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Commissurotomy is a procedure that separates fused commissures, which are junctions where tissue leaflets meet. In cardiovascular care, the term most commonly refers to opening fused heart-valve commissures to relieve valvular stenosis. Mitral commissurotomy is especially associated with rheumatic mitral stenosis. Treatment can be performed surgically or, in suitable patients, with a catheter-based balloon technique.
read more about commissurotomy ...Mitral commissurotomy is performed to enlarge a narrowed mitral valve opening and improve blood flow from the left atrium to the left ventricle. It can reduce symptoms such as shortness of breath, exercise intolerance, and pulmonary congestion when significant stenosis is present. Percutaneous mitral balloon commissurotomy is preferred for many patients with favorable rheumatic valve anatomy, no left atrial thrombus, and no more than moderate mitral regurgitation. Surgical commissurotomy can be considered when balloon treatment is unsuitable or another cardiac operation is needed.
During open surgical mitral commissurotomy, the heart is accessed through the chest and cardiopulmonary bypass is commonly used so the surgeon can inspect the valve directly. Fused commissures are carefully divided, and associated leaflet or subvalvular abnormalities can be addressed when appropriate. During percutaneous balloon commissurotomy, a catheter is passed through the circulation and across the mitral valve, where an inflated balloon separates fused commissures. Imaging and pressure measurements are used to evaluate valve opening and detect complications.
Recovery depends greatly on whether treatment is catheter based or performed as open-heart surgery. Patients undergoing balloon commissurotomy generally recover more quickly and are monitored for bleeding, rhythm changes, valve function, and embolic complications. Open surgical recovery includes healing of the chest incision or sternum along with cardiac rehabilitation and activity restrictions. Follow-up echocardiography is used to assess valve area, pressure gradients, regurgitation, and later restenosis.
Possible complications include significant mitral regurgitation, incomplete valve opening, recurrent stenosis, arrhythmias, embolic stroke, bleeding, or vascular injury. Balloon commissurotomy can rarely cause cardiac perforation or tamponade and can require emergency surgery. Open commissurotomy also carries risks associated with cardiopulmonary bypass, infection, wound healing, and major surgery. Some valves are too calcified or structurally damaged for commissurotomy and require valve replacement instead.
No. Commissurotomy preserves the patient's valve and separates fused areas to enlarge the opening. Valve replacement removes or bypasses the diseased valve with a prosthetic valve.
It is a catheter-based procedure that inflates a balloon across a stenotic mitral valve to separate fused commissures without open-heart surgery.
Yes. It can be used when balloon treatment is unsuitable, when valve anatomy requires direct surgical repair, or when another cardiac operation is needed.
Yes. Restenosis can develop over time as rheumatic valve disease progresses or commissures fuse again, sometimes leading to repeat intervention or valve replacement.
Mitral Valve Stenosis. American Heart Association. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-mitral-valve-stenosis. Date Accessed August 12, 2026.
2020 ACC/AHA Heart Valve Disease Guideline: Key Perspectives, Part 2. American College of Cardiology. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2020/12/16/22/00/2020-acc-aha-vhd-gl-pt-2-gl-vhd. Date Accessed August 12, 2026.
Surgical Mitral Commissurotomy. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK563263/. Date Accessed August 12, 2026.
Percutaneous mitral balloon valvotomy. PubMed. https://pubmed.ncbi.nlm.nih.gov/17253604/. Date Accessed August 12, 2026.
Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial. PubMed. https://pubmed.ncbi.nlm.nih.gov/9462525/. Date Accessed August 12, 2026.