Dissection of the young women without Marfan disease is related, in most instances, to pregnancy. The structural changes in the arterial wall that occur during pregnancy may predispose women to this complication of pregnancy. In this study, two young women, who had none of the characteristics of Marfan's syndrome, were operated upon for dissection of the ascending aorta. The first patient was in the 35th week of gestation and a cesarean section was performed prior to replacement of the ascending aorta. In the second patient, diagnosis of dissection and severe aortic regurgitation occurred in the postpartum period. Knowledge of this albeit relatively rare complication of pregnancy may assist the clinician in diagnosing and referring patients early for surgical treatment that, in most instances, may save the lives of both mother and fetus.

The hazards related to ten patients who underwent 11 urologic surgical procedures during a 36 month period were taken into consideration. Electrocautery was used in all instances and there were no complications. All of the pacemakers were preset for ventricular pacing and sensing inhibited or multiprogrammable and were reprogrammed during the operation to ventricular pacing fixed rate mode or magnet mode, with very satisfactory outcome. To avoid life-threatening situations arising from pacemaker inhibition or ventricular fibrillation during cautery for transuretheral resection, three basic factors were considered: 1, appropriate type of pacemaker; 2, the proper grounding of all medical electronic equipment used during the procedure, and 3, the directing of the complete flow of the electrocautery circuits substantially below the level of the pacemaker unit.

An 18 year old girl suffering from a giant angiolipoma of back and chest wall with A-V malformation underwent total excision of the tumor in 4 stages. The first two stages included surgical ligation of the arterial blood supply to the tumor. In the third and fourth stages the tumor was resected with the use of an autotransfusion system. The last stage was complicated with massive bleeding and disseminated intravascular clotting. Control of bleeding was achieved by the use of autotransfusion system, right thoracotomy and massive transfusion of blood and its components. After long convalescence period associated with renal and respiratory failure the patient recovered completely without sequellae. This case demonstrates the complexity associated with the treatment of these rare tumors.

An unusual case of late partial tamponade of the right atrium is reported in a patient 35 days after aortic valve replacement. Chest x-rays, echocardiograms and ECG were not helpful. The diagnosis was made by emergency bedside right heart catheterization which showed a 7 cm H2O gradient between the junction of the superior vena cava and right atrium and also a 12 cm H2O pressure difference between the femoral vein and the right atrium with a normal capillary wedge pressure. Re-thoracotomy with evacuation of blood clots and control of bleeding points improved the hemodynamics dramatically. However the patient succumbed 3 weeks later due to irreversible brain damage. This is thought to be the first report of a late partial right atrial tamponade in the English medical literature.

Coarctation of the aorta was surgically treated in 28 infants (16 male, 12 female) aged 2 days-3 months, with 19 younger than 1 month. Body weight at operation was 1.6-4.2 (mean 2.8) kg. 3 infants had coarctation alone, 10 had a wide patent ductus arteriosus as the only associated anomaly and 15 had a variety of other anomalies. Resection with end-to-end anastomosis was performed in only one case, while 21 underwent subclavian flap aortoplasty and six patch graft aortoplasty. Additional procedures were banding of the pulmonary artery in five cases and open aortic commissurotomy in one case. The early mortality was 10.7% (3 infants) and three more died later. Further cardiac surgery was subsequently performed on four of the infants. Of the 22 survivors, two had significant recurrence of coarctation which, however, was successfully corrected in one case. The blood pressure was within normal limits in all survivors, except those with recoarctation.

The method of continuous catheter drainage for pericardial tamponade as used in 108 patients is described. The efficacy of this procedure in relieving tamponade resulting from a variety of diseases is demonstrated. Blood clot in the pericardium probably constitutes a contraindication to catheter drainage.

Myocardial infarction (MI) and coronary artery bypass graft surgery (CABG) are two acute but contrasting events for the patient. From the patients’ perspective these events differ in that MI presents as a sudden pathophysiological event as a result of which the patient is categorized as chronically ill with a potential threat to his life. Coronary artery surgery, on the other hand, can be categorized as a surgical intervention which may prevent a pathophysiological development and may represent for the patient a potential turning point from a state of illness to one of health. Researchers who have examined the implications of MI and CABG for the patient’s life-style have emphasized those parameters directly concerned with the disease which are related to the pathophysiological event and the symptomatology. Psychological parameters have been referred to less commonly. Most of the research has involved male coronary patients and rarely their spouses.

