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The investigational Carpentier-Edwards supra-annular valve was implanted in 592 patients from November, 1981, to February, 1984 (aortic valve replacement in 286, mitral valve replacement in 259, and multiple valve replacement in 47, for a total of 638 prostheses). A previous cardiac operation had been performed in 77 patients (13%). Concomitant procedures were performed in 202 patients (34.1%), including coronary artery bypass in 163 patients. The patient evaluation was 98.6% complete. The early mortality was 7.4% (44 patients) and the late mortality was 6.2% per patient-year (41 patients). The valve-related causes of late mortality were thromboembolism (five), anticoagulant-related hemorrhage (one), and prosthetic valve endocarditis (one). The overall patient survival, including operative death, was 85% at 2 years. The linearized occurrence rate for valve-related complications was 5.6% per patient-year (37 events)--thromboembolism 2.7% per patient-year (18) anticoagulant-related hemorrhage 1.2% (eight), prosthetic valve endocarditis 0.8% (five), and periprosthetic leak 0.9% per patient-year (six). There were no cases of primary tissue failure or structural failure. At 2 years, the freedom from valve-related complications was 86.9%, from valve-related mortality, 98.7%, and from valve-related mortality and reoperation, 97.7%. This valve is fixed in glutaraldehyde at low pressure and is designed to improve durability. It has provided a low incidence of valve-related complications without structural failure. The structural design of the prosthesis does not always conform to the anatomy of bicuspid aortic valves.

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In recent years evidence has emerged that most post-transfusion hepatitis is caused by one or more previously unknown agents named non-A, non-B. A prospective investigation was made of 74 patients who underwent open-heart surgery. Only volunteer blood was used for transfusions. Transfusion-associated hepatitis appeared in 15 (20%) of the patients 4-12 weeks after the operation. In no case was the hepatitis found to be caused by hepatitis B, A or Epstein-Barr virus. One patient had a cytomegalovirus infection; the other 14 cases (19%) were classified by definition as non-A, non-B hepatitis. Although most of the patients were asymptomatic and all were anicteric, the course of the hepatitis was protracted in many cases. Thus, 6/12 observed patients still had pathologic transferase values more than a year after the onset of hepatitis. Liver biopsy was performed in 3 cases and showed histologic signs of chronic active hepatitis in all of them.

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The number and nature of bleeding complications subsequent to cardiac catheterization and angiography were determined in 50 anticoagulated and 50 control patients. There were six bleeding complications in the anticoagulated group and five in the control group. Although the complications were somewhat more severe in anticoagulated patients, the difference was not enough to justify a change in our general policy of continuing anticoagulant treatment in patients with artificial heart valves who are admitted for postoperative invasive cardiac investigations.

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During the twenty-year period 1954--1973, 208 patients were referred to the Department of Thoracic and Cardiovascular Surgery for treatment of mediastinal tumours. Forty-nine patients had malignant tumours (24%), 86 benign tumours and 73 non-neoplastic lesions. The most common histologic types were neurogenic tumours and malignant lymphomas, followed by thymomas and germinal tumours. Most non-neoplastic lesions were cysts. The mediastinal tumours were often asymptomatic, the malignant tumours in 31%, the benign tumours and tumourlike lesions in 65% of the cases. The most common symptom was pain, which occurred in one-fifth of the patients. The most useful diagnostic method was X-ray examination of the chest. However, a final diagnosis could usually be made only at operation. Thirteen malignant tumours were excised radically, 18 palliatively and 18 were only biopsied. Almost all benign tumours were radically excised. Forty-four patients received postoperative radiation therapy and 6 received chemotherapy. The hospital mortality was 8.2% for the patients with malignant tumours and 1.9% for those with benign tumours. At the end of the follow-up period, which varied from 2 to 21 years (median 10.3 years), 41% of the patients with malignant tumours were alive. Two patients with benign tumours had died of an apparently malignant change in a neurofibroma.

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There are only a few reports in the literature on cysts of the thoracic duct. This case report concerns a 56-year-old female patient, who was operated on because of a mediastinal mass that later proved to be a cyst of the thoracic duct. The operation and immediate postoperative course were uneventful. Six months later, the patient was doing well and no further investigations were recommended.

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During a period of 20 years, 19 patients with thymomas and 5 with thymic cysts were surgically treated at this clinic. Excluding one operative death, none of these patients had died of causes related to the tumour 7.4 years (average) after operation. Two patients had died of unrelated causes, and in one case a recurrent mediastinal tumour was observed 3.5 years postoperatively. Myasthenia gravis, present at the time of operation in 3 cases, had been alleviated in one case, remained unchanged in another and become aggravated in the third case. In addition, one patient had developed myasthenia 7 years after resection of thymoma. In one case, a preoperative tentative diagnosis of lupus erythematosus disseminatus had been confirmed. Infiltrative growth was mascroscopically observed in only 2 cases. One of these patients died of haemorrhage during the operation; the other patient was in good health 1.5 years after partial resection and subsequent irradiation of the tumour. Four patients received radiotherapy. In one of the 15 cases treated solely by operation, the tumour fell to pieces on resection; a recurrent mediastinal tumour (cf. above) was removed 3,5 years later.

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A clinical series of 216 patients with carcinoma of the oesophagus or cardia, who underwent surgical resection of the oesophagus, is presented. There were 104 patients with oesophageal carcinoma and 112 patients with carcinoma of the cardia. Histologically, there were 102 squamous cell carcinomas, 98 adenocarcinomas, 11 anaplastic carcinomas and 7 non-differentiated carcinomas. Oesophago-gastrotomy was the procedure mostly used; colon interposition was done in only 13 cases. The hospital mortality was 21%. The 5-year survival rate for the whole series after oesophageal resection was 23%. The duration of symptoms, location of the tumour, age and sex of the patients, pre- or postoperative radiotherapy and the histological type of the tumour had only a minor bearing on survival. The two most important prognostic factors were the spread of the tumour at time of operation and a preceding lye stricture. The 5-year survival rate was 34% for the patients with a local tumour at operation and 44% for those in whom the carcinoma developed at the site of a previous lye stricture. The variance of the results in the literature is discussed. Surgical approach to the carcinoma of the oesophagus and cardia is recommended in all the cases in which the patient and tumour seem to be eligible for resection.

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