Lingular Biopsy in Mitral Stenosis

Interest in the pathology of the lung vessels in mitral stenosis was stimulated by the masterly paper of Parker and Weiss in 1936, and has been increased in recent years by the development of surgical treatment of the stenosed valve. In 1949 Larrabee, Parker, and Edwards reasserted the findings of F. Parker and Weiss, and suggested that changes in the vessels might diminish the improvement that could be expected to result from valvotomy. In the series of Brock at Guy's Hospital lingular biopsy was done as a routine in an attempt to correlate the pathological findings with the clinical state and catheter studies of individual patients, and with the general object of increasing our knowledge of mitral stenosis. This was abandoned after 40 consecutive cases when it appeared that the procedure was not entirely harmless to the patient, the most important determining event being the development of a lingular abscess (Brunsdon, Enticknap, and Milstein, 1953). It was then important to take stock of what had been gained, to attempt to evaluate lingular biopsy as a research measure, and to balance the knowledge acquired in individual cases against any possible increased risk of post-operative morbidity.