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SURGICAL TREATMENT OF MITRAL STENOSIS

SURGICAL TREATMENT OF MITRAL STENOSIS Abstract SURGICAL relief of mitral obstruction may now be said to have become an established practice. In sharp contrast to the insurmountable difficulties which beset the attempts to apply this form of therapy in the 1920's, current procedures have the advantage of advances in surgical technique, in anesthetization, in preoperative and postoperative care, and in the control of infection with chemotherapy and antibiotics. Furthermore, it is now possible, with techniques of cardiac catheterization and tests of circulatory and pulmonary function, to appraise, in more or less quantitative terms, the physiological changes consequent upon the obstruction at the mitral valve. Finally, changes in pressure in the pulmonary circulation and even in the left auricle may also be checked at the time of operation. Not only have such measurements served to confirm deductions, based on symptoms and physical signs, with regard to the dynamic consequences of mitral stenosis, but they have demonstrated the References 1. Levine, S. A., and Love, D. E.; Mitral Stenosis Without Murmurs , Cardiologia 21:599, 1952Crossref 2. In the two cases described as "failures," the left auricle could not be entered at operation, in one because of massive organized thrombus and in the other because of lack of auricular appendage and small pulmonary veins. 3. Harken, D. E.; Ellis, L. B.; Ware, P. F., and Norman, L. R.: Surgical Treatment of Mitral Stenosis: Valvuloplasty , New England J. Med. 239:801, 1948.Crossref 4. Bailey, C. P.: The Surgical Treatment of Mitral Stenosis: Mitral Commissurotomy , Chest Dis. 15:377, 1949.Crossref 5. Glover, R. P.; O'Neill, T. J. E., and Bailey, C. P.: Commissurotomy for Mitral Stenosis , Circulation 1:3291950.Crossref 6. Baker, C.; Brock, R. C.; Campbell, M., and Wood, P.: Valvulotomy for Mitral Stenosis: Further Report on 100 Cases , Brit. M. J. 1:1043, 1952.Crossref 7. Nomenclature and Criteria for Diagnosis of Diseases of the Heart, New York Heart Association, 1940. 8. The preoperative observations and some of the early postoperative measurements were made by Dr. Richard Bing, the remainder by Drs. Henry Bahnson and Arthur Otis. 9. "Total pulmonary resistance" equals PA × 1332/CO, where PA is mean pulmonary arterial pressure in millimeters of mercury; 1322 is the conversion factor from the millimeters of mercury to dynes per centimeter squared, and CO is cardiac output in cubic centimeters per second. 10. Cohn, J.; Riley, R. L., and Carroll, D.: Pulmonary Function in Mitral Valvular Disease; Distribution and Diffusion Characteristics in Resting Patients, J. Clin. Invest., to be published. 11. Ellis, L. B. and others: Studies in Mitral Stenosis: A Correlation of Physiologic and Clinical Findings , A. M. A. Arch. Int. Med. 88:515, 1951.Crossref 12. Kuchner, M., and Others: Rheumatic Carditis in Surgically Removed Auricular Appendages , Am. Heart J. 43:286, 1952.Crossref 13. Sabiston, D. C., Jr., and Follis, R. H., Jr.: Lesions in Auricular Appendages Removed at Operation for Mitral Stenosis of Presumed Rheumatic Origin , Bull. Johns Hopkins Hosp. 91:178, 1952. 14. Biörck, B.; Winblad, W.. and Wulff, H. B.: Studies in Mitral Stenosis: Observations on Incidence of Active Rheumatic Carditis in Left Auricular Appendages Resected at Operation for Mitral Stenosis , Am. Heart J. 44:325, 1952.Crossref 15. In one patient without overt signs of recurrent disease, symptoms and signs appeared which indicated that the valve orifice had again become critically narrowed. 16. Prevention of Rheumatic Fever , Mod. Concepts Cardiovas. Dis. 22:158, 1953. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

SURGICAL TREATMENT OF MITRAL STENOSIS

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References (17)

