-Congenital hypoplasia of the anterior tricuspid leaflet as a cause of high-grade tricuspid valve insufficiency in a 64-year-old patient-. / Konnatale Hypoplasie des anterioren Trikuspidalsegels als Ursache einer hochgradigen Trikuspidalinsuffizienz bei einem 64jährigen Patienten.

In a 64-year-old man a heart murmur was present since childhood and could be identified 8 years ago as isolated tricuspid regurgitation. Because of progressive dyspnea there was an indication for surgical treatment. Intraoperatively, we found a hypoplastic anterior leaflet, though the other two leaflets were preserved in totally good condition, without any evidence of endocarditis. Tricuspid valve replacement was performed as there was no chance of reconstruction. To our knowledge, this is the first description of a congenital hypoplastic anterior leaflet of the tricuspid valve.

[Acute coronary artery occlusion after elective percutaneous transluminal coronary angioplasty. Incidence and therapy in 5000 consecutive patients]. / Akuter Koronargefässverschluss nach elektiver perkutaner transluminaler Koronarangioplastie. Inzidenz und Therapie bei 5000 konsekutiven Patienten.

Five thousand consecutive percutaneous transluminal coronary angioplasties (PTCA) were electively performed between January 1988 and June 1993. They were analysed for the incidence of acute coronary occlusion, its acute treatment and subsequent course. In 133 patients (2.7%) the occlusion persisted. Recanalization by repeat PTCA was attempted in all of them, but succeeded in only 68 (51%). In 65 patients recanalization was impossible. In 25 of the latter--patients with a small infarct vessel and infarction having already occurred in the vessel's supply area while the haemodynamics remained stable--conservative treatment was practised. Acute surgical revascularization was undertaken in 30 patients (23%) with a large area and/or haemodynamic instability. In all, 14 patients died (overall death rate 0.28%, death rate of patients with occlusion 11%), ten of them before operative intervention was possible.--Not all coronary artery occlusions can be treated nonsurgically. Consequently, availability of surgical intervention at the place of elective PTCA is mandatory.