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The technique of mitral valvulotomy employed in twenty-one consecutive patients with mitral stenosis is presented. An anterior fourth intercostal space incision with division of the fourth costal cartilage has provided satisfactory exposure. The maneuvers of introduction and withdrawal of the finger without blood loss are described briefly. Digital dissection of the commissures is the standard procedure, but on occasion a valvulotome may be necessary to initiate the division of the commissures. Closure of the auricular appendage is done with multiple interrupted sutures. The amputated auricular appendage and a lung biopsy are studied for characteristic histologic changes. The use of procaine hydrochloride as intravenous injection, pericardial instillation, or myocardial infiltration has not been found necessary. Instead, quinidine is employed to reduce the complications produced by cardiac arrhythmias.
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Received: March 3, 1952
© 1952 Published by Elsevier Inc.