Cor triatriatum sinistrum, aortic coarctation and bicuspid aortic stenosis in an adult.

Cardiac anomalies are usually diagnosed early in life, which is particularly true for their various combinations. The diagnosis in adulthood is rare. Here we report the case of a young man with an aortic coarctation corrected at the age of 16, however the associated stenotic bicuspid aortic valve and cor triatriatum sinistrum were corrected after Streptococcus viridans endocarditis 7 years later.

The Yugoslavia Cardiovascular Disease Study. 3. Death by cause and area.

In the seven years following initial examination (1964--65) 758 deaths were observed in 11,121 Yugoslav men aged 35--62. The mortality rate was similar to that found for men in the Framingham (Massachusetts) study. However, coronary heart disease (CHD) mortality was much lower in Yugoslavia but mortality from cancer, accidents and violence and respiratory disease was much higher. The excess cancer mortality was chiefly from stomach cancer. The excess respiratory mortality was from both tuberculosis and chronic obstructive respiratory disease. Within Yugoslavia there were area differences in mortality by cause but little difference in total mortality: in Tuzla (Bosnia) there was a higher respiratory disease mortality but a lower mortality from accidents and violence than in Remetinec (Croatia). In the rural areas of the study there was a higher mortality from respiratory diseases and accidents and violence than in urban areas but a counterbalancing lower mortality from cardiovascular diseases. The low coronary death rates and high cancer of the stomach death rates in this population present an important epidemiological challenge.

The Yugoslavia cardiovascular disease study. II. Factors in the incidence of coronary heart disease.

In a 7-year follow-up of 11,121 Yugoslav men first examined in 1964-1965 when they were 35-62 years old, it was found that the incidence of coronary heart disease (CHD) was one-fourth that of a comparable Framingham (USA) group. Incidence in rural men was only 59% of urban men. In both urban and rural groups, men with higher blood pressures had greater CHD incidence, and cigarette smoking was also associated with greater incidence. In the urban but not the rural groups serum cholesterol and weight/height were also CHD risk factors. Levels of serum cholesterol and weight were lower in urban Yugoslavia than Framingham and lowest in rural Yugoslavia. At the same levels of these characteristics Framingham incidence was 3 times that in Yugoslavia. At the very low rural levels of weight and blood pressure CHD incidence was the same in urban as rural Yugoslav groups.

[Revascularization syndrome]. / Revaskularizacijski sindrom

The author presents two cases of serious trauma of the extremities complicated with lesions of the arteries. Both cases were treated in the cardiovascular surgery clinic in Ljublgana. In the first case besides on osteosynthesis of a fractured femur, a termoterminal anastomosis was performed on the totally severed Superficial Femoral Artery. In spite of the the Thrombectomin that was later performed on the Posterior Tibial Artery, gangrene of the foot set in, and exitus lethalis, due to a cerebral process. In the second case, besides a fractured femur, the patient had an arterial stupor of the popliteal Artery with periarterial hematomas. A revision of the Popliteal Artery was made. The ruptured Femoral Vein was ligated. Despite surgical intervention, gangrene of the foot set in, and a below the leg amputation was carried out. Due to renal insufficiency, this patient had to undergo peritoneal dialysis. The common denominator of both cases was acute ischemia of the distal portions of the lower extremities, and pathological processes throughout the eitire organism and, above all, of the renal function. In the general theapy of such cases, the author insists on adequate; revascularization, and concrrent regulation of hypovolemia, measures in preventing acidosis, and concern for late diuresis.