Surgical Aspects of Rheumatic Heart Disease

In the treatment of acquired heart disease there has always been conflict between the anatomical or mechanical damage to the valves and the more functional element of the disease of the heart muscle itself. In the present age it is difficult to realize how the actual mechanical factor was ignored for so long, and indeed in my young days we were taught that the dominant factor was the rheumatic involvement of the myocardium. Today the pendulum has swung to the other extreme and only lip service seems to be paid to the muscle factor and all attention is directed towards the effect of the disease on the valves.