Role of Closed Mitral Commissurotomy for Mitral Stenosis: Mid- and Long-term Surgical Outcome of 36 Patients
Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years.
Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 ± 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours ± 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade ³ 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients.
Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.
Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N. 1984. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg 87:394-402.nIung B, Cormier C, Ducimeticre P, et al. 1996. Functional results 5 years after successful percutaneus mitral commissurotomy in a series of 528 patients and analysis of predictive factors. J Am Coll Cardiol 27:407-14.nLaschinger JC, Cunningham JN, Baumann FG, et al. 1982. Early open radical commissurotomy: surgical treatment of choice for mitral stenosis. Ann Thorac Surg 34:287-96.nLogan A, Turner R. 1959. Surgical treatment of mitral stenosis with particular reference to the transventricular approach with a mechanical dilator. Lancet 2:874-80.nMolajo AO, Bennett DH, Bray CL, et al. 1988. Actuarial analysis of late results after closed mitral valvotomy. Ann Thorac Surg 45:364-9.nNichols HT, Blanco G, Morse DP, Adam A, Baltazar N. 1962. Open mitral commissurotomy. Experience with 200 consecutive cases. JAMA< 182:268-70.nPatel JJ, Shama D, Mitha AS, et al. 1991. Balloon valvuloplasty versus closed commissurotomy for pliable mitral stenosis: a prospective hemodynamic study. J Am Coll Cardiol 18:1318-22.nAgarwal BL. 1981. Rheumatic heart disease unabated in developing countries. Lancet 2:910-1.nBailey CP. 1949. The surgical treatment of mitral stenosis (mitral commissurotomy). Dis Chest 15:377-97.nCohen DJ, Kuntz E, Gordon SPF, et al. 1992. Predictors of long-term outcome after percutaneous balloon mitral valvuloplasty. N Engl J Med 327:1329-35.nCutler EC, Levine SA. 1923. Cardiotomy and valvulotomy or mitral stenosis. Experimental observations and clinical notes concerning an operated case with recovery. Boston Med Surg J 188:1093.nDetter C, Fischlein T, Feldmeier C, Nollert G, Reichenspurner H, Reichart B. 1999. Mitral commissurotomy, a technique outdated? Long-term follow-up over a period of 35 years. Ann Thorac Surg 68:2112-8.nDubost C. 1976. Place of conservative surgery in acquired valve disease. Arch Mal Coeur Vaiss 69:215-8.nEguaras MG, Jimenez MA, Calleja F, et al. 1993. Early open mitral commissurotomy: long term results. J Thorac Cardiovasc Surg 106:421-6.nEllis F Jr. 1967. Surgery of acquired mitral valve disease. Philadelphia: WB Saunders. p 181-6.nEllis LB, Singh JB, Moraleus DD, Harken DE. 1974. Fifteen-to twenty-year study of one thousand patients undergoing closed mitral commissurotomy. Circulation 50(2):II-200.nFarhat MB, Boussadia H, Gadjbakhch I, et al. 1990. Closed versus open mitral commissurotomy in pure noncalcific mitral stenosis. J Thorac Cardiovasc Surg 99:639-44.nHarken DE, Ellis LB, Ware PF, Norman LR. 1948. The surgical treatment of mitral stenosis: valvulaplasty. N Engl J Med 239:801-9.nHickey MSJ, Blackstone EH, Kirklin JW. 1991. Outcome probabilities and life history after surgical mitral commissurotomy: implications for balloon commissurotomy. J Am Coll Cardiol 17:29-42.nRihal CS, Schaff HV, Frye RL, et al. 1992. Long-term follow-up of patients undergoing closed transventricular mitral commissurotomy: a useful surrogate for percutaneous balloon mitral valvuloplasty? J Am Coll Cardiol 20:781-6.nScalia D, Rizzoli G, Campanile F, et al. 1993. Long-term results of mitral commissurotomy. J Thorac Cardiovasc Surg 105:633-42.nShrivastava S, Mathur A, Dev V, Saxena A, Venugopal P, SampathKumar A. 1992. Comparison of immediate hemodynamic response to closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty in rheumatic mitral stenosis. J Thorac Cardiovasc Surg 104:1264-7.nSpencer FC. 1990. Acquired disease of the mitral valve. In: Sabiston DC Jr, Spencer FC, editors. Surgery of the chest. 5th ed. Philadelphia: WB Saunders. p 1511.nTokmakoglu H, Vural KM, Ozatik MA, Cehreli S, Sener E, Tasdemir O. 2001. Closed commissurotomy versus balloon valvuloplasty for rheumatic mitral stenosis. J Heart Valve Dis 10:281-7.nWilkins GT, Weyman AE, Abascal VW, Block PC, Palacios IF. 1988. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J 60:299-308.n
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