Surgical treatment of mitral incompetence.

Abstract

Fifty-one patients were treated by repair for mitral incompetence and followed for 4 to 45 months. Criteria for assessing severity, which is related to valvular incompetence and to the equally important myocardial damage, are described. Twenty-eight patients were classified as having severe or very severe rheumatic heart disease, 23 moderately severe disease, and none mild. Clinical manifestations are discussed in detail. An ecg pattern of left ventricular hypertrophy was infrequent in comparison with its incidence in patients with aortic valvular disease of comparable severity. Most patients were investigated by cardiac catheterization and angiocardiography and the findings are described. Post-operative studies were carried out 1-12 months after operation in 20 patients. Of the 51 patients, 7 died as a result of the operation, 1 from a post-operative nursing accident. There were 2 late deaths. Three patients, early in the series, sustained cerebral damage at the time of operation but recovered. There has been no such occurrence in the past 18 months. One patient with moderate stenosis, calcification of the valve, and clot in the left atrium had a fatal cerebral embolism. Three patients subsequently sustained systemic embolism, 2 weeks, 4 weeks, and 10 months, respectively, after operation. In none had slot been observed. None was under treatment with anticoagulants at the time. Two have recovered almost completely and the 3rd has residual dysphasia. All patients are now treated with anticoagulants on a long-term basis. It is concluded that in the good and moderately good risk groups the surgical mortality is sufficiently low for operation to be advised earlier than had previously been the case, that long-term results will largely depend on the degree of previous myocardial damage caused by rheumatic myocarditis as well as mitral regurgitation, that early results in the majority of cases are encouraging, and that at present this technque, in suitable cases, is preferable to valve replacement.