Circulatory effects of mitral commissurotomy with particular reference to selection of patients for surgery

Of 60 patients with mitral stenosis referred as proper candidates for commissurotomy, less than half (27) proved suitable after further study. One half of these (13) had a good postoperative result as judged not only clinically but by objective physiologic measurements. The latter represent the best criteria for the effects of surgery since subjective impressions may be unreliable. Eight subjects originally advised to undergo surgery would now be rejected inasmuch as myocardial insufficiency and not mitral block was their predominant difficulty. Clinical criteria appear as yet inadequate for the selection of the proper candidate for mitral commissurotomy, as there is no good clinical means of establishing in every instance the presence of pulmonary hypertension which remains the best evidence of a significant degree of mitral block.