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(Circulation. 2004;110:1876-1878.)
© 2004 American Heart Association, Inc.

Editorial

Percutaneous Heart Valve Replacement

Enthusiasm Tempered

R. David Fish, MD

From the Texas Heart Institute, St Luke’s Episcopal Hospital and Baylor College of Medicine, Houston, Tex.

Correspondence to R. David Fish, MD, St Luke’s Medical Tower, Suite 2220, 6624 Fannin, Houston, TX 77030. E-mail rdfish@swbell.net

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In 1954, Charles Hufnagel, Proctor Harvey, and colleagues¹ published their classic description of the first effective surgical treatment of end-stage aortic insufficiency, or indeed of any form of advanced valvular insufficiency. First at the Peter Bent Brigham, they had worked long on the matter, later moving to Georgetown University Medical Center. There they developed a clever and elegantly simple approach to the task of supporting the overloaded left ventricle within the particular anatomic and physiological allowances of valvular aortic insufficiency. The challenge, which was met with gratifying effectiveness, was to interrupt the aortic outflow without the benefit of circulatory support machinery not then available, and to then interpose a prosthetic valve at a point where regurgitant flow could be arrested. The now famous solution was to accept a remedy not entire, interrupting the aorta distal to the left subclavian artery. As the flow to the arch vessels was not interrupted, the simple surgical interposition of the caged ball valve device in the descending aorta was understandably well-tolerated. The relief of regurgitation was thus only partial, but proved to be sufficient to provide meaningful palliation. In fact, the first patient survived for 7 years. Other physiological issues, such as the adequacy of the remaining compliance chamber or the effect on coronary blood flow did not dictate the clinical response to the treatment.

Later was to come the development of circulatory support machines and with them techniques for surgery on the arrested heart with full exposure of the valvular anatomy for repair . . . [Full Text of this Article]

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