Sixty-one patients with chronic cardliaic compression were stu(lie(l critically, the largest series in the literature. All patients had pericardiectomy perfoilie(l. The operative mortality was 18 pel cent. Satisfactory result was obtainedl 72.1 pei cent of the patients operate(l. Tuberculosis wa.1s the ca.use in 28.2 pei cent. In most of the remaining cases the etiology was obscure. The symptomlls, physical signs, and laboratory examinations are reported. The physiologic stuldies after operation (lemonstrato improved cardiac filling and emptving.The imllortance of diagnosis and the desirability of pericar(liectomy are stressed. With antiliotic therapy there is less risk in operating patients with active infection and the compression syndlrome.IN THE past 20 years the many cases of chronic compression operatecl at IUniversity Hospitals of Cleveland offered an opportunity for careful study. This report is based upon 61 operative cases from the service of Dr. C. S. Beck, with a study of pre-and postoperative observations. To our knowledge, this is the largest series e-ver reported.Chronic cardiac compression occurs as the result of a contracting pericar(lial scar which encroaches upon the diastolic filling and the systolic emptying of the heart, thereby reducing output. Usually the entire pericardium is converti into a compressing, nondistensible sac. Occasionally a localized fibrous band constricts the inflow or outflow tract of either ventricle. This is the basic pathologic and physiologic disturbance causing the various clinical and laboratory findings.Excellent historical reviews have been written by White

The electrocardiographic behavior of the heart was observed in 100 patients undergoing heart operations. Most of the arrhythmias were unrelated to the cardiac operative procedure, but as in other thoracic procedures, were related to hypoxia, level of anesthesia, vagal reflexes, and changes in blood pressure. TA and S-T displacements occurred in all groups and were thought to be related to altered dynamics of the right auricle and ventricle. Prevention, recognition and control of disturbances of cardiac mechanism are discussed.T HERE are excellent observations"1-2' concerning cardiac mechanism during anesthesia and surgery but there are few10-'4 on the behavior of the heart during cardiac and cardiovascular surgery. The pressent report is a record of the behavior of the heart in four common types of surgical procedures: ligation or section of a patent ductus arteriosus,1 resection of the aorta in coarctation,2 increasing pulmonary artery blood flow in congenital cyanotic heart disease3' 4, and resection of pericardial scar in Pick's Disease. In all cases a medical cardiologist was present throughout the operation. The observer took frequent records and, in addition, watched the electrocardiogram. Changes in the electrocardiogram were correlated with direct observation of the heart,

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