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The authors report 4 Oriental cases of total occlusion of the left main coronary artery (LMCA) with differing presentations. The first patient had a twelve-year history of stable angina pectoris. The second patient had angina for a year, which became unstable two months prior to diagnosis. The third patient had myocardial infarction seven years ago and presented with a one-month history of rest angina. The fourth patient had stable effort angina for six years but presented with accelerated angina three months prior to diagnosis. The incidence of total occlusion of the LMCA is rare and survival depends on the existence of collateral circulation. In LMCA disease, there is usually disease in other parts of the coronary arterial tree, and hence, the need for urgent coronary bypass surgery.

EDITORIAL COMMENT: We accepted this case report forpublication to remind readers that nyocam'ial infarction or ischaemia can occur in women in the reproductive age group. In the [1988][1989][1990] triennium in Australia there were 33 indirect maternal deaths, in 3 of which myocardial infarction or ischaemia was the primary cause. CASE REPORTA 36-year-old gravida 7 para 5 Indian female was admitted for investigation of prolonged retrosternal chest pain and vomiting. She had noted similar pains at rest and occasionally during exertion for the past 2 yearsdoctors had attributed this to 'gastritis'. On the day of admission she had been treated in another hospital for peptic ulcer disease and as her symptoms did not improve she sought a second opinion in our hospital.On examination she was noted to be obese. Her plasma cholesterol value was elevated (7.4 mmol/l,

Mitral incompetence (MR) is a complication of balloon mitral valvuloplasty. There are few reports of long-term outcome. We believe this is the first report in the literature of complete resolution during follow-up of severe mitral regurgitation resulting from balloon valvuloplasty.

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