Article

lock Open Access lock Peer-Reviewed

16

Views

ORIGINAL ARTICLE

Open mitral commissurotomy: how are the longterm results?

Antoninho S ArnoniI; W. J CoutoI; Jarbas J DinkhuysenI; Paulo ChaccurI; Zilda M MenegheloI; Luiz Carlos Bento de SouzaI; Adib D JateneII; Paulo P PaulistaI

DOI: 10.1590/S0102-76381990000200006

ABSTRACT

To evaluate a longterm evolution of patients who were submitted to an open mitral commissurotomy, we studied 100 patients who were operated upon between 1962 and 1975. They have had follow-up in the Instituto Dante Pazzanese de Cardiologia for the minimum of 14 years. Sixty-six were women and 24 were men. Their ages ranged from 11 to 50 years, and the media was 30.8 years. Sixty-five patients were reoperated and 18 of them were submitted to a new commissurotomy; in one a revascularization was done; in one the replacement of tricuspide valve; and in 45 times the valve was replaced (43 biological prosthesis and 2 metalics). The medium time among he first and the second surgery was 13.6 years. There wasn't any death among the reoperations. Thirty five patients keep in evolution of the first surgery, the medium time is 17.2 years (minimun 14 years and maximum 27 years). Ten are in the NYHA functional class I, 17 in II, seven in III and one in class IV. After this time of evolution, 52 patients are with their natural valves, showing good evolution of the mitral commissurotomy.

RESUMO

Procuranco saber qual a evolução a longo prazo daqueles pacientes submetidos a comissurotomia mitral há mais de 14 anos, analisamos 100 pacientes, operados entre 1962 e 1975 e que tiveram seu acompanhamento no Instituto Dante Pazzanese de Cardiologia. Muitos pacientes foram operados nesse intervalo, mas não tiveram seu seguimento em nossa Instituição e não foram considerados. Setenta e seis eram do sexo feminino e 24 do masculino, com idades variando de 11 a 50 anos, com média de 30,8 anos. Sessenta e cinco pacientes foram reoperados, sendo que em 18 ocasiões realizou-se outra comissurotomia, em um fez-se a revascularização, em um substituição da valva tricúspide; em 45 vezes a valva foi substituída (43 próteses biológicas e duas metálicas). O tempo médio entre a primeira e a segunda cirurgias foi de 13,6 anos. Não houve óbitos na reoperação. Trinta e cinco pacientes continuam em evolução da primeirs cirurgia, com um tempo médio de 17,2 anos, com um mínimo de 14 anos e um máximo de 27 anos. Dez estão no grupo funcional I, 17 no II, sete no III e um no grupo IV. Desta forma, dos 100 pacientes iniciais, 52 ainda estão com suas valvas naturais, mostrando que, apesar de a evolução da doença poder levar a alterações nas valvas operadas, a comissurotomia mitral consegue uma boa evolução a longo prazo.
Full text available only in portuguese PDF format.

REFERENCES

1. AKINS, C. W.; KIRKLIN, J. K.; BLOCK, P. C.; BUCKLEY, M. J.; AUSTEN, G. - Preoperative evaluation of subvalvar fibrosis in mitral stenosis. Circulation, 60: 71-76, 1979. [MedLine]

2. ANTUNES, M. J.; MAGALHÃES, M. P.; COLSEN, P. R.; KINSLEY, R. H. - Valvoplasty for rheymatic mitral valve disease: a surgical challenge. J. Thorac. Cardiovasc. Surg., 94: 44-56, 1987. [MedLine]

3. ARNONI, A. S.; SALERNO, P. R.; HENRIQUES NETO, A. T. M.; DINKHUYSEN, J. J.; CHACCUR, P.; ABDULMASSIH NETO, C.; NAVARRO, S. L.; ESTEVES, C. A.; RAMOS, A. I. O.; SOUSA, J. E. M. R.; JATENE, A. D.; SOUZA, L. C. B.; PAULISTA, P. P. - O papel do cirurgião nas valvopatias reumáticas tratadas com valvoplastia percutânea. Rev. Bras. Cardiovasc., 4: 51-63, 1989.

4. BAILEY, C. P. - The surgical treatment of mitral stenosis (mitral comissurotomy). Dis. Chest., 15: 377-389, 1949.

5. CAMARANO, G. P.; POMERANTZEFF, P. M. A.; JATENE, F.; BARBERO-MARCIAL, M.; MORAES, A. V.; GRINBERG, M.; BELLOTTI, G.; PILEGGI, F. J. C.; JATENE, A. D. - Avaliação do tratamento cirúrgico da valva mitral através de ecocardiografia intra-operatória. Arq. Bras. Cardiol., 50: 237-242, 1988. [MedLine]

6. CARPENTER, A.; CHAUVAUD, S.; FABIANI, J. N.; DELOCHE, A.; RELLAND, J.; LESSANA, A.; D'ALLAINES, C. L.; BLONDEAU, P.; PIWNICA, A.; DUBOST, C. - Reconstructive surgery of mitral valve incompetence: ten year appraisal. J. Thorac. Cardiovasc. Surg., 79: 338-348, 1980. [MedLine]

7. COSGROVE, D. M.; CHAVES, A. M.; LYTLE, B. W.; GILL, C. C.; STEWART, R. W.; TAYLOR, P. C.; GOORMASTIC, M.; BORSH, J. A.; LOOP, F. D. - Results of mitral valve reconstruction. Circulation, 74: 182-187, 1986.

8. CUTLER, E. C. & BECK, C. S. - The present status of the surgical procedure in chronic valvular disease of the heart. Arch. Surg., 18: 403-416, 1929.

