bluuebunny/crossref_metadata_2025 huggingface dataset:
Secondary Malignant Tumors of the Pericardium
Authors: THURBER DELORAN L. , EDWARDS JESSE E. , ACHOR RICHARD W. P.
Published: June 2012

Among 13,314 necropsies following death from neoplastic and nonneoplastic diseases performed at the Mayo Clinic from 1942 through 1958, 189 cases of secondary malignant lesions of the pericardium were demonstrated, an incidence of 1.42 per cent. Carcinoma of the lung and breast, the lymphomas, and leukemia constituted the large majority of the primary malignant lesions that caused the pericardial metastasis. Fifty-five of the 189 patients were adjudged to have had some impairment of cardiac function as a consequence of the pericardial metastasis and the following conclusions concern this group.

1. In 47 patients (86 per cent), the lesions were either the immediate or a contributory cause of death.

2. The most common mechanism whereby metastatic lesions in the pericardium interfered with cardiac function was by the development of pericardial effusion. Next in frequency was effusion combined with myocardial invasion and then cardiac constriction by tumor. Combinations of these processes with malignant encroachment on the great vessels and with invasion of coronary veins were the other mechanisms noted. Involvement of coronary arteries and the cardiac nerve supply was not noted.

3. Pericardial fluid was significant in causing tamponade in 31 cases. The fluid was frankly hemorrhagic in a small minority of these cases although fibrinous pericarditis was present in 45 (82 per cent) of the group. Pleural effusion was present in 48 (92 per cent) of 52 cases and was usually bilateral. Ascites was present in 22 (50 per cent) of 44 cases; the quantity was usually rather small.

4. Only one patient had metastasis to the pericardium without metastasis to other thoracic structures; exclusive of patients with leukemia, 43 (92 per cent) of 47 patients had extrathoracic metastatic lesions.

5. Dyspnea, cough, pleural effusion, hepatomegaly, and thoracic pain were the most commonly recorded signs and symptoms that might be related to the pericardial lesions. However, more specific signs and symptoms directing attention to pericardial or cardiac involvement were not commonly recorded.

6. The diagnosis of pericardial metastatic disease was suspected or established in only 16 (29 per cent) of the 55 patients, although 34 (62 per cent) either received treatment for congestive heart failure or were given roentgen therapy to mediastinal structures.

7. Of the 27 patients whose electrocardiograms were available, 25 had T-wave abnormalities, 22 had low QRS voltage, and 15 showed sinus tachycardia.

8. Thoracic roentgenograms, made on 53 patients, supplied clues to the diagnosis of pericardial malignancy in 28.
Thoracic Arterial Arch Anomalies
Authors: BLAKE (MD) HU A. , MANION WILLIAM C.
Published: June 2012

Forty-one well-studied thoracic arterial arch anomalies are related to cases previously reported in the literature and presented with simplified drawings in an attempt to provide a workable understanding of these anomalies.
Congenital Absence of the Pulmonary Valve
Authors: MILLER ROBERT A. , LEV MAURICE , PAUL MILTON H.
Published: June 2012

A group of cases of tetralogy of Fallot with congenital absence of the pulmonary valve are presented, and it is indicated that this abnormality presents a characteristic clinical, physiologic, and pathologic syndrome.

It is postulated that the aneurysmal dilatation of the pulmonary artery may result either from a congenital weakness at the base of the pulmonary artery or from the hemodynamic effects of a ventricular septal defect and infundibular stenosis in the presence of pulmonary regurgitation.

