[Surgery of mitral valve stenosis: open or closed commissurotomy?]

Up to October 1975 a total of 206 mitral commissurotomies were performed in Berne. 170 patients underwent closed commissurotomy (CMC). In the period from 1973, 36 patients underwent open commissurotomy (OMC). To compare results and operative risk as between OMC and CMC, the last 36 consecutive patients of the CMC group were selected for critical evaluation. Though not coinciding chronologically the 2 groups turned out to be essentially comparable with regard to preoperative clinical and hemodynamic findings. In neither group was there a hospital death. Frequency and severity of postoperative complications did not prove to be greater following OMC. Cerebral embolism was observed in 3 cases after CMC, whereas this complication occurred only once following OMC. On the basis of clinical, radiological and electrocardiographic data, OMC must be considered superior to CMC. The incidence of significant residual stenosis and the risk of causing mitral regurgitation appear to be lower. Without involving a higher operative risk, the open approach to mitral commissurotomy offers the following main advantages: safe removal of intraatrial thrombi, precise and complete incision of the fused commissures under direct vision, avoidance of leaflet tears, separation of fused chordae tendineae and incision of papillary muscles in order to remove subvalvular stenosis, debridement of calcium from leaflets, and repair of concomitant mitral regurgitation by valvuloplasty.