The place of closed mitral valvotomy in the modern cardiac surgery era.

Rheumatic mitral stenosis continues to be a major public health problem in developing countries. Rheumatic heart disease is usually encountered following streptococcal infections in the socioeconomically poor communities. The first successful results of closed mitral valvotomy (CMV) were reported by Cutler and Levine in 1923 (1) and by Souttar in 1925 (2). During the 1940s, when social conditions were poor and cardiopulmonary bypass (CPB) not yet available, Harken and colleagues utilized a CMV technique, with successful outcome (3). Following the first direct approach to the mitral valve by Lillehei in 1957 (4), prosthetic valve replacement or valve reconstruction became the preferred technique to treat patients with mitral stenosis. Percutaneous mitral valvotomy, which was first introduced by Inoue et al. in 1984 (5), provided comparable results with CMV in the treatment of mitral stenosis. Today, in industrialized countries CMV has been largely abandoned in favor of percutaneous mitral balloon valvuloplasty (PMBV), despite the latter method being very costly. Nonetheless, CMV remains an alternative approach in developing countries due not only to its low cost, short duration of hospital stay and lack of any need for postoperative anticoagulation, but also to its preservation of the native valve in women of child-bearing age. Herein, the results are presented of the long-term follow up of 1,134 patients with pure mitral stenosis who underwent CMV over a 36-year period between 1964 and 2002. Address for correspondence: Dr. Ufuk Tutun, Doktorlar 91 Sitesi 688, Sokak No: 11/11 06530 Umitkoy, Cayyolu-Yenimahalle, Ankara, Turkey