9. DEKKER, A.; BLACK, H.; VON LICHTENBERG, F. - Mitral valve restenosis: a pathologic study. J. Thorac. Cardiovasc. Surg., 55: 436-446, 1968.

10. DURAN, C. G.; REVUELTA, J. M.; GAITE, L.; ALONSO, C.; FREITAS, M. G. - Stability of mitral reconstructive surgery at 10-12 years for predominantly rheumatic valvular disease. Circulation, 78: 191-196, 1988.

11. GALLOWAY, A. C.; COLVIN, S. B.; BAUMANN, G.; ESPOSITO, R.; VOHRA, R.; HARTY, S.; FREEDBERG, R.; KRONZON, I.; SPENCER, F. C. - Long-term results of mitral valve reconstruction with Carpentier techniques in 148 patients with mitral insufficiency. Circulation, 78 (Supl. 1): 97-105, 1988.

12. GERMANI, S.; MESSMER, B. J.; HALLMAN, G. C. - Open mitral commissurotomy. J. Thorac. Cardiovasc. Surg., 62: 366-368, 1971.

13. GROOS, R. I.; CUNNINGHAM Jr., J. N.; SNIVELY, S. L.; CATINELLA, F. P.; NATHAM, I. M.; ADAMS, P. X.; SPENCER, F. C. - Long-term results of open mitral commissurotomy: ten-year follow-up study of 202 patients. Am. J. Cardiol., 47: 821-825, 1981. [MedLine]

14. HALSETH, W. L.; ELLIOT, D. P.; WALKER, E. L.; SMITH, E. A. - Open mitral commissurotomy: a modern re-evaluation. J. Thorac. Cardiovasc. Surg., 96: 33-38, 1988. [MedLine]

15. HARKEN, D. E.; ELLIS, L. B.; WARE, P. F.; NORMAN, L. R. - The surgical treatment of mitral stenosis: I. Valvuloplasty. N. Engl. J. Med., 239: 804-808, 1948.

16. HERMANN, H. C.; WILKINS, G. T.; ABASCAL, V. M.; WEYMAN, A. E.; BLOCK, P.C.; PALACIOS, I. F. - Percutaneous balloon mitral valvotomy for patients with mitral stenosis. J. Thorac. Cardiovasc. Surg., 96: 33-38, 1988. [MedLine]

17. HIGGS, L. M.; GLANCY, D. L; O'BRIEN, K. P.; EPSTEIN, S. E.; MORROW, A. G. - Mitral restenosis: an uncommon cause of recurrent symptoms following mitral commissurotomy. Am J. Cardiol., 26: 34-37, 1970. [MedLine]

18. HOUSMAN, L. B.; BONCHEK, L.; LAMBERT, L.; GRUNKEMEIER, G.; STARR, A. - Prognosis of patients after open mitral commissurutomy: actuarial analysis of late results in 100 patients. J. Thorac. Cardiovasc. Surg., 73: 742-745, 1977. [MedLine]

19. INOUE, K.; OWAGI, T.; NAKAMURA, T.; KITAMURA, F.; MYIAMOTO, N. - Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J. Thorac. Cardiovasc. Surg., 87: 394-402, 1984. [MedLine]

20. KENNEDY, J. W.; DOCES, J. G.; STEWART, D. K. - Left ventricular function before and following surgical treatment of mitral valve disease. Am. Heart J., 97: 592-598, 1979. [MedLine]

21. KYO, S.; TAKAMOTO, S.; MATSUMURA, M.; ASANO, H.; YOKOTE, Y.; MOTOYAMA, T.; OMOTO, R. - Immediate and early post-operative evaluation of results of cardiac surgery by transesophageal two dimensional doppler echocardiography. Circulation, 76 (Supl. 5): 113-121, 1987.

22. McGOON, D. C. - Repair of mitral insufficiency due to ruptured chordae tendinae. J. Thorac. Cardiovasc. Surg., 39: 357-362, 1960.

23. MANTEUFFEL-SZOEGE, L.; NOWICKY, J.; WASNIEWSKA, M.; SITKOWSKI, W.; TURSKI, C. - Mitral commissurotomy: results in 1700 cases. J. Cardiovasc. Surg., 11: 350-354, 1970.

24. MULLIN, M. J.; ENGELMAN, R. M.; ISOM, O. W.; BOYD, A. D.; GLASMANN, E.; SPENCER, F. C. - Experience with open mitral commissurotomy in 100 consecutive patients. Surgery, 76: 974-982, 1974. [MedLine]

25. PALACIOS, I.; BLOCK, P. C.; BRANDI, S.; BLANCO, P.; CASAL, H.; PULIDO, J. I.; MUNOZ, S.; D'EMPAIRE, G.; ORTEGA, M. A.; JACOBS, M.; VLAHAKES, G. - Percutaneous balloon valvotomy for patiens with severe mitral stenosis. Circulation, 75: 778-784, 1987. [MedLine]

26. SMITH, W. M.; NEUTZE, J. M.; BARRATT-BOYES, B. G.; LOWE, J. B. - Open mitral valvotomy: effect of preoperative factors on results. J. Thorac. Cardiovasc. Surg., 82: 738-751, 1981. [MedLine]

27. STARR, A. & EDWARDS, M. L. - Mitral replacement: clinical experience with a ball valve prosthesis. Ann. Surg., 154: 726, 1961. [MedLine]

28. VEGA, J. L.; FREITAS, M.; MARTINEZ, R.; GALLO, J. I.; GUTIERREZ, J. A.; COLMAN, T.; DURAN, M. G. - Open mitral commissurutomy. Ann. Thorac Surg., 31: 266-270, 1981. [MedLine]

CCBY All scientific articles published at www.bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2024 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY