Effect of the preservation of annulo-papillary continuity on left ventricular ejection fraction after mitral valve replacement. A clinical randomized study on patients affected by rheumatic valve disease.

This perspective study has been designed to evaluate the modifications induced on left ventricular contractility by the interruption of annulo-papillary continuity during mitral valve replacement in patients with rheumatic valve disease. Patients with associated cardiac diseases were not admitted to the study. Sixty-nine patients entered the trial, each patient was randomly assigned to mitral valve replacement either with preservation of the annulo-papillary continuity (PAPC) or with excision of all the chordae (EC).

[Ultrasonic decalcification in aortic stenosis. Clinical and doppler echocardiographic results].

Ten elderly patients with aortic valve stenosis and with a small calcified annulus (less than 20 mm) were treated by ultrasonic valve debridement (UVD) while 17 other elderly patients underwent aortic valve replacement (AVR) during the same period. The clinical and doppler results were assessed for a mean follow-up period of 20 months. Patients with significant aortic regurgitation or associated valve disease were excluded.

Reoperation for myocardial revascularization using the internal mammary artery.

From October 1984 up to February 1989, 40 patients had "redo" myocardial revascularizations using one or both internal mammary arteries (IMA) in over 1000 cases operated upon in our Department for coronary bypass grafts. Thirty-one patients had a further operation for unstable angina difficult to control with drugs. Mean interval of recurrence of angina after previous surgery was 48.

[Emergency myocardial revascularization in acute evolving myocardial infarct].

Immediate coronary artery bypass for acute evolving myocardial infarction could be the elective therapy if provided on useful time, because myocardial salvage can be achieved by early reperfusion. Thirty eight patients had emergency coronary artery by-pass graft for acute evolving myocardial infarction during the early phase: 35 were male, the mean age was 51 years (34 to 74). The mean interval between the onset of symptoms and surgery in this series of patients was two hours and a half.

Aspergillus flavus-infection of a pacemaker wire: continuing evidence for active management of infected pacemakers.

A rare case of fungal endocarditis (Aspergillus flavus) on a permanent pacemaker is described. Owing to negative blood culture and non-specific echocardiographic findings, a complete diagnosis was made only on histologic examination of the surgically removed material. In our opinion this case supports an active management of infected pacemakers.