ABSTRACT
Over a period of 10 years [1992-2002], a total of 261 patients [145 females, 116 males; age range 10-70y; mean 32y] with mitral valve disease underwent 275 operations on their mitral valves. Mitral valve replacement [MVR] was performed on 172 [63%] patients, open mitral valvotomy [OMV] on 76 [28%] patients, closedmitral valvotomy [CMV] on 20 [7.2%] patients and mitral valve repair [MVRp] on 7 [2.5%] patients. Mitral stenosis [MS] was the predominant lesion in 162[59%] patients with 66[41%] patients requiring valve replacement, whereas mitral regurgitation [MR] was predominant in 113 [41%] patients, out of which 106 [94%] patients required valve replacement. Redo surgery was performed on 32 [12%] patients. Concomitant operations were performed on 46 [17%] patients, mainly aortic valve replacement [30 patients]. Left atrial [LA] thrombus was present in 19 [11.7%] patients out of 162 patients with mitral stenosis. Overall early mortality [EM] occurred in 13 [6%n] patients. Closed mitral valvotomy carried a 0% EM but high [35%]reopoation rate, whereas OMV carried a 2.6% EM and 35% reopermion rate. MVR had a low EM of 2% when performed for predominant MR but a high EM of 11.3% when performed for predominant MS. The presence of an LA thrombus was an independent predictor of high mortality, being 1%. Mitra valve repair for rheumatic MR carried a low EM 0% but a high reoperation rate of 55%. For patients with rheumatic MR, MVR is superior to valve repair and carries a low EM. Whereas for patients with MS. the primary aim is for an OMV, with valve replacement as a second choice since it carries a higher EM. Closed mitral valvotomy is indicated when facilities for ballon valvuloplasty/pen valvotomy are lacking. Patients with an LA thrombus should be recognized as high risk