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A meta-analysis of 140 neuroimaging studies was performed using the activation-likelihood-estimate (ALE) method to explore the location and extent of activation in the brain in response to noxious stimuli in healthy volunteers. The first analysis involved the creation of a likelihood map illustrating brain activation common across studies using noxious stimuli. The left thalamus, right anterior cingulate cortex (ACC), bilateral anterior insulae, and left dorsal posterior insula had the highest likelihood of being activated. The second analysis contrasted noxious cold with noxious heat stimulation and revealed higher likelihood of activation to noxious cold in the subgenual ACC and the amygdala. The third analysis assessed the implications of using either a warm stimulus or a resting baseline as the control condition to reveal activation attributed to noxious heat. Comparing noxious heat to warm stimulation led to peak ALE values that were restricted to cortical regions with known nociceptive input. The fourth analysis tested for a hemispheric dominance in pain processing and showed the importance of the right hemisphere, with the strongest ALE peaks and clusters found in the right insula and ACC. The fifth analysis compared noxious muscle with cutaneous stimuli and the former type was more likely to evoke activation in the posterior and anterior cingulate cortices, precuneus, dorsolateral prefrontal cortex, and cerebellum. In general, results indicate that some brain regions such as the thalamus, insula and ACC have a significant likelihood of activation regardless of the type of noxious stimuli, while other brain regions show a stimulus-specific likelihood of being activated., (Copyright © 2011 Wiley Periodicals, Inc.)

Despite the fact that the rate of surgical complications mainly related to the necessary anticoagulation has been reported to be significant in patients supported by ventricular assist devices (VADs) who underwent noncardiac surgery, we report two cases showing that adequate peri-operative management of medical therapy and utilization of mini-invasive surgical approaches (i.e. laparoscopy) may limit the risks of morbidity, especially when surgery is required on an urgent basis.

This event-related functional MRI study examines the neural correlates of vibrotactile sensation within the context of different psychophysical demands. Nine subjects received vibrotactile stimuli on the right volar forearm during detection, localization, and passive tasks. In the detection task, subjects indicated the offset (end) of each stimulus by pressing a response key with their left hand. In the localization task, subjects identified the location of the stimulus ("distal?" or "proximal?") by pressing the appropriate response key 4 s after the end of the stimulus. In the passive task, subjects received the same vibrotactile stimuli, but no response was required. Analysis of stimulus-evoked activity compared with the resting baseline period revealed significant bilateral secondary somatosensory cortex activation for all three tasks. However, only in the offset-detection and localization tasks was stimulus-evoked activation observed in other expected areas of tactile processing, such as contralateral primary somatosensory cortex neighboring the posterior parietal cortex (SI/PPC) and in bilateral anterior insular cortex (aIC). During the localization task, we identified vibrotactile-evoked activation in the right aIC, which was maintained after the termination of the stimulus. Results suggest that vibrotactile-related activation within SI/PPC and aIC is enhanced by the increased levels of attention and cognitive demands required by the detection and localization tasks. Activation of aIC not only during vibrotactile stimulation, but also during the poststimulus delay in the localization trials, is consistent with the growing literature linking this area with the perception and short-term memory of tactile information.

Background: Heart failure is the leading cause of hospitalization among the elderly. This study compares clinical characteristics, management, and prognosis of octogenarians (OLD) with younger (YOUNG) patients in the Italian Survey on Acute Heart Failure (AHF)., Methods: A nationwide, prospective, observational study on AHF was done. Two hundred six Italian departments with intensive cardiac care units enrolled 2,807 patients in 3 months., Results: Octogenarians (mean age 84 +/- 4 years) represented 28% of enrollees. Females were 50% in the OLD group versus 36% in the YOUNG group (P < .0001). Risk factors such as obesity, diabetes, and smoking were more frequent in the YOUNG group. Comorbidities such as anemia and renal dysfunction were more common in the OLD group (64% vs 53%, P < .0001, and 56% vs 43%, P < .0001). More octogenarians were admitted with cardiogenic shock and pulmonary edema, whereas younger patients presented more frequently in New York Heart Association class III to IV (P = .002). Left ventricular ejection fraction was measured in 90% of octogenarians versus 93% of the younger ones and was preserved in 41% of the OLD group versus 31% of the YOUNG group (P < .0001). Coronary angiography was performed in 20% of the YOUNG group and 10% of the OLD group. In-hospital mortality was twice as high in the OLD group (11.8% vs 5.6%, P < .001). In multivariable analysis, the strongest predictors of this event were use of inotropic agents, advanced age (> or =80 years), and elevated troponin at admission., Conclusions: Octogenarians represent more than one fourth of the admissions for AHF and have a more severe clinical presentation. Their management is less aggressive, and treatments recommended by guidelines are underused. In-hospital mortality is high in the OLD group independently of left ventricular ejection fraction.

