[Plastic surgery of the mitral valve in patients undergoing closed commissurotomy]

The authors report on 64 valve-preserving operations conducted under conditions of extracorporeal circulation in patients with a history of closed mitral commissurotomy (59 patients with restenosis of the mitral orifice and 5 patients with iatrogenic mitral insufficiency); hospital lethality was 14%. The peculiarities of the diagnosis and operative techniques of the second intervention in this pathological condition are discussed in detail. From study of the immediate postoperative results the authors conclude that during the second operation after closed mitral commissurotomy the patient's own valve can be preserved in 30-35% of cases. They claim that restenosis of the mitral orifice and iatrogenic mitral insufficiency are a complicated form of mitral valvular disease and should be corrected on an open heart with extracorporeal circulation.