The absence of the pulmonary valve has not been a deterrent to successful corrective surgery aimed at the basic pathology of tetralogy of Fallot in three cases.
Paroxysmal Tachycardia after Exercise
Authors: MILLER PERRY B. , POLLARD LAWRENCE W.
Published: June 2012

Two cases of coronary artery heart disease are presented in which the Master two-step exercise test provoked short bursts of paroxysmal tachycardia. In one patient, nodal tachycardia was present; in the other, the tachycardia was either ventricular or nodal with aberrant conduction. Difficulties in assessing the probable etiology of paroxysmal tachycardia after exercise, which appears as an isolated finding in the coronary age group, are discussed.
Myocardial Infarction Patterns in Young Subjects with Normal Coronary Arteriograms
Authors: LIKOFF WILLIAM , SEGAL BERNARD , DREIFUS LEONARD
Published: June 2012

For the present, the primary obligations of this communication are to acknowledge that the electrocardiographic patterns of myocardial ischemia, injury, and necrosis may appear in asymptomatic, young white males who have low-intensity systolic murmurs; to record that any implication that these electrical deviations result from obstructive coronary disease cannot be substantiated by coronary arteriography; and to suggest that individuals possessing these diagnostic features may represent a distant, recognizable clinical entity the etiology of which remains obscure.
Arteriovenous Aneurysm of Phrenic Vessels Simulating Cardiac Fistula
Authors: GRAY IAN R. , WILLIAMS H. PARRY
Published: June 2012

A child is described with an arteriovenous communication between the left phrenic artery and the left pericardio-phrenic vein. The differential diagnosis of continuous murmurs in the chest is discussed in the light of this case. The hemodynamic consequences of arteriovenous communications and indications for their surgical treatment are briefly outlined.
Operative Results in Aortic Valve Surgery
Authors: KAY EARLE B. , SUZUKI AKIO , MENDELSOHN DAVID
Published: June 2012

An analysis of the surgical management in relation to factors contributing to morbidity, mortality, and results in 90 patients having artificial valvular replacement for diseased aortic valves is presented. Twenty-four factors occurred in 15 patients which were responsible either alone or in combination for the deaths. These factors fell into five main groups related to the patient, the heart, the myocardial protection, the general body protection, and the valve. Most of these factors contributing to death are preventable. Therefore, the over-all operative mortality of 16 per cent should be materially reduced in the future.
Correlation of Arteriographic and Pathologic Findings in the Coronary Arteries in Man
Authors: GRAY C. R. , HOFFMAN H. A. , HAMMOND W. S. , MILLER K. L. , OSEASOHN R. O.
Published: June 2012

The accuracy or clinical coronary arteriography was studied by comparing pathologic and radiologic findings in 130 major coronary arterial segments obtained from 13 individuals at autopsy. Abnormal roentgenographic findings were verified by pathologic examination; however, half of the segments that appeared normal or minimally involved radiologically demonstrated more severe changes at autopsy.
The Electrical Potential Difference Across the Cell Membrane of Heart Muscle
Authors: PAGE ERNEST
Published: June 2012

The electrical potential difference across the cell membrane of heart muscle cells is a diffusion potential arising from the interaction of fixed charges within the membrane pores with NaCl and KCl diffusing into and out of the cell. The magnitude and sign of this potential difference depend on the relative permeabilities, of the membrane to K, Na, and Cl. The resting membrane is predominantly permeable to K, while the action potential is characterized by a transient increase in Na permeability. An intracellular solution of high K concentration and low Na concentration is separated by the cell membrane from an extracellular solution having a low K concentration and a high Na concentration. These concentration differences are maintained by active transport processes that utilize the energy derived from cellular metabolic reactions to transport Na and K "uphill" against electrical and concentration gradients.
Early Osmotic History of the Plasma Membrane
Authors: JACOBS MERKEL H.
Published: June 2012

The following topics, among others, are conisidered: Pfeffer's hypothesis of an invisible plasma membrane, to account for similarities in the osmotic behavior of plant cells and artificial osmometers; early doubts as to the reality of Pfeffer's membrane; denial by colloid chemists of the existence of plasma membranes because of the supposed failure of cells to obey osmotic laws; demonstrations of thin, external cell membranes by electrical and micromanipulative methods; use of the plasma membrane in the mathematical treatment of cell permeability; the nature of so-called "perfect osmometers"; the erythrocyte as an osmometer; hemolytic evidence of the existence of an erythrocyte membrane.
Growth of the Concept of the Paucimolecular Membrane
Authors: DAVSON HUGH
Published: June 2012

