PSYCHIATRIC ASPECTS OF MITRAL VALVOTOMY.
A review is undertaken of studies relating to mental disturbance following mitral valvotomy.

A total of 90 patients having mitral valvotomy were studied. Forty of these were seen before and at stated times after operation and a further 50 were assessed at intervals varying from 2 years to 4½ years after operation.

It was found that post-operative "psychotic" disturbances were uncommon, but other psychiatric disorders, and particularly hysteria, were frequently encountered. It is also suggested that those patients who are objectively worse or unchanged after valvotomy, yet improved subjectively, may be stable extraverts.

It was noted that not infrequently emotionally determined pre-operative symptoms appeared to contribute to the decision to advise surgery.

It is proposed that those subjects who do not benefit appropriately from valvotomy may be selected pre-operatively on the basis of a history of pronounced dependency needs and sexual maladjustment, a score of 10 or greater for area M-R of the C.M.I. and a dyspnoeic index of 35 per cent. or less.