Introduction: The quality of life (QoL) is an important outcome indicator for heart failure management. As the use of a validate questionnaire in a different cultural context can affect data interpretation our main objective is the Italian translation and linguistic validation of the Severe Heart Failure Questionnaire (SHF) and its comparison with the MLHF (Minnesota Living with Heart Failure) Questionnaire., Methods: The SHF and "The Minnesota Living with Heart Failure Questionnaire" were translated. A consensus involving parallel back-translations was established among a group of cardiologists, psychologists and biostatisticians. SHF and MLHF were both administrated to a sample of 50 patients., Results: The patients' median age was 63 years. Ace inhibitors therapy was administered in 88% of cases and betablockers in 56% of cases. Finally the Italian version of SHF correlates well with MLHF for all domains, except life satisfaction SHF domain., Discussion: The Italian version of the SHF correlates well with MLHF for almost all domains and it represents a valid alternative for quality of life assessment in heart failure patients.

Tactile sensory information is first channeled from the primary somatosensory cortex on the postcentral gyrus to the parietal opercular region (i.e., the secondary somatosensory cortex) and the rostral inferior parietal lobule and, from there, to the prefrontal cortex, with which bidirectional connections exist. Although we know that tactile memory signals can be found in the prefrontal cortex, the contribution of the different prefrontal areas to tactile memory remains unclear. The present functional MRI study shows that a specific part of the prefrontal cortex in the human brain, namely the midventrolateral prefrontal region (cytoarchitectonic areas 47/12 and 45), is involved in active controlled retrieval processing necessary for the disambiguation of vibrotactile information in short-term memory. Furthermore, we demonstrate that this particular part of the prefrontal cortex interacts functionally with the secondary somatosensory areas in the parietal operculum and the rostral inferior parietal lobule during controlled processing for the retrieval of specific tactile information.

Distinct brain regions process sensory discriminative and affective components of pain; however, the role of these areas in pain memory is unknown. This event-related study investigated the short-term memory for sensory features of cutaneous heat pain using a delayed-discrimination paradigm and functional magnetic resonance imaging. During memory trials, subjects discriminated the location and intensity of two painful stimuli presented sequentially to the right hand. Control trials comprised the same sequence of stimuli and motor responses but required no delayed discrimination. Stimulus-evoked activity for memory and control trials was generally indistinguishable within the network of regions normally responsive to experimental pain [i.e., the primary somatosensory cortex/posterior parietal cortex (SI/PPC), secondary somatosensory cortex (SII), and anterior insular cortex (aIC)]; these data confirm the painful nature of the stimuli and the similar levels of attention and stimulus encoding engaged during the two randomly presented trial types. Memory-specific activity, assessed by contrasting the interstimulus interval in memory and control trials, was observed in SI/PPC and aIC but not in SII. We propose that SI/PPC plays a role in the short-term retention of spatial and intensity aspects of noxious stimuli and that aIC activation during memory trials is consistent with the integration of sensory and cognitive (attention, awareness, salience, and memory) components of pain perception. The absence of memory-specific anterior cingulate cortex activation, generally associated with pain unpleasantness, suggests that remembering affective aspects of the stimuli was not required during performance of the sensory delayed-discrimination task.

