Haemodynamics after mitral valvotomy. Reasons for unsatisfactory clinical results.

pure or predominant mitral stenosis before and 34 to 40 months after valvotomy. The patients were divided into 3 groups: pure mitral stenosis without increased pulmonary vascular resistance (group I, n =33), pure mitral stenosis with abnormal increase of pulmonary vascular resistance (group II, n= I2), and predominant mitral stenosis with mild insufficiency (group III, n= 9; all patients undergoing additional annuloplasty). In all 3 groups operation was followed by a significant decrease in mean left atrial pressure, a and v wave, and mean pulmonary artery pressure. A significant increase in cardiac index was observed only in group II, accompanied by a significant decrease of the raised pulmonary vascular resistance to almost normal levels. Effective working capacity (bicycle ergometry) increased for all 3 groups; yet this was significant only for groups X I and III. The mild postoperative resting gradient with an average of less than 6 mmHg, observed in almost all patients, was not related to unsatisfactory clinical results which were found mainly in patients with mitral valve calcification (5 of I5 patients not improved), whereas latent myocardial insufficiency or severe pulmonary hypertension was of lesser importance, as well as mitral restenosis (i patient) or valvotomy combined with annuloplasty. Thus, closed valvotomy still seems indicated for the majority of patients with pure mitral stenosis, even those with severe pulmonary hypertension. In the presence of moderate or extensive calcification, preference should, however, be given to mitral valve replacement.