DIGITALIS IN OPEN HEART OPERATIONS.

In addition to the usually accepted indications for digitalis therapy, we believe there is a group of patients, not having heart failure, who would benefit from digitalis in connection with open operations on the heart. This group includes all adults, all with the tetralogy of Fallot, and all with high pressure ventricular septal defects. Digitalis preparations can be given in the usual digitalizing doses several days before operation to insure the presence of some glycosides at the end of the operation when cardiopulmonary by-pass is discontinued. An additional maintenance dose can be given by the anesthetist at the time of completion of cardiopulmonary by-pass and another dose the evening of operation. If during the immediate postoperative period supraventricular arrhythmia occurs, particularly tachycardia, the ouabain test is extremely useful and safe in determining whether or not more digitalis is needed.