In patients with AVSD of various morphologies closure of the left AV valve cleft significantly improves outcome without affecting the need for reoperation. Risk factors for early and late death (multivariate analysis) were a pulmonary/aortic pressure ratio >0.7 and the occurrence of any complication after surgery. The concept of an early surgical AVSD correction before an increase in pulmonary vascular resistance and AV valve deformations occur would represent a better surgical option than a late correction as done in our series. Early correction allows for reduction of early mortality, superior long-term survival rates and a high freedom from subsequent valve degeneration.

Background-Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the relative merits of either technique in treatment of unstable angina. Methods and Results-Seven hundred fifty-five patients with stable angina were randomly assigned to coronary stenting (374) or bypass surgery (381), and 450 patients with unstable angina were randomly assigned to coronary stenting (226) or bypass surgery (224). All patients had multivessel disease considered to be equally treatable by either technique.Freedom from major adverse events, including death, myocardial infarction, and cerebrovascular events, at 1 year was not different in unstable patients (91.2% versus 88.9%) and stable patients (90.4% versus 92.6%) treated, respectively, with coronary stenting or bypass surgery. Freedom from repeat revascularization at 1 year was similar in unstable and stable angina treated with stenting (79.2% versus 78.9%) or bypass surgery (96.3% versus 96%) but was significantly higher in both unstable and stable patients treated with stenting (16.8% versus 16.9%) compared with bypass surgery (3.6% versus 3.5%). Neither the difference in costs between stented or bypassed stable or unstable angina ($2594 versus $3627) nor the cost-effectiveness was significantly different at 1 year. Conclusions-There was no difference in rates of death, myocardial infarction, and cerebrovascular event at 1 year in patients with unstable angina and multivessel disease treated with either stented angioplasty or bypass surgery compared with patients with stable angina. The rate of repeat revascularization of both unstable and stable angina was significantly higher in patients with stents.

Thromboangiitis obliterans (TAO) occurs almost exclusively in young male smokers. Its involvement of the small and medium-sized arteries and veins leads to ischemic complaints and/or changes in the extremities. The possibility of organ involvement is a matter of controversy. The authors report a case of TAO with multiple organ involvement, including myocardial, splenic, and cerebral infarctions; pulmonary embolisms; and probable intestinal ischemia during a twenty-three-year course.

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In a prospective study of psychological and neurological reactions to coronary artery bypass surgery, 45 patients were examined preoperatively, postoperatively, and 21 to 27 months after, using a variety of neurological, psychiatric, and psychological investigations. Within the follow-up sample, three subgroups of patients could be identified by cluster analysis who differed with respect to their emotional status and life satisfaction. One group (24% of the total sample) was characterized by high levels of anxiety, depression and life dissatisfaction and appears as a risk population. The other groups could be described as either average (42%) or stable (33%). At the follow up, the risk group further indicated a preference for depressive coping styles, a slightly higher degree of cognitive impairment, more neurological and psychopathological symptoms (specifically giving-up and hostility), a considerably lower return-to-work rate, more subjective physical complaints and a poorer attitude toward the outcome. While postoperative measurements (obtained 2-3 and 6-8 days after surgery) as well as intraoperative parameters did not reveal significant group differences, the analysis yielded an increased impairment within the risk group already prior to surgery, especially emotional problems, specific health-related cognitions and a more fatalistic attitude. The results are in line with those of other studies investigating the late postoperative psychological status with regard to the proportion of patients showing psychological impairments as well as to their specific psychological characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)