdly, to re-emphasize to the patients or their parents the continued need for sulphonamide prophylaxis and prompt treatment of sore throats or limb or joint pains should they occur.