Some controversial aspects of rheumatic heart disease are discussed in the light of personal experience in Edinburgh. Symptoms are not always a reliable guide to severity, and the correct time for surgical treatment should be based on an objective assessment. Dangers of delay include progressive damage to the pulmonary circulation, lungs, right ventricle, and liver, and the risks of systemic embolism, pulmonary oedema, and pulmonary infarction.
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Chanarin et al. (1968) studied this question.
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