Mitral Commissurotomy in Patients with High Pulmonary Arterial Pressure

The 46 patients with pulmonary arterial hypertension out of 125 cases of mitral commissurotomy undergone during the 17 years period ending in April, 1975, were separaterly studied to find the clinical significance of pulmonary hypertension in mitral stenosis.

They were in progressed symptomatic distress and 91.4% were in NYHA Class III and IV. The electrocardiogram had the characteristic findings of right axis deviation and right ventricular hypertrophy in most of the cases. The valvular calcification was present in 39.1% and the left atrial thrombi in 21.7% of the cases. Preoperative pulmonary capillary pressure and intraoperative left atrial pressure recorded in part of the patients were high (average 34mmHg) and demonstrated the severe degree of stenosis along with the pronounced degree of surgically estimated valvular narrowing.

Comparing with the cases without pulmonary hypertension, the need of open mitral commissurotomy according to the criteria was hiher in the reported cases. Twenty-eight patients (60.9%) underwent closed valvulotomy with hospital deaths of 2 (7.1%) and 18 patients (39.1%) open valvulotomy with 6 deaths (33.3%), the overall hospital mortality of 17.4%.

The hemodynamic sudies after surgery proved the beneficial effects of mitral commissurotomy on the intraoperative postcommissurotomy left atrial pressure and in 5 cases of recatheterization. The phonocardiographic measurements reflected the hemodynamic results. Clinical improvement was achieved in 79.3% of the 29 cases known and alive with single late death in the follow-up upto 8 years 3 months of the longest.

The stress in discussion was placed on the significance of pulmonary hypertension in mitral stenosis which reflected the severe degree of stenosis and the more damaged valve and on the importance of achieving the good relief of stenosis which might be possible only with open surgery, although its risk was yet high in this report.