To the Editor:—
Lamkin et al (194: 1019, 1965) have done a service in calling attention to the commonest late complication of heart-valve replacement, namely, thromboembolism. In discussing the genesis of the thromboemboli in their patient, the authors did not consider the loud apical holosystolic murmur. Such a finding in the presence of a Starr-Edwards mitral prosthesis usually means regurgitation through a break in the suture line about the valve. After angiographic confirmation, closure of the defect is indicated, because this will probably reduce the likelihood of thromboembolism.