yes, if there is no facility for pbmv  and patient is suitable you can go ahead with cmv.

It is an interesting question. Though open Mitral commissurotomy is considered to be a safer procedure, ironic Mitral Stenosis usually due to Rheumatic fever is mostly seen in the poor third world countries. Access to facilities with open heart surgery programs (or facilities with interventional cardiology) is not easy for majority of the patients. Close mitral commissurotomy can give good medium to long term results in patients with mitral valve pathology suitable for  commissurotomy.

Closed mitral commissurotomy was used for decades with very good results. The results where much better than those achieved, more recently, with balloon dilatation.

The technique is simple and cost effective. However, open mitral commisurotomy was progressively implemented and unfortunately young surgeons did not learn how to perform closed mitral commissurotomy.

You can hardly find a recent comparison between closed and open heart mitral commissurotomy.

In my opinion this technique is not obsolete and should be teached by senior surgeons who have a large experience and are confident with this technique

It is an obsolete.

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It is a Class III guideline (Please check out the: ACC/AHA 2006 guidelines for the management of patients with valvular heart disease

Dear Murat, Do you know how long data from the guidelines are valuable?

You will be surprised? You should look at the article published in the JAMA, 2014; 311: 2092-2100. Durability of Class I American College of Cardiology/American Heart Association Clinical Practice Guideline Recommendation.

If a young surgeon with no experience in closed mitral commissurotomy but with large experience in open mitral commisurotomy published his results, the results will be in favor of open heart surgery. Nowadays, closed mitral commussurotomy is performed mainly in poor third world countries and are not published. As always, the human factor (i.e. the quality of the surgeon) is very important when you want to compare two techniques.

A good example today, on a different subject, is the comparison of on-pump and off-pump coronary artery bypass graft. This comparison is and endless debate.

One of the (very few) advantages of old age is learned experience.  I did many closed commissurotomies prior to availability of prosthetic valves and was an earlier investigator of open valve surgery--again hundreds of cases.  My opinion is that in rheumatic mitral stenosis the results of closed surgery, when done with experience (e.g., gained at autopsies) and understanding of the pathology, the results are always good and frequently excellent.  As mentioned by Drs. Zahidullah;  Durandy; & Gutti, circumstances vary. (I did a commissurotomy in Vietnam during the war--good outcome.).

Late stage pregnancy is the last group that I elected over open pump because of the fetus; religious objection  to blood transfusions is another good choice.

Dr. Duranty is absolutely correct.  Guidelines, like guide dogs, can mislead you!

I AGREE WITH DR PATE   CMC IS MAINLY DONE IN POOR COUNTRIES  AND IN  LATE PREGNANCY .

In National Heart Institute in Egypt, we did a lot of this cases with excellent, result, you can imagine, that some of that cases still have good result even after,of 25 years old, one of them relative to me, we did not have yet statistic for that approach to gave perfect answer, it just personal experience,  if any one have it, we are interested to know

Dear Ibrahim,

This confirm my opinion. Closed commissurotomy was not abandoned because of poor results but because cardiopulmonary bypass was becoming a "safe" routine technique and because it was expected that surgery under view control could be better. Short term, middle term and long term mortality are equivalent with the two techniques, but the incidence of re-operation is higher with closed commissurotomy, 

Short term morbidity is higher following open heart commissurotomy.

Unfortunately, most of the publications on closed commissurotomy were done in the past: Closed mitral commissurotomy for mitral stenosis CR Hanlon et al. Annals of Surgery 1968; 167:796-800. This interesting article demonstrates progress in the technique and good results, except for rigid and calcific valves.

Two more recent articles are of interest:

Ates A et al. Heart Surg Forum 2005;8: E55-59

Romanov EI et al. Kardiologlia 1992; 32/44-6

Closed mitral commissurotomy is an excellent procedure with long term benefit in a non-calcified valve if done with finger separation of subvalvular adhesion especially at the commissures