FACTORS INFLUENCING THE LATE RESULTS OF MITRAL VALVULOPLASTY FOR MITRAL STENOSIS

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Abstract
A study is reported of various factors that affect the late results in patients with mitral stenosis operated by mitral valvuloplasty. It is based chiefly on a follow-up of the first 500 patients. Of the patients surviving operation 78% showed significant and usually persistent improvement over the observation period, which averaged 22 months. Factors leading to less favorable results were (1) age over 40; (2) auricular fibrillation; (3) associated aortic valve disease; (4) associated mitral insufficiency of moderate degree or more; (5) a preoperative valve size of more than 1.0 square cm; (6) a postoperative valve size of less than 2.5 square cm; (7) calcification of the mitral valve. Even in the less successful categories the over-all results were still good in a majority of the patients. Poor late results occurred in direct proportion to the number of adverse factors present. The operative mortality in Groups II and III is now less than 3% and appears to be below 1%. It is 20% in Group IV. The procedure appears to protect substantially against late peripheral embolization, although the incidence of operative emboli is somewhat greater in patients who have had previous emboli than in the groups as a whole. Good end results depend on intelligent and careful selection of patients and on the quality of the valvuloplasty performed.