Giuliani, Emilio R.

Twenty-two patients had ventricular septal rupture complicating acute myocardial infarction. Sixteen of the 22 patients underwent surgical repair. The clinical findings, catheterization data, and operative results suggest that closure of the rupture should be delayed when possible from three to six weeks after the infarction to allow firm fibrous healing of the region. When surgery is thus delayed, the operative risks are smaller and the long-term results are good.

The echocardiographic features of Ebstein's anomaly include a large anterior chamber, paradoxic ventricular septal motion (type B), increased velocity and amplitude of anterior tricuspid leaflet (ATL) motion, and delayed closure of the ATL. This delayed closure has been thought to be secondary to right bundle-branch block (RBBB). We have studied two patients by simultaneous echocardiography and phonocardiography. The findings in both patients were similar. One patient had RBBB and therefore resembles the previously reported patients. However, the other patient had W-P-W preexcitation syndrome, type B, and is reported here in more detail. The ATL closure of this patient was markedly delayed in spite of right ventricular preexcitation. This finding gives further insight into the altered pathophysiology in Ebstein's anomaly and implies that the delayed ATL closure is probably not due to RBBB and may be a specific feature of this anomaly.

One hundred sixty-nine patients underwent replacement of the aortic valve with an aortic valve homograft; of these patients 17 had concomitant commissurotomy or annuloplasty for an associated mitral valve lesion. Homografts were prepared by sterilization with beta-propiolactone solution and stored in Hanks' solution, or were prepared by sterilization with irradiation and stored at -70 C. Operative mortality was 5.3%. Thirty (19%) of the 160 surviving patients had an aortic diastolic murmur at the time of hospital dismissal, and five of these patients had hemodynamically significant homograft incompetence. For 156 patients, follow-up was longer than 6 months; among the 147 patients who survived operation, there were 12 late deaths. Eighty-four per cent (132) of these 156 patients were alive and well 6 to 54 months after operation. Six patients have required reoperation for valve incompetence. An aortic diastolic murmur was present in 43% of patients. Five patients had significant valve incompetence; four of these patients are markedly improved over their preoperative status. Thromboembolism has been a rare complication despite the fact that anticoagulant therapy was not used. Late calcification of the homograft valve has been noted in only one patient.

The first 50 cases at the Mayo Clinic of insertion of an aortic valvular homograft after excision of the aortic valve are reported. The hospital mortality rate was 6%. An aortic diastolic murmur was noted in 17% of the surviving patients just prior to their dismissal from the hospital. In none was there evidence of hemodynamically significant aortic valvular incompetence. At follow-up examination 3 to 12 months postoperatively, an aortic diastolic murmur was audible in 44% of the traced patients. Only one patient had hemodynamically significant aortic valvular incompetence. The patients were not given anticoagulant therapy, and there were no thromboembolic complications.