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One hundred and eighty-seven patients who had surgical closure of a ventricular septal defect between 1958 and 1975 were followed for up to 21 years. there were 17 late sudden deaths of which eight occurred in completely fit patients while nine were already under medical care. In an attempt to elucidate possible risk factors and reoperative and serial postoperative electrocardiograms of all patients were studied. Fifty-one unselected healthy follow-up patients agreed to 24 hour ambulatory monitoring. Progressive exercise testing (Bruce protocol) was carried out on 31 of them and an additional seven patients. There was a significant correlation between recorded ventricular arrhythmias and conduction defects, particularly progressive conduction defects. Transient complete heart block carried a bad prognosis and grade 3-4b ventricular arrhythmias were a major risk factor and recorded in 10 of the 17 patients who died. Long-term postoperative electrocardiographic follow-up is recommended and 24 hour ambulatory monitoring and exercise testing complement the findings of the resting electrocardiogram. The long-term treatment of survivors found to have ventricular arrhythmias must be considered.

A four-month-old male Springer Spaniel presented for investigation of ascites of three weeks’ duration. On transthoracic echocardiogram, cor triatriatum dexter was diagnosed with associated right-sided congestive heart failure. Medical therapy consisting of furosemide, spironolactone and benazepril was initiated. On the day of surgery, the dog was premedicated with methadone 0.2 mg/kg intravenously, and general anaesthesia was induced with midazolam 0.2 mg/kg intravenously and propofol 25 mg. Anaesthesia was maintained with isoflurane in oxygen. Concurrently, constant rate infusions of fentanyl 0.2–0.3 µg/kg/minute and lidocaine 50 µg/kg/minute were administered. Ventricular premature complexes and ventricular tachycardia developed during the placement of the catheter and during the first balloon dilation. Antiarrhythmic therapy with lidocaine 2 mg/kg was required. At the end of the procedure, acepromazine 5 µg/kg intravenous and buprenorphine 20 µg/kg intravenous were administered. Recovery from general anaesthesia was uneventful.

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