Closed mitral commissurotomy—a cheap, reproducible and successful way to treat mitral stenosis

Abstract

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

The Technological Basis of a Balloon-Expandable TAVR System: Non-occlusive Deployment, Anchorage in the Absence of Calcification and Polymer Leaflets

“…Yet, the transapical access had allowed general surgeons to successfully treat RHD making it the commonest heart operation performed in the beginning of the second half of the twentieth century especially in countries of the southern hemisphere. This highlighted the potential of this route to treat valvular heart disease in the absence of open heart surgery ( 111 ) making it one of the backbones of our concept.…”

Rheumatic Heart Disease in the Developing World

“… 61 , 62 Nevertheless, CMC may still offer some utility in particularly resource-scarce locations. 58 The above is further supported by the more recent study showing comparable long-term results of CMC compared with BMV. 63 …”

“…The main limitation of CMC was the presence of calcified leaflets and/or diseased subvalvular apparatus. 58 It was largely replaced by open mitral commissurotomy after the development of cardiopulmonary bypass due to direct visualization and the ability of open commissurotomy to also address the abovementioned limitations. 58 Open surgery achieved a larger mitral valve area and a greater increase in cardiac index compared to CMC.…”

“… 58 It was largely replaced by open mitral commissurotomy after the development of cardiopulmonary bypass due to direct visualization and the ability of open commissurotomy to also address the abovementioned limitations. 58 Open surgery achieved a larger mitral valve area and a greater increase in cardiac index compared to CMC. 59 Furthermore, it was reported that both the incidence of reoperation as well as valve-related morbidity and mortality were significantly lower after open commissurotomy.…”

Cardiac Anesthesiologist and Global Capacity Building to Tackle Rheumatic Heart Disease

“…15 Re-adoption of CMV could save thousands of lives in the poor countries of Africa and some parts of Asia. 16 Reoperation, if necessary is feasible and carries acceptable morbidity and mortality. 17 Thus, CMV has the potential to be a viable option in many parts of the world where BMV and open-heart surgery are not readily available.…”