Surgery for Mitral Stenosis

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EVALUATION of a new surgical procedure such as mitral commissurotomy must depend upon consideration of its total cost as compared to the benefits obtained by its use. Functional improvement due to mitral commissurotomy can now be assessed only on a short-term basis. A number of years must pass before the ultimate results of combined surgical and medical management can be ascertained. At present, the value of surgical intervention in properly selected patients with mitral stenosis appears to be clearly established.

In assessing the cost of the procedure, the mortality and morbidity involved are the primary considerations. Of these, mortality is more important and more easily defined. The first mitral commissurotomy at the Cleveland Clinic was performed in M ay 1951, and the 100th operation of the consecutive series in December 1953. Of the 100 patients, 92 survive. The purpose of this report is to analyze the causes of death in the early postoperative period with the aim of determining such measures as may make the operation safer in the future.

Of the eight patients, six died in the hospital after operation; two died of their disease after discharge from the hospital, one approximately two months after discharge and the other more than a year later. The cause of death in each of the six who died during postoperative hospitalization was determined by postmortem examination (table 1). The two patients who died elsewhere after discharge were not observed during the terminal phases of their illnesses. Postmortem examinations were obtained in both . . .



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