Closed mitral valvotomy: actuarial analysis of results in 654 patients over 12 years and analysis of preoperative predictors of long-term survival.

The records of 654 patients with mitral stenosis who underwent closed mitral valvotomy over a 12-year period were submitted to actuarial analysis. This revealed a low (2.97%) operative mortality. At 12 years, the overall cumulative proportion surviving was 78%; 47% of patients survived without reoperation. The usual clinical indicators of suitability for closed valvotomy were successful in predicting improved survival. The surgeon's assessment of the suitability of the valve correlated well with outcome. Valvotomy during pregnancy was associated with a good long-term outlook. The presence of pulmonary hypertension and atrial fibrillation did not alter survival significantly. Sex ane age were not associated with adverse prognosis. We conclude that closed mitral valvotomy still has a place in the management of mobile mitral stenosis, particularly in areas where there is a high incidence of rheumatic heart disease and a large number of young patients have mobile mitral stenosis.