THE PREOPERATIVE ASSESSMENT OF MULTIPLE VALVE DISEASE.

Representative case histories are used to discuss the difficulties in preoperative assessment of patients with multiple valve disease and the dangers of correcting one lesion when two or more valves are seriously damaged. Errors fall into three broad categories: existing second valve disease (1) may not be suspected, (2) may be considered insignificant or (3) may be considered a consequence of the first.Recommendations are offered to minimize these errors. The four valves should be studied physiologically, no matter how "normal" the other three may appear to be clinically, whenever open-heart surgery is contemplated. In bivalvular disease angiographic methods are preferable to pressure studies, for data so obtained are not dependent on cardiac output. Mitral and tricuspid regurgitation can never be attributed with certainty to a more distal lesion but require direct examination at time of operation for assessment.