Persistence of right ventricular hypertrophy following mitral valvotomy.

Severe pulmonary hypertension due to an increased hindrance to blood flow in the small pulmonary arteries frequently complicates mitral stenosis, and when this occurs electrocardiographic evidence of right ventricular hypertrophy (RVH) is invariably present. Mitral valvotomy is commonly undertaken in patients with such changes, though their reversibility is the subject of controversy and opinions differ as to the benefit to be obtained from operation. In view of these conflicting opinions we have reviewed the results of surgical treatment of sixty patients with mitral stenosis and cardiographic evidence of RVH, and find that in addition to excellent functional improvement in the majority, the electrocardiogram has returned to normal in almost 60 per cent of the survivors. METHODS Mitral valvotomy was performed in approximately 200 patients in the Manchester Royal Infirmary by Mr. Frank Nicholson between 1952 and 1957 and of these 54 had electrocardiographic evidence of RVH. A further 6 such patients were operated on in the Manchester Regional Thoracic Surgical Centre by Mr, Gordon Jack and Mr. John Dark. Eleven (18%4) of these 60 patients died within 24 hours of operation. The 49 survivors (14 men, 35 women) have been closely followed and the cardiographic changes related to functional improvement and the valve size estimated by the surgeon at operation. All patients were examined clinically and radiologically in the University Department of Cardiology, Manchester Royal Infirmary, before operation and were considered to have predominant mitral stenosis with associated pulmonary hypertension. Two had mild aortic regurgitation in addition and one tricuspid regurgitation. Patients were classified functionally, using the New York Heart Association's classification (1939) and all have been reviewed recently. Those operated on within the last six monlths were not included. Electrocardiograms were recorded before operation and at intervals after in all patients. The examination consisted of standard leads, augmented unipolar limb leads, and pr=ecordial leads VI to V6 using Wilson's central terminal. In two patients the standard leads only were recorded before operation.