Experiences with complications relative to mitral commissurotomy : their mechanisms, prevention, and management

ABSTRACT

Fifty-two cases who underwent mitral commissurotomy were studied for complications. Twenty-two or 42.3 per cent developed twenty-nine complications including four deaths, an immediate mortality of 7.6 per cent. The role of various factors were studied in order to ascertain why complications occur with such a relatively innocuous procedure as mitral commissurotomy, The following seem to be operative functional classification, duration of symptoms, history and number of congestive heart failures, pre-existing atrial fibrillation, previous embolic history, previous hemoptysis, concomitant lung pathology, extreme heart size, recent infetion or rheumatic activity, transcommissural calcification or clot, and presence of associated cardiac pathologyFactors such as intracardiac instrumentation, too early removal of thoracotomy tubers, too early use of steroids, pre-operative antiarrhythmic medication were also discussed. The responsibility of the internist regarding early referral of the patient to the cardiac surgeon is stressed in an effort to reduce mortality as well as the incidence of complications. (Summary)