Post-operative data have been presented in seven patients with atrial septal defect. In five of them, residual patency of the atrial septum was found at cardiac catheterization, but in two the defect had been closed. All showed evidence of 'left-sided dysfunction', expressed either as an increase in the pulmonary arterial wedge pressure or the left ventricular end-diastolic pressure or both. The reasons for these findings are not clear, though in several there were indications of impaired right ventricular compliance and possible transmission of raised right-sided pressures to the left side of the heart through a still patent atrial septum. This could not, however, be the mechanism in all cases, and dysfunction of the left ventricle has been seen in two patients in whom the defect was securely closed. The cause of this phenomenon in these selected cases remains obscure.

Three of nine patients in whom the Edwards low-profile valve was placed in the mitral position have shown serious valve malfunction. Two of these expired despite emergency valve replacement. The third valve was replaced semielectively, with a good outcome. The valve malfunction has resulted from pannus formation on the uncovered metal struts, with severe limitation of motion and cocking of the valve disc. It is felt that careful serial evaluation of signs, symptoms, and valve cinefluorography is mandatory in patients with this valve. Should one or more of these parameters indicate valve malfunction, especially if serial observations indicate progressive worsening, valve replacement with another type of prosthesis should be very seriously considered. Serial cinefluorographic observation of the disc motion is indicated even in a setting of clinical well being.

No abstract