Circulatory Effects of Mitral Commissurotomy with Particular Reference to Selection of Patients for Surgery

Abstract

Of 60 patients w'ith mitral stenosis referred as proper candidates for commissurotomy, less than half (27) proved suitable after further study. One half of these (13) had a good postoperative result as judged not only clinically but by objective physiologic measurements. The latter represent the best criteria for the effects of surgery since subjective impressions may be unreliable. Eight subjects originally advised to undergo surgery would now be rejected inasmuch as myocardial insufficiency and not mitral block was their predominant difficulty. Clinical criteria appeal as yet inadequate for the selection of the proper candidate for mitral commissurotomy, as there is no good clinical means of establishing in every instance the presence of pulmonary hypertension which remains the best evidence of a significant degree of mitral block. SINCE Bailey', 2 and Harken3 have demonstrated the feasibility of the surgical approach to the problem of mitral stenosis, patients with this lesion are being re-evaluated in numerous clinics with the possibility of commissurotomy in mind. It is well to remember that surgical treatment is directed at the relief of the mechanical difficulties imposed by mitral valve obstruction. It has been postulated and recently re-emphasized4-6 that chronic pulmonary hypertension is one of the chief resultants of significant mitral block. This postulate has been confirmed by physiologic studies which also showed decrements in pulmonary artery pressures after successful mitral surgery.2' 7 Thus, it has become established that operative intervention can alleviate at least some of the consequences of mitral block. However, it has also been found

The Diffusing Capacity of the Lungs in Patients With Mitral Stenosis Studied Post-Operatively 1

“…Because of their location in relation to vascular structures, one would expect that such lesions might interfere with the flow of blood through the lungs or with the diffusion of gases across the pulmonary membrane. Hemodynamic studies by a number of different workers have demonstrated an increase in pulmonary vascular resistance in patients with mitral stenosis (4)(5)(6)(7)(8)(9)(10). This paper deals with studies of the diffusion of gases across the pulmonary membrane in a group of patients on whom mitral valvulotomy had been performed.…”

Pulmonary Hypertension in Mitral Stenosis

“…Hg) although the capillary venous pressure had fallen to normal; the fourth case had not been recatheterized and continued to show some incapacity; and in only one was the result excellent. Ferrer et al (1955) studied the circulatory effects of mitral valvotomy in 27 patients. Of the 18 with severe pulmonary hypertension, the result was classed as excellent in only seven.…”

André F. cournand: Father of clinical cardiopulmonary physiology

“…The hemodynamics spectrum of circulatory changes secondary to chronic lung disease and rheumatic valve disease was described in serial reports with Irene Ferrer and Rejanne Harvey, together with studies on the circulatory and cardiac effects of quinidine (Ferrer ef al., 1948); the effect of digoxin in chronic cor pulnionale (Ferrer et al, 1950); and in left ventricular failure ; the relationship between electrical and mechanical events of the cardiac cycle (Coblentz et ul., 1949); hemodynamic studies in rheumatic tricuspid stenosis (Femr et al, 1953) and mitral stenosis (Harvey et ul., 1955); mechanical and myocardial factors in chronic constrictive pericarditis ; effects of mitral comniissurotomy with reference to selection of patients for surgery (Ferrer et al, 1955); and cardiocirculatory studies in pulsus alternans of the systemic and pulmonary circulation (Ferrer PI al., 1956) and in atrial flutter (Harvey et d . , 1955b).…”