Surgical treatment of mitral stenosis

Indications:

• dyspnoea despite control of atrial fibrillation:
• operation is required before atrial fibrillation becomes irreversible
• calculated valve area < 1.5 cm sq with signs of critical stenosis
• gradient of more than 10 mmHg across valve

Technique:

• if there is a mobile valve (as demonstrated by the presence of a loud first sound and opening snap, or by echocardiography) -> mitral valvotomy
• rigid calcified valve -> mitral valve replacement

Results:

• closed mitral valvotomy:
  • mortality 3%
  • perioperative embolism 2%
  • restenosis 2% per year
    
    
• open mitral valvotomy:
  • mortality 3%
  • less risk of embolism
  • long-term function is better
    
    
• mitral valve replacement:
  • mortality 7%
  • embolism and thrombosis 5%