The course of 22 pregnancies in 11 women undergoing heart valve replacement with a porcine xenograft is reported. All of the pregnancies treated with warfarin were interrupted by induced abortion. Of the 11 pregnancies treated with dipyridamole which were not interrupted by induced abortion, fetal wastage occurred in five. There was no fetal wastage among three patients who were not treated by any kind of anticoagulant. A review of the literature revealed that fetal complications among patients with the mechanical prosthetic valve are significantly higher compared with patients with bioprosthetic valves. There was no maternal hemorrhagic or thromboembolic event in patients with bioprosthetic valves. Delivery after porcine xenograft insertion is safe provided that the patient is in good cardiac condition and does not require warfarin treatment.

Pacemaker carriers are at risk when undergoing operations involving the use of diathermy. The Shaw Scalpel utilizes a method by which the cutting edge of the blade is heated to a selected temperature that seals blood vessels as they are cut. No electrical currents are passed to or through the patient and there is no sparking or electrical arcing to the tissue. This apparatus was used as the sole method of thermal coagulation in 20 patients undergoing replacement of pacemaker batteries.

The terms “return to work” and “frequency of sexual relations” appear in the literature dealing with the rehabilitation of coronary patients. These terms are used as important measurements of the patients’ rehabilitation. Most research work has dealt with the male patient and only rarely with the spouse of the male patient. Reports about the rate of return to work after the events of myocardial infarction (MI) or coronary artery bypass graft surgery (CABG) vary, and researchers point to a number of variables which are likely to explain the results of their work.

A 20-year-old woman required urgent replacement of a calcified prosthetic mitral porcine xenograft with a mechanical one during the 32nd week of pregnancy. Five weeks later the patient delivered a normal child. Following delivery the patient refused oral anticoagulant treatment and 7 months later she underwent emergency removal of a prosthetic valve thrombus. Six months later, still refusing anticoagulant treatment, she died of cerebral embolization. We suggest that the replacement of a degenerated biologic valve with another biologic valve should be considered in patients who refuse anticoagulant treatment and that patients with prosthetic xenografts should be kept under close medical follow-up, including echocardiography because of possible accelerated xenograft failure during and/or following pregnancy.

A review of 41 children from 10 months to 16 years of age who had a valve replacement between the years 1966 to 1981 is reported. Sixty-one per cent of the valve deformities were rheumatic and 39% congenital. Twenty-two children had the mitral valve replaced, 14 had an aortic valve and 5 had both aortic and mitral valve replacement. There was a hospital mortality of 9.7% and only one later death during a mean follow up period of 6.75 years. Three children have required a second mitral valve replacement. Thrombo-embolic episodes were encountered in 4 children. The special problems of valve replacement in infants and children are discussed.

Cardiac rhythm disorders are commonly encountered problems in cardiology. In pathological cardiac diseases where antiarrhythmic drugs have been ineffective, surgical interruption of the conduction system and implantation of a pacemaker are accepted therapeutic procedures.

Myocardial protection was evaluated in 2 groups of 5 infants each undergoing correction of either tetralogy of Fallot (TOF) or subcristal ventricular septal defect (VSD). In group A, profound hypothermia and total circulatory arrest (PHTCA) was utilized. In group B, profound hypothermia and total circulatory arrest combined with potassium cardioplegia (PHTCA + K) was the method of protection used. The analysis was carried out by sequential measurements of clinical, electrocardiographic, enzymatic (CK-MB) and ultrastructural parameters. There were no operative deaths. One infant had a second operation for recurrent VSD. The average anoxic time was 35.4 min in group A (PHTCA) and 32.6 min in group B (PHTCA + K). Analysis of our data demonstrated that when potassium cardioplegia was added to PHTCA, there was less intraoperative myocardial damage according to physiological, ultrastructural and biochemical parameters than when profound hypothermia and total circulatory arrest was applied alone.