Objective: Heart failure (HF) is a major health problem resulting in a high financial burden for the healthcare system. Many previous HF management programmes reduced adverse clinical outcomes and costs, but they usually involved several professional figures as well as huge investments, requiring resources and budgets not often available in our healthcare system. We evaluated the effects of our HF management programme, which included patient education and regular outpatient contact with the HF team, on re-hospitalisation and death, optimising the few resources already available at our hospital., Methods: Two hundred consecutive patients admitted to the internal medicine department with a diagnosis of HF were randomised to the intervention group (nurse-led education programme, facilitated telephone communication and follow-up visits with an internist at 15 days, 1 and 6 months) or to the usual care group (follow-up by their primary care physician). The primary endpoints were all-cause readmissions and all-cause deaths during the 6-month post-discharge period., Results: There were 81 all-cause hospital readmissions in the intervention group and 82 in the control group (P = NS). Fourteen patients (14%) in the intervention group and eight patients (8%) in the control group died during the study period (P = NS). Unplanned outpatient visits were less frequent in the intervention group than in the control group (39 [28%] versus 99 [72%], P < 0.001)., Conclusions: The present low-cost HF management programme reduced unplanned outpatient visits but proved ineffective in reducing subsequent readmissions and in improving clinical status. More intense follow-up monitoring and more resources are needed to achieve better results.

Attenuation of responses to repeated sensory events has been thoroughly studied in many modalities; however, attenuation of pain perception has not yet benefitted from such extensive investigation. Described here are two psychophysical studies that examined the effects of repeated exposure to thermal stimuli, assessing potential attenuation of the perception of pain and its possible spatial specificity. Twenty-two subjects were presented thermal stimuli to the volar surface of the right and left forearms. Twelve subjects in study 1 received the same stimuli and conditions on each of five daily experimental sessions, whereas 10 subjects in study 2 received thermal stimuli, which were restricted to one side for four daily sessions and then applied to the other side on the fifth session. Ratings of warmth intensity, pain intensity, and pain unpleasantness were recorded while the subjects performed a thermal sensory discrimination task. Results of study 1 demonstrate that repeated stimulation with noxious heat can lead to long-term attenuation of pain perception; results of study 2 extend these findings of attenuation to both pain intensity and unpleasantness and show that this effect is highly specific to the exposed body side for both aspects of the pain experience. We suggest that the functional plasticity underlying this attenuation effect lies in brain areas with a strong contralateral pattern of pain-related activation.

The ability to localize both touch and pain has been attributed mainly to the primary somatosensory cortex (S1), based on its fine somatotopic mapping of tactile inputs. Recently, S1 has also been implicated in the differentiation of noxious stimulation, such as distinguishing between pain arising from viscera and skin. Recent MEG and fMRI studies show that there is at least a rudimentary tactile topographic representation in the supra-sylvian cortex [encompassing secondary somatosensory area (S2)], suggesting that this area may contribute to touch localization. Nevertheless, the role of this region in pain localization or its role in the differentiation of various types of pain has not been clearly established. Healthy subjects (four males, three females) underwent fMRI-scanning (1.5 T, standard head coil, BOLD analysis) during painful balloon distention of the distal esophagus and painful heat on the midline chest in the zone of referred pain for the esophageal stimulation. Five of the seven subjects exhibited significant activation of the parasylvian region in both experimental conditions, and in each of these five subjects activation related to esophageal pain was represented more laterally within the parasylvian cortex than that associated with cutaneous trunk pain (paired t-test, p's < 0.01). Our results suggest segregation of visceral esophageal and cutaneous chest afferents within parasylvian cortex, possibly implicating this region in the perceptual differentiation of visceral and cutaneous pain.

Unlabelled: Patients affected by heart failure have a compromised quality of life (QOL) and in the last few years "health related quality of life" has become an important outcome indicator for the evaluation of heart failure treatment., Methods: Translation into Italian of the Left Ventricular Dysfunction Questionnaire (LVD-36), a new, 36-item, disease-specific health status instrument for patients with congestive heart failure, and its subsequent validation by administration to 50 consecutive patients in our heart failure outpatient clinic. The Italian LVD-36 was compared to the "The Minnesota Living with Heart Failure Questionnaire" (MLHF)., Results: The Italian version of the LVD-36 correlates well with MLHF for ejection fraction (EF), NYHA class I and II, etiology and therapy. Since, however, the LVD-36 has only one domain, it may be able to offer more synthetic information than MLHF about patients' status., Conclusions: The Italian version of the LVD-36 appears to be a reliable instrument for assessing patients' QOL and the degree of limitations imposed on them by the disease. It is short, clear and easy to complete. In patients with heart failure the LVD-36 correlates well with the MLHF and may be considered a new disease-specific instrument to estimate changes in health status, and an useful support in optimizing therapeutic options.

