SUMMARY Disopyramide phosphate was administered intravenously in a dose of 1-2 mg/kg body weight over one minute to nine patients after open-heart surgery and coronary artery bypass grafting. The haemodynamic changes were studied during and for 30 minutes after drug administration. Heart rate was unchanged throughout the study. During infusion the only significant changes were an increase in systemic blood pressure and systolic impedance signifying a direct increase in peripheral arterial resistance. Systemic blood pressure remained significantly higher for 10 minutes and systolic impedance for 30 minutes. Immediately after infusion max. dPower/dT, a measure of ventricular contractility, was significantly depressed for 15 minutes. Both cardiac output and aortic flow were significantly depressed for 30 minutes. DPTI/TTI, an estimate of subendocardial supply/demand ratio, showed an insignificant increase throughout the study.This study shows that intravenous disopyramide starts acting within 45 seconds of the start of infusion, directly increases peripheral arterial resistance, has a brief negative inotropic action, and does not reduce subendocardial blood flow.

At Sheffield Regional Cardiothoracic Unit, the AVCO intra-aortic balloon pump has been used on 25 occasions in 21 months. Of the 25 patients, 12 survived and left hospital. The procedure is particularly beneficial in patients who have suffered some failure of myocardial protection during operation and to those who are suffering from acute ischaemia or the sequelae of myocardial infarction. The place of preoperative counterpulsation is discussed. Patients with long-standing cardiac disease who have emergency surgery benefit less from counterpulsation. Those patients with chronic ischaemic damage to the heart have nothing to gain from the use of counterpulsation.

The case is reported of a 45-year-old woman with a metastatic tumour within the mitral valve.Involvement of the heart by metastatic neoplasm is not uncommon. Postmortem studies of patients with malignant disease show that cardiac involvement occurs in up to 21 per cent of cases (Bisel, Wr6blewski, and LaDue, 1953). The pericardium, epicardium, and myocardium are the areas of the heart most commonly involved by secondary tumour; spread to the endocardium and heart valves is rare (Coller, Inkley, and Moragues, 1950 At operation the heart showed only the changes associated with mitral stenosis. Open exploration of the mitral valve showed thickening and calcification of both cusps, with fibrosis and shortening of the subvalvular mechanism. The valve was replaced by a Bjork-Shiley prosthesis.Histological studies were done of the excised valve: routine paraffin sections were prepared from the formalin fixed specimen and stained with haematoxylin and eosin and Machiavello's and the phloxine tartrazine method for inclusion bodies as part of a separate study being conducted into the association of psittacosis and valvular disease.The valve showed fibrotic thickening with a moderate degree of calcification and several areas of myxoid connective tissue in which were dilated small blood vessels and endothelium lined spaces resembling lymphatics. There were no vegetations and no bacterial involvement. There were two small clumps of neoplastic cells lying within the 'lymphatics', which were present only in two successive sections at one level, which had been stained by the phloxine tartrazine and Machiavello's methods. Numerous further sections were cut but no more tumour was found.The tumour cells showed considerable nuclear pleomorphism and a high nuclear/cytoplasmic ratio. There was no apparent mucin or pigment production and a diagnosis was made simply of 'poorly differentiated carcinoma'. No attempt was made to restain either of the positive sections.The possibility that these deposits were 'floaters' was excluded by a careful check on the other specimens cut up and processed at the same time, in none of which was a similar carcinoma processed. Moreover, the appearance of the deposits in two successive sections is not characteristic of an artefact ( Fig. 1 and 2). 218 on 11 May 2018 by guest. Protected by copyright.

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