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Summary Significant right ventricular outflow obstruction may result from large anomalous muscle bundles traversing the right ventricular cavity. These bundles are located below the infundibulum and are distinct from the trabecula septomarginalis and the moderator band. This type of obstruction may occur independently and is anatomically distinguishable from the more common types of infundibular stenosis. Eleven patients with intact septa and anomalous muscle bundle obstruction to right ventricular outflow are presented. In 5 patients, these bundles represented the only cardiac abnormality and were the sole cause of obstruction to blood flow; while in the remaining 6 patients there was an associated pulmonary valvular stenosis. Cardiac catheterization and angiocardiography provided the correct diagnosis in all cases. Eight patients have undergone operation and all have since been asymptomatic. The authors acknowledge with appreciation Dr. James H. Moller’s courtesy in providing us the opportunity to review Case 11.

SUMMARY Thirty-nine infants with surgically proved patent ductus arteriosus were analyzed for clinical clues of diagnostic importance. The occurrence of rubella during pregnancy, a widened pulse pressure or a murmur heard during systole and diastole in the pulmonary area should alert the examiner to the possibility of patent ductus. In addition to those findings related to the presence of a left-to-right shunt, conventional x-rays films revealed left atrial enlargement in 31 and aortic knob enlargement in five instances. Comparison of the electrocardiograms with infants with VSD revealed no clues of differential diagnostic value, except possibly for presence of an upward concavity in the R-ST segment. Because of the favorable surgical prognosis this diagnosis offers at any age a high index of suspicion and a willingness to perform special diagnostic procedure is warranted. In this institution we have come to favor the thoracic retrograde aortogram for diagnosis.

The report consists of five patients with chronic postinfarct left ventricular aneurysms. The age distribution was between 47 and 63 years. The time lapse between the initial infarct and the appearance of the left ventricular aneurysm was 2 weeks to 2 years. The time interval between the initial infarct and surgery was 5 months to 6 years. Less than adequate bedrest following the infarct, multiple infarcts, and systemic hypertension were other factors present in this group. Right heart catheterization was performed in two patients and showed reduced cardiac output and elevated pulmonary pressures in one. The electrocardiograms were consistent with extensive old myocardial infarction and ventricular aneurysm. The diagnosis was suggested by electrocardiograms and roentgenography, supported by kymography, and confirmed by angiography. The world literature on surgically treated patients with ventricular aneurysms is briefly reviewed with emphasis on the varied surgical approaches to the problem in the past. The method of complete excision with ventriculoplasty during cardiopulmonary bypass was used in all our patients during the past 4 years. The anatomic distribution of the ventricular aneurysm as well as the histopathology of the resected specimen is described. All patients survived the operation, and were observed from 6 months to 40 months after operation. There have been no late deaths to date, and all patients have been rehabilitated. Postoperative catheterization studies have confirmed the clinical improvements observed. More attention should be given to this relatively common complication after infarct because excision under temporary heart-lung bypass is a safe and feasible approach.

The past decade has brought forth an impressive display of clinical achievements in the field of cardiac surgery. As recently as 1948 there were only three congenital cardiac lesions then amenable to surgical treatment. These were patent ductus arteriosus, coarctation of the aorta, and the systemic-pulmonary artery anastomotic procedure for tetralogy of Fallot. In effect, the interior of the heart represented an important barrier to progress, the last anatomic frontier of the many that have confronted surgeons through the generations. The present important advance in cardiac surgery has been the development of the open operation, in which the surgeon sees precisely what has to be done within the cardiac interior chamber and then proceeds to carry out the necessary reparative measures in a dry field, unhurriedly. Every advance such as this brings the possibility of a fuller life to many who are at present disabled or handicapped. The magnitude of