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Supraventricular tachyarrhythmias (SVT) complicate postoperative management after coronary bypass surgery in about 30% of all patients. Though a prophylactic treatment both with beta-adrenergic blocking agents and the calcium antagonist diltiazem has been used for the prevention of post-operative SVT, no study yet has performed a prospective comparison of the efficacy of these therapies.To investigate the prophylactic effect of either a calcium antagonist (diltiazem, 0.1 mg/kg per h i.v.) or a beta-adrenergic blocking agent (propranolol, 10 mg every 6 h postoperatively), we randomized prospectively 103 consecutive patients into three groups, the third one serving as a control group. Anti-arrhythmic medication was started with the procedure and was continued until the 3rd postoperative day.Preoperative conditions were the same for the three groups concerning age, extent of coronary heart disease, ventricular function and heart-related medication. There were no differences in intraoperative parameters or postoperative enzyme patterns. Diltiazem was ineffective in preventing SVT, the incidence being exactly the same as in the control group (35%). Propranolol reduced the occurrence of SVT significantly (7%, P0.05). Furthermore, patients treated with diltiazem needed positive inotropic support more often in the first hours after surgery than patients of the control group (30% vs 5%, P0.01).The perioperative administration of low-dose propranolol is considered a safe and effective drug prophylaxis to avoid the occurrence of SVT after bypass surgery.

Between 1983 and 1922 70 patients of the author's institution underwent valve replacement for bacterial endocarditis of native valves. In 22 cases the source of infection could be identified. Among them the most frequent source of infection was dental manipulation (7 patients). The predominating causative microorganism was Streptococcus viridans followed by Staphylococcus aureus. Preoperative complications, the intraoperative finding of extensive destructions, and the histological finding of acute changes influenced significantly the occurrence of perioperative complications. 20 patients died (28.6% overall mortality), there were 9 perioperative deaths (perioperative survival 87.1%). The one-year survival was 73.8% the five-year survival 61.5%. Significant risk factors for the prognosis were preoperative complications, positive bacteriological result of the analyzed resected valves, perioperative complications, duration of the postoperative antibiotic treatment, and the postoperative NYHA functional class. Therefore one should intervene surgically before preoperative complications appear. Perioperative complications must by treated immediately, and an adequate postoperative antibiotic therapy must be guaranteed.