Valvulotomy for Mitral Stenosis

SIR LAUDER BRUNTON (1902) suggested that the only proper and logical approach to the problem of mitral stenosis was "to lengthen the slit." This suggestion has now been carried into effect. Allen and Graham (1922) and Pribram (1926) published single unsuccessful cases. Souttar (1925) described a case which survived the operation and was said to have been improved. He employed his finger to dilate the mitral ring, making his approach via the left auricular appendage. After an initial encouraging case, Cutler and Beck (1929) had six patients who died soon after operation. Brock (1948 and 1949) showed that it was possible by direct surgical methods to relieve congenital pulmonary valvular and infundibular stenosis. More recently (1950) he developed the technique of dilating the stenosed mitral valve with a finger passed through the left auricular appendage. In a minority of cases Brock found it necessary to cut the valve along one or both commissures, using a specially designed flat knife. Several American teams are at present engaged in tackling this problem. Bland and Sweet (1949) employ an anastomosis between the inferior pulmonary vein and the azygos vein. In Paris this operation has been done by D'Allaines and his team (1949). Harken (1948 and 1950) has tried the creation of an artifical atrial septal defect in some cases, and direct operation on the mitral valve in others. Smithy (1949) did seven mitral valvulotomies with two deaths. Murray (1949) has attempted to resect one cusp of a stenosed mitral valve, replacing it by a portion of cephalic vein. In Philadelphia Bailey and his colleagues (1949 and 1950) have operated on more than a score of patients.