title: Role of closed mitral commissurotomy for mitral stenosis: mid- and long-term surgical outcome of 36 patients.
abstract: OBJECTIVE
  To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years.
  
  
  METHODS
  Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 +/- 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours +/- 30 minutes.
  
  
  RESULTS
  After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm(2). No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade >or=3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients.
  
  
  CONCLUSIONS
  The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.
authors.affiliation: Department of Cardiovascular Surgery, Atatürk University School of Medicine, Erzurum, Turkey. azmanates@yahoo.com
authors.forename: Azman
authors.initials: A
authors.lastname: Ates
authors.forename: Yahya
authors.initials: Y
authors.lastname: Unlü
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yekeler
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Erkut
authors.forename: Ahmet Yavuz
authors.initials: AY
authors.lastname: Balci
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozyazicioglu
authors.forename: Hikmet
authors.initials: H
authors.lastname: Koçak
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications; D016019:Survival Analysis; D016896:Treatment Outcome