Abstract
The commissurotomy for the relief of mitral stenosis is now widespread and increasing. Numerous technics have been recommended and used. We experienced four technics, such as finger fracture, incision of the commissures with a transatrial valvotome (SAKAKIBARA type), use of transventricular dilator and open mitral commissurotomy using extracorporeal circulation.
From our experiences, transventricular mitral valvotomy obtains the most satisfactory results, when the usual closed commissurotomy is employed.
In some cases, however, it is difficult to regain the normal valve functions. This has been due usually to the extensive destruction or calcification of the mitral leaflets. It would be desirable to perform mitral commissurotomy under direct vision for these cases. But the mortality of the open operation is so high that it is not considered to be general technics. For that reasons, the open operation is advisable for I) secondary operation, II) patients with a previous embolus, III) patients with heavily calcified valves, IV) patients in whom some mitral regurgitation is suspected, and V) patients with congenital anomalies or multiple valve lesions. In future, we consider that the open operation is routine method for the relief of mitral stenosis.
We are also discussed postcommissurotomy complications and pre-and postoperative managements.
