Long-term results of open mitral valvuloplasty

The long-term results of open mitral valvuloplasty in 51 patients are assessed. At the time of operation, 4 patients were in New York Heart Association Functional Class II, 41 in Functional Class III, and 5 in Functional Class IV. Group I (14 patients) had had previous closed mitral commissurotomy. Three patients died 2 to 4 years after open valvuloplasty. One patient died following valve replacement 7 years after the open valvuloplasty. Five others required mitral valve replacement 1 to 12 years following open valvuloplasty. Only 4 of the 14 patients are in Functional Class I or II 10 to 15 years following valvuloplasty. Group II (36 patients) had never undergone a previous mitral operation. Four of them died of progressive myocardial failure 4 to 6 years following valvuloplasty. One patient died of carcinoma of the lung 2 years postoperatively. Six patients underwent valve replacement 6 to 11 years following initial operation. Twenty-six have survived for at least 10 years without additional operation. Fourteen are in Functional Class I, and 12 are in Funcitonal Class II. Open mitral valvuloplasty allows for (1) accurate commissurotomy and careful subvalvular dissection, (2) direct vision to diagnose clot in the left atrial appendage or left atrium proper, (3) accurate assessment of residual or induced mitral regurgitation and immediate repair, and (4) reasonable operative mortality and morbidity.