Open mitral commissurotomy for recurrent mitral stenosis after closed commissurotomy.

We evaluated the long-term results in 43 patients who had undergone open mitral commissurotomy for recurrent mitral stenosis after closed commissurotomy. There was one operative death (2.3 percent) and one case of reoperation (2.3 percent). Twenty patients (42 percent) were in NYHA Class I and 22 patients (51 percent) in Class II. In 12 randomly selected patients subjected to postoperative cardiac catheterization, the pulmonary arterial mean pressure remained high at rest and increased to 48 mmHg (mean) during exercise with significant differences in patients who underwent open mitral commissurotomy in the first operation (control group). The left atrial mean pressure was significantly high at rest and rose to 27 mmHg (mean) during exercise. The pulmonary vascular resistance also increased during exercise, with significant differences for the control group. We conclude from these studies that the less satisfactory clinical improvement in patients undergoing reoperation apparently was related to advanced pathology of the mitral valve and development of pulmonary vascular disease.