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Inexorable Aortic Stenosis: Surgical Palliation and Restenosis After Blind Transventricular Aortic Commissurotomy

Inexorable Aortic Stenosis: Surgical Palliation and Restenosis After Blind Transventricular... Abstract Aortic valvular stenosis has been amenable to surgery since the development of blind instrumental commissurotomy and dilatation.1-3 Despite the significant mortality of transventricular or transaortic commissurotomy, the surgical risks of these "blind" procedures were accepted because of the poor prognosis of patients with advanced, symptomatic aortic stenosis.4,5 With the use of cardiopulmonary bypass techniques, open-heart aortic valvuloplasty and total valve replacement have supplanted the earlier blind procedures.6,7 The technical advantage of the direct visual approach appears to be a major contribution to the management of patients with this lesion, since the heavily calcified, immobile, rock-like valve was often refractory to blind instrumental dilatation. In this report the late results of transventricular aortic commissurotomy are described in terms of symptomatic improvement, postoperative survival, and hemodynamic responses. These data should be of value for comparison with late results following newer procedures. Material and Methods Thirty out of 34 patients References 1. Left ventricular failure was judged to have been present when the patient presented historical evidence, physical signs, or x-ray findings which prompted the administration of digitalis and decongestive therapy prior to surgery. 2. Bailey, C. P.; Redondo Ramirez, H. P.; and Larzelere, H. B.: Surgical Treatment of Aortic Stenosis , JAMA 150:1647-1652, 1952.Crossref 3. Larzelere, H. B., and Bailey, C. P.: Aortic Commissurotomy , J Thorac Cardiov Surg 26:31-65, 1953. 4. Glover, R. P.: Present Status of Surgery for Aortic Stenosis , Minnesota Med 37:167-170, 1954. 5. Bergeron, J., et al: Aortic Stenosis—Clinical Manifestations and Course of Disease: Review of 100 Proved Cases , AMA Arch Intern Med 94:911-924, 1954.Crossref 6. Mitchell, A. M., et al: Clinical Features of Aortic Stenosis , Amer Heart J 48:684-720, 1954.Crossref 7. Hufnagel, C. A., and Conrad, P. W.: Calcific Aortic Stenosis , New Eng J Med 266:72-76, 1962.Crossref 8. Bailey, C. P., and Likoff, W.: Surgical Management of Aortic Stenosis , AMA Arch Intern Med 99:859-889, 1957.Crossref 9. Logan, G. A., et al: Preliminary Evaluation of Transventricular Aortic Commissurotomy With an Improved Dilator , New Eng J Med 266:802-809, 1956.Crossref 10. Kinsman, J. M.; Moore, J. W.; and Hamilton, W. F.: Studies on Circulation: I. Injection Method; Physical and Mathematical Consideration , Amer J Physiol 89:322-339, 1929. 11. Gorlin, R., and Gorlin, S. G.: Hydraulic Formula for Calculation of Area of Stenotic Mitral Valve, Other Cardiac Valves and Central Circulatory Shunts: I , Amer Heart J 41:1-29, 1951.Crossref 12. Baker, C., and Somerville, J.: Clinical Features and Surgical Treatment of 50 Patients With Severe Aortic Stenosis , Guy Hosp Rep 108: 101-125, 1959. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Inexorable Aortic Stenosis: Surgical Palliation and Restenosis After Blind Transventricular Aortic Commissurotomy

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References (12)

Publisher
American Medical Association
Copyright
Copyright © 1964 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1964.00280110086017
Publisher site
See Article on Publisher Site

Abstract

Abstract Aortic valvular stenosis has been amenable to surgery since the development of blind instrumental commissurotomy and dilatation.1-3 Despite the significant mortality of transventricular or transaortic commissurotomy, the surgical risks of these "blind" procedures were accepted because of the poor prognosis of patients with advanced, symptomatic aortic stenosis.4,5 With the use of cardiopulmonary bypass techniques, open-heart aortic valvuloplasty and total valve replacement have supplanted the earlier blind procedures.6,7 The technical advantage of the direct visual approach appears to be a major contribution to the management of patients with this lesion, since the heavily calcified, immobile, rock-like valve was often refractory to blind instrumental dilatation. In this report the late results of transventricular aortic commissurotomy are described in terms of symptomatic improvement, postoperative survival, and hemodynamic responses. These data should be of value for comparison with late results following newer procedures. Material and Methods Thirty out of 34 patients References 1. Left ventricular failure was judged to have been present when the patient presented historical evidence, physical signs, or x-ray findings which prompted the administration of digitalis and decongestive therapy prior to surgery. 2. Bailey, C. P.; Redondo Ramirez, H. P.; and Larzelere, H. B.: Surgical Treatment of Aortic Stenosis , JAMA 150:1647-1652, 1952.Crossref 3. Larzelere, H. B., and Bailey, C. P.: Aortic Commissurotomy , J Thorac Cardiov Surg 26:31-65, 1953. 4. Glover, R. P.: Present Status of Surgery for Aortic Stenosis , Minnesota Med 37:167-170, 1954. 5. Bergeron, J., et al: Aortic Stenosis—Clinical Manifestations and Course of Disease: Review of 100 Proved Cases , AMA Arch Intern Med 94:911-924, 1954.Crossref 6. Mitchell, A. M., et al: Clinical Features of Aortic Stenosis , Amer Heart J 48:684-720, 1954.Crossref 7. Hufnagel, C. A., and Conrad, P. W.: Calcific Aortic Stenosis , New Eng J Med 266:72-76, 1962.Crossref 8. Bailey, C. P., and Likoff, W.: Surgical Management of Aortic Stenosis , AMA Arch Intern Med 99:859-889, 1957.Crossref 9. Logan, G. A., et al: Preliminary Evaluation of Transventricular Aortic Commissurotomy With an Improved Dilator , New Eng J Med 266:802-809, 1956.Crossref 10. Kinsman, J. M.; Moore, J. W.; and Hamilton, W. F.: Studies on Circulation: I. Injection Method; Physical and Mathematical Consideration , Amer J Physiol 89:322-339, 1929. 11. Gorlin, R., and Gorlin, S. G.: Hydraulic Formula for Calculation of Area of Stenotic Mitral Valve, Other Cardiac Valves and Central Circulatory Shunts: I , Amer Heart J 41:1-29, 1951.Crossref 12. Baker, C., and Somerville, J.: Clinical Features and Surgical Treatment of 50 Patients With Severe Aortic Stenosis , Guy Hosp Rep 108: 101-125, 1959.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1964

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