ESTABLISHMENT of safe, prolonged extracorporeal circulation and the advent of suitable prosthetic valves have allowed surgeons to operate upon patients with multiple valvular deformities. Due to the increased duration of the operative procedure and additional trauma, the mortality of multiple valve insertion would appear to be incremental with each valve replaced. In review of our own cases, however, this has not been found. The late mortality indicates a need for conscientious involvement by physicians in the long-term care of such patients.
Preoperative evaluation of all patients with multivalvular disease consists of chest x-ray films, electrocardiograms, routine laboratory studies, and cardiac catheterization. Occasionally the clinical signs of valve malfunction are sufficiently overt that cardiac catheterization is not deemed essential. Angiography is rarely used as an aid in establishment of the diagnosis.All patients are operated upon with the use of mild general body hypothermia (32 to 34 C) and rotating