Mitral valvulotomy: II. Operative results after closed valvulotomy: A report of 500 cases

Since 1951 at Yale University, mitral valvulotomy for mitral stenosis has been performed by the closed method in 500 cases. A primary closed heart procedure was performed in 472 of these, a second closed procedure was performed in twenty-seven, and a third procedure was carried out in one. In 1954 we introduced a new technic for opening the stenosed valve widely through the use of metal thimbles of graduated sizes attached to the index finger of the operator. Since that time this technic has been used in 206 patients. A detailed analysis of the preoperative status, operative findings, and the postoperative course in these cases is reported. The results show an operative mortality of about 3.8 per cent (7 per cent in the first hundred cases and none in the last 162 cases). Reoperation because of restenosis was carried out in 16.5 per cent. The cumulative postoperative mortality (sixteen years) was 22 per cent (one hundred cases). Two of the principal factors determining the operative results were (1) the pathologic changes in the valve and the presence or absence of calcium and of regurgitation and (2) the technic of valvulotomy. The prognosis when there was a calcified valve with or without regurgitation was less favorable than that with a noncalcified valve. The thimble technic for opening the valve produced results superior to the finger or knife technic. We conclude that closed mitral valvulotomy, when executed properly in properly selected patients, is the procedure of choice in the surgical treatment of mitral stenosis of rheumatic origin. Further, all patients undergoing closed valvulotomy are potential candidates for restenosis, and evaluation of their functional state at frequent intervals is advisable to determine the optimal time for reoperation should this become necessary.