To evaluate the benefits of operative treatment of congenital heart disease in older age groups, a clinical study on patients over 40 years of age with atrial septal defect was carried out. The series consisted of 125 consecutive patients operated on between 1966 and 1974. There were 8 cases with a primum, 12 cases with a sinus venosus type of secundum and 105 cases with a simple secundum defect. The operative mortality was 2 patients (1.6%). It was due to myocardial infarction in one case and high pulmonary vascular resistance in the other. On re-examination 3-6 months postoperatively, 107 patients were improved, 13 patients unchanged and 3 patients were worse than before operation. On re-evaluation after an average period of 6 years, 88 patients were still improved. 32 patients unchanged and 3 patients were worse compared with their pre-operative status. On the basis of the results and the previous reports on atrial septal defect without operation, the surgical correction of ASD even in older age groups can be recommended. The problem of deterioration of some patients, despite a good immediate postoperative result, is discussed.

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Five hundred and eleven patients with penetrating or perforating chest injuries were admitted to the Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki, during the 25-year-period 1952-77. There were 433 stab wounds, 59 gunshot wounds and 19 other penetrating injuries. The organs most often involved were lungs (major haemo- or pneumothorax in 385 patients), heart (63 patients) and liver (61 patients). About one third of the patients were in profound shock on admission. The treatment was immediate thoracotomy in 176 (35%) and laparotomy in 123 cases (24%). Tube thoracostomy was applied in 117 patients and needle aspiration performed in 88 patients. Nine patients died (mortality of 1.8%). Two patients required later open-heart procedure. One of them had an aortopulmonary fistula and the other a traumatic VSD combined with aortic valve lesion. One of the traumatic VSDs closed spontaneously during the follow-up time. An active operative approach in the early phase seems to guarantee the best final results, especially in the most critically ill patients.