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September 20, 1958


Author Affiliations


Director, the Thoracic and Cardiovascular Research Laboratory at Presbyterian Hospital; Chief of Thoracic and Cardiovascular Surgery at Presbyterian, Episcopal, and Fitzgerald Mercy hospitals and St. Christopher's Hospital for Children; Assistant Professor of Clinical Surgery, University of Pennsylvania Medical School (Dr. Glover); and Postdoctorate Research Fellow, National Heart Institute, U. S. Public Health Service, at the Presbyterian Hospital, Department of Thoracic and Cardiovascular Surgery (Dr. Gadboys).

JAMA. 1958;168(3):229-236. doi:10.1001/jama.1958.03000030001001

Aortic stenosis is a more difficult problem than mitral stenosis, and it should be treated before it progresses to the stage of impending left ventricular failure. Five stages in its evolution can be recognized and are here described. Ideally, surgical treatment should be undertaken at stage 2, when the patient becomes subjectively aware of his forceful heart action, has palpitations, and is easily fatigued. He should not be allowed to go beyond stage 3, marked by spells of dizziness, syncope, substernal discomfort, effortangina, and dyspnea. These opinions are based on a study of 78 patients. The first 37 were operated on with a three-bladed expandable split-dilator inserted through the apex of the left ventricle. The other 41 were operated on by a greatly refined transventricular technique, and the improvement in results is strikingly shown by the lower mortality figures, the degree of symptomatic relief, and the better occupational adjustment of the patients. Present methods of selecting patients and performing the operation result in a mortality of only 5% and give functional amelioration in approximately 70% of the patients. Further improvements are anticipated.