Background: The Acorn CorCap cardiac support device (CSD) is a mesh-like device intended to provide end-diastolic support and reduce ventricular wall stress. Animal studies with the CorCap CSD have demonstrated beneficial reverse remodeling, and preliminary safety studies in patients with heart failure have shown that the device is safe and associated with improved left ventricular (LV) structure and function. The objective of the current study was to further evaluate the safety and efficacy of the CorCap CSD in patients with advanced heart failure., Methods: Twenty-four patients with dilated cardiomyopathy, severe LV dysfunction, and advanced heart failure (NYHA class II-IV) were enrolled at four centers in Italy and Sweden. All patients underwent CorCap CSD implantation either alone (n = 3) or in combination with mitral valve repair/replacement (n = 13), coronary artery bypass surgery (n = 6), combined mitral valve repair/coronary artery bypass surgery (n = 1) or aneurysmectomy (n = 1)., Results: The LV end-diastolic diameter decreased from 69.3 +/- 7.2 to 60.1 +/- 9.0 mm at 3 months, 60.9 +/- 9.6 mm at 6 months, and 58.9 +/- 8.0 mm at 12 months (all p < 0.05). A trend toward an improved LV ejection fraction (28.8 +/- 10.5% at baseline and 32.4 +/- 12.7, 33.1 +/- 10.8, and 33.8 +/- 13.9% at 3, 6 and 12 months respectively) was also noted. The NYHA functional class, 6-min walking distance, and quality of life as measured using Uniscale were all improved. There were no differences in response among the patients submitted to the different types of concomitant surgery., Conclusions: In agreement with earlier safety studies, even the present investigation demonstrated improvements in cardiac structure and function as well as in patient functional status after Cor Cap CSD implantation. Randomized controlled trials are in progress.

Prevalence of isolated left ventricular (LV) diastolic dysfunction has been reported to be as high as one-third of all heart failure (HF) cases, with an increasing prevalence in the elderly population. However, there is a paucity of prospective data about the prevalence and prognosis of isolated LV diastolic dysfunction in an unselected population of patients hospitalized with HF. Therefore, we prospectively evaluated 179 consecutive patients discharged from our hospital with HF to assess the prevalence of systolic versus diastolic LV dysfunction among patients hospitalized with HF and to compare their demographics, clinical features, self-perceived quality of life (QOL), and 6-month readmission rate and mortality. Among them, 133 (59% men, median age 74 years) showed in sinus rhythm and had no significant primary valvular disease. LV diastolic dysfunction was diagnosed on the basis of the European Study Group on Diastolic HF echocardiographic criteria. QOL was assessed at hospital discharge and 6-month follow-up visit using the Minnesota Living with HF questionnaire. Survival of patients with HF was compared with that of age- and sex-matched general population. In all, 29 patients (22%) had isolated LV diastolic dysfunction and 102 (78%) had prevalent LV systolic dysfunction (ie, LV ejection fraction

Background: Several studies have demonstrated that patients affected by heart failure have a compromised quality of life and, in the last few years, "health-related quality of life" has become an important outcome indicator for the evaluation of heart failure treatment and a basis for the improvement of its strategies., Methods: The translation into Italian of the Kansas City Cardiomyopathy Questionnaire (KCCQ), a new, 23 item, disease-specific health status instrument for patients with congestive heart failure, and its subsequent validation by asking 50 consecutive patients in our heart failure outpatient clinic to answer it. The KCCQ was compared to the "Minnesota Living with Heart Failure Questionnaire" (MLHF)., Results: The Italian version of the KCCQ correlates well with the MLHF for all domains with the exclusion of symptom stability score and MLHF emotional domain. However, the KCCQ, due to its multiple domains, provided more detailed information about the patients' status, and identified the more compromised ones., Conclusions: The KCCQ appears to be a valid and reliable instrument for the assessment of a patient's quality of life and the degree of limitations imposed upon him/her by the disease. When compared to the MLHF, the KCCQ, however, is somewhat more sensitive in identifying more compromised patients. This capacity could be advantageously used for the identification of clinical changes in future trials and lead to a better planning of new therapeutic interventions.

