Long-Term Results of Open Mitral Commissurotomy : Effects of Pathologic Features and Surgical Techniques

Of the 174 patients with mitral stenosis (MS) who underwent open mitral commissurotomy (OMC) at Nagasaki University Hospital between 1971 and 1988, the cases of the 50 pure MS patients who underwent OMC alone as the first operation were retrospectively investigated, and the indications for OMC in these MS patients were evaluated. According to the pathological features of the mitral valve (Types I-III) and operative methods used (r: radical OMC, c : conservative OMC), the patients were classified into 4 groups, groups I, IIr, IIc, and III, and we compared the changes in the mitral valve area before and after the operation and the cardiac functions and clinical status in the late postoperative period in these groups. In all groups, the mitral valve area was significantly increased in the early postoperative period, then gradually decreased, but on average it remained larger in the late postoperative period than before the operation. However, significantly larger mitral valve areas were maintained in the late postoperative period than those before the operation only in groups I and IIr. Group IIr showed the highest % increase of the valve areas in the late postoperative period. Furthermore, group IIr maintained the best NYHA cardiac function classes and the highest percentage of normal sinus rhythm on electrocardiograms in the same period. These results suggested that OMC was effective in the Types I and II MS patients, and the complete removal of subvalvular fusions with debridement of calcified foci was considered to be particularly effective for Type II patients to maintain the favorable operative effects and high quality of life for a long period

Simultaneous Combined Resection with Trachea, Bronchus and Aorta for Carcinoma of Thoracic Esophagus

Clinical experiences with combined sleeve resection of the trachea, bronchus and aorta with esophagectomy for esophageal cancer were reported in 6 cases including concurrent combined resection of the aorta and left main bronchus in one. 1) These cancers were advanced ones, showing nodal involvement of n2 in one, n3 in three and n4 in two. 2) In the three cases of combined resections of the aorta, it was made via left thoracotomy using preceding bypass with artificial vessel. There was no complication related to vascular surgery. 3) It must be prudent to determine the extent of the resection for involved trachea on the basis of an experience having recurrence at anastomosis. 4) It was sure that surgical outcome of combined resection was not necessarily satisfactory but improvement of it would be expected by avoiding early postoperative complication with meticulous postoperative care. 5) Based on our clinical experience with appearance of early lung metastasis following surgery, it is emphasized that potent multidisciplinary treatment is mandatory for improvement of the surgical result

Long-Term Results of Open Mitral Commissurotomy : Effects of Pathologic Features and Surgical Techniques

Of the 174 patients with mitral stenosis (MS) who underwent open mitral commissurotomy (OMC) at Nagasaki University Hospital between 1971 and 1988, the cases of the 50 pure MS patients who underwent OMC alone as the first operation were retrospectively investigated, and the indications for OMC in these MS patients were evaluated. According to the pathological features of the mitral valve (Types I-III) and operative methods used (r: radical OMC, c : conservative OMC), the patients were classified into 4 groups, groups I, IIr, IIc, and III, and we compared the changes in the mitral valve area before and after the operation and the cardiac functions and clinical status in the late postoperative period in these groups. In all groups, the mitral valve area was significantly increased in the early postoperative period, then gradually decreased, but on average it remained larger in the late postoperative period than before the operation. However, significantly larger mitral valve areas were maintained in the late postoperative period than those before the operation only in groups I and IIr. Group IIr showed the highest % increase of the valve areas in the late postoperative period. Furthermore, group IIr maintained the best NYHA cardiac function classes and the highest percentage of normal sinus rhythm on electrocardiograms in the same period. These results suggested that OMC was effective in the Types I and II MS patients, and the complete removal of subvalvular fusions with debridement of calcified foci was considered to be particularly effective for Type II patients to maintain the favorable operative effects and high quality of life for a long period