Cardiac pathology: Rheumatic heart disease: Mitral stenosis

An autopsy specimen from a 40 year old woman had increasing dyspnoea for thirteen years with recent attacks of winter bronchitis and haemoptysis. On admission she was found to have mitral stenosis and was fibrillating. At operation, after controlling the central vessels, the atrium was opened and organised thrombus found. During digital manipulation of the heavily calcified mitral valve ventricular fibrillation supervened and could not be averted.