patients had heart valve replacement with frame-mounted autologous or homologous fascia lata or with heterologous pericardial grafts. There were 111 single aortic, 95 single mitral, and seven tricuspid valve replacements.The incidence of hospital and late mortality was each 10% for the entire series and the main causes were myocardial failure and infective endocarditis.The majority of patients obtained significant symptomatic improvement. In patients with aortic replacement there was a statistically significant reduction in cardiothoracic ratio and in the voltage of the electrocardiogram.Regurgitant murmurs developed in 11 6y% of aortic patients and in 51'6% after mitral replacement (in 37-5 % the murmur has not increased in intensity while in 14-1 % it has gradually progressed). None of these mitral patients requires reoperation. Grafts in the tricuspid position have not shown signs of dysfunction or failure. Graft failure has not occurred in the aortic replacement series. From the mitral position six grafts have been removed due to failure. All six were made of autologous fascia and all showed varying degrees of thickening and retraction of cusps. There were six episodes of peripheral embolization (five transient) and one left atrial thrombosis. All seven patients are alive. Anticoagulants were not used.The results of haemodynamic studies and in vitro hydrodynamic experiments are discussed and an explanation for graft dysfunction in the mitral position is presented.The actuarial analysis of this series of patients over a period of up to 54 months postoperatively has shown encouraging results.

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Summary: Insulin secretion tests were carried out before and after treatment in patients with severe congestive heart failure. Before treatment the plasma insulin level and the insulin secretion response to intravenous tolbutamide were significantly reduced in all patients. In patients who made a good clinical recovery the plasma insulin level and the insulin secretion response were significantly improved. Patients who had a poor response to medical treatment showed little improvement in their insulin secretion test. This suppression of insulin secretion is probably due to the reduced blood flow to the pancreas together with a high level of circulating catecholamines.

As part of a follow-up investigation in mitral annuloplasty by reflected ultrasound, 39 studies have been carried out in I5 patients who underwent mitral valve reconstructive operations. The rate of diastolic toward closure movemeiit from point E (EF speed) and total amplitude did not correlate with the final valve orifice dimension obtained at operation. Mitral stenosis and incompetence were shown within the first 6 months after repair. Such a noninvasive technique is therefore regarded as an additional method of study of the structural andfunctional state of the mitral valve after annuloplasty and the subsequent changes in time. The contribution of mitral ring movement to the familiar mitral echogram pattern is discussed passim.