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The clinical and hemodynamic data available in the five-to eight-year follow-up of 45 patients who underwent aortic debridement for aortic stenosis are presented. Eight patients (18%) remain in follow-up (average duration 6.4 years) with excellent clinical results. Twenty-seven (60%) of these patients have undergone a second operative procedure for correction of aortic stenosis, having achieved an average of 4.3 years of palliation prior to the second operative procedure. Including the operative deaths occurring with the second procedure and the subsequent follow-up of these patients, 29 patients are alive with average follow-up period of 5.7 years. Two of these deaths were not due to cardiovascular disease. Substantial residual aortic gradients were compatible with excellent periods of palliation, provided a reduction of the gradient for the particular patient was achieved. We feel that operative debridement for aortic stenosis, when technically feasible, is a realistic approach to this disease state. Although reoperation may eventually be necessary in the course of the patient's disease, a significant period of palliation with limited morbidity is gained by the patient.

The immediate functional deficit resulting from acute regional myocardial ischemia was evaluated in 40 anesthetized dogs. Ventricular function curves, maximum dp/dt, isovohimetric force-velocity curves, and peak systolic and resting diastolic length-tension curves were assessed at fixed heart rate and constant aortic pressure before and during occlusion of the anterior descending coronary artery 2 to 3 cm distal to its origin. Mild, moderate, or marked depression of the ventricular function resulted from occlusion of the anterior descending artery, depending upon the anatomy of the intercoronary collateral vessels. Maximum loss of function was apparent 2 minutes after occlusion, and was quantitatively reproducible by reocclusion after an intervening period of unobstructed flow. Resting diastolic length-tension relations were not significantly altered by occlusion of the anterior descending artery. In 12 dogs, force-velocity relations were determined during the inscription of ventricular function curves and in every instance when depressed function was evident from the ventricular function curve, the simultaneously determined forcevelocity curve also demonstrated impaired performance. At low preload levels, however, the force-velocity curves inscribed before and during occlusion of the anterior descending artery were not very dissimilar; with increasing ventricular volumes, the force-velocity curve inscribed during coronary artery occlusion progressively shifted downward and to the left of the control curve. Maximum velocity, however, appeared to be unchanged suggesting that this index of contractility is not a satisfactory method for assessing cardiac performance during acute regional myocardial ischemia.

SUMMARYRadioisotopic angiocardiography has been performed in 120 patients after the intravenous injection of 99mTc pertechnetate. A

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