PREFACE

The numeric age, which started a few decades ago, provides new tools of communication to all domains, including medicine. An enormous amount of data can be collected and thousands of figures can be stored so as to be used whenever necessary. Doctor Farzan Filsoufi, from Mount Sinai Medical Center in New York, took advantage of these revolutionary tools to develop an original program of teaching anatomy, pathology and surgical management of heart valves. His keen interest and deep culture in history as well as his large experience in valve surgery allowed him to offer us a master website where the reader can navigate from one valve to another and from the past to the present, picking up several thousands of genuine information and several hundreds of figures, some of them so rare that they cannot be found in commonly available treatise. The largest place has been given to the mitral valve because of its complexity, its functional importance and the possibility to effectively repair it for the rest of the patient's life. The other valves will receive similar development in the near future.

I have been watching with admiration and respect the considerable amount of work displayed by the author to collect the necessary documentation drawn from the most reliable sources. The information is analyzed and presented in an organized manner so as to be easily available to all specialists, from historians to practitioners, anatomists to physiologists and physicians to surgeons.

This website also shed some light to the future by its interactive section on "case studies and news" from all over the world, involving the most prominent specialists. No doubt that it will be a reference in the field. A true masterpiece!

Alain Carpentier, MD, PhD

Introduction

The ValvesofHeart.org is an educational website designed to provide readers with a comprehensive view of valvular heart disease with both historical and contemporary approaches. The first edition primarily focuses on the mitral valve and is entitled TheMitralValve.org (LaValveMitrale.org).

This unique educational tool of the 21st century contains two major components: Historic Review, and Current Status.

The Historic Review is organized into the following four sections:

The first section describes in a C hronologic Approach the development of knowledge of the structure and function of the heart, circulatory system and subsequently the diseases of the heart with a particular emphasis on the mitral valve. In this section, we analyze the work of major contributors from the European Renaissance until the end of the 19th century. Briefly, the 16th century can be viewed as the century of descriptive anatomy. The development of the science of experimental physiology with the discovery of blood circulation took place in the 17th century . During that era, the science of histology was established and microscopic observation played a critical role in our understanding of the physiology of the circulation.The first pathological reports appeared toward the turn of this century with the description of ossification of cardiac valves. The 18th century witnessed the birth of anatomo-pathology and a great emphasis was placed on the correlation of clinical symptoms with autopsy findings. Finally, during the first half of the 19th century , great progress was made in physical diagnosis with the broader application of percussion and the invention of stethoscope.

The second section describes the development of D iagnostic Tools such as sphygmography , X-ray , electrocardiogram , cardiac catheterization and more recently echocardiography . For each technology, we have provided the developmental background and then analyzed their applications in the diagnosis of the diseases of mitral valve. This section covers primarily an era extending from the mid 19th century to the seventh decade of the 20th century.

The third section entitled, D isease Specific Approach , focuses on the development of knowledge pertaining to the specific etiologies of valvular heart disease. We have described in a chronologic manner the progress which was made in our understanding of the most common causes of mitral valve disease namely rheumatic fever , infective endocarditis , degenerative disease and ischemic cardiomyopathy .

The fourth section is entirely devoted to the birth of Mitral Valve Surgery in the 20th century.

It is important to stress that the selection of the authors and their work(s) has been based on major medical bibliography references. We have read and analyzed their work(s) using the primary sources in almost every instance. They were extracted from a large personal collection on the history of cardiovascular medicine. In addition to this source of information, some of the recent material and images are reproduced from other origins. Every attempt has been made to ensure that such material is only used after the permission of the publisher.

Finally for each author, we have presented the entire title of the first edition of their work(s), a portrait (if available), the frontispiece and the title page. Along with the description of their work(s), appropriate illustrations, of museum quality, and book excerpts from the original text are displayed. We have attempted to provide a translation in English or French for authors whose text was published in Latin.

The Current Status is organized into the following six sections:

The first section is entitled Fundamentals and describes our understanding of mitral valve disease based on pathophysiological triad and Carpentier's approach of valve analysis using functional classification.

The second section, Disease Specific Approach, analyzes the state-of-the-art knowledge of predominant etiologies of mitral valve disease. For each etiology, we have described the clinical presentation, pathology, diagnosis with a particular emphasis on echocardiography, and modern treatment with a specific focus on surgical indications and management.

The third and fourth sections, Case Study and Video Surgery, are self-explanatory. We adopted a disease specific approach for the case study section and a functional approach for the video surgery section. Techniques of valve reconstruction in each functional group based on their pathological features and the "one lesion one technique principle" are described in detail. Extensive imaging studies and operative views are displayed and discussed.

The fifth section, Prosthetic Heart Valves , describes in detail mechanical and bioprosthetic valves. We have provided long-term outcomes of valve replacement in the aortic and mitral positions. Valve-related complications and long-term survival are reported for the most commonly used prosthetic valves. We have extensively analyzed clinical studies published during the last decade with a minimum follow-up of five years.

The sixth section, Literature Review , includes the most important articles on valvular heart disease published since 2011 . For each article, the abstract is displayed and there is a link to the journal if you wish to read the entire text.

Welcome to TheMitralValve.org Bienvenue a LaValveMitrale.org

Farzan Filsoufi, MD Alain Carpentier, MD, PhD