ABSTRACT
Familiarity with replacement of the mitral valve (MVR) with prosthetic and tissue valves has dimmed awareness of the usefulness of open mitral commissurotomy (OMC). This is a review of a 10 year experience ending in December, 1978, of 222 consecutive patients operated upon with a clinical diagnosis of pure mitral stenosis. MVR was necessary in 25 patients (11.3%), primarily because of severe deformity of valvular and subvalvular structures. No closed commissurotomies were performed, as that operation is now considered passé. Of the 197 patients undergoing OMC, 12 had additional cardiac procedures. Of the three patients who died (1.52%), two were operated upon on an emergency basis because of rapidly progressive cardiac failure. Follow-up data were obtained on 191 (97%) of the 197 OMC patients. There were 18 late deaths, of which 14 were related to cardiac disease. Following OMC, 76% (146) of the patients had improved by at least one New York Heart Association class. Fourteen (7%) of the 191 OMC patients had subsequent MVR at times varying from 2 to 92 months after OMC (mean 41.6 months). Ten-year survival for the 197 OMC patients was 81%. This clinical experience emphasizes that open commissurotomy rather than valve replacement is the best initial treatment for most patients with mitral stenosis.
Subject(s)
Heart Valve Prosthesis , Mitral Valve Stenosis/surgery , Mitral Valve/surgery , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mitral Valve Stenosis/mortality , Postoperative Complications/surgeryABSTRACT
The success of mitral valve repair for regurgitation or stenosis can largely be determined at the time of operation. Mitral valve repair is tested by creating aortic regurgitation, which fills the left ventricle with systemic aortic perfusion pressure. The competent mitral valve is salvaged and the incompetent valve is replaced.
Subject(s)
Heart Valve Prosthesis/standards , Mitral Valve/surgery , Humans , Intraoperative Period , MethodsABSTRACT
A stainless steel marker for tagging the proximal aorta--saphenous vein anastomosis in a bypass operation has been devised and utilized in more than 600 patients over the past 3 years. This marker has been found superior to other methods used for marking vein grafts in that it encircles the anastomosis, providing accurate marking, and can be attached after both anastomoses are complete.
