Eighty-three patients with valular heart diseases underwent exercise stress tests with bicycle ergometer and their exercise performances were evaluated by means of the workload they achieved. Twenty eight of them were waiting for surgical therapy at the time of study and 55 were outpatients who had undertaken valvular surgery. They were from 13 to 68 years old (mean 49.3 years). Fifty three patients were male and 30 were female. Thirty six of them were in the state of NYHA functional classification class 1, 35 class 2 and 12 class 3. Workloads and oxygen uptake were measured at anaerobic threshold (AT) and maximal achieved workload (MAX). Measured values of workloads were assessed by the percent attainments of predicted normal values for age, sex, height and weight from the equation which were calculated from the data of 213 sedentary normal Japanese adults. Oxygen uptake was also assessed by the percent attainment of predicted normal value from Posner's equation. Woakloads and oxygen uptake were corelated significantly (p<0.01) both at AT and MAX. Workloads differed significantly between the NYHA classes not only at AT but also at MAX (p<0.01, p<0.01). Ten patients were reassessed more than six months after the operation and revealed significant increases in workload. The differences were more prominent at MAX than at AT.

A 55-year-old women with von Recklinghausen's disease was admitted to our hospital after sudden left-sided chest pain. She became shocked with a blood pressure of 50mmHg and pulse of 120per min. Chest radiography showed a massive left pleural effusion. Thoracentesis revealed bright blood. Emergency operation was perfomed. The source of bleeding was not clearly identified, but we suspected rupture of the intercostal artery. So we resected a part of descending aorta and implanted a Dacron graft. The bleeding was stopped. She discharged about five months later because of post-operative respiratory and hepatic failure. Histological examination of the aortic wall revealed extensive adventitial infiltration with neurofibromas. The turbulance of the aortic medial elastic fiber was also observed. We considered these histological change of the vessel caused spontaneous rupture of the intercostal artery.

A case of a 51-year old male with pulmonary valve endocarditis accompanied by aortic regurgitation, and ruptured aneurysm of Valsalva sinus was reported. Repeated blood cultures grew α-streptococcus on a single occasion. After medical treatment, resection of pulmonary valve vegetation, resection and patch closure of aneurysm, and aortic valve replacement were performed successfully. Twenty one cases of pulmonary valve endocarditis reported in Japan, including our case, were collected and reviewed. Causative organism was streptococcus in 93% of cases. No case of intravenous drug abuse was found in this series. A variety of preexisting heart diseses were found in 20 cases out of 21 (95%). All these diseases were congenital ones, such as ven-tricular septal defect, patent ductus arteriosus, pulmonary stenosis and ruptured aneurysm of Valsalva sinus. This fact means that jet lesion of pulmonary valve is a major predisposing factor of pulmonary valve endocarditis. Surgical procedures were reported in 12 cases: resection of vegetation in 4 cases, resection of pulmonary valve in 2, and pulmonary valve replacement in 5. Appropriate surgical procedures should be chosen, depending upon the activity of infective endocarditis, severity of destruction of the valve, and pulmonary vascular resistance.