Closed mitral commissurotomy [CMC]

ABSTRACT

Like any other developing country, Rheumatic heart disease is one of the leading cardiovascular problems in Pakistan. Mitral valve is the most frequently affected valve and takes a more fulminant course than in the west. There are only three cardiac surgical centres dealing with cardiac problems, in Pakistan in a country of 120 million population. They are already overburdened and are unable to cope up with the large number of patients visting them. Therefore, cardiac patients presenting with pure mitral stenosis with pliable valve are being operated by closed mitral commissurotomy in general surgical units even without the facilities of cardiopulmonary bypass. An example of which exists in the surgical centre Islamabad, where four female patients who presented with pure mitral stenosis and had a past history of rheumatic fever, underwent this operation successfully. This article throws some light over the role of closed mitral commissurotomy in patients presenting with pure mitral stenosis and updates the anatomy, pathophysiology, echocardiographic feactures and medical and surgical management of mitral stenosis