Valvotomy for Mitral Stenosis

Title page reproduced by permission from the British Medical Journal 1:1043, 1952.

July 25, 1972 The American Journal. of CARDIOLOGY Volume 30 161

Commentary by R. C. Brock, MD, MS, FRCS, FACS (Hon.)

Although I worked very closely with Paul Wood from 1948 until his death in 1962, he and I col- laborated on only one article and that one a com- bined effort with Maurice Campbell and Charles Baker on the results of operation in our first 100 cases of mitral valvotomy.

the numbers of these and other laboratory studies that he was doing in a wide range of cardiac cases.

I performed my first mitral valvotomies in 1948, and a report of nine cases was made in 1950 with Baker and Campbell from Guy’s Hospital. Concur- rently, however, I had been collaborating with Paul Wood at the Brompton Hospital where I was op- erating on an increasing number of patients for him. Hence his inclusion in the authorship of the report of our first 100 cases. Once the success of operation for this condition had been established, Wood was a devoted follower of it and realized fully that it provided a means of affording me- chanical relief for an organic end-result condition that otherwise could only be imperfectly palliated. It was not only a great help to have his enthusias- tic support in advising and employing the opera- tion, but his keen clinical judgment and his great experience were of immense value and also a great stimulus to effort in these difficult pioneering days.

This work inevitably involved congenital cases, and I operated on many patients with congenital heart disease in collaboration with him over the years. Again, in this field, I profited greatly from his skill and experience and particularly his in- tense and devoted interest in his cases and pa- tients. Although we wrote no articles together on our many cases of congenital heart disease, Wood made abundant use of the material thus derived from our combined efforts for his authoritative writings on congenital heart disease. He was al- ways a little disappointed that the volume of con- genital cases coming to him was smaller than that coming to the clinic at Guy’s Hospital. The clinical research that he based on these cases was in no way lessened by the somewhat smaller experience.

Wood tended to be somewhat of a lone wolf in cardiology, and it was therefore worthy of com- ment that we succeeded in getting him to partici- pate in a paper on mitral stenosis with three other authors. The article itself is today somewhat pe- destrian in view of our enormously increased knowledge of and experience in this condition. At that time it was a valuable survey of the position in regard to mitral stenosis and all that operation offered.

All who knew Paul Wood will testify to his ex- traordinary, indeed his brilliant skill as a clinician in cardiology. He would approach each patient as a challenge and would devote intense effort to elucidating the individual problem by application of the clinical methods of which he was such a master. Often his clinical assessment was totally correct and the laboratory investigations served principally as a confirmation of what he had al- ready deduced. I suppose he was head and shoul- ders above his contemporaries as a pure clinician, but he lacked no application to obtaining the ad- vantages of laboratory methods for extension, am- plification and confirmation of his clinical findings.

Wood played an important part in the compila- tion of the article, which was definitely a joint effort, and as I remember contributed particularly to the presentation of pulmonary hypertension and pulmonary edema. It would, however, be diffi- cult to select those parts that were especially in- fluenced by him. I remember that, characteristi- cally, there were some sections of which he did not fully approve, but after registering his pro- tests he did not press the matter unduly. At this time Wood not only was doing the cardiac cathe- terization of all his patients himself, an immense task, but was almost unique in this respect and in

I recall many individua1 cases in which his as- sessment and advice was penetrating and abso- lutely correct. The simplicity of his approach at times was noteworthy, and it could clarify an otherwise difficult problem. I remember asking his advice about operation on a man of forty-three with an aortic coarctation who had married a much younger woman who already had produced two young children. The responsibilities involved were obvious. Paul Wood’s assessment included pointing out that it would be reasonable to assume that the patient’s expectation of life without op- eration was not much more than five years. This being so, he indicated that the average mortality to be faced was in the first year 20 percent, in the

162 July 25, 1972 The American Journal of CARDIOLOGY Volume 30

second year 25 perce:nt, in the third year 33 per- cent, and so on. This he pointed out was the medi- cal or expectant mortality risk ; he then asked whether I thought the surgical risk was compar- able. As I placed the risk of operation at no more than five percent, his reply was, “Well, you have your answer.”

Paul Wood’s death, although anticipated or ex- pected by him, came with shattering suddenness to many and especially to one who was a close friend

and colleague. He did so much in the pioneer days to establish successful heart surgery that his early death rather cheated him of being able to observe, share in and profit from the great advances in car- diology and cardiac surgery that we are privileged to enjoy today. The ten years since his death have seen remarkable progress which he would have rejoiced to see and for which he could have prop- erly shared the credit. His death to me was a great personal loss.

Lond Brock is Director of the Department of Surgical Services, Royal College of Surgeons of England and Surgeon Emeritus to the Brompton Hospital and to Guy’s Hospital, London, England.

July 25, 1972 The American Journal of CARDIOLOGY Volume 30 163