Clinical experience with the Ionescu-Shiley xenograft valve: four to five-year follow-up.

Between January 1977 and July 1981, 132 Ionescu-Shiley xenografts were implanted in 124 patients. Early and late mortality was 13.7% (17/124) and 9.2% (10/107), respectively. Cumulative survival rates at 4 to 5 years were 76% (aortic) and 84% (mitral). Thromboembolic analysis showed 0.72 episodes per 100 patients per year, without chronic anticoagulation. The thromboembolism free rates were 96.8% (mitral) and 100% (aortic); 75% of the mitral patients were in atrial fibrillation. No primary valve dysfunction was detected. In the aortic position (8 patients with valve stent diameter from 19 to 25 mm), the mean peak systolic gradient pressure was 10 +/- 5.5 mm Hg, and calculated valve surface areas were 1.6 +/- 0.5 cm2 at rest and 2 +/- 0.1 cm2 after exercise. A satisfactory correlation between catheterization-derived valve area (from hemodynamic data) and valve stent diameter was obtained (r = 0.94). In the mitral position, the mean diastolic gradient pressure was 4.7 +/- 3.1 mm Hg at rest and 13.8 +/- 0.9 after exercise with the 27 mm xenograft. The corresponding calculated surface areas were 2.8 +/- 6 cm2 and 3 +/- 0.8 cm2. The present data show minimal thrombogenicity without chronic anticoagulation, even in patients with atrial fibrillation or enlarged left atrium and advantageous hemodynamic characteristics, particularly in those with small aortic annuli.

Traumatic rupture of the pericardium: report of two cases with unusual features.

We describe two cases of traumatic rupture of the pericardium with unusual features. The first patient had isolated pericardial rupture with extrapericardial luxation of the heart, and the sound patient had a combined rupture of the pericardium and diaphragm, with prolapsing bowel into the pericardial cavity. After emergency operation, both patients recovered uneventfully.

Duplication of the right atrioventricular orifice in a patient with common atrium and mitral cleft.

The following case involved duplication of the right atrioventricular valve in a patient with a common atrium. The accessory orifice, formed by two fine leaflets, connected the right atrium with the right ventricular outflow tract and had no subvalvular apparatus. Successful surgical correction was accomplished under standard cardiopulmonary bypass.

Cor triatriatum with mitral valve disease in adults.

One 16-year-old boy with cor triatriatum and congenital mitral regurgitation and two women, 35- and 54-years-old, with cor triatriatum and rheumatic mitral stenosis are reported. The regurgitant mitral valve in the boy had three papillary muscles and short chordae tendineae. One of the patients with rheumatic mitral stenosis had a subtotal cor triatriatum with enlargement of the left atrial appendage and without asymmetry in the signs of pulmonary congestion. The mitral regurgitation facilitated the angiographic diagnosis of cor triatriatum. However, neither of the two patients associated with rheumatic mitral stenosis were correctly diagnosed preoperatively. All three patients were operated on with satisfactory results.

[Post-infarction left ventricular free wall rupture]. / Rotura post-infarto de la pared libre del ventrículo izquierdo.

We report four cases of subacute left ventricular free wall rupture after myocardial infarction successfully treated with emergency surgery. Some aspects dealing with clinical presentation, diagnosis and treatment are discussed.