[Surgery of ventricular aneurysms and akinetic zones]

Operation was performed in 180 patients with post-infarction ventricular aneurysm (12 cases) or akinesia (92 cases). Simultaneously in 2 cases mitral valve replacement was performed and in 2 cases ruptured ventricular septum was treated by patch. The results are reported and discussed.

[504 implantations of aortic valve prostheses]

The results in 504 patients operated with aortic valve replacement are reported. In 153 patients other associated valvular diseases or complications were present. The mortality in non complicated case was 3%. The long term mortality (1--14 years) was 4%. The results and indications are discussed.

Effect of sodium bicarbonate on canine left ventricular function

Left ventricular performance was evaluated in seven canine right heart bypass preparations during and after the intraauricular administration of sodium bicarbonate (100 ml, 1100 Osm, 60 mEq). Under conditions of constant cardiac input and left ventricular volume, sodium bicarbonate produced mild and brief left ventricular depression, as manifested by a decline of left ventricular dp/dt with simultaneous rise of left ventricular end-diastrolic and left atrial pressures. These findings occurred as aortic impedance fell. Identical results accrued in paced and unpaced preparations. The data lends credence to the proposition that a sudden rise in blood pCO2 produces increased transport of CO2 across the cardiac membranes with intracellular acidosis. However, the data is also compatible with hyperosmolality induced contractile depression. Possible clinical implications are discussed.

Effects of ketamine on canine cardiovascular function

Left ventricular contractility was assessed before and during the peak effect of ketamine in eight canine right heart bypass preparations. Myocardial contractility was defined in terms of maximum left ventricular dp/dt, the ejection fraction, and left ventricular end-diastolic and left atrial pressures at constant heart rate and cardiac inflow. Ketamine produced significant decreases in contractility and there were some indications of a dose-response pattern. The action of ketamine was dependent partly on changes in arterial pressure, as the drug caused a mild but sustained vasodilatation which was not dose-dependent. These data offer further evidence of a small and transient negative inotropic effect of ketamine.

[Megaloblastic anemia in the recovery of the malnourished child]

With the purpose of analyzing the evolution in weight before and after treatment of megaloblastic anemia with folic acid, we studied the clinical changes and the evolution in weight in 8 malnourished children who developed this type of anemia during their recovery. Seven out of the 8 cases were less than 20 months of age; 5 of them came from mothers who had had five or more pregnancies; in 7 a history of diarrhea of prolonged course was presented and 2 cases had been given sodium diphenylhydantoin. Increase in weight before treatment of anemia with folic acid was lesser than the one for the days following treatment in seven of the patients. Simultaneously, an important change in behavior was appreciated, without being possible to atribute this change or the increase in weight to a quantitative change favorable to the ingestion of proteins and calories.

Ascending aorta-right pulmonary artery anastomosis in children with complex cardiac malformations. Long-term results in 30 cases

In this report, we shall analyze the results obtained with palliative treatment in 30 patients with congenital heart disease who were operated upon at the University Hospital of Caracas during the period 1968 to 1972. In all cases, an ascending aorta-right pulmonary artery anastomosis was performed. Although we believe that the Blalock-Taussig and Potts shunt are satisfactory operations in some cases, at the present time we prefer the aorta-right pulmonary branch anastomosis in Fallots tetralogy and other congenital heart diseases such as single ventricle. In Fallot's tetralogy, particularly, this procedure provides better results, because the anastomosis can be closed through the aorta when these patients are later subjected to total correction with extracorporeal circulation.

[The clinical problem of hereditary hemorrhagic diseases developing prolonged bleeding time]

Thirty-two patients with hereditary hemorrhagic diseases and a platelet functional abnormality were set apart from our group of patients with hereditary hemorrhagic diseases, and their symptoms, signs and hematological examinations were collected; the initial events and the age of the patients when they were obsserved, the main hemorrhagic manifestations during their clinical course, the clinical severity of the disorders, the survival of the patients and the laboratory test for hemostasis useful to make the diagnosis, were evaluated. In reference to bleeding time, thirty patients had abnormal bleeding time, but the other two had normal bleeding time.