The concept of the paucimolecular membrane derived in the first place from studies, such as those of Gorter and Grendel, on the amount of fatty material that could be extracted from the cell, based on the assumption that this was mainly concentrated at its surface. These studies, and other ones, led to the concept of the bimolecular leaflet of lipid as the fundamental basis of membrane structure. Various considerations demanded, also, the presenee of protein as an intimate part of the structure. The simple structure put forward can account for many of the features of cell permeability, but, where facilitated diffusion is concerned, we must invoke the presence of specialized regions, perhaps pores, that have specific structures into which favored molecules and ionis are able to fit. If this is true, variations in the gross analysis of cell membraines are unlikely to be correlated with gross variations in permeability characteristics; instead we must seek, by indirect methods, to lay bare the chemical features of these specialized regions, which doubtless share many of the characteristics of enzymes.
A Consideration of the Extraneous Coats of the Plasma Membrane
Authors: BRANDT PHILIP W.
Published: June 2012

This review is concerned with the role of the "extraneous coat" of the ameba in pinocytosis. It also considers the possible role of the extraneous coat as an additional barrier to those exchanges between the cytoplasm and the environment which involve diffusion. Several examples of pinocytosis in mammalian tissues are presented and are appraised with respect to the physical-chemical properties of the extraneous coat. Types of transport that do not appear to operate by way of pinocytosis are similarly considered.
On the Plasma Membrane of Some Bacteria and Fungi
Authors: ROBINOW CARL F. , Marak John
Published: June 2012

The contents of bacterial cells can be reversibly pulled away. (plasmolyzed) from the wall by strong salt solutions. Bacterial "protoplasts"—living cells divested of their wall—shrink or swell with changing concentrations of solutes in their environment and burst when this concentration falls below a critical level. These observations have long suggested that the cytoplasm of bacteria is covered by a selectively permeable plasma membrane.

In recent years electron microscopy has revealed the existence of a narrow profile at the surface of the cytoplasm of bacteria. In some bacteria, these profiles have the dimensions of sections of the "unit membrane" found in the interior and at the surface of plant and ainimal cells.

In the place of a unit membrane, single tracks of densely stained granules are found in many bacteria. New electron micrographs confirm the observation of Young and Fitz-James (1959) that the first spore membrane is derived fromn an infolding of the plasma membrane of the mother bacterium.

Illustrations are provided of the plasmna membrane of
B. mycoides
and of the yeast
Lipomyces lipofer
.
Physiologically Significant Specializations of the Cell Surface
Authors: FAWCETT DON W.
Published: June 2012

This paper presents a brief review of the ultrastructure of some of the structural elaborations of the plasma membrane that may be regarded as adaptations for specific cell functions. Among the relatively stable specializations of the free surface, it considers the striated border of the intestinal mucosa, the brush border in the nephron, and filamentous coatings on the membranes of certain cells of the gastric mucosa. It then turns to those transient configurations of cell surfaces involved in the dynamic processes of pinocytosis, phagocytosis, and liberation of secretory products and considers the turnover of membranes associated with these phenomena. Discussion of specializations of the contact surfaces includes the desmosomes and terminal bars and the present status of intercellular cement and interfacial canals. A section on specializations of the cell base considers the basement membrane and basal infoldings of the plasma membrane in cells engaged in active transport. And finally, there is a description of the terminal web and the marginal band of nucleated erythrocytes—specializations of the superficial cytoplasm concerned with maintenance of cell shape.
The Excitable System in the Cell Surface
Authors: TOBIAS JULIAN M. , AGIN DANIEL P. , PAWLOWSKI RAYMOND
Published: June 2012

