Intracardiac irradiation of the valves from radium emanation,employing a two-stage operative technique.

In mitral stenosis there is indicated, on theoretical grounds, some form of intervention designed to dilate the narrowed orifice and thereby relieve the functional embarrassment of the heart. In advanced cases such relief must come through an intracardial approach. The operative dangers of such a course are necessarily great, but in hopeless cases of stenosis the chances of final success through opening-up of the constricted orifice, with the resulting advantages, may well outweigh the dangers. A single attempt in this direction has already been reported by Dr. Cutler, of Boston.

An important characteristic of mitral stenosis from the standpoint of its ultimate relief is the slow progressive nature of the lesion as it normally occurs. This makes it impossible to predict whether surgical dilation will effect a permanent relief or will only alleviate the condition temporarily, after which there will occur a reformation of the old stenotic ring. The latter possibility makes it irrational, in the present state of our knowledge, to expose a patient to the dangers of this surgical operation.

In view of these considerations we have been attempting in the past year to produce in dogs a real stenosis characterized by scar formation on valves and ring and presenting a progressive nature, as contrasted with the many previous attempts in this direction which have, for the most part, been in the nature of mechanical ligations of the orifice. With some reliable method of provoking a valvular lesion of this kind, it is our aim, then, to observe more fully the course of events following surgical intervention.