Highlights the historical importance of careful patient selection and multidisciplinary medical management for mitral commissurotomy in rheumatic mitral stenosis.
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Supports conservative thresholds for mitral commissurotomy; leaves open prospective validation in contemporary cohorts with advanced imaging.
The selection of patients for mitral commissurotomy must be made after considering all manifestations of the rheumatic state. A conservative approach is urged and no patients should be operated upon without evidences of increasing pulmonary hypertension and right heart strain. The preparation of the patient, the management of the arrhythmias during surgery and the postoperative care are the full responsibilities of the physician. A team composed of physiologists, cardiologists and surgeons must work together.
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Griffith et al. (1953) studied this question.
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