A membrane model, composed of phospholipid and cholesterol, is described. The electrical resistance and hydration of this model can be controlled by manipulation of ambient ions and by current in ways strongly reminiscent of the behavior of living cells. The behavior of the model may resemble that of the membrane component of the cell. In addition, an interdependent, lipid-protein molecular structure may exist at the cell surface.
Functional Implications of Interactions of Extracellular Ions with Ligands of the Cell Membrane
Authors: ROTHSTEIN ASER
Published: June 2012

Three examples are discussed in which interactions of chemical agents with ligands of the plasma membrane have been chemically characterized and in which the resulting disturbance in membrane function has been quantitatively measured. Uranyl ion reacts with phosphoryl groups and specifically blocks the transfer of glucose across the membrane. Cationic redox dyes and mercuric chloride react with sulfhydryl groups and destroy the structural integrity of the membrane. Arsenate competes with phosphate for a specific active-transport system and blocks the system by irreversibly combining with one of its components.
Ventricular Fusion Beats
Authors: MARRIOTT HENRY J. L. , SCHWARTZ NEIL L. , BIX HAROLD H.
Published: June 2012

Relatively precise criteria are proposed for the recognition of ventricular fusion beats. Apart from the obvious and widely accepted criteria involving contour, duration, and time of appearance, other less obvious characteristics have been adduced: (1) the P-S time of the fusion beat must always be considerably longer than the P-R interval of the component sinoatrial beat; (2) the P-R interval of the fusion beat is generally not more than 0.06 second shorter than the sinoatrial P-R; (3) the terminal vector of the fusion beat is always different from that of the sinoatrial beat, while the initial vector may or may not differ. Exceptions to these criteria are seen in the presence of bundle-branch block, during periods of inconstant atrioveutricular conduction times, and presumably in the presence of diffuse intraventricular conduction delays.

The shortcomings of conventional diagrams for depicting the mechanisms of arrhythmias are noted, and a plea is made for the use of more accurate symbols in their construction.

Fusion beats are not an indispensable criterion for the diagnosis of ventricular parasystole.
The Apical First Heart Sound as an Aid in the Diagnosis of Atrial Septal Defect
Authors: LOPEZ JOSE F. , LINN HAROLD , SHAFFER AARON B.
Published: June 2012

The phonocardiograms of 187 patients were reviewed. In 89 the apical first heart sound was soft or single; in 57 M
1
was louder than T
1
and in 23 the two components were equal. In only 18 cases was T
1
louder than M
1
at the mitral area, and of this group five were suspected of having atrial septal defect and 10 were proved cases. In three of the proved cases, this was the only significant finding, the other usual features being absent. Only two proved cases of atrial septal defect in this series did not have T
1
louder than M
1
at the apex; both had T
1
equal to M
1
. One case suspected of having atrial septal defect also had T
1
equal to M
1
and in another suspected case the first heart sound was single. This unusual characteristic of the first heart sound may be useful as an indication favoring the diagnosis of uncomplicated atrial septal defect.
Rupture of the Infarcted Interventricular Septum
Authors: BOICOURT ORVILLE W. , RITZMANN LEONARD W. , CHASE JOHN D. , STARR ALBERT , MCCORD COLIN W.
Published: June 2012

Successful surgical closure of a ruptured interventricular septum following myocardial infarction is reported. The patient developed the loud pansystolic parasternal murmur characteristic of septal perforation, and cardiac catheterization confirmed an unusually large left-to-right shunt. The patient's course was not the typical rapid deterioration with shock or intractable heart failure, but when myocardial insufficiency developed insidiously 5 weeks postinfarction, surgical closure with a Teflon patch was accomplished during cardiac bypass.

