Surgical Treatment of Acquired Valvular Disease as Viewed by the Internist

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Abstract
The evaluation of the surgical treatment of acquired valvular disease is based upon a review of current techniques, their ability to alter the anatomical and pathophysiological aspects of a lesion, their mortality and morbidity rates and on a consideration of the devolutionary pattern of defects when they are not treated by surgery. The closed heart methods are inadequate but have not been replaced by open techniques routinely because of deficiency in pumps and oxygenators. In the transition from immature to mature methods, technical inadequacies more than any other single factor account for the unreliability of surgery as the complete answer to acquired valvular disease. Results must be judged in terms of objective or pathophysiological change. In the large area of paradox where symptoms alone improve, the lasting accomplishment is apt to be small. Although the morbidity and mortality rates are rapidly falling they remain high for the newer techniques. Each type of valvular lesion varies in its devolutionary pattern when it is not treated by surgery. It remains to be established at what phase surgery can be applied with the greatest likelihood of success and the least risk. The promise of surgery as a lasting mechanical answer to an essential mechanical problem is excellent.

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