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It is considered that the anesthetic solution administered according to the regional intravenous anesthesia method will be non-uniformly dispersed due to the valvular system of the veins, the competence and disposition of which varies from one individual to the other. The anesthetic solution will progress to the level of venous capillaries, but will penetrate the tissues of the blood-deprived segment in variable concentrations. The anesthetic will pass from the venous network to the extravascular space in large amounts and this is facilitated by the vasodilatation, increased vascular permeability, and the increased number of functional capillaries. The anesthetic drug when present at the level of the cells will exert its action on the cellular membrane by a process which is facilitated by low pH and hypercapnia decreasing excitability and conduction in the nerves. The anesthetic solution will exert its action both at the level of the trunk and at the level of the peripheral nerve endings. However, the major effects occur at the periphery, while trunk blockade is secondary and mostly due to consecutive ischaemic modifications.

On the basis of the authors' experience acquired between 1956 and 1973 (a total of 401 cases with inter-atrial communications and 234 cases of ostium secundum that have been operated by them), data are presented concerning the diagnostic means, the indications and the contra-indications of the surgical treatment, as well as the attitude to be adopted towards the associated lesions.

Between 1953 and 1976 a total of 2527 mitral commissurotomies have been performed in the Clinic for Cardio-Vascular Surgery of the "Fundeni" Hospital. This group included cases with pure mitral stenosis (predominantly following rheumatic disease), but also cases of mitral stenosis associated with other cardiac lesions in which the major hemodynamic element was the mitral obstruction. Criteria are discussed for surgery, the preoperative preparation of the patient, incidents, accidents and complications, as well as technical difficulties of the digital and/or instrumental mitral commissurotomies on closed heart, either carried out for the first time in the respective patient, or as iterative intervention. Comparing the results in relation with the functional stage of the disease (62.5% of the patients were classified in the III-IV evolutive degree, according to the NIHA classification), pulmonary hypertension (61.6% of the patients had medium or severe pulmonary hypertension), associated lesions (present in 17% of the cases--mitral failure predominated, together with tricuspid or aortic failures), it is appreciated that the technique of mitral commissurotomy on closed heart is an useful therapeutic method (88.6% very good and good results, a global death rate of 3.9%) that can be applied in a large category of patients, although there is a trend toward open-heart surgery, with all medico-economical major implications.

Two cases are discussed, of severe myocardial ischaemia determined by coronary obstruction. The cases were solved by surgical treatment that consisted in direct myocardial revascularization with the aid of aorto-coronary by-pass with a fragment of autologous saphene vein.