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Review
. 2023 May 1;50(3):e228007.
doi: 10.14503/THIJ-22-8007.

Closed Mitral Valvotomy: Celebrating 100 Years of Surgical History

Uberto Bortolotti  1 , Igor Vendramin  1 , Aldo Domenico Milano  2 , Ugolino Livi  1
Affiliations
Review

Closed Mitral Valvotomy: Celebrating 100 Years of Surgical History

Uberto Bortolotti et al. Tex Heart Inst J. .

Abstract

The year 2023 marks the 100th anniversary of the first successful valvotomy for mitral valve stenosis by Elliott C. Cutler in 1923. Closed-chest mitral valve commissurotomy developed further before being replaced by an open procedure after the advent of the heart-lung machine. Currently, because of the almost complete disappearance of rheumatic disease in the Western World, mitral commissurotomies are infrequently performed in those countries, although the procedure-either closed or open-is still performed in developing countries and select patients. This review retraces the 100-year journey from a historic operation to the current era-a milestone in the treatment of patients with mitral stenosis.

Keywords: Mitral valve; mitral valve stenosis; mitral valve surgery.

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Conflict of interest statement

Conflict of Interest Disclosure: The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Image of the valvotome Cutler and Levine used in 1923 for the first closed mitral stenosis procedure. The instrument, similar to a knife, was introduced through the left ventricular apex to blindly cut the valve commissures. Reproduced from Cohn. Annals of Thoracic Surgery. 56(5), 1187–1190. Reprinted with permission from Annals of Thoracic Surgery (Copyright ©1993). Elsevier. All Rights Reserved.
Fig. 2
Fig. 2
Image of a Tubbs mechanic dilator A) and its open tip B). C) Drawing showing insertion of the dilator in the left ventricle, guided into the mitral valve by the forefinger, introduced through the left atrial appendage.
Fig. 3
Fig. 3
Image of the mitral commissure-splitting instrument used by Earle B. Kay et al in 1960. The device was applied to the superior aspect of the index finger, which, once extended, exerted adequate pressure on the mitral leaflets to open the commissures. Reproduced from Sancho-Fornos et al. Thorax. 26(4), 486–487. Reprinted with permission from Thorax (©1971). BMJ Publishing Group Ltd & British Thoracic Society. All Rights Reserved.
Fig. 4
Fig. 4
Drawing showing the basic steps of open mitral commissurotomy. A) A No. 11 scalpel blade separates the fused commissures up to 1 to 2 mm from the mitral annulus; the commissures are cut following the dotted line. B) When needed, splitting the head of a papillary muscle or the fused chordae can be added.
See this image and copyright information in PMC

References

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