Surgery of Stenotic Valvular Disease of the Heart

The past decade has seen the development of cardiac surgery assume a position of major importance, to climax a half century of far-reaching surgical achievement. For the most part, however, this surgery has been cardiovascular in nature and has been directed at the great vessels in close proximity to the heart (patent ductus arteriosus, coarctation of the aorta and anomalies of the aortic arch). Even when the vascular defects lay within the confines of the cardiac chambers (tetralogy of Fallot or mitral stenosis), newly developed familiarity with vascular anastomoses and an inborn dread of violating the sanctity of the heart itself suggested that indirect relief by vascular shunts might offer the most reasonable and effective solution, The brilliant successes of Gross,¹Crafoord and Nylin,²Blalock³and Sweet⁴have been epochal in this regard, and their contributions cannot be overestimated. Concomitantly with these essentially extracardiac developments, however,