A Comparison of Medical and Surgical Treatment of Mitral Stenosis

The efficacy of mitral valvotomy in the relief of critical mitral stenosis is not in doubt. It has, however, been noted that lesser degrees of mitral stenosis may not prevent survival to an old age. The influence of operation on the overall long-term prognosis of patients with mitral stenosis will be determined only by comparing the prognosis of medically treated patients with that of those subjected to surgery. There has been recent demand for such a comparison (Annotation, Lancet, 1960). A prospective study of this type is very difficult, but it was thought that a retro-spective study in which the prognosis in a surgically treated group was compared with the reported prognosis of medically treated groups might be of value. In this paper the prognosis of a group of patients subjected to mitral valvotomy is compared with that of three medically treated groups with mitral stenosis reported by Grant (1933), by Olesen (1955), and by Rowe et al. (1960). RESULTS IN GROUP TREATED SURGICALLY Six hundred and twenty-six patients have had mitral valvotomy in this hospital up to May 1959, but the 28 who were pregnant at the time of operation were excluded from this series. The results of the remaining 598 have been compared with the medically treated series of Grant, of Olesen, and of Rowe et al.