Surgical treatment of hypertensive heart disease and of heart failure of hypertension

Abstract

After the purely speculative period of Danielopolu and Pende, who suggested the operation, after the heroic period of the pioneers of the method, Peet, Crile, Adson, and many others, who tried the most varied techniques of rhizotom).! sympathectomy, and ganglionectomy, we clinicians remained skeptical or even distrustful, because of the great number of failures. In the last six years surgery seems to have improved the technique and to have established a method by which results have turned favorable. .\mple intervention, both thoracic and abdominal, such as Smithwick’s, with resection of great portions of the sympathetic chain, have produced results which were previously thought to be impossible. Today, everywhere, a great number of hypertensive patients are operated upon. They may not be cured, but their blood pressures are lowered and their symptoms at least are improved. Perhaps fatal complications are eliminated or delayed. In an!. event, operation makes many hypertensive patients capable of returning to normal life and activit!.. It is a sure fact that surgical treatment lowers high blood pressure considerably in the majority of cases and that improvement usually lasts for long periods of time. As a natural consequence the excessive strain on the heCart is reduced proportionate]!-. Nevertheless, it is wise to review the probIem with ;i critical spirit in order to determine whether surgical intervention is the propc’r way in which to cure heart failure which is so often a complicatiomin hypertension. Let us then review the possibilities offered b!. surgical treatment. It is accepted that patients whose hypertension is slight and responds to medic-al treatment present no particular problem and are not to he considered for surger!‘. The problem arises with patients in whom the blood pressure, particularI!, the diastolic, is very high and in whom medical treatment has proved inefficacious, and particularI!, with patients in whom severe. complications are to be expec?ctl. --Presented before the Third Inter-American Cardiological Congress, Chicago. III.. .Junr 13-17, 19th. *Professor of (‘ardiology. DfrecOor of the Jnstitute of C’ardiolog)-. Iremtter of “El (‘01~40 N acional. ” tprofessor of thr School of Medicine. Attending Physician 10 t hr Xstional Institute of (‘ai-diol<tiyy.