159 CLOSED VERSUS OPEN MITRAL COMMISSUROTOMY IN CHILD REN WITH RHEUMATIC MITRAL STENOSIS

Abstract

There has been controversy about the relative merits of closed mitral commissurotomy (CMC) versus open mitral commissurotomy (OMC) in younger patients with rheumatic mitral stenosis (RMS). In an attempt to resolve this uncertainty, 23 patients (pts) aged 10-15 years, consecutively admitted with RMS and pulmonary hypertension (PH) were randomly assigned to OMC (12 pts) and CMC (11 pts). All had cardiac catheterization and left ventricular angiography prior to surgery and again 3-73 wks (x=18) after operation. All pts had RMS either alone or associated with insignificant mitral regurgitation (MR). All pts had PH [pulmonary artery systolic pressure (PASP) 92.5 ± 16.5 mmHg]. In CMC group, 3 pts (27%) had poor results: one died 3 days after surgery, 2 required mitral valve replacement shortly afterwards due to massive MR, whereas only 1 pt (8%) in OMC group developed severe MR. All remaining pts have had significant clinical improvement. Although decrease in PASP was similar in both groups (OMC=36%, CMC=37%), pts in OMC group had greater decrease in pulmonary wedge pressure (PWP) than CMC group (48% vs 33%, p < 0.01). After commissurotomy, only 2 of 10 pts (20%) in CMC group had normal PWP, (≤13 mm Hg) whereas 6 of 12 pts (50%) in OMC group had normal PWP, indicating residual MS in a large number of pts in CMC group. It is concluded that in a center where large numbers of OMC and CMC are performed routinely, OMC should be the preferred method in children with RMS