Surgical Treatment of Acquired Valvular Disease as Viewed by the Internist

IT IS an obvious fact that acquired valvular deformities may impose a serious mechanical burden upon the heart. Over the years it has been logical to hope that definitive surgical technics would be developed to alter these defects so as to restore normal cardiac function. However plausible the need, the evolution of surgery for acquired valvular disease was delayed by the fear that the heart could not tolerate unusual manipulation and continue its necessary function. When it was established that the heart was remarkably durable and competent in the face of arduous operative interference, cardiac surgery developed with dramatic rapidity. Today, approximately a decade after the first successful modern operation for stenosis of the mitral valve, the current and potential role of surgery in the treatment of acquired valvular disease requires examination. The title of this presentation implies that the medical profession holds an ambivalent view on the matter-one by the internist, the other by the surgeon. Unfortunately this was, and in many areas continues to be, true. Trained in the unique promise of the direct approach, the surgeon has been an enthusiast. Sensitive to the slowly deteriorating pattern of many diseases, the internist has been reluctant to accord the surgeon a primary role in the treatment of cardiac ailments. This dichotomy should not persist. Perceptive reflection on the work accomplished in the past decade permits an evaluation based on experience and fact, not prejudice. Unfortunately both protagonists and antagonists must admit that much of this information was exploited far beyond its natural importanee. The first acknowledgment today must be that all of the