Surgical Treatment of Mitral Stenosis by Open Technique

Kay, Earle B.

doi:10.1001/jama.1960.03020330012003

Cited by 18 publications

(1 citation statement)

References 12 publications

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“…This would make it possible to remove calcifications and to correct incompetence. In some clinics this technique is already being used in cases of secondary stenosis and combined mitral defect and in the rare cases in which marked incompetence develops during the blind operation (Kay and Nogueira, 1960;De Jesus, Breneman, Keyes, and Lam, 1960;Edwards and Lyons, 1960). However, as long as the results of operations for mitral incompetence remain unsatisfactory, and as long as the use of extracorporeal circulation involves considerable difficulties of organization, the open technique of commissurotomy seems to be acceptable only in exceptional cases.…”

Section: Discussionmentioning

confidence: 99%

The Use of Instruments in Commissurotomy for Mitral Stenosis

Nauta¹,

Hartman²

1962

Thorax

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This study was made in order to establish the effect of the use of instruments during commissurotomy for mitral stenosis. Initially, the adherent commissures between the mitral valves were severed exclusively with the finger, because the digital method had the advantage that possible adhesions between the papillary muscles could be detached with the finger. Soon it was found, however, that a good result could not be obtained in all cases; for example, the adhesions between the valves were sometimes too firm to permit of digital severance. In other cases the commissures were readily severed but the finger caused incompetence (Ellis, Harken, and Black, 1959;Bailey and others, 1959).In the case of exclusively digital commissurotomy, therefore, it is possible to distinguish two groups of patients in whom the operation cannot be considered sufficiently successful, viz., (1) patients in whom the orifice cannot be sufficiently opened during the operation, and (2) patients who develop an incompetence which did not previously exist or existed in a lesser degree than after the operation.It is understandable that various instruments were introduced to overcome the above shortcomings of digital commissurotomy, and it would be desirable to know which instruments are best suited to this operation. It is as yet impossible to establish this with certainty because comparative series are still lacking. During the operation every surgeon has the choice of a variety of instruments; in some cases he will use none of these; in others he will use instrument A or instrument B, dependent on his own experience and preference and on the intracardiac situation which he encounters. Only few have so far managed, like Gerbode (1960)

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Section: Discussionmentioning

confidence: 99%