Surgery for Mitral Stenosis

Abstract

The renewed interest in surgery for mitral stenosis is reviewed and the progress of the past five years summarized. The present status of the indirect operation (pulmonary-azygos shunt) is discussed, and the notable advances with the direct attack (finger-fracture valvuloplasty and commissurotomy) have been brought up to date (May 1951) by means of a survey of selected centers here and abroad. Detailed information is available on 352 patients who have had an operation on the mitral valve. It is quite likely that the total now approaches 500 cases. The over-all operative mortality has been 15 per cent. Post-operative embolism occurred in 6 per cent. Clinical improvement in the majority has been prompt and striking, and this has been fully supported by catheterization data. An appraisal of the more remote effects must await the passage of time. Those most likely to benefit are patients under the age of 50 with only slight to moderate cardiac enlargement who are nevertheless seriously limited by pulmonary hypertension and congestion. A formidable procedure of this magnitude should be reserved for those in trouble; it has no place in the management of patients with little or no disability.