Reoperation for Mitral Stenosis

A series of 80 reoperations for mitral stenosis in 79 patients is reported and analyzed. The most important causes of deterioration after valvuloplasty for mitral stenosis are inadequate initial operation, restenosis, and mitral insufficiency. Generally more than one of these factors pertain. An adequate mitral valvuloplasty requires the complete opening of both the anterior and posteromedial commissures and the mobilization of the chordae tendineae from each other and from the wall of the ventricle. The advantages and limitations of closed reoperation, open reoperation, the right-sided approach, and the use of the transventricular valvulotome are reviewed. More complete correction of stenosis with mobilization of posteromedial, anterior, and subvalvular chordae is emphasized. This is attained by operating from both the ventral and dorsal aspects of the patient through a left posterolateral thoracotomy incision. An Ivalon operating tunnel sutured to the left atrial wall at reoperation makes it possible to carry out the more extensive valvuloplasty at reoperations. A lower operative mortality, better longterm results, and fewer instances of deterioration are anticipated when this concept of improved valvuloplasty is effected initially.