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Forty eight cases with infections endocarditis (IE) are analyzed--27 males and 21 females (75% at the age of 31-60). Only in 12.5% IE has developed on intact valvular apparatus. In 83.4% the preceding valvular pathology is rheumatic heart defect (RHD), and congenital cardiac malformations and valvular dysplasia--8.3% each. The mitral-aortic valvular defects predominate in RHD, followed by aortic, tricuspid and mitral ones. In 83.3% X IE is with valvular localization, in 4.2%--parietal and in 12.5%--on valvular prostheses. Vegetations are highly specific for valvular IE (100%) as well as ulcerations (90%) and perforations (45%). Ruptures of extra-valvular structures are established in 8.3%. The inflammatory alterations in myocardium are in 62.5%. The pericardial changes are found in 14.6%, mainly in the cases with valvular prosthesis. Septic changes are established in all cases in the spleen and regeneration of bone marrow, and vascular changes--in 85.4%. The cases with embolism and infarctions predominate in the kidneys (79.1%), followed by the cases with Löhlein's focal nephritis (18.6%). The inflammatory changes in liver are rare--6.9%. In 37.5% changes in brain were established, embolism according to incidence being first, followed by cerebral hemorrhages, cerebral abscesses and purulent leptomeningitis Staphylococcus aureus proved to be most frequent causative infectious agent established et necropsy.

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A patient with hypertrophic cardiomyopathy and infectious endocarditis has been described, confirmed clinically and bacteriologically. L-forms of alpha-streptococcus were isolated from the hemocultures. Aortic valve was affected in the course of the septic process. That morbid state was very favourable influenced by the treatment with high dose penicillin, combined with streptomycin. The control hemocultures 40 days after the discontinuation of the treatment proved to be negative.

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A total of 592 women in child-birth, at an average age between 15 and 42, mean 26.8 +/- 8.4 years, have been studied. The women with mitral valve defects predominate--83.9% (mitral stenosis--39.8%, mitral insufficiency--18.5% and combined mitral stenosis and insufficiency--41.7%), followed by the women with combined) aorto-mitral defects--9.8% and those with isolated aortic defects--6.3% (out of them with aortic stenosis 35.1%), aortic insufficiency--43.2% and combined aortic defect 21.7%). Pulmonary hypertension proved to have 83 women (14%), all with mitral and mitral-aortic defects. Cardiac insufficiency was established in 130 patients (22%-53.8%, stage I, 38.5%, stage II A and 7.7%--stage II B). Cardiac complications during pregnancy were observed in 29.6% of the patients, during delivery--in 5.4 and in puerperium--in 7.4%. Three women have died--one during delivery and two--during the early puerperal period. The percentage of the women that have given birth by via naturalis is 81.6% and the women that needed assistance--18.4%. A total of 587 viable children have been born (7 twins), 9--non-viable and 3--stillborn. A proper evaluation, in advance, of the cardiac affection and adequate behaviour during pregnancy and labour are necessary for the successful outcome of the pregnancy and delivery in females with valvular heart defects.

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Seventy patients with valvular cardiopathies were performed selective coronarography besides the routine hemodynamic examination during the period 1973-1983. Those 70 patients could be subdivided in the following way: 46 with aortic, 17 - with mitral-aortic and 7 with mitral valvular lesion. Their average age is 46,15 +/- 1,42. Considerable changes (stenosis over 50% of at least one artery of the three main ones) were established in 9 patients (12,85%). The average age of the patients with the changes is 47,44 +/- 1,64. Angina pectoris had 57 out of 70 patients (81,42%). The mean telediastolic pressure of left ventricle of the patients with coronary alterations was 3,94 +/- 0,63 kPa (29,6 +/- 4,71 mm Hg) whereas the others, with intact coronary arteries had a mean telediastolic pressure of 2,6 +/- 0,43 kPa (19,43 +/- 3,26 mm Hg). Out of the nine patients with coronary changes--6 were males and 3--females. All had aortic valvular lesions--four with high degree stenosis, there--with high degree insufficiency and two--with mixed defect. The authors think that the systematic coronarographic investigations of the patients that are to have valvular prosthetization, is not necessary.

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Marfan's syndrome in its complete and incomplete forms takes very often a course with cardiac complications, predetermining the fate of such patients. The incomplete forms often present difficulties for the timely etiological elucidation of the cardiac changes leading to a retardation in the prescribing a rational regime to the patients and timeliness of the operation treatment. The authors' team own observations are reported on 10 patients with Marfan's syndrome, one with complete form and nine--incomplete forms, all of them with cardiac complications; two with mitral insufficiency, three with aortic insufficiency, four with aortic and mitral insufficiency and one with aortic, mitral and tricuspidal insufficiency; seven of the patients had aneurysm at the initial part of the aorta, manifested to various degrees and one--dysplasia of aorta. Rhythm disturbances were found in one of the patients. One of the patients underwent operation--prosthesis of mitral and aortic valve--with good results. Three of them died of severe total cardiac insufficiency.

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Echocardiographic findings are comparatively analyzed in 25 patients with congestive cardiopathy, combined with mitral regurgitation, a control group of healthy and 10 patients with volume loaded left ventricle with rheumatic "pure" mitral insufficiency. Some discrepancies were established in the usual echocardiographic characteristics of congestive cardiomyopathy in the patients with CCMP, combined with significant mitral insufficiency: normal, even increased amplitude of movement of the interventricular septum in the absence of systolic increase of the septal thickness. The differentiation between the rheumatic mitral insufficiency and mitral insufficiency in case of congestive myocardiopathy is difficult, due to the considerable differences in the functional Echo-C characteristics of left ventricle and morphological characteristic features in mitral echogram.

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Valvular prosthesis made a good reputation in the treatment of acquired and a series of congenital heart diseases. At the Research Institute of Cardiovascular Diseases, 288 subjects were implanted a total of 324 valves from 1965 to 1979. Only from January 1, 1977 to May 1, 1979--132 patients got valvular prostheses, 71 of them with mitral prostheses, 42--with aortic prostheses and 19--with double valvular prostheses,with a total and immediate postoperative lethality of 22.8%. In 18 of the patients valvular prosthetization was accompanied by some other heart interventions--valvular commissurotomy or plastics, plastics of interauricular defect, etc. The potentialities and indications are developed for surgical treatment with valvular prostheses in cases of mitral aortic and tricuspid heart diseases.

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