Open mitral commissurotomy: a better procedure?

Percutaneous balloon commissurotomy has emerged as an alternative method for the treatment of mitral stenosis, and several comparative studied have recently claimed superior results as compared with those obtained by surgical commissurotomy. However, valve areas after balloon commissurotomy, calculated by Doppler echocardiography have, in the best cases, averaged 2.0-2.2 cm2 and in some cases much less. Areas of 1.5 cm2 have often been considered as good results. In our opinion, open commissurotomy on pliable valves is capable of achieving areas closer to normal. Furthermore, it remains to be determined whether residual transvalvular gradients resulting from an incomplete balloon commissurotomy will cause increased fibrosis, accelerate restenosis and render repeat commissurotomy impossible. To prove this assumption, we have prospectively studied 100 consecutive patients who underwent open mitral commissurotomy, but whose stenotic mitral valves had been considered pliable enough for balloon commissurotomy. They constitute 41.7% of the 240 open commissurotomies performed during the 3-year study period (1988-1991) which, in turn, represent 75.7% of the 317 stenotic mitral valves submitted to surgery. The mean age of the patients was 47.6 +/- 11.5 years (range 19 to 69 years), the majority (87 patients) were female and 54 were in sinus rhythm. Associated procedures included aorto-coronary bypass in two, aortic valve surgery in nine and tricuspid valve annuloplasty in three patients. Bilateral incision of the mitral valve commissures, was performed in all patients. Additionally, division of fused commissural chordae tendineae and/or papillary muscles was performed in 56 cases and excision of thickened basal chordae of the posterior leaflet in 14 patients.(ABSTRACT TRUNCATED AT 250 WORDS)