Transventricular Mitral Valvotomy

IN THE rediscovery period of mitral surgery, beginning with the efforts of Harken and associates' and Bailey,2 3 it was clearly demonstrated that even a moderate increase in the size of the mitral orifice would improve the physiologic status of the patient considerably. However, as time went on it was apparent that finger fracture alone was not sufficient for many badly scarred and calcified valves. This observation led to the use of various types of knife and other devices to increase the valve orifice and to obtain some degree of mobility. Historically, instrumental means to open the valve were thought an essential approach to the solution of valve stenosiS.4 5 Thus, in 1912, Schepelmann6 used the transventricular approach to cut the mitral valve in experimental animals. The first successful human operation for the relief of mitral stenosis was performed through the left ventricle by Cutler in 1923, an attempt having been made to incise the valve blindly with a tenotome.7 A few years later Souttars definjitely demonstrated the feasibility and safety of finger fracture valvotomy. The belief that it was necessary to accept a degree of insufficiency in the effort to relieve the stenosis through instrumental means was questioned by Geoffrey Bourne in 1927,9 who emphasized that, if possible, extending the commissures was preferable to an incision into a valve cusp. In more recent history, Smithy, in 1948,10 employed the transventricular approach with success in several patients, although regurgitation was still accepted by him as a necessary aftermath of the operation. DuBost and coworkers"L introduced instrumental transatrial valvotomy, a blind operation that was done