Recurrent Stenosis of the Mitral Valve

REPEAT mitral commissurotomy has become necessary when there is evidence of refusion of the mitral valve. Patients presenting with evidence of recurrent mitral stenosis have been classified by Belcher' into two groups, i.e., "true" and "false" restenosis. In the true type, stenosis occurs after one or both commissures have been completely opened; false restenosis is that which occurs when neither commissure has been divided beyond the area of insertion of the papillary muscles. Whether or not a difference exists in the pathogenetic mechanism of these two types is not clear. Reactivation or a continued smoldering of the rheumatic process may cause restenosis of the diseased valve. Since a rigid valve is more likely to give trouble, division of both commissures, if at all possible beyond Broek's critical area of tendon insertion, should restore the valve to maximum mobility and reduce the chances of restenosis.2