Björk-Shiley valve malfunction by prolapsed sutures.

Severe aortic regurgitation developed in three patients after aortic valve replacement within six months due to long sutures prolapsing across the "annulus" of Björk-Shiley prosthesis. At reoperation the offending sutures were trimmed or tucked back to the aortic wall to eliminate aortic regurgitation. Prolapse of unravelled knots may be the likely cause. Everting the sewing skirt during the first replacement may prevent this complication.

Repair of atrial septal defect with partial anomalous pulmonary venous return from the left upper lobe.

A patient with partial anomalous venous return from the left upper lobe in the presence of a large atrial septal defect is presented. The diagnosis was confirmed by selective angiographic studies. Two technical points are emphasized: first, that the exposure through a midsternal incision is excellent, and second, that the anomalous vein must be detached from its connection to the innominate or subclavian artery as high into the left chest as it is technically possible to reach. Postoperative cardiac catheterization and angiograms confirm the completeness of the repair.