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In acute experiments on the anesthetized dog, partial or complete occlusion of the left innominate vein resulting in a rise of pressure in the venous territory into which the thoracic duct drains, commensurate with the venous pressure rise seen in congestive heart failure, reduces the flow of lymph in the thoracic duct. This decrease in thoracic duct lymph flow is due, at least partially, to the accumulation of lymph in the lymphatic system and possibly the intercellular spaces. The present acute experiments suggest the possibility that this factor may play a role in the genesis of the systemic edema of chronic congestive heart failure, although only chronic experiments now under way will permit definitive conclusions.

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Late follow-up (average = 7.2 years) has been obtained in 249 patients with mitral valve disease who had quantitative angiographic assessment of left ventricular function at thetime of initial catheterization in the 1960s. Surgically treated patients with mitral valve disease had significantly improved survival as compared to medically treated patients with mitral disease. The subgroup with mixed mitral stenosis and regurgitation and the subgroup with moderate impairment of ejection fraction account for this improved survival in surgically treated patients, which occurred despite greater functional and hemodynamic impairment in the surgical cohorts. Using univariate life table survival analysis, ten variables were found to be predictive of survival in the medical cohort, and three in the surgical cohort. With multivariate Cox's regression analysis, end-diastolic volume and arteriovenous oxygen difference were significantly predictive of survival in the medical cohort; age was predictive of survival in the surgical cohort.