By Donald N. Ross B. Sc., M. B., CH. B., F. R. C. S. (auth.)
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Extra info for A Surgeons’ Guide to Cardiac Diagnosis: Part II The Clinical Picture
The demonstration of valve calcification is of the greatest importance in diagnosing aortic valve stenosis. In any case of congenital aortic stenosis over the age of twenty-five years, calcification can generally be demonstrated and, when present, it indicates an obstruction at valve level. Conversely, where calcification is absent in this age group, sub-aortic stenosis should be considered. Left ventricular puncture is a useful investigation in assessing the level and severity of aortic stenosis.
Hg. have been thought to require surgical relief but it IS probably a mistake to be too rigidly influenced by an arbitrary figure. Principles of Treatment The treatment ofthis condition by BROCK and SELLORS marked the beginning of the present phase of direct surgery on the heart. Closed pulmonary valvotomy is performed, as in Fallot's tetralogy, by passing valvotomes and dilating instruments through the narrowed valve cone. More recently the valve has been divided along the line of the fused commissures under vision after arrest of the circulation during hypothermia or with the aid of the heart-lung machine.
In the same area, communications may occur between the aortic sinus and the right ventricle or right atrium, and these conditions merge with high supracristal ventricular septal defects. Among the obstructive lesions we include aortic and pulmonary valve stenosis and subvalvar or supra-valvar obstructions. In addition, obstructive lesions may co-exist with a left-to-right shunt. Thus, the combination of a ventricular septal defect and some degree of pulmonary stenosis not uncommon; so that, even the obstructive and shunting conditions merge.
A Surgeons’ Guide to Cardiac Diagnosis: Part II The Clinical Picture by Donald N. Ross B. Sc., M. B., CH. B., F. R. C. S. (auth.)