[Patients with indications of open mitral commissurotomy undergoing mitral valve replacement]

Between 1970 and 1979 one hundred and sixty seven patients underwent open mitral commissurotomy (OMC). In 22 of these cases the surgeon had to replace the mitral valve by a prosthesis. The authors discuss the pre-operative cardiac status, the surgical findings and mishaps which led to prosthetic implantation. Mean age for the group was 35 years; atrial fibrillation was found in 73%. Most patients were in class II and III of the NYHA, with a cardiac-thoracic ratio of 56-60%. On X-ray systemic emboli had occurred in 45% prior to surgery. All had predominant mitral stenosis without other valve lesions. Surgical findings were: valve fibrosis in 59%, sub-valvular fibrosis in 33%, moderate calcification in 27% and intracavitary thrombus in 12%. Half of the patients had associated mitral regurgitation (MR) of slight degree. In 11 patients, (50%), the surgeon aggravated the pre-existing MR while performing the valvotomy and had to replace the mitral valve (MVR). In 4 other patients, without previous MR a severe regurgitation was produced during valvotomy and MVR was required. In the 7 remaining, patients MVR was indicated because of valvular, subvalvular fibrosis or calcification. Surgical mortality was 14% as compared to less than 1% for OMC.