Reoperation for Mitral Stenosis.

SIGNIFICANT clinical improvement after valvuloplasty for mitral stenosis can be anticipated in 70 per cent of group III patients followed 5 years and 52 per cent of those in group IV1 Nevertheless, the first 1,000 patients in our series have been followed from 2 to 9 years, and some degree of deterioration after an initially favorable result was found in 228. Critical scrutiny of the factors involved in this deterioration should lead to better selection of patients, to the evolution of better operations, and perhaps to the prevention of " restenosis. " In the analysis of the results,' 3 factors appeared to be particularly responsible for deterioration: inadequate initial surgical correction (45 per cent) ; mitral insufficiency preexisting or following operation (22 per cent); and recurrence of rheumatic fever (17 per cent). Many of these patients have seemed suitable for reoperation. Experience gained at these second operations has not only emphasized the seriousness of an inadequate initial operation but has underlined the difficulties and hazards of the usual method of reoperation. Dissatisfaction with the safety and results of the old method of reoperation prompted the development of the new procedure, presented here. This new technic has been chosen after careful consideration and trial of the right* sided approach as advocated by Neptune