Evaluation of surgery for mitral valve disease

Abstract

T wenty years have gone by since the first commissurotomy for mitral stenosis was performed. A few years later, by extracorporal circulation, direct approach to the mitral valve was realized. Ten years ago mitral-valve prostheses were developed which allowed total replacement in cases of advanced mitral lesions.2,4,41,43 We believe that the follow-up is now sufficient so that we can try to assess the results of different surgical techniques, discuss patient selection, and categorize the status of surgical therapy in view of our personal experience at Broussais Hospital.* Acquired rheumatic mitral lesions are multiple. Pure mitral stenosis with moderate scarring of the leaflets and chordae tendineae, as it is observed in young women, does not involve the same surgical procedure as calcified mitral stenosis. Between these two poles, many intermediate varieties are observed in which lesions of the leaflets, chordae tendineae, and papillary muscles may reach various stages, and surgical procedure must be adapted to the type of malformation. Indication for surgery is not limited to rheumatic inflammation; it must also be considered in congenital mitral insufficiency, ruptured chordae tendineae, bacterial endocarditis, traumatic insufficiency, and post-myocardial-infarction mitral insufficiency. First degree mitral stenosis