Among the different anatomical forms of anomalous pulmonary venous return, that of the inferior vena cava is of particular interest for the following reasons: the special radiological pattern which is referred to as the scimitar sign and the associated anomalies which often occur in the lungs. We have successfully operated on three' patients who are reported in this paper, and we have included a review of the literature. CASE REPORTS CASE 1 Liliane D., aged 9, presented because of repeated episodes of 'bronchitis' since infancy. At the age of 2 years a diagnosis of atrial septal defect (A.S.D.) had been made. On examination she was noted to have retarded development and some bulging of the left hemithorax. On auscultation she had a systolic murmur of moderate degree in the second and third intercostal spaces on the left, radiating towards both axillae and the back and of maximum intensity in the right axilla. On radiography (Fig. 1) the right border of the heart was predominantly enlarged, showing increased vascularization and also an opacity along the right cardiac border. The electrocardiogram showed right axis deviation and hypertrophy of the right ventricle.Catheterization confirmed the existence of an A.S.D. of ostium secundum type. There was a leftto-right shunt of 3 volumes, and moderate elevation of the pulmonary artery pressure. The right ventricular pressure was 48 mm. Hg. Stenosis of the right pulmonary artery with a gradient of 20 mm. Hg across the obstruction was also found. Right anomalous pulmonary venous drainage was found, but the exact site was not known.Operation was performed on 18 September 1963, using a mid-sternal incision and extracorporeal circulation with a moderate degree of hypothermia. Findings at operation included a huge right atrial chamber, and a small aorta and superior vena cava.On opening the right pleural space it became evident 'Recently, a fourth patient has been successfully operated on.

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From January 1975 to September 1983, 615 patients underwent valve replacement using 698 bioprosthetic valves for selected indications. This group represents the third of all patients having valve replacement during the same period. Children younger than 15 years were excluded. The mean pre-operative functional class was 2.9. The early mortality rate was less than 5% and the follow-up range 3 months to 9 years (3.2 yrs). The symptomatic improvement was attested by a mean post-operative functional class of 1.4. In a linear study the following rates of valve related complications were noted: thromboembolism 4.6%, endocarditis 2.5%, primary tissue valve degeneration 1.1%, paraprosthetic leak 2.5%. In an actuarial study, at 8 years, 83% of patients were free from any valve failure. The probability rates of complications were the following: thromboembolic events 8%, endocarditis 5%, degeneration 3%, reoperation 7%. The probability of survival at 8 yrs was 69% and the probability rates of late mortality were noted as follow: cardiac related mortality 27%, valve-related mortality 4%. Despite an expected increasing rate of degeneration, the results warrant the use of bioprostheses in a selected group of patients.

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