[Results of open heart mitral commissurotomy in 85 patients]. / Commissurotomie mitrale à coeur ouvert. Résultats chez 85 opérés.

Open heart mitral commissurotomy was performed in 85 patients between January 1973 and January 1976. This series comprised 38 patients with pure mitral stenosis and 47 patients with associated mitral and aortic or tricuspid lesions. Mitral commissurotomy, always complete, was associated with correction of mitral incompetence, either preexisting or peroperative, in 19 cases; in 44 cases with correction of an aortic lesion and in 10 cases with correction of a tricuspid lesion. The surgical mortality was 2.3 p. 100 (2 deaths); one post-operative myocardial infarction and one spontaneously regressive post-operative jaudice was observed. No cases of post-operative systemic embolism was observed. A short apical systolic murmur was detected in 12 cases. The results of this series together with those already published suggest that the indications of this operation should be widened and that it should be employed whenever the best immediate anatomical result and long-term prognosis are desired.

[Surgical treatment of obstructive cardiomyopathies by mitral valve replacement]. / Traitement chirurgical des cardiomyopathies obstructives par remplacement valvulaire mitral

The authors present a series of 10 cases of OCM which were treated by replacement of the mitral valve. Mitral incompetence was present in all patients, and was major or massive in 7 of them. Direct surgery to the mitral valve area has demonstrated pathological lesions in the mitral valve mechanism in 7 patients. A formal indication for mitral valve replacement in the surgical treatment of cases of OCM therefore exists when there is major mitral incompetence, intraventricular conduction defect, cardiac failure, or failure of previous myotomy.

[Tricuspid prosthetic replacements. Indications and results]. / Remplacements prothétiques tricuspidiens. Indications et résultats

Out of 350 cases of tricuspid regurgitation operated between 1968 and 1975, a serie of 53 prosthetic replacements (3 of them isolated) was analysed, with specification of operative indications, pre-operative condition, operative findings, procedure used and results. Operative death rate was high (28 per cent) and remote results (6 months to 7 years) were not all satisfactory. This is because functional "tricuspid regurgitation", secondary to advanced mitral lesions, expresses in fact considerable myocardial weakening with severe polyvisceral implications. This picture, where tricuspid patency is in fact contingent, is not always improved by mitral correction and reestablishment of a satisfactory tricuspid function, whatever the procedure used. Thus in very advanced mitral lesions, tricuspid repair should be done only if regurgitation is real and severe. Tricuspid prosthetic replacement should be reserved to valvular destruction; semi-circular annulo-plasty, which is efficient and not very traumatising, is applicable to all the other cases. The best treatment of this syndrome is preventive: as aortic lestions, mitral lesions should be operated early to permit a low risk operation and complete functional recuperation.