Correction of mitral insufficiency under direct vision.

MANY ingenious closed or blind technics have been devised and enthusiastically advocated in the recent past for the surgical correction of mitral regurgitation. Invariably, success was transitory and such operations were short lived, to be replaced sinmilarly by others. During the past 3 years we have operated upon 82 patients with varying degrees of mitral insufficieney by the open-heart tech-nic. During this period there have been modifications and improvemenits in the technics, although the principles involved have remained essentially unchanged. For the first time, postoperative results have continued to warrant our initial enthusiasm. Pathology In 25 patients pure mitral regurgitation was found (table 1). There was generalized dilatation of the annulus fibrosus. The re-gurgitant jet was most proniounced through the posteromedial half of the valve orifice but also occurred in varying degrees throughout the valve. In only 1 patient was there a flail anterior leaflet from rupture of the chordae tendineae. More than adequate valvular tissue was present in all instances, even though in the nmajority there was some thickening of the leaflets with rolling of their edges. Seventeeni patients had predominanit mitral regurgitation but with significant degrees of mitral stenosis. The valve rings for the nmost part were fairly normal in size. The leaflets and chordopapillary structures showed greater degrees of thickening, although adequate val-vular tissue remained. The residual orifice was either centrally located and patulous or eccentrieally located and of the tear-drop va-riet.