Long-term evolution of mitral commissurotomy in rheumatic patients with low echocardiographic score.

INTRODUCTION: The good results of open mitral commissurotomy are well known and there is a hypothesis that it could provide better results in patients selected by echocardiographic score.

OBJECTIVE: The purpose of this study is to analyze the late results with open mitral commissurotomy in patients selected by score and to identify variables influencing these results.

METHODS: From January 1990 to August 1994, 50 patients were submitted to open mitral commissurotomy due to rheumatic mitral stenosis in Heart Institute of University of Sao Paulo Medical School. Patients with age < 60 years, in functional class II, III or IV (New York Heart Association) and echocardiographic score 9 were included. The mean age was 32.7 ± 8.3 years and 41 patients (82%) were female. The functional class was II in three patients (6%), III in 46 (92%) and IV in one (2%). Forty six patients (92%) were in sinus rhythm and four (8%) were in atrial fibrillation. The mean mitral valve area was 0.9 ± 0.2 cm².

RESULTS: There was no hospital mortality. There were two late deaths, one related to valve disease. Actuarial survival was 95.5 ± 3.1 %, freedom from reoperation was 62.3 ± 11,8% and freedom from tromboembolism was 88,2 ± 5,0% in 18 years. There was no endocarditis. The grade of the echocardiographic score had no significant influence on the reoperations in late evolution.

CONCLUSION: Open mitral commissurotomy presented excelent long term results in rheumatic patients with low echocardiographic score.