Deterioration after mitral valvotomy.

It is now more than ten years since the introduction of mitral valvotomy. The initial results (Baker, Brock, and Campbell 1950; Baker et al., 1952) and a three-year follow-up of the first 45 Guy's cases (Baker et al., 1955) have been published. We now report a larger group of 200 patients followed up for over five years, which allows a more complete assessment of the long-term benefits of mitral valvotomy and of the incidence of restenosis and other causes of deterioration. The details and length of the follow-up were as follows. In a consecutive series of patients referred to Guy's Hospital there were 239 operations between September 16, 1948 and November 6, 1953. Of these 239 patients 12 were excluded, 7 because their operation was for dominant mitral regurgitation, 2 because the stenosis at operation was insignificant, and 3 because follow-up was not possible. There were, in addition, 27 operative deaths, a mortality of 11-3 per cent. These 39 patients are not further considered, leaving 200 patients followed up for over 5 years after valvotomy, 98 for over 6 years, 36 for 7 years, and 8 for 8 years or more. Clinical assessment has been made at yearly intervals using the grades of disability previously defined (Baker et al., 1952), which are briefly: 0, no disability; 1, slight disability; 2, moderate disability; 3, severe disability; and 4, total incapacity. Improvement of 3 or more grades is considered an excellent result, of two grades a good result, of one grade a fair result, and no grade of improvement a poor result. For simplicity in reviewing these patients, the good and excellent results have been classed together as "good ", and the poor and fair results have been classed together as " poor ". Those who deteriorated after having good results for one year or longer are classed as "deteriorated." In discussing the causes of deterioration they are compared with the good results who have maintained their improvement to date.