Tuesday Afternoon, May 4,1954

2:00 P.M. Executive Session. (Limited to Active and Senior Members).

3:00P.M. Scientific Session: REGULAR PROGRAM.

Address of the President, Emile Holman, San Francisco, Calif.

28. The Surgery of Infundibular Pulmonic Stenosis with Intact Ventricular Septum. (A Type of "Pure" Pulmonic Stenosis.)

Robert P. Glover, Hugo Gontigo (by Invitation),

Thomas C. McAuliffe (by invitation), Thomas J. E. O'Neill and

Robert E. Wells (by invitation), Philadelphia, Pa.

The term pulmonary stenosis has been loosely applied to all obstructions of pulmonary artery blood flow, be they due to pulmonary valvular stenosis, obstructing malformations of the infundibulum proximal to the valve, pulmonary artery stenosis or combinations of these defects.

True pulmonary stenosis is a valvular lesion recognizable clinically, easily confirmed by physiologic studies and readily relieved by surgical means. The condition is not associated with a ventricular septal defect and does not produce cyanosis except in rare instances (patent foramen ovale with high right atrial pressure).

A fact little realized clinically and scarcely referred to except in pathological treatises is that this same syndrome not infrequently is reproduced by an infundibular stenosis in which the pulmonary valve is normal. This condition is recognizable if not clinically then certainly by physiologic means (catheterization) and can be treated with equal satisfaction by surgical methods.

Six of our 25 cases of "pure" pulmonic stenosis were of the infundibular variety-a startling and rather significant finding. Their management, catheterization data, technic of surgery and eventual result are detailed. There was no mortality in the entire series. Illustrated by slides and moving pictures in color.

29. Pulmonic Valvular Stenosis: Technic of Open Valvuloplasty and Results.

Henry Swan, Henry C. Cleveland (by invitation), Helmut Mueller

(by invitation) and S. Gilbert Blount (by invitation), Denver, Colorado

Pure pulmonic valvular stenosis has been treated almost universally by the trans-ventricular incision procedure of Brock. The operation is of low risk and is followed by apparent clinical improvement. However, objective physiologic studies, when made some months postoperatively, have been disappearing in the majority of instances, and serious elevations of right ventricular pressures remain. The long term outlook of such individuals would seem to be far from normal.

Hypothermia has allowed visual exploration of the valve and direct valvuloplasty via the pulmonary artery. Under direct vision, the funnel-shaped deformity is converted to a bicuspid valve with commissures extending the entire distance to the valve ring.

Postoperative studies on patients undergoing this procedure have to date been most gratifying. The dynamics of the right circulation have returned essentially to normal. The evidence is good that the valvular stenosis has been entirely relieved. Complete data on five patients will be presented. Eight patients have been treated by this method and there have been no deaths.

The techniques of the operation and the significance of pulmonary regurgitation, should it occur, will be discussed. A colored sound movie illustrating the surgical procedure will be presented.

30. Experiences in the Surgical Treatment of Aortic Stenosis.

William H. Mueller, Jr., Albert A. Kattus (by invitation),

J. Francis Dammann, Jr. (by invitation) and Rodney T. Smith

(by invitation), Los Angeles, Calif.

The importance of developing a method for surgically treating aortic stenosis cannot be overemphasized, because it is the second most common acquired stenotic valvular deformity. Many investigators have helped to establish methods for the treatment of this defect on a sound clinical basis. Bailey and co-workers demonstrated the blunt dilatation of the valve with the usual tear along the commissural fusion areas. At present this is the most satisfactory procedure for opening the valve but yet preventing significant regurgitation.

We have used a method which employs the introduction of a dilating instrument through a stab wound in the wall of the left ventricle to engage the aortic valve and open it. If an additional deformity such as mitral stenosis is present, this valve is also opened in the usual manner.

We have performed aortic valvulotomy on 16 patients. Their ages range from 14 to 61. All had acquired deformities except one who had a congenital lesion. Six had comcomitant mitral stenosis which was relieved simultaneously, and one had a coarctation of the aorta which was resected also. The oldest patient died during an operation in which the dilating instrument was being passed retrogradely through the innominate artery into the valve. Two others died, one three days after operation and one five days after operation. A cardiac pace-maker was used for 60 hours on one patient who developed complete heart block just after the aortic valve was opened and who later developed cardiac arrest. He subsequently regained a sinus rhythm.

Technical considerations, pressure studies, and problems encountered in dealing with these patients will be presented.

6:30 P.M. Cocktails, Dinner and Dancing, Sheraton-Mt. Royal Hotel.

Address by Guest of Honor, Dr. F. Cyril James, Principal and Vice-Chancellor, McGill University, Montreal.

Attendance limited to Members of the Association and their ladies, Invited Speakers and their ladies.

Dinner Dress.