Mitral stenosis with atrial fibrillation: Surgical considerations and results of operation

Abstract

Between 1968 and 1979, 2309 patients underwent closed mitral commissurotomy. Among these, 252 subjects (10.9%) were in atrial fibrillation at the time of surgery. 148 were males and the rest females. Majority of them (214) were on anticoagulant therapy prior to surgery. In 52.8 percent patients, the surgical approach was through the left atrial appendage and the remainder through the body of the atrium. 100 subjects (37%) had clots in the left atrium at the time of surgery. Thirty-five patients gave a history of major preoperative embolic episode. Only few (21) underwent cardiac catheterisation before surgery. Concomitant closed aortic valvotomy was done in five subjects. One subject underwent a closed triple valvotomy, tricuspid valve included. The incidence of embolic episode in the immediate postoperative period was only 0.4 percent. Hospital mortality was 3.9 percent. Five subjects required reoperation 6 to 12 years after the initial valvotomy. There were 5 late deaths. Follow-up over a period of 2 to 13 years showed excellent or good results in 96.3 percent. There was no instance of postoperative embolism in the long term survivors. Eighteen patients have reverted back to sinus rhythm.