Hypertrophic subaortic stenosis. Some physiologic concepts and the role of operative treatment.

Abstract

The developmental phase of intracardiac surgery might be localized in time to the mid and late 1950's. During this period, surgeons became increasingly familiar with the various congenital malformations affecting the heart and great vessels including, of course, the several forms of discrete congenital aortic stenosis. At about this same time catheterization of the left side of the heart began to be generally applied in preoperative diagnostic assessment, and patients with congenital aortic stenosis could be intelligently selected for operation on the basis of the severity of the obstruction to left ventricular outflow, a physiologic approach which proved sound in the management of almost all patients. Occasionally, however, to the consternation of all concerned, the findings at operation were totally different from those that had been predicted by the preoperative studies. One of my own patients, operated upon in 1958, is probably representative. He was distinctly symptomatic, and severe obstruction