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The postoperative course of 294 patients with rheumatic mitral valve disease, who underwent mitral valve surgery during a period from July, 1978 to June, 1981, was studied by comparing the influences of the following clinical parameters: a low left ventricular ejection fraction (LVEF), a high pulmonary arterial systolic pressure (PASP), a high pulmonary vascular resistance (PVR), tricuspid regurgitation (TR), a high right ventricular end-diastolic pressure (RVEDP) and a giant left atrium (GLA). The patients with a functional capacity of class III or IV according to the New York Heart Association were classified into 3 groups (improved, unimproved and died), and from this data we calculated the improvement ratio and the mortality rate. The improvement ratios were 73% in patients with a low LVEF, 70% with a high PASP, 78% with a high PVR, 66% with TR, 11% with a high RVEDP and 77% with a GLA; the mortality rates were 19, 14, 17, 24, 78 and 19%, respectively. As compared with the case of deteriorated left ventricular performance and pulmonary hypertension, deteriorated right ventricular performance, especially high RVEDP, was accompanied by a comparatively poorer surgical prognosis. It is concluded that mitral valve surgery should be performed during the period in which the right ventricular function is still preserved.

japanese circulation journal

Surgery in Severe Rheumatic Mitral Valve Disease : Recognition of Severity and Risk Factors : Medical and Surgical Aspects of Treatment of "High Risk" Cardiovascular Diseases