Conservative Mitral Valve Surgery

Once extracorporeal circulation became safe to use, surgical treatment of mitral stenosis under direct vision was recommended and progressively implemented. Initially, only open heart commissurotomy was performed, rapidly followed by papillary myotomy of the subvalvular apparatus. When there was significant mitral incompetence, the patient was considered to be a candidate for valve replacement. The description of new valvular reconstruction techniques [1, 2] aimed mainly at treating mitral incompetence has progressively modified the concept of open heart mitral surgery. At the present, a new attitude toward all mitral surgery is taking place; it is considered as such from the simple mitral commisurotomy to valve substitution that includes more or less complex valvular reconstruction procedures. It is the anatomic status of the valve that determines the selection of a certain technique and its restrictions rather than the preoperatory functional diagnosis of the valve as stenotic or incompetent.