CLINICAL PROGRESS Editor: HERRMAN L. BLUMGART, M.D. Associate Editor: A. STONE FREEDBERG, M.D. Medical Aspects of Patients Undergoing Surgery for

THE ADVANCE of cardiac surgery has made necessary the revision, in recent years, of many views on rheumatic heart disease. If the mitral valve is affected, it is now most important to determine whether mitral stenosis is mild or severe and whether it is the main cause of the patient's disability if other valvular lesions are present. During the last four years, the authors and their colleagues have supervised the selection and medical management of approximately 600 patients undergoing surgery for mitral valve disease by Dr. Dwight E. Harken. This report embodies the experience gained. In many as-pects it reflects combined medical and surgical opinion and in others only that of the authors; it is certainly not to be regarded as final or unequivocal. The subject must be constantly under revision as further experience accumu-lates. Since this report deals entirely with our own experience, the bibliography is limited. For a wider perspective, the reader is referred to the first seven articles listed in the references. A brief review of the pathologic physiology of mitral stenosis will first be presented, in a