Reconsiderations of mitral stenosis: rheumatic mitral valve repair and the Wilkins score.
BACKGROUND
Mitral valve repair is a feasible treatment option in patients with rheumatic mitral valve disease, but it is not always successful. Mitral valve replacement is generally the surgical treatment of choice in such patients. We aimed to examine whether the Wilkins score can predict the feasibility of surgical repair in such patients.


METHODS
Mitral valve surgery was performed on 14 patients by the same surgeon (A.A.). Five patients underwent mitral valve repair (group I), and nine patients underwent mitral valve replacement (group II). The Wilkins scores were determined by assessing echocardiography findings. The selection of mitral valve repair or replacement was based on the intraoperative findings and the preferences of the same surgeon (A.A.). In group I, we performed chordal reconstruction, augmentation of the posterior leaflet, resection of chordae, decalcification of the commissure, commissurotomy, slicing of the anterior leaflet, division of the papillary muscle, and ring annuloplasty in various combinations.


RESULTS
There were no significant differences between the two groups with regard to any component of the preoperative Wilkins score. There was no significant difference in the pre- and postoperative scores in group I; however, the mitral valve orifice area was significantly improved after the operation (pre- and postoperative mean values: 1.3 ± 0.3 and 2.0 ± 0.4, P < 0.05).


CONCLUSIONS
Mitral valve repair is effective in treating rheumatic mitral stenosis. However, the Wilkins score may not be useful in predicting the feasibility of mitral repair.
Department of Cardiovascular Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Haruka
H
Makinae
Department of Cardiology, Juntendo University, Tokyo, Japan.
Masao
M
Daimon
Department of Cardiovascular Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Keiichi
K
Tambara
Department of Cardiology, Juntendo University, Tokyo, Japan.
Sakiko
S
Miyazaki
Department of Cardiovascular Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Hiroshi
H
Iwamura
Department of Cardiovascular Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Hirotaka
H
Inaba
Department of Cardiovascular Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Taira
T
Yamamoto
Department of Cardiology, Juntendo University, Tokyo, Japan.
Hiroyuki
H
Daida
Department of Cardiovascular Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. a-amano@juntendo.ac.jp.
Atsushi
A
Amano
Cardiac surgery; Echocardiography; Mitral stenosis; Mitral valve repair; Valvular heart disease; Wilkins score