Loss of apical left ventricular contraction after closed mitral valve surgery

28 patients with advanced mitral valve restenosis were studied by cardiac catherization on an average of 7.2 years after previous closed mitral valvotomy, performed using the Tubbs dilator technique. Loss of left ventricular apical contraction was noted in 17 of 31 left ventricular cineangiograms. In the other regions, only 2 cases of local anterior wall akinesia and 1 of posterobasal akinesia was observed. The extent of akinesia was rather small: from 4 to 21%, a mean of 10.1% of the left ventricular circumference. Though ejection fractions remained 21% smaller in those with regional left ventricular dysfunction than in those with normal contraction (p less than 0.005), no other clinical haemodynamic consequences were found. The mechanical trauma caused by insertion of the dilator seems to result frequently in focal contraction abnormalities of the left ventricle, but these are of minor degree.