Mitral Stenosis: Unexpected Improvement After Inadequate Valvotomy

Out of 150 consecutive valvotomies performed by one of us (K. F.) during 1951-7, 68 had a final valve size of 2.5 cm. or less. All operations were performed by the transatrial route, using the finger or a Brock's knife to achieve the "split." Eleven (16%) patients have died since operation: the cause of death was congestive cardiac failure in nine and cerebral embolus in two. Twenty-one cases have had re-operation, the details of which have already been published (Fraser and Kerr, 1962). Of the remaining 36, 35 have been traced and reviewed. When the patients were seen at the follow-up, account was taken of their exercise tolerance, liability to bronchitis, haemoptysis, and chest pain, and their digitalis requirements. Clinical, electrocardiographic, and chest x-ray examination of each patient was carried out. The results of the operation were graded as poor, good, or very good, depending upon our assess ment of exercise tolerance. Fifteen cases were graded as poor and 20 as good or very good. In an attempt to explain the variation in results these two groups were compared under the following headings: (1) duration of symptoms before operation ; (2) age at operation ; (3) findings at operation ; (4) time interval between operation and assessment ; (5) clinical findings at assessment ; (6) chest x-ray findings ; (7) B.C.G. records ; (8) histology of pulmonary lingula biopsies.