RECURRENT MITRAL STENOSIS

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Abstract
• Analysis of the results of mitral commissurotomy in 1,000 patients revealed that 22 had recurrent symptoms caused by restenosis. Six of the 22 had given evidence of clinical improvement for one or more years after the original operation but subsequently developed congestive heart failure and died; at autopsy they were found to have a severe degree of mitral stenosis due to refusion of the parts that had been separated surgically. In the other 16 reoperation was done because of the recurrence of symptoms, and direct examination of the restenosed valves was possible. Data from all 22 patients are tabulated, and six of the histories are given in some detail. Evidence of continued active rheumatic endocarditis was found in some cases. Simultaneous catheterization of right and left sides of the heart proved valuable in establishing the diagnosis of restenosis. Recent improvements in technique include a right-sided approach to the mitral valve. This permits a more complete separation of the valve elements and should reduce the incidence of restenosis.

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