[Mitral valve replacement after closed mitral commissurotomy].

From June 1978 to Dec. 1987, 35 cases of MVR were performed. All of these patients had closed mitral valvocommissurotomy before. Our experiences show: 1. The main causes of high mortality and morbidity are pericardial adhesion and blood oozing, poor exposure of mitral valve, and prolonged operative time. Therefore, it is wise not to do too much dissection, and to use biatrial incision. With these techniques, good results were obtained. The mortality decreased from 41.2% to 6.25%, the morbidity of postoperative complications decreased from 23.5% to 12.5%. 2. The important factors influencing late results were poor cardiac function and chronic atrial fibrillation. In this series, surgical mortalities of patients with CF of degree 4(NYHA) and degree 3 were 30% and 13.1%. So the main point is to discover the patients as early as possible and to advise them surgery whenever needed.