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Surgical treatment of mitral stenosis

Authoring team

Indications:

  • dyspnoea despite control of atrial fibrillation:
  • operation is required before atrial fibrillation becomes irreversible
  • calculated valve area < 1.5 cm sq with signs of critical stenosis
  • gradient of more than 10 mmHg across valve

Technique:

  • if there is a mobile valve (as demonstrated by the presence of a loud first sound and opening snap, or by echocardiography) -> mitral valvotomy
  • rigid calcified valve -> mitral valve replacement

Results:

  • closed mitral valvotomy:
    • mortality 3%
    • perioperative embolism 2%
    • restenosis 2% per year

  • open mitral valvotomy:
    • mortality 3%
    • less risk of embolism
    • long-term function is better

  • mitral valve replacement:
    • mortality 7%
    • embolism and thrombosis 5%

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