Posterior (17) and anterior (3) mitral cusp pericardioplasties were performed in 20 patients between 6 December 1961 and 10 July 1963. A long-term follow-up study was done in nine patients. In six of these, mitral valvectomy with Starr-Edwards ball valve replacement was required after intervals varying between two years and three months and seven years and three months. In only one of the six cases did the pericardium macroscopically appear normal. In four it was obviously thickened and in two of the four there was also evidence of calcification in the pericardium only. In one of these, calcification was gross, causing complete immobility of the whole 2 × 0·6 in (5 × 1·7 cm) pericardial inlay. In only one of the six cases had the pericardium become larger and thinner and this also was in the only patient with a dilated mitral ring. Only three patients remain with the pericardium as inserted into the posterior mitral cusp between eight years and eight years and eleven months previously, but in all three there is clinical evidence of progressive pathology in the mitral valve. The progressive mitral valve involvement in this series could well have been caused by progression of the pre-existing pathology in the cusps and chordae tendineae but the involvement of the pericardial inlay was much more extensive than that of the rest of the cusp.
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