P Wave Changes After Open Heart Mitral Commissurotomy for Isolated Mitral Stenosis

Abstract

A broad and notched P wave has long been recognized as an important finding in the ECG for the diagnosis of mitral stenosis. Recent studies concerning the leftward shift of the terminal P forces and the analysis of the P wave in lead V-1 have led to more precise criteria for the diagnosis of left atrial abnormalities. 1-3 Open heart mitral commissurotomy provides an excellent means for the correlation of mitral valve and left atrial abnormalities with P wave.The purpose of this study is to document the P wave changes following open heart surgery in patients with isolated mitral stenosis and to correlate these changes with clinical data in the postoperative period. MATERIAL AND METHODSA group of 109 consecutive cases with isolated mitral stenosis underwent open heart mitral commissurotomy Of those, 47 patients were fibrillating prior to surgery and were not included in the study. Of the remaining 62 patients in normal sinus rhythm, 12 were excluded because they either lacked sufficient postoperative clinical data for an adequate evaluation (nine cases), or they converted to fibrillation immediately after surgery (two cases) or died (one case). A group of 50 cases remained in normal sinus rhythm after surgery and are the basis of this study.The amount of failure at the time of the preoperative evaluation was considered to be nonexistent. An estimate of function capacity according to the New York Association classification4 was made pre-and postoperatively. Routine laboratory tests, X-rays (PA, both obliques and left lateral), and 12-lead scalar ECGs were available for the pre-and postoperative evaluations.