Background: The aim of this study was to compare the clinical characteristics of patients enrolled in randomized clinical trials on congestive heart failure treatment with those of real-world patients encountered in daily clinical practice., Methods: We searched the Cochrane review methodology, Medline and SilverPlatter databases to obtain the clinical characteristics of both patients enrolled in therapeutic clinical trials and real-world patients with heart failure. We selected 27 clinical trials, and 8 prospective epidemiological studies or registries published between 1987 and 2001 which enrolled 53,859 and 18,207 patients, respectively., Results: On average, compared to real-world heart failure patients, patients enrolled in clinical trials were younger (63 +/- 10 vs 75 +/- 11 years respectively, p < 0.0001), and more likely to be male (72 vs 54% respectively, p < 0.0001). Clinical trial patients showed a lower ejection fraction (26 +/- 7 vs 38 +/- 15% respectively, p < 0.0001) but a lower prevalence of NYHA functional class III-IV (62 vs 75% respectively, p < 0.0001) than real-world patients. In clinical trial patients, the prevalence of ischemic heart disease (67 vs 42% respectively, p < 0.0001) and a history of previous myocardial infarction (62 vs 42% respectively, p < 0.0001) were higher than in real-world patients. Conversely, the prevalence of chronic atrial fibrillation (12 vs 31% respectively, p < 0.0001) and of diabetes (22 vs 24% respectively, p < 0.02) was lower in trial patients than in real-world patients., Conclusions: Our data suggest that most clinical trials on congestive heart failure, on which the guidelines for clinical practice are based, have generally included patients who are not representative of the whole spectrum of patients actually managed in clinical practice.

Converging lines of evidence confirm a role for the anterior parietal cortex in pain processing and extend the traditional view of SI to include discriminative aspects of somatic stimulation that is potentially tissue-damaging (e.g., painful). Recent studies more specifically implicate SI in the sensory aspect of pain perception by demonstrating that SI activation is modulated by cognitive manipulations that alter perceived pain intensity, but not by manipulations that alter unpleasantness, independent of pain intensity. Nevertheless, despite the probable role of SI in the encoding of the various sensory features of pain, considerable evidence suggests that nociceptive input to SI may also serve to modulate tactile perception. Thus, SI cortex may be involved in both the perception and modulation of both painful and nonpainful somatosensory sensations. Defining a role in pain processing for the parietal operculum is somewhat more problematic. The absence of a fine somatotopic organization of cutaneous (or visceral) receptors virtually eliminates a substantial role for this region in localizing noxious stimuli. Several studies suggest separate representations for pain and touch within the posterior parietal cortex and SII, respectively; however, inter-species differences in cortical anatomy and inconsistencies in the designation of SII proper preclude a clear reconciliation of the data. Likewise, suggestions that SII activation is predominantly related to processing the nociceptive quality of the stimulus (60,61) are inconsistent with many studies in both human and nonhuman subjects, which show a strong functional relationship between SII activity and innocuous (especially, vibrotactile) stimulation. Nevertheless, the numerous studies indicating pain-related activation within the parietal operculum (and/or SII) underscore the potential importance of this region in the perception of pain and the need for continued research. Finally, a possible role of posterior parietal cortex (BA 5/7, 39/40) in orientation and attention toward painful sensory stimuli is consistent with existing literature describing this region as a poly modal association area concerned with intrapersonal and extrapersonal space; however, results from studies that actually manipulate the subjects' level of attention relative to painful stimuli have not uniformly supported this hypothesis (75). Future studies assessing both attentional demand and direct manipulation or motor interactions involving noxious stimuli may help to resolve this issue. In spite of some discrepant results concerning specific details of the nociceptive process, the weight of human pain research now firmly establishes a role for the parietal lobes in the conscious appreciation of the sensation of pain.

Rationale: In the management of heart failure the general practitioner (GP) plays an important role. However, international studies proved that the GP differs in the management of these patients from the cardiologist. This pilot study aims at investigating if such differences persist in the Italian community., Materials and Methods: Seventy patients with heart failure have been enrolled prospectively by 10 GPs in the Udine district (ASL 4). All of them have been evaluated at the first and subsequent visits, both with respect to clinical and instrumental parameters, overall resource consumption and quality of life., Results: We observed a high degree of heterogeneity in the follow up patterns; a low coordination between GP and cardiologists in managing patients; several co-morbidities; high social burden; a good adherence to treatment guidelines; a moderate workload, subjectively evaluated from the GP., Conclusions: This experience motivated the need of further research in the field, and, from the point of view of the daily practice, the need of integrating hospital and community management of patients with heart failure.

