Studies are made on the cases which underwent commissurotomy for mitral stenosis during 1953 and 1956. Of these cases, 88 cases are followed up at the First Surgical Department, Osaka University Medical School on questionaire or presonal interview ; 15 cases are left untraced. On the basis of New York Heart Association 37 cases belong to Grade I, 18 cases Grade II, 5 cases Grade III, and 2 cases Grade IV ; 16 cases prove late deaths. 10 cases are unspecified. Fifty-five cases (62 %) belonging to Grade I and Grade 2 are in a favorable condition. Factors which directly affect the long term follow up are corrected width of the mitral orifice, calcification of the leaflet and regurgitation. It is revealed that they are all concerned with valve function. Indirect factors are age, sex, and heart rhythm. The degree of pre-operative severity of the disease does not seem to affect the follow-up. Features of the surgery are discussed in reference to cardiac catheterization, x-ray and ECG findings.

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1. Patent ductus arteriosus treated by surgery untill 1960 was reviewed and studied. This includes 471 cases collected from the surgical institution in Japan and 46 cases of our own. 2. Overall mortality of patent ductus arteriosus operation was 8.9 per cent. This figure when compared with 11.0 per cent mortality of the same reported by Sakakibara in 1959 indicate clear improvement of surgical results during the last several years. 3. Size of the ductus as measured at operation showed good correlation in many instances with their clinical manifestations. 4. In typical cases of patent ductus arteriosus mortality was less than one percent. However in atypical cases especially in older age group surgical mortality is considerably higher. 5. Much higher incidence of recannalization and aneurysmal dilatation exists in patent ductus arteriosus ligation group than the ductus division group. Accordingly, Gross's division technic is recommended as procedure of choice for patent ductus arteriosus surgery. 6. Results of surgery and electrocardiographic changes following successful surgery indicated that the patent ductus arteriosus operation should be performed during child-hood.

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The long-term results of the closure operation of atrial septal defect were followed up on 59 patients. The majority of the cases had excellent results, but 17% of them had some complaint or could not gain clear-cut improvement. Three factors are important to have excellent results : (1) perfect closure of the defect, (2) repair of other possible coexsistent abnormalities, and (3) operation in early age, preferably under twenty years of age. The long-term results of shunt-operation were studied on 78 cases of Fallot's tetralogy. About 80% of these cases had excellent or good results. However 20% of them had no change or lost improvement. The causes of loss of improvement were commented. Among the age group under 5 years, there are many cases who showed loss of improvement, while excellent results are rarely seen among the patients over 15 years of age. Four cases were treated by Brock's method and the other four patiente received the corrective operations by direct vision. Of these cases the results were followed up and discussed.

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A report has been made of the comparison of the clinical results in 448 cases of acquired valvular disease treated surgically or medically. The superiority of the prognosis in patients with mitral stenosis who underwent valvulo-plasty over that in medically treated patients with mitral stenosis or other types of acquired valvular disease was shown in the comparison of survival rates of the patients with same severity of disease according to the NYHA classification at the time of discharge. The better prognosis was also proved by the degree of improvement in cardiac, pulmonary, renal and liver functions etc. The incidence of embolization, which causes no immediate death but makes a patient's life dismal in the majority of cases, has been significantly lower in operated than in medically treated mitral stenosis. But the conclusion as to whether valvuloplasty can prevent recurrence of embolism in patients with previous emboli was reserved in this series because of lack of a sufficient number of the cases. It was statistically indicated that the prognosis is best in operated mitral stenosis with sinus rhythm, next in that with auricular fibrillation, then in medically treated mitral stenosis with sinus rhythm, and worst in that with auricular fibrillation. Many pregnant cardiac patients who developed decompensation during pregnancy continued to be decompensated after delivery, but adequate treatment prevented death for at least one year after the onset of decompensation. No significant differences were noted in duration between onset of the cardiac symptoms and death among groups with different ages of onset. Combined valvular disease was most frequently complicated by subacute bacterial endocarditis, and the prognosis was poor in more than half of the patients with this complication. The authors have considered the pulmonary artery wedge pressure as a reliable and rather easily obtainable index in determining indications for valvuloplasty. It was ascertained again in this series that for the patient with mitral stenosis whose pulmonary artery wedge pressure exceeds 20 mm.Hg valvuloplasty is absolutely indicated. Moreover, it was asserted that the level of the pressure should be lowered to 15 mm.Hg, especially in young patients with mitral stenosis.

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