Effect of mitral commissurotomy on duration of life, functional capacity, hemoptysis and systemic embolism

Greenwood, W. F.; Aldridge, Harold E.; McKelvey, A. D.

doi:10.1016/0002-9149(63)90128-0

Cited by 32 publications

(10 citation statements)

References 13 publications

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“…The figure of 26% per patient-year in this series is similar to that recorded by Szekely (1964) but higher than that of Ellis et al (1959), Ellis and Harken (1961), and of Greenwood et al (1963). The variation in follow-up of the various series is also tabulated, as we have already commented on the increasing incidence in the later post-operative years.…”

Section: Pre-operative Embolic Incidencesupporting

confidence: 79%

“…Data concerning the precise age distribution of the patients in Szekely's (1964) series are not available, though it is stated that the material 'includes a large number of patients followed up for many years virtually in a stage of non-vulnerability'. Greenwood et al (1963) recorded an incidence of 4% per patient-year, 5900 of the patients being under 40 years of age at the time of operation, but the period of pre-operative study in a retrospective series was only five years.…”

Section: Pre-operative Embolic Incidencementioning

confidence: 99%

“…Previous authors (Ellis et al, 1959;Bannister, 1960;Kellogg et al, 1961 ;Greenwood et al, 1963 ;Szekely, 1964), in discussing the effect of mitral valvotomy on the incidence of systemic embolism, have found difficulty in determining the pre-operative incidence. In any retrospective study it has proved impossible to define the point at which vulnerability to systemic embolism begins in the course of the natural history of chronic rheumatic heart disease.…”

Section: Pre-operative Embolic Incidencementioning

confidence: 99%

“…The variation in follow-up of the various series is also tabulated, as we have already commented on the increasing incidence in the later post-operative years. It is of interest to remember that in the series of Greenwood et al (1963) there was a higher proportion of young patients who might be expected to be in the earlier years of rheumatic history. This, however, does not apply to the cases studied by Ellis et al (1959).…”

Section: Pre-operative Embolic Incidencementioning

confidence: 99%

“…It is now clearly established that mitral valvotomy improves survival in patients with mitral stenosis (Ellis, Harken, and Black, 1959;Olesen and Baden, 1961;Greenwood, Aldridge, and McKelvey, 1963), but there is still dispute as to whether the risk of systemic arterial embolism is reduced by the procedure. Belcher and Somerville (1955) stated, 'a successful valvotomy will not prevent further systemic embolism, but there is reason to believe it will reduce its incidence'.…”

mentioning

confidence: 99%

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Incidence of systemic embolism before and after mitral valvotomy

Deverall

Olley

Smith

et al. 1968

Thorax

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Mitral valvotomy is of established value in improving the clinical condition and life expectancy of patients with rheumatic mitral stenosis. Its value in preventing or reducing the incidence of systemic arterial embolism is less certain. A comparison of pre-and post-operative embolic incidence can only be accepted if it is clear that the method of assessing the pre-operative figure is reliable. It is shown that the figure varies according to the length of the pre-operative study, and evidence is presented to show a changing incidence with increasing length of chronic rheumatic history. By studying patients in whom the time of onset of rheumatic heart disease is accurately known, a rising embolic incidence with the passage of time is shown. A comparison is made between groups of patients who have experienced the same length of chronic rheumatic history but who differ in respect of mitral valvotomy. We conclude from our comparison that this operation does not diminish the incidence of embolism, though only about a quarter of all our patients had atrial appendagectomy at the time of valvotomy. A reduction in the incidence of recurrent embolism in a given patient after mitral valvotomy is shown but may be more apparent than real. Operative embolism, defined here as that occurring either at or within 48 hours of operation, has an incidence of 3-8%. The factors related to pre-operative, operative, and postoperative embolism are presented.

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