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Closed commissurotomy for mitral stenosis: Obsolete or relevant?

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Abstract

Between 1956 and 1989, 5326 patients with rheumatic mitral stenosis were treated with closed mitral commissurotomy. Two-thousand one-hundred and fourteen (39.7%) were in New York Heart Association functional Class IV. The overall hospital mortality was 3.1 per cent and during the last ten years only 1.55 per cent. Five-thousand two-hundred and twenty (98.0%) patients had a satisfactory surgical result. In the remaining patients the commissurotomy was inadequate, 16(0.3%) requiring emergency valve replacement. An actuarial analysis showed a 94.0, 89.4, 85.0 and 78.3 per cent survival at six, 12, 18 and 24 years respectively without requiring a second procedure. The incidence of restenosis varied from 4.2 per cent to 11.4 per cent per 1000 patients/year between the fifth and fifteenth yeart of follow-up. Closed transventricular re-commissurotomy was carried out in 200 patients. Based on this experience we prefer and recommend closed commissurotomy as the palliative procedure of choice in rheumatic mitral stenosis.

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Authors and Affiliations

  1. Department of Thoracic & Cardiosvascular Surgery, Christian Medical College and Hospital, Vellore, India

    Stanley John, K. M. Shyam Prasad, Edwin Ravikumar, Colin John, P. S. Jairaj & S. Krishnaswamy

  2. Department of Cardiology, Christian Medical College and Hospital, Vellore, India

    Stanley John, K. M. Shyam Prasad, Edwin Ravikumar, Colin John, P. S. Jairaj & S. Krishnaswamy

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  1. Stanley John
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  2. K. M. Shyam Prasad
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  3. Edwin Ravikumar
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  4. Colin John
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  5. P. S. Jairaj
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  6. S. Krishnaswamy
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John, S., Prasad, K.M.S., Ravikumar, E. et al. Closed commissurotomy for mitral stenosis: Obsolete or relevant?. Indian J Thorac Cardiovasc Surg 7, 8–12 (1991). https://doi.org/10.1007/BF02667126

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