Mitral stenosis with atrial fibrillation: Surgical considerations and results of operation

Bashi, V. V.; Jairaj, P. S.; Muralidharan, S; Ravikumar, Edwin; Babuthaman, C.; Krishnaswamy, S.; Cherian, G; Sukumar, I P; John, Stanley

doi:10.1007/bf02664142

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“…Over 40% of our patients under 20 years old were in the second-or third-degree stage of malnutrition (less than 70% based on weight for age by American standards). Auscultatory 891 NO 5 1983 8.5% of patients, presumably the result of associated aortic valve disease or thin chest walls, which were common. The criteria for left ventricular hypertrophy was an R wave in V5 or V6 and an S wave in VI more than 35 mm in height (for adults) or over 45 mm in height (for children).…”

Section: Methodsmentioning

confidence: 99%

Closed mitral valvotomy: early results and long-term follow-up of 3724 consecutive patients.

John¹,

Bashi²,

Jairaj³

et al. 1983

Circulation

186

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Between 1956 and 1980 closed mitral valvotomies were performed in 3724 consecutive patients (male:female ratio 1.1:1) with mitral stenoses. Their ages ranged from 6 to 69 years, with a mean (SD) of 27.3 (9.3). Mitral stenosis in the younger age group is a unique condition and a great majority of these patients rapidly develop significant pulmonary hypertension and congestive cardiac failure. In this study a large number of subjects belonged to functional class IV (41.5%). Hospital mortality was 1.5% over the last 5 years. After valvotomy, 11 patients (0.3%) developed severe mitral regurgitation that made valve replacement necessary in the immediate postoperative period. Early postoperative embolism occurred in 0.4% of those who were in atrial fibrillation and had preoperative anticoagulation whereas it occurred in 0.95% of those in sinus rhythm who had no anticoagulation. Late postoperative embolism occurred at a rate of 0.3 to 1.6 per 1000 patients per year over a 20 year period. Rheumatic reactivity occurred at a rate of 1.3 to 2.2 per 1000 patients per year during the same period. Rate of occurrence of restenosis varied from 4.2 to I 11.4 per 1000 patients per year between the fifth and fifteenth year of follow-up. Closed transventricular revalvotomy for restenosis was accomplished in 130 subjects with a 6.7% mortality. Excellent symptomatic improvement was evident in 86% of long-term survivors at the end of 15 years. Actuarial survival was 95%, 93.1%, 89.5%, and 84.2% at 6, 12, 18, and 24 years, respectively, after closed mitral valvotomy. Late deaths occurred in 4.3%. This study serves to highlight the excellent palliative effect of closed valvotomy for mitral stenosis without significant valvular calcification, substantial regurgitation, or significant associated valvular lesion. Circulation 68, No. 5, 891-896, 1983

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Section: Methodsmentioning

confidence: 99%