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We report the unusual occurrence of severe intra-vascular haemolysis following mitral valve repair. Mild to moderate mitral regurgitation was detected after repair, but severe haemolysis was the only indication for re-operation. Following prosthetic valve replacement there was an immediate cessation of haemolysis. We postulate that a small regurgitant jet directed against the teflon pledgets used in the repair was the reason for the haemolysis.

During coronary artery bypass surgery graft flows were measured. The measurements were made after cardiopulmonary bypass had been discontinued. The recordings were made over a ten year period and a total of 1,151 grafts in 720 patients are included. Except where the flow down a graft was large, 20 mg of Papaverine were injected into the graft and this usually resulted in the flow increasing by at least 100%. A satisfactory response was not achieved in 32 of the 538 grafts in which Papaverine was injected but subsequent probing of the distal anastomosis achieved a markedly improved flow in 80%.

A case of intractable right ventricular failure following open heart surgery is presented which responded dramatically to moderate whole-body hypothermia. In addition to its depressant effect on heart rate, allowing improved ventricular filling when this is impaired by severe tachycardia, evidence is presented that hypothermia also has a direct positive may make hypothermia valuable in the management of severe heart failure.

Between 1973 and 1985, 349 patients had isolated mitral valve replacement by a Bjork-Shiley prosthesis with an overall early (30 day) mortality of 5.1%. Of the 331 survivors, 294 patients have been traced and their clinical outcome was followed for up to 13 years in order to define the long term performance of the mitral Bjork-Shiley models MBRP-standard, MBRC-convexo concave and MMSM-monostrut. Cumulative follow-up extends to 6620 patient years (mean 5.75 years). The MBRP valve was implanted in 236 patients, the MBRC valve used in 44 patients and the MMSM valve inserted in 14 patients. The late mortality and morbidity was 0.8% and 0.6% per patient year at 13 years respectively. Actuarial survival rate for the whole group excluding operative deaths was 85% at 5 years, 66% at 10 years and 58.5% at 13 years. The freedom from all valve related complications at 13 years was 70.75%. Bjork-Shiley models MBRP, MBRC and MMSM mitral valve prosthesis show excellent durability with only one case of mechanical failure over a 13 year period.

The intraoesophageal rupture of a large thoracic aortic aneurysm is reported in a 49 year old man. He had been hypertensive for some years while the aneurysm increased in size. Although a graft was successfully inserted to repair the leak, infection from the oesophagus with candida albicans, subsequently led to secondary haemorrhage and death 17 days later. A plea is made for the earlier referral of patients with aneurysm prior to rupture, as the operative mortality rises markedly after rupture has occurred and in this case the situation was virtually irreparable.