Which of the following may be indications for operation for mitral stenosis?

A. Systemic embolization.

B. Infective endocarditis.

C. Onset of atrial fibrillation.

D. Worsening pulmonary hypertension.

DISCUSSION: Although each is only a relative indication for operation for mitral stenosis, systemic embolization, infective endocarditis, onset of atrial fibrillation, and worsening pulmonary hypertension may each be an indication for operation for mitral stenosis. Systemic embolization, infective endocarditis, and onset of atrial fibrillation are each complications of mitral stenosis that portend a risk of further complication with continued medical therapy. Patients older than 40 years with mild class II congestive heart failure stand to gain symptomatically from operation for significant mitral stenosis and do not run excessive risk of multiple reoperative procedures.