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Myxomatous mitral valve disease is now the most common cause of mitral regurgitation in the western world. Repair of the leaking valve has become standard surgical procedure during the past 2 decades. Between 1993-1999 we performed 113 repairs of the mitral valve. In 25 patients the etiology was myxomatous degeneration (no mortality). Long-term clinical results depend on patients' functional class at surgery. Based on this fact, and the good surgical results, it is recommended to refer such patients even with severe mitral incompetence for surgery at an early stage, even if symptoms are minimal.

A total of 266 patients entered into a study comparing the effect of intravenous magnesium and propranolol following acute myocardial infarction. Of these, 97 were able to receive either drug and were therefore randomized into the magnesium (n = 51) or propranolol group (n = 46). 88 patients were unable to receive propranolol and formed a third group (NR) while a further 81 patients could not receive either drug and formed a fourth group (N). The study showed that intravenous magnesium was as effective in preventing potentially lethal arrhythmias as propranolol and could be given to some 70 per cent of such patients whereas propranolol could only be given to 36 per cent.

Ninety-five patients with acute myocardial infarction were followed up for 6 months to 3 years (mean 25.4 months) in a preliminary study to compare the effects of intravenous magnesium (49 patients) with that of intravenous propranolol (44 patients) given immediately after admission to the intensive care unit. There were four cardiac deaths in the propranolol group and no deaths in the magnesium group (P0.046) and 27 per cent of patients who received propranolol subsequently developed cardiac failure as opposed to 12 per cent of those who had received magnesium (P0.04). Intravenous magnesium given in the early stages of myocardial infarction reduces the subsequent cardiac death rate possibly by reducing infarct size.

This study analyzes the use of PAC in a registry comprising 5,841 hospitalized patients with AMI. A total of 371 patients received PAC. In-hospital mortality was higher in patients with CHF who received PAC, while there was no difference in patients with cardiogenic shock or persistent hypotension. Mortality in patients receiving PAC was higher irrespective of the presence or absence of "pump failure." A separate analysis of discharge summaries of 364 patients with CHF showed that PAC was used more frequently in sicker patients and that when severity of CHF was assessed, no difference in mortality was found in patients with mild or moderate CHF. We conclude that while a higher in-hospital mortality is found in patients receiving PAC, this excess is likely related to difference in severity of CHF, which had not been assessed in every individual. It is unlikely that PAC increases mortality.

Two hundred and fifty patients admitted with acute myocardial infarction were treated with a continuous infusion of magnesium sulfate for 24 h (a total of 46 mmol of elemental magnesium). Only 1 patient had ventricular fibrillation; no patient had sustained ventricular tachycardia requiring cardioversion. Twenty-five patients had short runs of non-sustained ventricular tachycardia and did not need cardioversion. In 6 further patients, the infusion had to be discontinued because of a drop in blood pressure. The in-hospital mortality for the group was 3.4%.

Seven of 48 patients (14.6%) with acute myocardial infarction who were given 2.4 g of magnesium sulfate as a single intravenous dose had potentially lethal arrhythmias during the first 24 hours after admission, whereas 16 (34.8%) of 46 patients receiving placebo had similar arrhythmias. In addition, 14 of these 16 patients in the placebo group had their first arrhythmia (in the intensive coronary-care unit) within two hours after the start of the study, whereas in the magnesium-treated group, there were no such arrhythmias until some four hours later. The higher the lymphocyte potassium concentration, the greater the reduction in the incidence of arrhythmias. Serum magnesium levels increased by 16.5% and lymphocyte magnesium concentrations by 72% in the magnesium treated group. Intravenous magnesium reduces the incidence of serious arrhythmias after acute myocardial infarction.