Minimally invasive closed mitral commissurotomy.

Today, technical advances have decreased the risk of cardiopulmonary bypass to the point that closed mitral commissurotomy is performed infrequently in most cardiac centers and is considered hazardous. We describe a modified technique for closed mitral commissurotomy, improved in terms of safety and efficacy, and adapted for situations in which resources are limited. This operation was performed in 12 symptomatic patients with severe mitral stenosis whose valves were judged suitable for closed mitral commissurotomy or balloon valvuloplasty. After modified closed commissurotomy, the mitral valve areas of these patients were increased substantially, from 1.8 to 3.1 cm2. There was no new incidence of mitral regurgitation. We conclude that closed mitral commissurotomy is a safe alternative to open mitral commissurotomy, provided that patient selection criteria are strictly followed.