Since early death ensues so frequently, surgical repair has been attempted in only a small number of instances; this patient is one of the very few with successful closure and long-term survival. The pathology, clinical course, and cardiac catheterization data of this entity are reviewed from previously reported cases.
Psychological Factors and Heart Disease
Authors: FISHER STANLEY H.
Published: June 2012

A number of studies have revealed that perceived emotional stress can produce various transient cardiovascular responses. The reactions may include changes in heart rate and cardiac output. They may include abnormalities in heart rhythm, changes in blood pressure, peripheral resistance, blood viscosity, blood clotting time, and serum cholesterol levels. A hypothesis suggested by the findings which requires further research follows: If these cardiovascular responses were sustained for a period of time, they would ultimately influence the onset or course of coronary artery disease. These studies also suggest that emotional tension at one's work may place an additional strain on an already diseased heart.

In patients whose cardiovascular system is already impaired, investigators have traced the sequence from emotional upset to heart disease. Since the reported evidence has been based on cardiac subjects, it is still possible that "gradual increase in tension" is perceived only after illness occurs, but not necessarily perceived as stressful before beart disease. Owing to the lack of prospective studies in which the life stress factors are studied prior to heart disease, emotion as a cause or contributory factor to heart disease has not been fully accepted. These studies suggest that certain personality traits may be common to certain forms of heart disease. Most of this evidence has been observed from time-consuming, detailed personality analysis, and the evidence depends on studies of relatively few patients and poor or no controls.

It is important to note that these studies on personality type and heart disease were conducted after heart disorders developed. This raises the question of whether the reported personality characteristics preceded or followed the heart disease. The investigations to date assume that the personality structure occurred before the appearance of the heart disease, but before we can answer this question, a longitudinal study of the personality of individuals prior to cardiovascular disease would be necessary.
Intercoronary Anastomotic Channels and Sudden Unexpected Death from Advanced Coronary Atherosclerosis
Authors: SPAIN DAVID M. , BRADESS VICTORIA A. , IRAL PEDRO , CRUZ ANTONIA
Published: June 2012

Within the limits of the technic in this study, intercoronary anastomotic channels over 40 µ in diameter were unrelated to age and the degree of coronary atherosclerosis.

Intercoronary anastomotic channels over 40 µ in diameter with one exception were found only in the presence of myocardial infarcts.

Those persons who died suddenly and unexpectedly with advanced coronary atherosclerosis did not reveal any evidence of intercoronary anastomoses over 40 microns in diameter. This may be a possible factor in the inability of such individuals to survive a severe initial attack of myocardial ischemia.
The Syndrome of Severe Mitral Regurgitation with Normal Left Atrial Pressure
Authors: BRAUNWALD EUGENE , AWE WILLIAM C.
Published: June 2012

It has been generally thought that significant elevations of the left atrial and pulmonary vascular pressures occur in patients with mitral regurgitation of sufficient severity to produce serious disability and gross enlargement of the left atrium. Ten patients with severe mitral regurgitation have been encountered in whom gross left atrial enlargement was accompanied by normal left atrial and pulmonary artery pressures. These patients ranged in age from 8 to 49 years, all were in functional classes III or IV, and the average duration of symptoms was 7.3 years. Nine patients had rheumatic mitral regurgitation while one had a congenital lesion. Atrial fibrillation and the physical findings of pure mitral regurgitation were present in all patients, as was striking left atrial enlargement on their roentgenograms. Left atrial pressure, determined by left heart catheterization, averaged 9.1 mm. Hg and did not exceed 12 mm. Hg in any patient, and the V wave was not particularly prominent. The cardiac index was markedly depressed and averaged 2.0 L./min./M.
2
B.S.A.

The observed discrepancy between left atrial size and pressure must reflect a disturbance in the compliance of the left atrial wall. It is suggested that long-standing mitral regurgitation may modify the mechanical characteristics of the atrial wall and that the presence of a normal left atrial pressure must not be assumed to exclude the presence of severe mitral regurgitation. The manner in which variations in left atrial compliance affect the clinical picture of mitral regurgitation and the selection of patients for operative intervention are discussed.
The Use of Isoproterenol (Isuprel) in the Evaluation of Congenital Cardiac Defects
Authors: MOSS ARTHUR J. , DUFFIE EDWARD R.
Published: June 2012

Isoproterenol was infused intravenously at a rate of 0.03 to 0.07 µg. per Kg. per minute in 38 patients undergoing cardiac catheterization to evaluate the routine postoperative condition of 19 patients and to support or confirm the clinical diagnosis in 19 others.

