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COMMISSUROTOMY FOR MITRAL STENOSIS

1958; American Medical Association; Volume: 166; Issue: 17 Linguagem: Inglês

10.1001/jama.1958.02990170025006

2376-8118

George E. Maha,

Cardiac Valve Diseases and Treatments

The histories of 85 cardiac patients have been reviewed in order to define more sharply the indications and contraindications for mitral commissurotomy. The operation was completed in 72 patients without operative deaths, and three pregnant women in whom the operation was completed survived without fetal mortality. The effectiveness of the operation was clearly shown by comparing the preoperative and postoperative status of the patients with respect to the New York Heart Association functional classification. Case histories are given for five of these patients who died from 4 to 48 months after commissurotomy. The operation was not completed in 13 patients who presented various difficulties. Case histories were given for this group, in which four deaths occurred within the immediate postoperative period. In one instance the entire left atrium was found to have been converted into a smooth, bonelike mass through which entry was impossible. Mitral commissurotomy has become an effective, safe procedure for competent surgeons in well-selected patients. But when the heart is greatly enlarged and atrial fibrillation is present, when the auscultatory findings are not classic, when other valvular lesions exist (notably mitral insufficiency or aortic stenosis), or when the electrocardiogram shows left axis deviation, careful evaluation by other methods should be done, including fluoroscopy, phonocardiography, and catherization.