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Five patients were found during surgery or at necropsy to have the mitral valve orifice obstructed by vegetations. They had had unexplained severe and recurrent episodes of acute febrile pulmonary oedema, and four had few cardiac ausculatory findings. Three patients died suddenly and unexpectedly; the other two were operated on and survived. In view of its ominous prognosis, acute mitral valve obstruction should be considered in patients whose pulmonary symptoms are compatible with endocarditis and are not adequately explained by the findings on examination of the heart. The condition, which should be confirmed by echocardiography, requires emergency surgery.
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