Mitral stenosis in West Indian patients: results of closed mitral commissurotomy (1955-1985) at the University Hospital of the West Indies - abstract

ABSTRACT

Mitral stenosis (MS) is not infrequently seen in patients presenting at referral clinics in the University Hospital (UH). These patients are offered surgical palliation - Closed mitral commissurotomy (CMC) - as published reports indicate such therapy is quite satisfactory. A study of all patients subjected to CMC for MS at UH was undertaken to evaluate the results of this operation. There were 97 women and 23 men and their ages ranged from 9 to 57 years (mean 24.7). A clinical diagnosis of MS was made in all patients. Thirty-four and 28 patients were subjected to cardiac catheterisation and echocardiography respectively to confirm the clinical diagnosis and /or to exclude other cardio-vascular abnormalities. The operative procedures performed were as follows CMC - 117, CMC + lung biopsy - 1, Thoracotomy - 1, Prosthetic aortic and mitral valve replacement (failed CMC) - 1, Total = 120; Subsequent operations performed were as follows- CMC - 1, Homograft mitral valve replacement - 5, Porcine xenograft mitral valve replacement - 3, Tracheostomy - 1, Thoracotomy (tamponade2, no tamponade 2) - 4, Total = 14. There were 3 intra-operative deaths (left coronary embolus, bleeding, acute cardiac failure), a 2.5 per cent mortality. Five and 9 patients died in the early and late post-operative periods respectively (cardiac failure, systemic embolisation, re-stenosis, re-operative), 4.2 and 7.5 per cent mortality. Follow-up studies after CMC indicate adequate symptomatoic relief over a period of 1 to 27 years. The results of CMC at UH indicate that the techniques of anaesthesia and surgery are associated with low morbidity and mortality. Patients with MS should therefore be considered for surgical palliation (AU)