Role of Closed Mitral Valvotomy in Mitral Stenosis with Severe Pulmonary Hypertension
Lokeswara Rao Sajja MCh, FACS, Gopi Chand Mannam FRCS(CT)

Surgical closed mitral valvotomy (CMV) was performed in 27 patients with severe pulmonary arterial hypertension (PAH; pulmonary artery systolic pressure >100 mmHg). Preoperatively, the mean systolic pulmonary artery (PA) pressure was 107.85 ± 5.74 mmHg (range: 100-118 mmHg), mean mitral valve area (MVA) 0.704 ± 0.106 cm² (range: 0.5-0.91 cm²), and transmitral mean gradient 11.93 ± 1.54 mmHg (range: 10-15 mmHg). Mean echocardiographic mitral valve score was 6.37 ± 1.11 (range: 6-10). After CMV, the systolic PA pressure fell significantly to 33.33 ± 8.20 mmHg (range: 30-60 mmHg), MVA increased to 2.385 ± 0.248 cm² (range: 1.9-2.8 cm²), and transmitral mean gradient fell significantly to 2.44 ± 0.51 mmHg (range: 2-3 mmHg). There was no hospital mortality or incidence of significant (>2+) mitral regurgitation. During a mean follow up of 26.9 months, 23 patients were in NHYA class I, and four in class II. Surgical CMV is a safe procedure that results in a greater MVA in patients with mitral stenosis and systemic and suprasystemic PA pressures.