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This report documents a case of ball variance in a Smeloff-Cutter aortic prosthesis occurring 24 years after implantation. After episodes of embolic complications the patient died in acute shock. The silicone rubber ball showed several alterations including discoloration, grooving, cracking, swelling and subtotal fracture of the poppet. Terminal valvular malfunction was caused by complete thrombosis of the prosthesis. In most patients ball variance occurred during the first years after valve replacement; thus, the observed case is a very rare late complication of a ball-valve prosthesis.

In a controlled randomized cross-over trial, 21 patients with coronary artery disease and frequent ventricular arrhythmias were studied to test the efficacy and tolerance of mexiletine 200 mg t.i.d. in comparison to a released application form of mexiletine perlongettes 360 mg b.i.d. During 24-hour Holter monitoring, all patients but one showed more than 30 ventricular premature beats/h; additionally, in 16 patients, complex ventricular arrhythmias (Lown class IV) were documented. In all patients each medication was given for 5 days. Before treatment and during both medication periods, a 4 days' wash-out period was interposed. Mexiletine and mexiletine perlongettes each resulted in a suppression of ventricular ectopy of more than 84% in 10/21 patients (47%); in two patients the response was different. The mean reduction rate in all patients was 68% for mexiletine and 64% for mexiletine perlongettes. In the responder group, the mean reduction rate amounted to 95% under both medications. Ventricular pairs and tachycardia were reduced by more than 90%. Plasma concentration under mexiletine perlongettes was slightly higher, as compared to the standard form of mexiletine; however, under mexiletine, significant changes of plasma concentration were observed during the day only when the standard form was used. Side effects were observed in 8/21 patients (38% for mexiletine) and in 5/21 patients (24% for mexiletine perlongettes). These were mainly gastrointestinal or neurological, but were mild in all patients and did not necessitate discontinuation of the medication in any patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Dissection of the three coronary vessels as a rare fatal complication after intraoperative cannulation is described. A 58-year-old man died from progressive cardiac failure 12 days after mitral and aortic valve replacement. The cause of death was a nearly 12-day-old anteroseptal myocardial infarction as a result of a dissection of all three coronary vessels including the septal arteries. Histologic examination revealed a tear of the left and right coronary artery at their ostia. Thrombi of different age in the dissection and satellite-like recent necroses surrounding the 12-day-old myocardial infarction indicate a gradual progression of the dissection.

To study the effect of small amounts of ethanol 1 ml whisky (43 vol. %) per kg body weight was given to normal subjects (n = 11) and patients with coronary heart disease (n = 11) and the systolic time intervals (STI) PEP (preejection period), LVET (left ventricular ejection time), QS2 (total electromechanical systole) and PEP/LVET were measured. A control group consisted of five patients with coronary heart disease. The following results were obtained: Already at rest PEP/LVET was significantly higher in patients with coronary heart disease. After the ingestion of alcohol, significant changes of the STI were observed; mainly an increase of PEP and PEP-LVET was found. In patients with coronary heart disease the effect began earlier, was significantly higher and lasted significantly longer than in normal subjects. According to invasive correlation-studies of different authors, these results indicate an impairment of left ventricular function, especially of ejection fraction and contractility. These alterations seem to be more pronounced in patients with coronary heart disease. The results of this study should be considered in advising patients with coronary heart disease.