In the August issue of the Journal, Xu et al. (1), from China, discuss the case of a patient who had a successful reoperation for restenosis of the mitral valve performed 30 years after closed mitral commissurotomy (CMC). The specific aspects of this case were most appropriately commented by several experienced surgeons from different parts of the world. I was now invited by the Editor of this Journal to write a Comment on this paper and its subject.
History of the treatment of the stenotic mitral valveCMC was one of the first operations routinely performed on the heart, long before the beginning of the open-heart surgery era brought to us by Gibbon's heart-lung machine in 1953. The first CMC was successfully performed by Elliot Cutler, in 1923, at the Peter Bent Brigham Hospital, Boston, through a median sternotomy, by a transventricular approach and with a tenotomy knife, on a 12-year-old girl with rheumatic mitral stenosis, who survived the operation (2). This was followed by seven other operations but all patients died; Cutler's colleagues refused to send him more patients and he gave up the operation in 1929. Meanwhile, in 1925, Souttar (3), in London, intervened on the mitral valve via the left atrial appendage, using the index finger to achieve a true mitral commissurotomy, by contrast with Cutler's procedure which opened the valve through the leaflets, causing regurgitation. But, again, Souttar did no other case because the cardiologists never sent him another patient!The procedure was revisited only more than two decades later, in the late 1940's, by Dwight Harken and Charles Bayley (4,5) and then became widely accepted. Subsequently, the technique of CMC suffered several modifications, both