SOME DIFFICULTIES IN EVALUATING FUNCTIONAL RESULTS AFTER MITRAL COMMISSUROTOMY

Abstract

Most reports on the so-called functional improvement following mitral commissurotomy have to be taken on faith. The almost universal acceptance of reports of results that defy critical analysis is unique in modern medicine. Everyone recognizes the difficulties in obtaining noteworthy physiological studies often enough in individual instances to permit some type of correlation with the subjective impression of the patient or even of his physician. Yet, these very difficulties should serve to sharpen the critical clinical acumen of the clinician, because mitral commissurotomy is a term that is applied to a group of blind and crude procedures, none of which, in our experience, in a single instance, has destroyed the characteristics of the lesion it purports to attack. The technical accomplishments of this procedure are interpreted by one person—the surgeon. We do not wish, at this time, to enter into a critical analysis of the surgeon's interpretation, but perhaps the