Late evolution of mitral commissurotomy in patients with low echocardiographic score.
OBJECTIVE
The purpose of this study was to analyze the late results with open mitral commissurotomy in patients with low echocardiographic scores and to identify variables influencing these late results.


METHODS
We studied 50 patients who underwent open mitral commissurotomy due to rheumatic mitral stenosis at the Heart Institute University of São Paulo Medical School. Enrolled patients had a Wilkins echocardiographic score <or=9 and a mean mitral valve area (MVA) of 0.94+/-0.19 cm(2). Patients underwent clinical, electrocardiographic, and echocardiographic evaluations preoperatively, immediate postoperatively, at 6 months, at 12 months, and then annually for 11 years.


RESULTS
There was no hospital mortality. During 383.58 patient/years of follow-up, there were two late deaths, one related to valve disease. Actuarial survival was 94.3+/-4.0% at 11 years. The linearized reoperation rate was 1.3% patient/year, and the linearized thromboembolism rate was 0.8% patient/year. No patients developed endocarditis. The mean MVA was 2.50+/-0.44 cm(2) during the immediate postoperative period, decreasing to 1.74+/-0.4 cm(2) over 60 months (P<0.01). Although it was 1.40+/-0.24 cm(2) at 132 months, variations observed after 60 months were not significant. In regard to MVA, patients with higher echocardiographic scores had worse late results than patients with low scores (P=0.002). Neither the grade of subvalvular apparatus involvement nor MVAs during the preoperative and immediate postoperative periods significantly influenced the late evolution of MVAs.


CONCLUSIONS
Open mitral commissurotomy produces satisfactory results in patients with low echocardiographic scores.
Instituto do Coração, Heart Institute University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, 2 andar, sala 7, Cerqueira César, CEP 05403-000 São Paulo, SP, Brazil. luciano.rapold@ig.com.br
Luciano Rapold
LR
Souza
Pablo Maria Alberto
PM
Pomerantzeff
Carlos Manuel
CM
de Almeida Brandão
Luiz Francisco
LF
Cardoso
Luis Ramón Virgen
LR
Carrillo
Luiz Felipe Pinho
LF
Moreira
Max
M
Grinberg
Sérgio Almeida
SA
de Oliveira
D000328:Adult; D000704:Analysis of Variance; D002315:Cardiopulmonary Bypass; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D015999:Multivariate Analysis; D018579:Patient Selection; D016019:Survival Analysis