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• W2000619574 abstract "T HE SUrgiCal treatment of Certain congenital heart lesions has been increasingly successful in the last decade. Improved methods of anesthesia and control of respiration in open chest operations together with the advent of effective antibacterial therapy are some of the factors that have contributed to the excellent results obtained in surgical correction of lesions such as patent ductus arteriosus and coarctation of the aorta. Another reason is that the operations used are not performed on the heart itself but on the large vessels within the thorax. Operations within the heart have been contemplated for a long time but trials have been only partly successful because the problems involved are of much greater magnitude than in the congenital vascular deformities. The problem of treating patients with rheumatic heart disease is of greater importance than the treatment of congenital heart disease, for both social and economic reasons. Rheumatic heart disease is more common than congenital lesions and frequently affects individuals in their early or middle period of active life. The medical treatment of patients with rheumatic heart disease, although it may be effective in certain situations, can not abolish the basic valvular deformity and usually fails to improve the situation beyond certain limits. This limitation in medical treatment has always been obvious but agreement as to its cause has not been reached until lately. Many physicians earlier considered that the lack of improvement following the usual medical therapy was mostly due to extensive myocardial damage resulting from the rheumatic infection, and thought the mechanical imbalance of the circulation caused by the damaged valve of only minor importance. Others had the impression that the mechanical disturbance was of greater importance than damage of the myocardium in the symptoms and signs in rheumatic heart disease. As early as the turn of the century several authors therefore proposed an operative approach to the treatment of valvular, mostly mitral stenosis.r7 This eventually gave the impetus to animal studies’.* but it was not until 1913 that the first patient with acquired valvular disease was operated upon. Tuffier then operated upon a young man with aortic stenosis, invaginating the wall of the aorta with the finger and dilating the aortic orifice successfully. The patient survived and was improved for several years.75 The first successful operation for mitral stenosis was performed by Cutler in 1923. He approached the valve from the left ventricle, using a special valvulotome.22 This operation was followed by the first era of mitral surgery in which several surgeons performed operations on the mitral valve either through the left ventricle or the auricle, almost always with unsatisfactory results.22~64”*72 Section of the valves usually caused marked mitral incompetence, giving rise to pulmonary edema and death of the patient during or shortly after the operation.24 The operation was therefore abandoned and it was not until about twenty-five years later that a renewed approach was ventured. During the last years of this interval several surgical attempts were made to relieve the pulmonary congestion that constituted the basis for the most embarrassing symptoms in the majority of patients with rheumatic heart disease. Anastomosis between a branch of a pulmonary vein and the azygos vein, creation of an interauricular septal defect.11*12~26 and creation of tricuspid incompetence or ligation of the inferior vena cava20 were all measures aimed at relief of the overburdened pulmonary circuit. It was realized, however, that these technics were only palliative and most of them were soon abandoned as the direct approach on the mitral valve became an established procedure. l2 Following the pioneer work of Harken and his" @default.
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• W2000619574 title "Surgical treatment of rheumatic heart disease" @default.
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• W2000619574 doi "https://doi.org/10.1016/0002-9343(54)90226-0" @default.
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