Rheumatic aortic stenosis in young patients presenting with combined aortic and mitral stenosis

This report describes 30 patients under the age of 30 years with rheumatic aortic stenosis, presenting with combined aortic and mitral stenosis. Three patients had additional tricuspid stenosis. Twenty-eight patients gave a history of rheumatic polyarthritis. The diagnosis was confirmed by right and left heart catheterisation in all. The murmur of aortic stenosis was not initially present in 8 out of 10 patients in congestive heart failure. Aortic valve calcification was not seen. Cineangiography showed a tricuspid aortic valve in all, unlike congenital aortic stenosis. A unique feature of this group was the raised pulmonary vascular resistance in 87 per cent of the patients. The present study shows that patients in India developing aortic stenosis after rheumatic fever do so early in the natural history of the disease.

Massive left atrial thrombus complicating mitral stenosis with atrial fibrillation: results of surgical treatment

Thirty-five patients with massive atrial thrombus complicating mitral stenosis and atrial fibrillation were treated surgically. The mean age in this series is lower than that reported in the West. Furthermore, the incidence of preoperative embolic manifestations has been less frequent in our experience. We believe it is desirable to document the presence of a thrombus by selective left atrial cineangiography. Surgical treatment was accomplished with an acceptable mortality. The vital role played by the use of low-molecular-weight dextran and early anticoagulation in decreasing the incidence of postoperative cerebral embolism is emphasized. Follow-up data in the survivors has shown excellent functional status with no late embolic phenomena in any subject.

[Intraocular pressure in snorkling and diving (author's transl)]

The reactions of the intraocular pressure (i.o.p) in snorkling and scuba diving were studies on 29 healthy subjects. A patient with chronic glaucoma simplex was examined in a pressure tank. The results confirm the author's opinion, that a well compensated chronic glaucoma simplex with intact discs and fields does not exclude fitness to dive. However, a diver with narrow angel glaucoma risks sudden rise in i.o.p. and acute glaucoma while ascending to the surface. Persons, who are examined for fitness to dive, should be seen by an ophthalmologist, if they have a glaucoma or if they are hypermetropic and over 40 years of age.

[Problems of intraocular pressure in scuba diving (author's transl)]

The reactions of intraocular pressure (i. o. p.), pulse rate, and blood pressure were studied on 30 scuba divers in a pressure tank. Under excess pressures of 2 and 4 atm the i.o.p. showed an average fall of 2-3 mm Hg. The pulse rate fell in average by 4-5/min, while the blood pressure only showed minor changes. In the authors' opinion a well compensated chronic simple glaucoma with intact discs and fields does not exclude fitness for scuba diving.

The profile and surgical management of mitral stenosis in young patients

Mitral stenosis in the younger age groups in India is a unique condition characterized by a short duration and a rapid progression of symptoms. The majority of patients with this lesion develop pulmonary hypertension at an accelerated pace, and about one third have associated congestive failure and functional tricuspid regurgitation. Five hundred consecutive patients with this condition were treated surgically, 493 with a closed valvotomy. The over-all hospital mortality rate of 5.8 per cent was related to the severity of the preoperative functional status. In the last 150 cases, the figure dropped to 2 per cent. Assessment during the first 5 years after surgery revealed an excellent functional status in 85 per cent. The incidence of restenosis was only 3.4 per cent in the first 5 year period and 11 per cent in a subsequent 6 to 10 year follow-up period. Twenty of the 21 subjects with restenosis had an excellent functional result following closed transventricular valvotomy, and this status has been maintained during the follow-up period. To our knowledge, there are no other reports of long-term follow-up data in young patients undergoing surgical treatment for mitral stenosis.

Constrictive pericarditis and its surgical management

The surgical management of 66 cases of constrictive pericarditis has been presented. Tuberculosis was the most common etiologic factor in this series. The importance of optimal myocardial function has been emphasized. Pericardiectomy was limited to release of the ventricles in order to correct the hemodynamic anomaly. The vast majority of patients claimed to have benefited from surgery.

Primary malignant tumours of the mediastinum and their management

Primary malignant tumours of the mediastinum are difficult clinical problems in thoracic surgery from both diagnostic and therapeutic points of view. Three cases of malignant seminoma of the mediastinum have been documented, thus bringing the total number of cases reported in the literature to 78. A case of metastasis to the subcutaneous tissue in malignant thymoma has been documented. Because of the multiple-cell types of these tumours and their ill-defined extent due to involvement of adjacent structures, surgery is often difficult. Radiotherapy along with chemotherapy has a definit place in their management, either as a primary treatment in inoperable cases or as a supplement to surgery if the condition is operable.

Intracardiac repair in tetralogy of Fallot. Hemodynamic studies following corrective surgery

Experience with the first 100 cases with tetralogy of Fallot subjected to intracardiac repair are presented. In this series there was an early hospital mortality of 12 per cent and 6 late deaths occurred. Eighty out of 82 survivors were available for follow-up and 33 of these underwent postoperative catheterization studies. The functional status of the survivors revealed excellent results in 89 per cent, good in 8 per cent, fair in 1 per cent and poor in 2 per cent. This is the largest series reported from India.