Second closed mitral valvotomy for recurrent mitral stenosis.

Sixty-seven patients undergoing a second closed mitral valvotomy between 1957 and 1974 have been reviewed. Since 1951, 510 patients have had a primary closed valvotomy in the same unit. The incidence of restenosis severe enough to warrant further surgery is higher after a finger fracture procedure (40%) than after a Tubbs dilator valvotomy (9.2%). There is an operative mortality of 10.4%, and a further late mortality of 23.8% after a second closed valvotomy. Of the surviving patients, 70.5% have had a good or excellent result. The group with poor results is characterised by the presence of a calcified fixed valve, making valvotomy difficult and incomplete. In the presence of a non-calcified valve, a second valvotomy still has a place when surgery for restenosis is required.