OBSERVATIONS ON THE VALUE OF MITRAL COMMISSUROTOMY: AN ANALYSIS OF LONG-TERM RESULTS.

Long-term follow-up of patients subjected to mitral commissurotomy permits evaluation of the late efficacy of this operation and the causes of subsequent deterioration in some cases.Three hundred and eighty-nine patients operated upon for mitral stenosis from 1950 to 1957 were studied. Of these, 89 died, 38 were lost to follow-up and 262 were re-examined.Results for the postoperative period of five to 12 years were satisfactory in 204 patients (77%) and unsatisfactory in 58 (22%). The possible causes of deterioration were studied separately.A second commissurotomy was performed on 23 patients (8.7%), because of re-stenosis thought to be due to a rheumatic process in one and to fibrotic scarring in nine, and because of an inadequate opening in 13.Mitral commissurotomy is a palliative operation, but is definitely useful in cases of tight mitral stenosis.The duration of improvement in patients with a functionally adequate opening is related to the state of the myocardium and to the possibility of rheumatic fever recurrences. Because of the risk of fibrotic restenosis, the possibility that a second commissurotomy might be required should be considered in each patient subjected to this operation.