Valvotomy in the Treatment of Mitral Stenosis

Th, Sellors; De, Bedford; Somerville, Walter

doi:10.1136/bmj.2.4845.1059

Cited by 93 publications

(17 citation statements)

References 7 publications

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“…In two patients (Nos. 2 Estimates of MVA by Doppler ultrasound have been shown to have a good correlation with results obtained by cardiac catheterization in patients with unoperated mitral stenosis (r = .85) as well as those who have undergone mitral commissurotomy (r = .90). 32 The results of our study confirm that Doppler ultrasound shows a good correlation with cardiac catheterization for the MVA before CBV (r = .8, SEE = 0.15 cm2).…”

Section: Methodsmentioning

confidence: 75%

Mechanisms of increase in mitral valve area and influence of anatomic features in double-balloon, catheter balloon valvuloplasty in adults with rheumatic mitral stenosis: a Doppler and two-dimensional echocardiographic study.

Reid¹,

McKay²,

Chandraratna³

et al. 1987

Circulation

132

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To study the mechanism of increase in the mitral valve area (MVA) and the anatomic features of the mitral valve that may affect the results of catheter double-balloon valvuloplasty (CBV) in adult patients with mitral stenosis, Doppler and two-dimensional echocardiography was performed in 12 patients before and immediately after CBV. Immediately after CBV, there was an increase in the transverse diameter of the mitral valve orifice from 18 + 1.6 to 25 + 2.8 mm (mean -+ SD, p < .001). The anterior angles at the commissure increased from 33 ± 6 to 57 ± 20 degrees (p < .05) and the posterior angles from 36 ± 9 to 54 + 14 degrees (p < .05). The MVA was greater after CBV in patients with pliable mitral valves (2.6 0.7 cm2) compared with those with rigid mitral valves (1.9 ± 0.8 cm2; p = .08). After CBV, MVA was smaller in patients with calcification (2.1 ± 0.2 cm2) compared with those without (2.7 ± 0.5 cm2; p -. 10) and in those with subvalvular disease (2.0 ± 0.6 cm2) compared with those without (2.9 ± 0.9 cm2; p = .03). The MVA by Doppler ultrasound before CBV (1.0 ± 0.2 cm2) correlated well with MVA by cardiac catheterization (1.0 ± 0.3 cm2; r = .8, SEE = 0.2 cm2). After CBV, the correlation of MVA by Doppler ultrasound (2.0 + 0.5 cm2) with MVA by cardiac catheterization (2.4 ± 0.8 cm2) was poor (r = .3, SEE = 0.44 cm2). Doppler studies showed that new mitral regurgitation was produced in four patients (mild in three and moderate in one) and an increase of mitral regurgitation was produced in one patient. We conclude that (1) the increase in MVA by double-balloon CBV occurred along the natural planes of the commissures resulting in increased commissural angle opening; (2) severe calcification of the commissures with rigid valve leaflets was associated with the least increase in mitral valve area after CBV; calcification of the commissures, rigid valve leaflets, and subvalvular disease were associated with smaller increases in MVA, (3) new or an increase in mitral regurgitation occurred in over a third of the patients by Doppler, but in most patients the change was small, and (4) Doppler ultrasound provided a reasonable estimate of MVA before CBV but was of limited value in the estimation of the MVA immediately after CBV.

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Section: Methodsmentioning

confidence: 75%

Mechanisms of increase in mitral valve area and influence of anatomic features in double-balloon, catheter balloon valvuloplasty in adults with rheumatic mitral stenosis: a Doppler and two-dimensional echocardiographic study.

Reid¹,

McKay²,

Chandraratna³

et al. 1987

Circulation

132

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“…In patients with extensive calcification, rigidity of the valve cusps prevented the full separation in diastole which freeing of the commissure at valvotomy would otherwise have allowed, stenosis being due as much to the rigidity of the cusps as to their fusion (Sellors et al, 1953). The longterm results of operation in this group have been poor, although some patients obtained considerable temporary improvement for one or two years (Table III).…”

Section: Degree Of Mitral Stenosismentioning

confidence: 91%

Determination of Success After Mitral Valvotomy

Mounsey¹

1957

BMJ

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The object of this paper is to describe the progress during two to six years of patients following mitral valvotomy for mitral stenosis at the London Hospital, and to emphasize the relative importance of circulatory obstruction, the state of the myocardium, and other factors in determining clinical improvement after operative treatment. Description of the Material and the InvestigationOne hundred patients, operated upon by Mr. Vernon Thompson and Mr. Geoffrey Flavell and under the care of the cardiac department, were followed before, during, and after operation by one observer. There were 71 women and 29 men in the series and their ages varied between 17 and 55 years. Fifty-six patients were in sinus rhythm before operation and the remainder in atrial fibrillation. In 68 patients the width of the heart was less than half that of the chest, measured in a postero-anterior radiograph, while in the remaining 32 patients it equalled or exceeded this measurement. Significant pulmonary hypertension was present in 47 patients. Associated valve defects, complicating dominant mitral stenosis, included mitral incompetence which was slight in 30 and considerable in 10 patients, aortic stenosis in 3, and aortic incompetence which was judged to be slight in 17 and moderate in 5. In addition 7 patients had pulmonary incompetence from pulmonary hypertension. No patient with tricuspid stenosis or organic incompetence before operation was included in this series. Severe emphysema and chronic bronchitis were present in four patients.A detailed history was taken; this not only provided a subjective account of the patient's exercise tolerance but also afforded an opportunity of getting to know the patients, and their reaction to the disease, which was thought to be an important factor in the selection of patients for mitral valvotomy. In addition, in 47 patients pre-and post-operative exercise tests were carried out, the patient being tested on his ability to climb the hospital stairs.Clinical examination included an electrocardiogram, using the standard leads and CR leads 1, 4, and 7, with the addition of full circumferential V leads in patients with doubtful right ventricular hypertrophy. Teleradiograms were obtained in every patient and each patient was screened, special care being taken to recognize calcification of the mitral valve. Phonocardiograms were recorded before and after operation in 68 patients.Cardiac catheterization was carried out in 10 patients, and was reserved for those in whom some adverse complicating lesion was present or suspected.While in hospital awaiting mitral valvotomy, patients, including those in sinus rhythm, were given full doses of digitalis in order to prevent a rapid heart rate, should atrial fibrillation occur during or shortly after operation. A mercurial diuretic was given where indicated. A strict low-salt diet was in general avoided before operation, in the belief that it predisposed to serious electrolyte disturbances during the immediate post-operative period.At operation a careful apprais...

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“…The incidence quoted in the literature (Sellors et al, 1953 ;Bailey, 1955) has varied between 4% and 7%.…”

Section: Operative Datamentioning

confidence: 99%