A steady response was obtained in 2 to 4 minutes, and no toxic effects were observed. During the infusion the heart rate increased an average of 55 per cent; the respiratory rate, 23 per cent. The right atrial pressure fell. In general the pulmonary and systemic arterial pressures also decreased. Limited observations on the cardiac output confirmed the previously reported increase. Ten patients developed a significant systolic gradient between the right ventricle and pulmonary artery (greater than 20 mm. Hg) during the infusion. Four of these were postoperative patients, three of whom were considered completely corrected prior to infusion of the isoproterenol. Four patients with aortic stenosis were studied, and the systolic gradient increased in three (80, 93, and 145 per cent).

The results indicate that infusion of isoproterenol is a safe, practical, and effective means of simulating exercise in infants and children. Used in addition to the customary cardiac catheterization studies, it is of distinct value in appraising congenital cardiac defects.
Optimum Criteria for the Diagnosis of Ventricular Septal Defect from Measurements of Blood Oxygen Saturation
Authors: GRAYZEL JOSEPH , JAMESON A. GREGORY , Seed Mary , Webster Jean B.
Published: June 2012

A combination of physical findings, x-ray films and fluoroscopy, electrocardiography, vectorcardiography, cardiac catheterization including oxygen analysis, indicator-dilution curves, and selective angiocardiography was employed to evaluate 259 consecutive patients undergoing right heart catheterization. All patients were classified on the basis of existing shunts. The present report concerns 63 patients with no shunts and 70 patients with a left-to-right shunt through a ventricular septal defect alone.

A method employing oxygen analysis of right heart blood was evaluated as an isolated diagnostic technic. Blood specimens were obtained in rapid sequence during withdrawal of the catheter from the pulmonary arteries. Spectrophotometric measurements of blood oxygen saturation were appropriately grouped. The difference in means between the right ventricular outflow tract and right atrium was standardized with the estimated standard deviation and the statistical significance determined from the
t
-distribution.

Reliability was defined as the probability of correctly excluding a shunt when none exists. Sensitivity was defined as the probability of diagnosing an existing shunt. By use of the 1-per cent level of signfiicance as critical the method employed was 98.4 per cent reliable and 97.1 per cent sensitive.

Sequential sampling is of vital importance. The value of larger numbers of specimens is illustrated, and the relationship of sensitivity and reliability to the size of the shunt and the number of blood specimens analyzed is illustrated.

The reliability and sensitivity of our method and criteria appear superior to previous criteria currently in use.
The Pulmonary Blood Volume in Rheumatic Heart Disease and Its Alteration by Isoproterenol
Authors: MCGAFF CHARLES J. , ROVETI GEORGE C. , GLASSMAN EPHRAIM , MILNOR WILLIAM R.
Published: June 2012

Pulmonary blood volume was measured in five hemodynamically normal subjects and 37 patients with heart disease. Mean pulmonary blood volume in 25 of these patients with moderate to severe mitral stenosis, alone or complicated by other valvular lesions, was 359 ml. per M.
2
(SE = ±24 ml. per M.
2
), which was significantly higher than the average value of 230 ml. per M.
2
(SE = ±14 ml. per M.
2
) in the five normal subjects (
p
< 0.025).

Multiple correlation of pulmonary blood volume with left atrial mean pressure, pulmonary vascular resistance, and stroke volume showed that each of these factors was significantly related to pulmonary blood volume, independently of the others. Increased left atrial pressure or stroke volume was associated with relatively high, and increased pulmonary vascular resistance with relatively low pulmonary blood volume.

