Late Results of Mitral Commissurotomy

Ninety cases of mitral stnosis (MS) were operated in our department in the period from July, 1962 to December, 1974.Digital commissurotomy was done in 13 cases early in our experience. From March, 1965, closed commissurotomy with dilator was performed in 62 cases, open commissurotomy in 14 cases, and mitral valve replacement in one case for restenosis two months after closed commissurotomy.Late results of closed commissurotomy with dilator and of open commissurotomy were compared in 55 cases who passed more than 2 years after operation. Results obtained were as follows : 1) In the group of closed commissurotomy (48 cases), hospital mortality rate was 4.2 per cent, and late mortality rate was 8.3 per cent. Fifty-two per cent of this group was improved markedly, but 25 per cent was not improved (unchanged or changed worse), and one case (2.1%) was lost to follow up.Of the unchanged, changed worse, and died cases, some cases might be suggested as indication of open commissurotomy.2) In the group of open commissurotomy (7 cases), hospital mortality rate was 14.3 per cent, but late death was none. All of survivors were markedly improved (71.4%), and one case (14.3%) was lost to follow up.3) From the above results, we considered that if the indication of commissurotomy is determined properly, good result is expected. Our indications for open commissurotomy are atrial fibrillation, episode of embolism, calcification of mitral valve etc.The idea of open commissurotomy for all cases is not proper, because it should be always considered that MS is a progressive disease and restenosis and reoperation may arise in future.