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Severe intravascular hemolysis is described as a complication of implantation of an aortic Starr-Edwards ball-valve prosthesis and insertion of a Teflon patch in the ascending aorta in a 9-year-old boy with severe aortic valvar stenosis. This progressive hemolysis of delayed onset was the sole indicator of extreme degeneration of the silicone rubber ball of the prosthetic aortic valve, a potentially lethal condition requiring surgical intervention. The phonocardiographic signs of aortic ball variance were not present, and there was no overt valvar incompetence. A lesser but noteworthy aspect in this case was the occurrence of an "aplastic crisis" superimposed on the severe hemolysis. This transient bone marrow, red cell aplasia, which was unrelated to drugs, precipitated an acutely severe anemia which accounted for the presenting symptoms of the patient and required transfusion.

Two pathological specimens are presented in which the morphological left ventricle contains the right atrioventricular ostium, completely or in its major portion and, totally, the left atrioventricular ostium. It is suggested from a consideration of these cases and of the pathological material available in the literature that this constitutes an entity that can be usefully separated from the heterogeneous group of single ventricle with which it has previously been classified. The entity is called double-inlet left ventricle and is defined as existing when two separate atrioventricular ostia open in a morphological left ventricle. An ontogenetic explanation is presented based on the study of normal human embryos. These cases resemble the heart of the embryo during the horizons XIII to XVI of Streeter. It is suggested that there has been a partial arrest in the widening of the atrioventricular canal and the changing relation of the atria with the ventricles at these stages. It is noted that both atria open into the morphological left ventricle whether situated to the left or to the right. This is an expected finding, since the left ventricle is derived from the primitive ventricle and the primitive ventricle is always connected with both atria during the early stages of embryological development. Other malformations include transposition of the great arteries in both cases and ventricular inversion in one.