The Use of Instruments in Commissurotomy for Mitral Stenosis

Abstract

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)

Surgical Treatment of Mitral Stenosis

“…Post-operative incompetence has been noticed in this series in 30.3% of patients (approximately as often as reported by Nauta and Hartman (1962)). This is a higher percentage than 17% cited by Logan and Turner (1959) or 16% cited by Bjork and Malers (1963).…”

“…Taking into consideration patients who did not have pre-operative incompetence, traumatic incompetence was present in 17.3 % of patients with non-calcified valves and in 44.7% of patients with calcification of the valve. In contra-distinction to other authors (Dubost et al, 1962;Nauta and Hartman, 1962), the lowest rate of incompetence was observed after digital valvotomy (Table VI).…”