Defects of the Mitral Valve

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THE initial work of Bailey, Glover, and O'Neill,1 and Harken, Ellis, and Norman,2 and others3 in 1950 aroused widespread interest in the surgical treatment of mitral valvular heart disease. Within a short time a large number of patients having such disease were being operated upon in various surgical centers. The original operations utilized the left transatrial approach that permitted either instrumental or finger-fracture commissurotomy. Enthusiastic early reports indicated that the closed approach was adequate in the majority of patients who suffered from pure mitral stenosis with noncalcified valves.

However, it was soon apparent that the closed-type of mitral commissurotomy always involved some element of risk related to postoperative embolization, recurrent stenosis, and chirurgic insufficiency. Cardiac surgeons quickly found that the insufficiency created by laceration of chordae tendineae or of either mitral cusp was a complication frequently less well tolerated than the preexisting stenosis. Bailey and Morse4 abandoned the left, transatrial operation on the mitral valve for the right, interatrial approach in an attempt to reduce attendant complications and to improve valvotomy results. In other surgical centers the transventricular approach, which employed some form of valve dilator, has become the method of choice. The multiplicity of operations that followed the original “standard operation” for mitral stenosis is testimony that there is a need for continued improvement in the surgical treatment of mitral stenosis.

In 1958, we reported our early experience with the open operations for mitral insufficiency.5 Our clinical experience at that time was limited to 14 operations in which some. . .



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