Background: The aim of this study was to evaluate the effectiveness of a health education intervention aimed at improving therapeutic compliance and quality of life of patients with chronic heart failure (CHF). In this 1100 bed Community hospital 97% of patients with CHF admitted to the Internal Medicine Unit have a high rate of readmission, mortality and negative quality of life., Methods: Two hundred patients (123 males, 77 females, mean age 75 years) were enrolled and randomized. CHF patients admitted to the Internal Medicine Unit were randomly assigned to usual care (n=100) or intervention group (n=100), which consisted of a nurse-guided education program, facilitated telephone communication and regularly scheduled follow-up visits with an internist. The primary endpoints were quality of life and quality of service improvement, and improved compliance with the heart failure guidelines. All patients were submitted to echocardiography., Results: Ejection fraction is available for 87% of them. Baseline quality of life is similar in both groups. Final data will be available after April 2001.

Using information from the Italian Network on Congestive Heart Failure, we examined whether clinical epidemiologic characteristics, drug prescription patterns, and outcome of patients with congestive heart failure differed according to sex and whether gender was an independent risk factor for mortality and hospital admissions.

Aims: To assess the prevalence, clinical characteristics, use of medical resources and quality of life in consecutive patients with chronic heart failure (CHF) hospitalized in a large community hospital during 3 months., Methods and Results: The study group included 354 patients with CHF, admitted in the Departments of Internal Medicine (97%) and Cardiology. Median age was 78 years [72;85], 45% were males. CHF was the main diagnosis in 72%; 28% were in NYHA class III and 49% in class IV; 42% had atrial fibrillation. The median hospital stay was 8 days [5;14], in-hospital mortality 9% in those admitted for CHF and 19% in those admitted primarily for other diseases. Patients with CHF occupied 15% of the beds; 1330 ECGs, 389 chest X-rays, 112 echocardiograms and 10 coronary angiograms were performed. A quality of life questionnaire revealed that 82% had problems with mobility, 54% with self-care and 88% with everyday activity. Thirty-nine percent of patients had at least one hospitalization during the previous year., Conclusions: Ninety-seven percent of hospitalized patients with CHF are admitted in the Internal Medicine wards and occupy 15% of beds. The majority of the patients are 72 years or older, with severe heart failure. The frequency of rehospitalization(s) and mortality rate in this population remains high. Echocardiography is performed only in 27% of patients.

Background and Methods: In a prospective protocol for noninvasive diagnosis of acute cardiac rejection, 83 routine endomyocardial biopsies, followed each time by the analysis of signal-averaged electrocardiography and by a cardiac Doppler echocardiographic study, were performed in 18 heart transplant recipients. The follow-up time was 5 +/- 3.6 months. To detect noninvasively acute cardiac rejection, we compared biopsy findings with the presence of late potentials at signal-averaged electrocardiography and with two diastolic indexes, pressure half-time, and isovolumic relaxation time obtained from Doppler echocardiographic study., Results: Thirteen acute rejection crises requiring modification of immunosuppression were diagnosed by means of endomyocardial biopsy. This clinically relevant acute cardiac rejection was associated with the presence of late potentials in 69% of cases and with the presence of pressure half-time < or = 55 msec and isovolumic relaxation time < or = 60 msec in 69% and 62% of cases, respectively. Sensitivity and specificity were as follows: for late potentials, 69% and 71%; for pressure half-time < or = 55 msec, 69% and 76%; for isovolumic relaxation time < or = 60 msec, 62% and 83%, respectively. The presence in a single patient of at least one abnormal parameter showed a sensitivity of 100% and a specificity of 60% in detecting important rejection., Conclusions: These data support the use of combined signal-averaged electrocardiography and Doppler echocardiographic study of the left ventricular diastolic function in the screening of acute cardiac rejection. Such results can suggest when endomyocardial biopsy should be performed, with the reliance that a normal noninvasive study highly excludes the presence of acute cardiac rejection requiring intensified immunosuppression.

39 patients aged 70 years and over, 24 males and 15 females underwent valve replacement at Groote Schuur Hospital between 1969 and 1979. 30 patients were affected from aortic valve disease, 6 from mitral valve disease and 3 from mixed mitral and aortic valve disease. The rate of postoperative complications have remained low, and specific complications for this age group have not been observed. 38 patients have been followed up for 1-120 months (mean 30 months). The majority of patients have experienced a remarkable functional improvement. The findings indicate that valve surgery can be performed in the older age group with the same low risk observed in the younger patients.