THE INFLUENCE OF SUPRADlAPHRAGMATIC SPLANCH- NICECTOMY ON THE HEART JN HYPERTENSION

S URGICAL treatment has been submitted by Peet and Isberg’ as a measure capable of arresting and sometimes reversing, in a significant percentage of cases, the progressive deteriorating course of arterial hypertension. This opinion has been founded on the results of a long-term study of a large group of hypertensive patients treated by splanchnic resection. The operation of bilateral supradiaphragmatic splanchnicectomy and lower dorsal sympathetic ganglionectomy has been performed in more than 1,500 hypertensive patients at the University Hospital since November, 1933. The purpose of the present study has been to obtain information concerning the cardiac aspects in arterial hypertension and how these have been influenced by surgical treatment. In order that temporary benefits from the operation he eliminated before judgment was passed, the results in only those cases operated upon five to thirteen years ago have been considered. Studies of surgically treated hypertensive patients have suggested that thch operation has influenced the destiny of the heart in hypertension. It was first recognized in 1934 that significant improvement in abnormal electrocardiograms and definite reduction in heart size occurred in some cases following splanchniccctomy. These clinical phenomena were first reported in 1939 by Bradtn and Kahn,’ associates of Peet. In 1940, the results in 3.50 consecutive, surgically treated cases were evaluated by Peet, Woods, and Braden,$ and again it was pointed out that cardiac enlargement and abnormal electrocardiograms wcrc’ sometimes beneficially improved after operation. Othersi* have recently confirmed the effect of sympathectomy on the electrocardiogram in hypertension Each of the foregoing reports dealt with patients who could be folknvcd only for a relatively short period of time. Electrocardiograms and heart size, were reported as improved in cases followed only six months and longer. ‘I’ll(~ present study is concerned entirely with the prolonged effects of splanchnicectomy : all patients have been followed from tive to twelve years since operation