Article

Surgery for Mitral Stenosis

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Abstract

THE purpose of this report is to summarize our experience to date with the surgical treatment of mitral stenosis. Thirty-two patients have been operated upon and have been followed for 2 to 20 months after operation. Two patients died during the immediate postoperative period and a third, three months after operation. The remaining 29 have survived, and all but 1 of 17 who have been observed for longer than six months have shown definite functional improvement.

Pathology

Functionally significant mitral stenosis is the pathologic end result of rheumatic mitral valvulitis and its subsequent healing. Its development requires many months. During the initial attack of rheumatic carditis, the clinical picture is dominated by the effects of myocardial damage, and mitral stenosis plays no role in altering circulatory dynamics. The first clinical manifestation of mitral valvulitis is the appearance of the apical systolic murmur of mitral insufficiency. In certain patients the auscultatory findings of “pure” mitral stenosis gradually evolve. In others, the features are those of uncomplicated mitral insufficiency, but the largest number present evidence of combined stenosis and insufficiency. With gradual healing of active myocardial lesions, the more stable pattern of chronic valvular disease becomes evident. These patients with fixed valve lesions are our primary concern.

Obstruction to blood flow across a narrowed mitral valve causes an elevation of pressure in the left auricle and the pulmonary veins, which is accompanied by a rise in pulmonary artery pressure. In many instances, the elevation of pulmonary artery pressure is simply the mechanical . . .


 

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