Circulation, Vol 68, 891-896, Copyright © 1983 by American Heart Association
S John, VV Bashi, PS Jairaj, S Muralidharan, E Ravikumar, T Rajarajeswari, S Krishnaswami, IP Sukumar and PS Rao
Between 1956 and 1980 closed mitral valvotomies were performed in 3724
consecutive patients (male:female ratio 1.1:1) with mitral stenoses. Their
ages ranged from 6 to 69 years, with a mean (SD) of 27.3 (9.3). Mitral
stenosis in the younger age group is a unique condition and a great
majority of these patients rapidly develop significant pulmonary
hypertension and congestive cardiac failure. In this study a large number
of subjects belonged to functional class IV (41.5%). Hospital mortality was
1.5% over the last 5 years. After valvotomy, 11 patients (0.3%) developed
severe mitral regurgitation that made valve replacement necessary in the
immediate postoperative period. Early postoperative embolism occurred in
0.4% of those who were in atrial fibrillation and had preoperative
anticoagulation whereas it occurred in 0.95% of those in sinus rhythm who
had no anticoagulation. Late postoperative embolism occurred at a rate of
0.3 to 1.6 per 1000 patients per year over a 20 year period. Rheumatic
reactivity occurred at a rate of 1.3 to 2.2 per 1000 patients per year
during the same period. Rate of occurrence of restenosis varied from 4.2 to
11.4 per 1000 patients per year between the fifth and fifteenth year of
follow- up. Closed transventricular revalvotomy for restenosis was
accomplished in 130 subjects with a 6.7% mortality. Excellent symptomatic
improvement was evident in 86% of long-term survivors at the end of 15
years. Actuarial survival was 95%, 93.1%, 89.5%, and 84.2% at 6, 12, 18,
and 24 years, respectively, after closed mitral valvotomy.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Closed mitral valvotomy: early results and long-term follow-up of 3724 consecutive patients
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