Closed Mitral Commissurotomy Complications and Their Effect on Survival

¹ Divisions of Cardiology and Clinical Pharmacology, Departments of Medicine and Pharmacology, University of Cincinnati College of Medicine, Cincinnati

The postoperative course of 145 patients with primary, closed mitral commissurotomy was analyzed with emphasis on the incidence and importance of various complications. For the entire series, 12-year cumulative mortality was 38.3 percent, ten-year 32 percent and five-year 18.6 percent. Satisfactory results were found in 43.3 percent of patients followed longer than ten years, in 53.9 percent at five to ten years and in 66.4 percent at one to five years after the first operation. Principal complicating factors were restenosis (32.3 percent incidence and 41.1 percent cumulative 12-year mortality), serious mitral regurgitation (15.9 percent and 56.5 percent), preoperative cardiomegaly (53.2 percent and 44.3 percent), progressive aortic regurgitation (4.1 percent and 50 percent), chronic atrial fibrillation (52.4 percent and 43.4 percent), preoperative right ventricular hypertrophy (43.7 percent and 41.1 percent) extensive mitral calcification at initial surgery (46.3 percent and 46.2 percent), postoperative embolism (22.1 percent and 52.6 percent) and obstructive pulmonary disease (4.1 percent and 50 percent). At all stages of follow-up, patients without these serious complications had a more favorable course. In optimally selected patients, closed mitral commissurotomy produces acceptable long-term results.