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172 consecutive palliative operations in patients with Fallot's tetralogy are presented. 19% of the patients were aged less than 6 and 45% less than 12 months. The overall mortality was 5.8%, but has been recently reduced with the improvement of anaesthesiologic and technical experience. In fact, during the last two years, 69 Waterston shunts (33 under 12, and 17 under 6 months of life) were performed with no deaths. On the grounds of this experience, indications of the different types of systemic to-pulmonary artery shunts are discussed, as well as problems related to the choice between one-stage and two-stages surgical correction. The authors' opinion is that palliative procedures still play an important role in the treatment of Fallot's tetralogy, although the future approach may well be early total correction. In their experience, the last approach is restricted to children over 18-24 months of life with favorable anatomy, and to all patients over 4 years of age.

A rare case of primary endocardial fibroelastosis, involving only the left atrium, simulating mitral stenosis is reported; the clinical and hemodynamic features which led to the diagnosis of mitral stenosis are described. The authors discuss the data upon which a differential diagnosis between the two similar diseases can be established. The suggest that isolated fibroelastosis of the left atrium could have been developed slowly because of ipoxia of the left atrium for agenesia of the circumflex coronary artery. An operation of endotelial decortication of the left atrium is described.

Forty patients with V.S.D. and coarctation of the aorta were operated on at Department of Cardiac Surgery, Ospedali Riuniti Bergamo. Surgical management of infants with V.S.D. and coarctation depends on the magnitude of the left to right shunt. Patients may therefore be divided into two groups: 1) those with aortic coarctation and a small V.S.D., who have normal or slightly elevated pulmonary artery pressure. If surgery is required, these patients can be successfully treated by repairing the coarctation alone. Ten cases in our series were operated on using this approach without deaths; 2) patients with coarctation and large V.S.D. and pulmonary hypertension. The management of these infants is controversial. One stage repair was used in four cases without deaths. On the other hand, nine out of 11 patients in whom the V.S.D. was left unrepaired at the same operation died, giving a 81.8% mortality rate. Repair of coarctation with simultaneous banding of the pulmonary artery was equally affected by high mortality. With this approach in 13 patients there were seven deaths, giving a 53.8% mortality rate.

From the pharingeal mucus of many carriers were isolated 155 strains of staphylococci ascribed, by anaerobic fermentation of glucose and mannite, to the groups St. aureus, St. epidermidis and Micrococcus. The sensibility to chloride of mercury and to desoxicholate was tested by inhibition of development on agar of paper stripes impegnated with the solutions of the indicated substances. A specific corresponsion between the sensibility of inhibitory substance and the biological properties of the staphylococci was not observed. However the more pathogen groups were more sensibles to mercury and the non pathogen to desoxicholate.

Mustard's operation for TGA (transposition of the great arteries) has been obstructive complications. In order to try to avoid these complications, we used Senning's operation for TGA. Our experience in 35 consecutive cases is reported. There were no operative or late deaths. Four patients had a PDA; three had a significant VSD with subpulmonary stenosis in two. Previous atrial septectomy and persistent LSVC did not represent contraindications to this procedure. The postoperative course has been smooth and uneventful in all patients. Follow-up periods of one to twenty months demonstrated sinus rhythm in all patients and there were no significant gradients between the venae cavae and the new systemic atrium in 12 reinvestigated patients. On the basis of these results, Senning's operation is recommended as a valid alternative to Mustard's operation.

Aneurysm of the left ventricle in infants is quite a rare cardiac malformation. In this paper two cases are described, six and seven years old respectively, the first one with a subvalvular annular type of aneurysm, the second with an apical type, both surgically treated with success. Ths most known and most frequent aetiological factors are discussed as well as their possible complications. Surgical treatment (aneurysmectomy) is emphasized as the only effective therapy to date.

Congenital mitral valve malformations are diverse. When they present clinically in infancy medical treatment is often ineffective. Mitral valve replacement with prosthesis in children carries an high operative and postoperative risk. For these reasons the Authors have undertaken in 1972 a cooperative study which includes: 1) a surgical classification of the congenital mitral valve lesions; 2) a systematic attempt to repair the mitral valve. Over 43 observed cases, 18 have been operated upon. Eleven cases (61%) presented associated cardiac lesions. Hospital mortality was 16% (3 cases). There have been either mortality nor morbidity in the follow-up period. Eight cases have been recatheterized two years after the operation. The pulmonary artery pressure has significantly decreased and the mitral insufficiency disappeared almost completely. The classification, suggested by the Authors, is explained in details.

