When Should the Patient with Acquired Valvular Heart Disease Be Operated On?

The proper time for surgical intervention in the management of acquired valvular defects is frequently difficult to decide. Surgical therapy of this type of heart disease should be regarded as palliative, not curative, even though complete relief of symptoms may occur. Surgical results are best for stenotic, noncalcified valves. The author recommends operation for mitral stenosis when significant obstruction is evidenced by dyspnea or symptoms of pulmonary hypertension; the risk is minimal. Operations on the aortic valve or the incompetent mitral valve require experience and facilities for direct-vision surgery (pump-oxygenator apparatus). A grossly calcified valve needs replacement by a prosthesis; encouraging results have been obtained in this way, but some years will be required for adequate evaluation.