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Electrophysiological disturbances were observed in four cases of non-penetrating cardiac trauma. Ventricular tachycardia occurred both as an early and late complication in three, responding to medical treatment in two; it was cured by cryoablation in the other case. The fourth patient developed an isolated conduction defect associated with anteroseptal myocardial infarction, the coronary arteries and left ventricular function being normal.

Patients with native valve endocarditis treated surgically between 1968 and 1978 (n = 15) and all patients presenting with prosthetic valve endocarditis during this period (n = 21) were followed up for at least four years. Five of the patients with native valve endocarditis required urgent early surgical intervention, of whom two died. The remaining 10 underwent valve replacement after a course of antibiotic treatment: all survived, though one required further valve replacement. The 21 patients with prosthetic valve endocarditis suffered 25 attacks. Nine were cured by medical treatment alone; two died before surgical intervention was possible; 11 required valve replacement, of whom three died; and two required valve replacement after a course of antibiotic treatment. The incidence of early prosthetic valve endocarditis--that occurring within two months of operation--was 0.67%, but that of late prosthetic valve endocarditis could not be determined. Medical treatment when started early should cure endocarditis in most patients, but vigilance should be maintained for the appearance of indications for surgery. When such indications exist surgery should not be delayed.

Cryoablation of the accessory pathway was used in the management of 20 patients with pre-excitation syndromes. All patients had presented with paroxysmal atrioventricular reentrant tachycardia; in addition, six had experienced atrial fibrillation. In 16 patients pre-excitation was overt and in four the accessory pathway was concealed. Intraoperative epicardial and endocardial mapping showed 10 left free wall pathways, seven septal pathways, and four right free wall pathways. One patient had two right free wall accessory pathways. There was one postoperative death (from a ruptured cerebral haemangioma) and one patient had transient hemiparesis. There was early recurrence of arrhythmia or pre-excitation in six patients and five of these were among the first ten in the series. Four of the six underwent successful reoperation; 17 patients remain symptom free of all antiarrhythmic treatment. Two patients did not undergo reoperation--one became symptom free on drugs that had previously been ineffective and the other received an antitachycardia pacemaker. The mean period of follow up was six years. Accessory pathway function was not restored and atrioventricular nodal function was preserved in all patients, demonstrating the feasibility of this technique in the long term management of patients with the pre-excitation syndrome.

Changes in work capability and quality of life were assessed retrospectively in 130 patients with ischaemic heart disease who had undergone aortocoronary bypass operations during 1976-7 because of medically uncontrollable angina. A total of 85 patients (65.4%) reported complete relief from angina six months after operation, though 12 later suffered a recurrence. Substantially fewer patients needed drugs after the operation. Before operation 9 out of 117 men fully employed at the onset of angina were working without restriction or doing lighter, fulltime work, 38 were at work but seriously incapacitated by angina, and 70 were forced to stop work. After operation 70 were working without restriction or engaged in lighter work, 15 were at work but still restricted by angina, and only 32 were forced to stop work. This result was highly significant (P less than 0.001). These differences were even more pronounced in heavy manual workers, of whom none cobld work normally before operation, whereas 16 were working without restriction afterwards. Of patients wishing to engage in hobbies or sports, social activity, and sexual intercourse but were restricted before operation, about two-thirds could resume these activities afterwards. Coronary artery surgery provided dramatic symptomatic relief in up to 90% of patients and permitted rehabilitation and return to gainful employment irrespective of type of labour. The degree of symptomatic improvement and increase in exercise tolerance after successful surgery is usually far greater than occurs with any other form of treatment and directly improves quality of life and work capability.

Seven patients with constrictive pericarditis associated with collagen disease underwent pericardiectomy with good results in all but one. The collagen disease was confirmed as rheumatoid arthritis in five patients, but in two its nature remained obscure. In one case the illness was marked by a persistent eosinophilia and eosinophilic infiltration of the pericardium. The association of constrictive pericarditis with rheumatoid arthritis and other collagenoses is briefly discussed.

From 1974 through 1983, 689 hospital survivors of Starr-Edwards (SE) valve replacement were identified; 279 (40.4%) patients with complete follow-up had an isolated mitral valve (SE model 6120 or 6400) replacement: 60.6% of these patients were women, 33.4% were in sinus rhythm, 32.3% had predominantly mitral stenosis, and 23.6% had predominantly regurgitation. Forty-six (6.7%) patients had mitral and aortic valve (SE model 1260 or 2400) replacement, 60.9% were women, and 13% were in sinus rhythm. To determine the long-term outcome of these SE valve prostheses, 325 (97.8%) patients were observed for up to 10 years. Total 10-year mortality was 40 patients (2.54% patients/yr) in the mitral group, of which 26 deaths (9.3%) were cardiac in origin; 8 deaths (2.8%) were directly valve related. Eight patients died (3.47% patients/yr) in the double-valve group, of which 5 deaths (10.8%) had a cardiac cause; 2 deaths (4.3%) were directly valve related. Primary valve failure was never proved. Actuarial estimates of survival at 10 years were 82 +/- 2.6% for the mitral valve group and 81 +/- 6% for the double-valve group. Actuarial estimates of freedom from valve-related morbidity were 87 +/- 2% for the mitral valve group and 59 +/- 7% for the double-valve group. Actuarial estimates of freedom from thromboembolism were 93 +/- 2% for the mitral valve group and 70 +/- 7% for the double-valve group. This prosthesis-based assessment has shown satisfactory long-term performance characteristics of the SE mitral models 6120 and 6400 without any recorded episodes of mechanical valve dysfunctions.