[Comparison of long-term outcome of closed mitral commissurotomy (CMC) versus open mitral commissurotomy (OMC) and mitral valve replacement (MVR)].

To predict the late result of percutaneous mitral balloon valvotomy (PMV), we studied long term outcome of CMC which is similar to PMV in terms of closed heart technic, comparing with those of OMC and MVR. 226 patients with mitral stenosis were studied. 117 patients had CMC, 72 had OMC and 37 had MVR. The cumulative follow up period in these groups were 1892 patient year, 632 patient year and 200 patient year respectively. Postoperative actual survival rate at 5, 10, 15 years in CMC patients were 95 +/- 2%, 91 +/- 3%, 86 +/- 3% respectively. No operative or late death was seen in OMC or MVR patients. Postoperative event free rate at 10 years in OMC or MVR patients (97 +/- 2%, 90 +/- 6%, respectively) were higher than that in CMC patients (79 +/- 4%). Thromboembolism developed in 7 (6%) CMC patients, and 4 of these patients died from cerebral embolism. No patient in OMC or MVR group had thromboembolism. Reoperation was done for mitral restenosis or regurgitation in 40 CMC patients. 15 (38%) of these patients were associated with pulmonary hypertension, and 22 (55%) patients had secondary tricuspid regurgitation. On the other hand, only 1 OMC patient and 1 MVR patient had reoperation due to restenosis or thrombosed artificial valve. These results suggest that PMV should be indicated for restricted cases of mitral stenosis.