Ten patients with congenital defects of the pericardium were treated in Departments of Cardiac Surgery, Silesian School of Medicine in Zabrze and Katowice between 1989 and 1998. There were eight children and two adults, eight males and two females. In each case the pericardial defect was discovered intraoperatively during surgery for congenital heart defect. There were no cases with clinical symptoms that could be clearly related to the defect of the pericardial sac. In the case of a child with a complete absence of the left pericardial wall the heart was significantly rotated contrary to the defect. The final outcome of the congenital heart defect surgery was satisfactory in each case. An abbreviated historical review of the diagnosis and treatment of the pericardial defects is presented with special attention placed on therapeutic management. Surgical correction of pericardial defects is concluded to be justified in patients with clinical symptoms. In most cases pericardial defects are discovered intraoperatively, but when they are large the said defects do not require any treatment.

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Xanthine oxidase is responsible for the release of free oxygen radicals during myocardial reperfusion. Allopurinol was shown to be an effective inhibitor of this reaction in the laboratory experiments, but not in patients. Thirteen male patients undergoing routine coronary artery bypass graft surgery were treated with allopurinol in doses of 15 mg/kg per day for 4 days before the operation. Haemodynamic function in the early period after cardiopulmonary bypass, ECG, enzyme release and ultrastructural findings in this group were compared with those in a control group of 13 male patients matched for age distribution and stage of coronary disease. Left ventricular stroke work index was higher in the treatment group 10 min (P less than 0.001) and 15 min after termination of cardiopulmonary bypass (P less than 0.01) and also 2 h later (P less than 0.02). In the early post-operative recovery phase fewer episodes of arrhythmia were observed in this group of patients (P less than 0.001). Electron microscopy studies of the myocardium and CK and CK-MB release showed no significant differences between groups. Thus, allopurinol may have a protective effect on the human ischaemic myocardium in the early period of reperfusion.

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