Valvotomy in the Treatment of Mitral Stenosis

Abstract

The selection of patients who need surgical treatment for mitral stenosis is a problem which is no longer confined to special centres for cardiac surgery. If patients who are in greatest need of surgical treatment, and who are most likely to benefit from it, are to be given priority, selection must start with the practitioner and in the general medical clinic. The advent of valvotomy as a method of treatment has stimulated an intensive investigation of the patho logical physiology of mitral stenosis by means of cardiac catheterization and related technical procedures. This has led in turn to a renewed interest in the interpreta tion of clinical signs and symptoms. Many physical signs which have been a source of speculation since the early days of auscultation can now be more precisely interpreted in the light of surgical experience and of recent haemodynamic research. Many of the patients in the present series, and a great many others judged unsuitable for operation, have been investigated by cardiac catheterization, and, at the start, the information so obtained often fortified the decision for or against operation. But with increasing experience we are now seldom influenced by catheter findings in selecting favourable cases for surgery. Admittedly, in extending the scope of surgery to less favourable cases, full investi gation is still desirable. The low mortality and good results of mitral valvo tomy are already well known, and it is with the indica tions for operation that we are now mainly concerned. In this respect we were guided from the start by the pioneer work at Guy's Hospital (Baker, Brock, and Campbell, 1950) and in the United States (Harken et al., 1948; Bailey, 1949), but our present views have been moulded largely by personal experience.