Sixty-three corrective operations have been performed in patients with Tetralogy of Fallot and a previously constructed Waterston shunt. The patients were from 1.4 to 8 years of age (median 4.3 years), and the mean interval between the Waterston shunt and the repair was 39.3 +/- 16.05 months. Three patients developed pulmonary atresia and six required a second anastomosis prior to intracardiac repair. Kinking and stenosis of the right pulmonary artery at the site of the Waterston anastomosis occurred in 12 (19 percent; 70 percent confidence limits 14 to 26 percent) patients who required patch enlargement of the right pulmonary artery at repair. Seven (11 percent; 70 percent confidence limits 7 to 17 percent) patients died in the hospital and three (5 percent; 70 percent confidence limits 2 to 11 percent) during the period of late follow-up. None of the early or late deaths was specifically related to the presence of the previously performed Waterston anastomosis.

Between March 1966 and May 1982, 257 patients with clinically noncritical right ventricular outflow tract obstruction with intact ventricular septum (RVOTO/IVS) underwent elective open-heart correction, with an overall early mortality of 3.9%. Age ranged from 13 months to 48 years (mean 6.6 +/- 6.5 - median 5). We describe three different anatomical types, for which a standardized surgical approach is suggested. When one or more of the following features--small right ventricular cavity; rigid infundibular stenosis; hypoplastic pulmonary annulus and trunk; dysplastic cusps--were present, the mortality (10.6%) was significantly higher than in isolated valvular stenosis (2.2%) or in valvular plus dynamic infundibular stenosis or isolated low-lying stenosis (2.5%). In a series of 159 consecutive patients operated upon since September 1974 the cumulative early mortality was 1.3%. Late results on 202 patients (mean follow-up period of 25.6 +/- 22.6 months) are good in 90.6% and fair in 8.9% of the cases. One patient died of encephalitis 2 years after the operation. We believe that a more precise characterization of the underlying lesions and a more liberal use of different surgical techniques to minimize residual gradients, iatrogenic pulmonary incompetence and impairment of right ventricular contractility, may decrease early mortality and improve overall results.

Fourteen patients younger than two years of age with persistent truncus arteriosus underwent primary repair. Twelve of them were less than 1 year and 4 less than 3 months of age. Intractable heart failure was the indication for surgery in all patients but one who had increased pulmonary vascular resistance. There were 5 hospital and 2 late deaths. Six out of the 7 survivors (median follow-up: 29 months) were symptom-free. The remaining infant who preoperatively had significant truncal valve regurgitation was doing fairly well 2 1/2 years after repair. Our experience suggests that, although the mortality remains high, primary repair for infants with persistent truncus arteriosus is feasible and offers better overall results than does pulmonary artery banding followed by later intracardiac repair. We advise primary repair for all infants with intractable heart failure or increasing pulmonary vascular resistance with or without truncal valve regurgitation. Elective repair is recommended before the age of 2 years to minimize the risk of pulmonary vascular disease.

Two hundred twenty-seven patients (median age 5.4 months) in whom a Waterston anastomosis was done for initial palliation of tetralogy of Fallot between 1966 and 1979 were studied. Twelve patients died in the hospital (5.3%; 70% confidence limits, 3.8% to 7.3%). Young age, low weight, and poor clinical condition did not appear to be incremental risk factors, whereas a too large or a too small shunt was largely responsible for the hospital mortality and morbidity. Follow-up information was available in all the 215 patients discharged from the hospital. At the last follow-up visit, before any further surgical procedure, 74% of the patients were clinically in good condition. By actuarial methods, 97.7% of hospital survivors were alive and 95.8% were event-free at and beyond 3 years postoperatively. Eighty-six patients have been catheterized in preparation for secondary repair (mean interval between Waterston shunt and catheterization, 2.9 +/- 1.38 years). One patient developed pulmonary vascular disease, four acquired pulmonary atresia, and 14 had a severe kinking of the right pulmonary artery at the site of the anastomosis.

An inquiry on the diffusion of the carriers of faecal pathogen staphylococco between the alimentarist people was performed in the province of Milan during 1966-72. Among 29804 persons examined, 1374 carriers of staphylococci were detected with a frequency of the 4.61 per cent. The strains of isolated staphylococci were with the test of the mannite, coagulase and hemolysins alpha and beta classified as 170 pathogens (12.37 per cent), 511 partially pathogens (37.19 per cent) and 693 non pathogens (50.44 per cent). The strains were sensibles to Rifamycin, Nalidixic Acid, Gentamycin, Kanamycin, and much resistent to the Sulfametoxazin and Ampicyllin.