The Assessment of Cases for Mitral Valvotomy and the Results of Operation

IN certain cases of inactive rheumatic heart disease when the lesion is predominantly mitral stenosis dramatic results may be obtained from surgical relief of the valvular obstruction (Bailey, 1949; Glover, et al., 1950; Baker, et al., 1950, 1952). Unfortunately, not all cases of mitral stenosis will benefit from operative interference. The major difficulty associated with the surgical treatment of rheumatic heart disease is that of deciding in which case, and at what stage in the course of the disease, operative interference is required. The responsibility for this decision is borne by the physician. In some cases it will be easy to determine whether or not benefit will be obtained from operation; in others it may be a matter of considerable difficulty. The object of this communication is to discuss the selection of patients for mitral valvotomy and to report 121 cases, 105 of whom were selected for this operation by one of us (J.F.P.). Mitral valvotomy is obviously indicated if a patient is becoming progressively incapacitated and the condition is one of "pure" mitral stenosis, i.e., mitral stenosis uncomplicated by significant mitral incompetence or aortic valvular involvement. It is apparent that by no means all patients with "pure" mitral stenosis are sufficiently incapacitated to require operation. The proper selection of cases requires therefore: (a) Information regarding the effects of mitral valvular obstruction on the circulation. (b) A clinical classification of patients suffering from the disease.