title: [Contribution of closed mitral commissurotomy in the surgery of rheumatic mitral stenosis].
abstract: The objective of this work was to study the indications, techniques and results of closed heart mitral commissurotomy in patients with rheumatic mitral stenosis in Morocco.
  
  
  METHODS
  All patients who had undergone closed heart mitral commissurotomy for rheumatic mitral stenosis, operated between 1999 and 2008 were collected in this study. Mitral stenosis was diagnosed and evaluated using Doppler echocardiography. Patients with commissural calcification, severe mitral regurgitation, and surgical tricuspid or aortic valvular disease were excluded from this study.
  
  
  RESULTS
  Six hundred and twenty-five patients have been collected. 62.2% were young with an age between 18 and 35 years and 491 (78.8%) were female. Seventy-nine percent of patients had stage III or IV NYHA and were in sinus regular rhythm. The closed heart mitral commissurotomy was performed for all patients through a left thoracotomy using either digital or dual dilatation. The mitral area was significantly increased postoperatively to 2.11 ± 0.32 with 100% opening of the anterior commissure, while the posterior commissure was opened only for 93.7% of patients. There were nine perioperative deaths (4.9%) and all patients who died had severe mitral stenosis (<0.8 cm(2)) with an elevated systolic pulmonary artery pressure (>60 mmHg).
  
  
  CONCLUSIONS
  The closed heart mitral commissurotomy provides excellent results in young patients with rheumatic mitral stenosis.
authors: Département de chirurgie cardio-vasculaire A, hôpital Ibn Sina, Rabat, Maroc. fadoulachhab@hotmail.com
authors: F
authors: F
authors: Lachhab
authors: M
authors: M
authors: Rifai
authors: H
authors: H
authors: Ouald Ali
authors: R
authors: R
authors: Sayah
authors: J
authors: J
authors: Rhissassi
authors: C
authors: C
authors: Benlafquih
authors: A
authors: A
authors: Bakkali
authors: H
authors: H
authors: Benyoussef
authors: M
authors: M
authors: Messouak
authors: M
authors: M
authors: Rahali
authors: Y
authors: Y
authors: Cheikhaoui
authors: A
authors: A
authors: Slaoui
authors: S
authors: S
authors: Ahid
authors: S
authors: S
authors: Belhaj
authors: W
authors: W
authors: Maazouzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004106:Dilatation / Q000379:methods*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications*; D055815:Young Adult