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The authors discuss in the introduction hitherto reported data on the incidence and course of post-infarction ruptures of the interventricular septum and the results of conservative treatment. The high mortality rate after the conservative procedure led to attempts to resolve post-infarction ruptures of the interventricular septum surgically. The authors discuss in detail the indications for early and delayed operations has a decisive influence on the patients' survival. The authors had the opportunity to operate since 1978 till February 1986 five patients with post-infarction perforation of the interventricular septum. Four of the patients were women, one was a man. The mean age of the operated patients was 61 years, the oldest patient was a 75-year-old man and the youngest a 46-year-old woman. During the last check-up in 1994 it was revealed that of five operated patients three had died. One of them three years after operation and two after seven years. One female patient survives for 13 years and one for 11 years. Both are in a satisfactory conditions.

The authors present their initial experience with surgery of pulmonary affections in 32 patients where they used medial sternotomy as the route of approach. They provide evidence of the advantages of this approach, in particular in high-risk patients, and of the favourable effect of this approach on the postoperative course. Successful radical surgery under conditions of extracorporeal circulation, although a very advanced tumour was involved where posterolateral thoracotomy was unequivocally contraindicated, indicates that there is a possibility to extend indications of surgical therapy of otherwise inoperable pulmonary tumours.

The authors submit a review of the surgical treatment of ischaemic heart disease, and based on data from the literature and their own experience, they evaluate the asset of so-called indirect revascularization operations under conditions when an aortocoronary bypass is impossible or has only a short-term effect due to the diffuse sclerotic affection of the coronary circulation. Special attention is paid to attempts of retrograde revascularization of the heart muscle by bypasses into the coronary veins. Because at present the possibility of indirect revascularization of the myocardium by a retrograde approach via the cardiac veins still remains a by far not yet resolved problem, the authors recommend for situations where the aortocoronary bypass is out of question a procedure making use of the advantages of a direct aortocoronary bypass and Vineberg's operation performed so as to relieve the blood flow through the sclerotic coronary artery beneath the anastomosis. In special situations also a sequential bypass could be considered with a side-to-side anastomosis into the artery and end-to-side into the appropriate vein.

The authors submit an analysis of patients operated in 1972-1982 at the First Surgical Clinic, Faculty of General Medicine, Charles University Prague. The group of patients was divided into those under 65 years and those above this age. The effect of the patients' age on the postoperative course was investigated, the survival of the two groups was compared, the causes of early postoperative deaths, the extent of the disease and histological type of tumour were evaluated. In was revealed that the risk of early postoperative death within one month is greater in patients above 65 years where it is 19.6%, as compared with 11.3% in the younger group. The risk increases in particular in patients above 70 years where it is as high as 26%. There is no fundamental difference in the causes of death between the two groups. The highest percentage of operated patients dies from embolism (40% and 42% in the patients above 65 years), the second place is held by inflammatory pulmonary complications which are somewhat more frequent in patients of the younger age group (24% as compared with 15% in the older patients). The survival curves of patients who had a radical operation in stage I and II of the neoplastic disease are almost identical and there is no significant difference in the survival of the two groups. In the group under 65 years 30% survive five years, in the older group 25%. The ratio of differentiated types of lung cancer, i.e. adenocarcinoma and epidermoid carcinoma is equal in both groups, contrary to small-cell carcinoma which was recorded in 6% in the older patients, as compared with 15% in the younger ones.

The authors report their experience with the application of decompression of the left ventricle of the heart by means or active suction from pulmonary artery. This way of heart drainage has been so far used in 53 patients, who were operated in extracorporal circulation. The drainage of pulmonary artery proved to be completely successful. It enabled a sufficient decompression of the left heart and prevented most complications which may occur if a direct drainage of the left ventricle of the heart is applied.

The paper demonstrates on brief case-histories of a small group of patients some possibilities how to use isolated regional perfusion of cytostatics combined with hyperthermia as an adjuvant therapeutic method in case of melanoblastomas and liposarcomas of the extremities.

Initial results of evaluation of scintigraphic examinations by means of the isotope 201thallium indicate the importance of this method in cardiosurgery, in particular in the postoperative evaluation of the effect of bypass operations. In patients with an objective improvement on the postoperative scintigrams also subjective improvement of the condition was recorded.

The paper deals with the problem of surgical treatment of cardiac aneurysms and akinesias from the aspect of indication of surgical tactics and technique, risk factors and achieved results. The group of 117 patients is divided into 74 patients operated in 1970-1982 and 43 patients operated in 1983-1987 when already medium hyperthermia was used permanently, similarly as cold cardioplegia, complete haemodilution, pulsed extracorporeal circulation and relieving drainage of the left ventricle via the pulmonary artery. The reduction of early mortality from 24.3% to 4.7% provides clear evidence of the advantages of this procedure. The authors draw attention to differences in indications of surgical treatment between classical aneurysms and akinesians and to the importance of revascularization operations performed nowadays, using aortocoronary bypasses.

The authors present an account on four cases of cardiac myxoma and two cases of a secondary malignant tumour. Despite the low incidence of cardiac tumours this disease must be taken into consideration. The diagnosis was established by echocardiography and angiography. Two-dimensional echocardiography is, however, often sufficient. Early surgical treatment has very favourable results in bening tumours. The prognosis of patients with malignant tumours is very poor and experience with treatment is scanty.