Surgical treatment of mitral stenosis
Indications:
- dyspnoea despite control of atrial fibrillation:
- operation is required before atrial fibrillation becomes irreversible
- calculated valve area < 1.5 cm sq with signs of critical stenosis
- gradient of more than 10 mmHg across valve
Technique:
- if there is a mobile valve (as demonstrated by the presence of a loud first sound and opening snap, or by echocardiography) -> mitral valvotomy
- rigid calcified valve -> mitral valve replacement
Results:
- closed mitral valvotomy:
- mortality 3%
- perioperative embolism 2%
- restenosis 2% per year
- open mitral valvotomy:
- mortality 3%
- less risk of embolism
- long-term function is better
- mitral valve replacement:
- mortality 7%
- embolism and thrombosis 5%
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