Publisher
American Medical Association
Copyright
Copyright © 1953 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1953.01260040803002
Publisher site
See Article on Publisher Site

Abstract

Abstract SURGICAL relief of mitral obstruction may now be said to have become an established practice. In sharp contrast to the insurmountable difficulties which beset the attempts to apply this form of therapy in the 1920's, current procedures have the advantage of advances in surgical technique, in anesthetization, in preoperative and postoperative care, and in the control of infection with chemotherapy and antibiotics. Furthermore, it is now possible, with techniques of cardiac catheterization and tests of circulatory and pulmonary function, to appraise, in more or less quantitative terms, the physiological changes consequent upon the obstruction at the mitral valve. Finally, changes in pressure in the pulmonary circulation and even in the left auricle may also be checked at the time of operation. Not only have such measurements served to confirm deductions, based on symptoms and physical signs, with regard to the dynamic consequences of mitral stenosis, but they have demonstrated the References 1. Levine, S. A., and Love, D. E.; Mitral Stenosis Without Murmurs , Cardiologia 21:599, 1952Crossref 2. In the two cases described as "failures," the left auricle could not be entered at operation, in one because of massive organized thrombus and in the other because of lack of auricular appendage and small pulmonary veins. 3. Harken, D. E.; Ellis, L. B.; Ware, P. F., and Norman, L. R.: Surgical Treatment of Mitral Stenosis: Valvuloplasty , New England J. Med. 239:801, 1948.Crossref 4. Bailey, C. P.: The Surgical Treatment of Mitral Stenosis: Mitral Commissurotomy , Chest Dis. 15:377, 1949.Crossref 5. Glover, R. P.; O'Neill, T. J. E., and Bailey, C. P.: Commissurotomy for Mitral Stenosis , Circulation 1:3291950.Crossref 6. Baker, C.; Brock, R. C.; Campbell, M., and Wood, P.: Valvulotomy for Mitral Stenosis: Further Report on 100 Cases , Brit. M. J. 1:1043, 1952.Crossref 7. Nomenclature and Criteria for Diagnosis of Diseases of the Heart, New York Heart Association, 1940. 8. The preoperative observations and some of the early postoperative measurements were made by Dr. Richard Bing, the remainder by Drs. Henry Bahnson and Arthur Otis. 9. "Total pulmonary resistance" equals PA × 1332/CO, where PA is mean pulmonary arterial pressure in millimeters of mercury; 1322 is the conversion factor from the millimeters of mercury to dynes per centimeter squared, and CO is cardiac output in cubic centimeters per second. 10. Cohn, J.; Riley, R. L., and Carroll, D.: Pulmonary Function in Mitral Valvular Disease; Distribution and Diffusion Characteristics in Resting Patients, J. Clin. Invest., to be published. 11. Ellis, L. B. and others: Studies in Mitral Stenosis: A Correlation of Physiologic and Clinical Findings , A. M. A. Arch. Int. Med. 88:515, 1951.Crossref 12. Kuchner, M., and Others: Rheumatic Carditis in Surgically Removed Auricular Appendages , Am. Heart J. 43:286, 1952.Crossref 13. Sabiston, D. C., Jr., and Follis, R. H., Jr.: Lesions in Auricular Appendages Removed at Operation for Mitral Stenosis of Presumed Rheumatic Origin , Bull. Johns Hopkins Hosp. 91:178, 1952. 14. Biörck, B.; Winblad, W.. and Wulff, H. B.: Studies in Mitral Stenosis: Observations on Incidence of Active Rheumatic Carditis in Left Auricular Appendages Resected at Operation for Mitral Stenosis , Am. Heart J. 44:325, 1952.Crossref 15. In one patient without overt signs of recurrent disease, symptoms and signs appeared which indicated that the valve orifice had again become critically narrowed. 16. Prevention of Rheumatic Fever , Mod. Concepts Cardiovas. Dis. 22:158, 1953.

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Dec 1, 1953

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