[Apparent cardiac malformations in old age]

In patients aged 79, 80 and 81 cardiac malformations were found at autopsy which did not permit to decide with certainty whether they were congenital or acquired. In the first case the lesions appeared as a band-shaped fibromuscular subvalvular aortic stenosis, the second one being an isolated aneurysm of the membranous septum directed to the righ side and combined with a minute diverticulum in the muscular part of the interventricular septum. The apex of the aneurysm faced the septal cusp of the tricuspid valve. From its dorsocranial circumference two tunnel-like formations projected in the dorsocranial direction terminating blindly beneath the atrial septal endocardium. The ventral canal protruded into the right, the dorsal one into the left atrium. Rather marked regressive changes and areas of florid chronic inflammation were found in the terminal parts of these channels. In the third case observed the pathological lesion were aneurysms of the Valsalva sinuses.

Serial hemodynamic observations in congenital valvular and subvalvular aortic stenosis

The present study is an attempt to clarify the natural history of valvular and subvalvular aortic stenosis. Twenty-eight patients with isolated and uncomplicated congenital aortic stenosis who had serial hemodynamic evaluation without intervening surgery were selected. They were divided into three groups according to the severity of the peak systolic pressure gradient. At the initial study, 16 of the 28 patients had mild stenosis, 11 patients had moderate stenosis, and one patient had severe stenosis. On restudy, there were only 9 patients with mild stenosis, 12 patients with moderate stenosis, and 7 patients with severe stenosis. The cardiac index and right-sided hemodynamics were normal. The electrocardiographic and radiographic findings in relation to severity of the lesion were also observed. It is our feeling that both valvular and subvalvular aortic stenosis are progressive lesions, the subvalvular being more so than the valvular.

[Pre- and postoperative examinations in congential aortic stenoses]

70 patients with congenital aortic stenosis had been operated upon between the age of 7 months and 23 years (average 8 years). For evaluation of the surgical result recatheterization and angiocardiography had been carried out on all patients between 1 and 12 years after operation (mean 7 years). The pre- and postoperative catheter findings, angiocardiograms, ECG, heart-size and clinical findings were analysed and compared with each other. In 2/3 of the cases the operative results could be defined as good or satisfactory. In the last third the operative results had been poor and a reoperation unavoidable. In half of the cases the poor results had been due to a significant residual aortic stenosis and in the other half it was due to massive aortic regurgitation. The prognosis and the indication to operation had been discussed.