The Annals of Thoracic Surgery, Vol 37, 159-163, Copyright © 1984 by The Society of Thoracic Surgeons
Long-term results of open mitral commissurotomy for mitral stenosis with severe subvalvular changes: a ten-year evaluation
S Nakano, Y Kawashima, H Hirose, H Matsuda, Y Shimazaki, S Sato and C Ohyama
Out of 212 patients undergoing open mitral commissurotomy for mitral
stenosis from January, 1972, to December, 1981, 53 patients had extremely
severe subvalvular changes. In this study, we evaluated postoperative
results in these 53 patients. There were 2 operative deaths (3.8%) and 1
late death (1.9%). Of the 50 surviving patients, 34 (68%) were in New York
Heart Association Class I and 13 patients (26%) were in Class II,
postoperatively. Three patients (6%) required reoperations an average of 5
years 5 months because of the progression of residual mitral regurgitation.
The actuarial rate of freedom from mortality and reoperation was 78.6% at
10 years after operation. When anticoagulant therapy was not given, no
patient had thromboembolic complications. Postoperative hemodynamic studies
demonstrated that mean diastolic gradients across the mitral valve were
5.30 +/- 1.25 mm Hg (standard deviation) at rest and 9.50 +/- 5.13 mm Hg
during exercise. Calculated mitral valve areas were 1.86 +/- 0.48 cm2 at
rest and 1.88 +/- 0.51 cm2 during exercise. There was no evidence of any
adverse effects of mild to moderate valve calcification. It is concluded
that for a follow-up period as long as 10 years, the stenosed mitral valve
with greatly advanced subvalvular deformities can be salvaged with low
mortality, low incidence of reoperation, and acceptable valve function even
when such deformities are associated with mild to moderate calcification.
