[Hemodynamic and echocardiographic long-term results of closed mitral commissurotomy]

During recent years open mitral commissurotomy (OMC) has seemed to be more favorable than closed commissurotomy (CMC). Up to now only few long-term results including hemodynamic data of mitral valve reconstruction have been reported. 69 of the 103 patients who underwent CMC between 1973 and 1980 were followed over a mean period of 5.3 +/- 2.1 years after intervention. 5 patients died. In 8 (11%) a prosthetic valve replacement was necessary (restenosis 4, insufficiency 2, combined valve disease 2). 36 of the patients were clinically improved (at least 1 NYHA class), 21 (30%) maintained the same NYHA class, and 7 (10%) had deteriorated. The relative heart volume (HV) from supine chest X-rays decreased from 1010 ml/1.71 m2 to 906 ml/1.73 m2 (n = 42, p less than 0.01). The mitral valve area ( MOFL ; n = 25) increased from 1.2 cm2 (Gorlin formula) to 2.6 cm2 (2D-echo) (p less than 0.001). Mean pulmonary artery pressure ( MPAP ) at rest decreased by 29% (from 33.6 mm Hg to 23.8 mm Hg, n = 37, p less than 0.001) and during exercise by 36% (from 69.5 mm Hg to 44.8 mm Hg, n = 10, p less than 0.01). The reduction in PA pressures and the increase in mitral valve area did not correlate and showed no relationship to the intraoperatively estimated success of commissurotomy. Our findings reflect very satisfactory long-term results after closed commissurotomy, which are comparable with those of open valvotomy.