What Is a Mitral Commissurotomy?

Mitral commissurotomy is a surgical treatment for mitral stenosis, where the mitral valve that controls the flow of blood to the left side of the heart narrows as a result of disease. There are a number of available treatment options for this heart condition including a full mitral valve replacement and a less invasive procedure to address the narrowed valve with a balloon catheter. A surgeon may recommend mitral commissurotomy if a patient clearly experiences health problems because of the stenosis.

Patients with this condition usually have a history of rheumatic fever in childhood and may seek treatment for heart problems as much as 20 years later. In these patients, the leaflets that make up the mitral valve have begun to fuse. This forces the heart to work harder and can lead to a dangerous increase in blood pressure, along with eventual heart failure. A surgeon can evaluate the patient to determine if he is a good candidate for the surgery.

In a mitral commissurotomy surgery, the surgeon will open up the chest and put the patient on cardiopulmonary bypass to access the heart. The surgeon can repair the valve, take note of any other issues in and around the heart, and close the surgical site. Patients may experience pain and discomfort during recovery as the incision heals, and typically need to curtail physical activities at least briefly to allow their bodies to fully heal.

After mitral commissurotomy, the mitral valve can still experience stenosis. The narrowing usually returns after an interval of healthy function. Patients can discuss this risk with their physicians to determine the most appropriate treatment for their needs. Because the surgery is invasive, a surgeon will usually not recommend the procedure unless it appears clinically necessary. Some stenosis may not be a cause for concern.

Treatment for this and other heart problems can require a patient to take time off from work or school for recovery. Patients may qualify for disability assistance and other benefits while they heal. After the mitral commissurotomy surgery, the doctor may also have some suggestions for the future maintenance of cardiovascular health, including diet and exercise modifications to help the patient lead a healthier life. The patient will also need a series of follow-up appointments to check on heart function and monitor the progress of post-surgical healing. These checkups allow doctors to catch returning stenosis early and make appropriate treatment recommendations.