In seven subjects 10 to 20 mg. of isoproterenol administered sublingually led to a marked increase in pulmonary blood volume and a small decrease in pulmonary vascular resistance. The average increase in pulmonary blood volume was 78 ml. per M.
2
, or 35 per cent of the control value (SE = ±15 ml. per M.
2
), while the average drop in pulmonary vascular resistance was 1.3 R.U.M.
2
(SE = ±0.5 R.U.M.
2
). Since the change in volume was too large to be accounted for by arteriolar dilatation alone, and there was a simultaneous decrease in pulmonary arterial and left atrial pressures, isoproterenol apparently increased the distensibility of a large but as yet unidentified segment of the pulmonary vascular bed.
Pulmonary Function in Adults with Intracardiac Septal Defect
Authors: WOOLF C. R.
Published: June 2012

Pulmonary function has been assessed in 45 patients with atrial or ventricular septal defect. Moderate and severe dyspnea occurred almost exclusively in patients with high pulmonary artery pressure irrespective of whether this was due to high pulmonary blood flow or high pulmonary vascular resistance.

Evidence is presented suggesting that this raised pulmonary artery pressure causes lung damage shown by a low compliance and high nonelastic resistance. These findings suggest an abnormal alveolar-capillary membrane and an abnormality of ventilation-perfusion relationships, which in turn cause a relatively low pulmonary diffusing capacity requiring excessive hyperventilation on exercise to maintain oxygen requriments. In patients with moderate or severe dyspnea, the abnormally high minute volume of ventilation during mild exertion is associated with a high work of breathing, the dual abnormality separating them from patients with only slight dyspnea on exertion.
Venous Obstruction of the Upper Extremity Caused by a Malformed Valve of the Subclavian Vein
Authors: CUCCI C. E. , BOTTINO C. G. , CIAMPA V.
Published: June 2012

A 39-year-old laborer with a venous obstruction of the left upper extremity was studied by selective phlebography. Surgery revealed that the obstruction was caused by an anomalous venous valve, diaphragm-like, at the middle third of the subclavian vein. The removal of the anomalous valve resulted in complete relief of the obstruction.

This is the only known case of venous obstruction caused bv a malformed valve.

The authors suggest that the term "primary venous obstruction" of the upper extremity be used instead of "traumatic thrombosis" or "Paget-Schroetter" syndrome, in cases in which the etiology has not been ascertained.
Detection and Quantitation of Intracardiac Left-to-Right Shunts by an Oximetric Inert Gas Technic
Authors: WOOD ROBERT C. , MARSHALL HIRAM W. , WOOD EARL H.
Published: June 2012

A method is described for detecting and quantitating small left-to-right shunts by recording continuously and simultaneously the changes in blood oxygen saturation at a systemic artery and at selected sites in the right heart chambers or great vessels produced by a few breaths of an inert gas such as helium or nitrogen.

The advantages of this technic for detecting and quantitating left-to-right shunts are (1) the same instrument, namely, the cuvette oximeter, used to determine blood oxygen saturation and indicator-dilution curves in conjunction with routine diagnostic catheterization procedures, also is used to record the inert gas curves, (2) only one right heart catheter is needed, (3) the method is relatively simple, (4) the shunt can be quantitated, and (5) shunts of less than 10 per cent of pulmonary flow can be detected.

It is concluded that the technic is of considerable practical value as a means of excluding the presence of or demonstrating and determining the magnitude of small left-to-right shunts.
Recognition of Anterior Wall Infarction in Patients with Left Ventricular Hypertrophy
Authors: HUGENHOLTZ PAUL G. , RYAN THOMAS J. , WOERNER THOMAS , LEVINE HAROLD D.
Published: June 2012

Horizontal plane projections of vectorcardiograms registered by the Frank lead system were analyzed in 36 patients with left ventricular hypertrophy and in 24 with left ventricular hypertrophy and associated anterior wall infarction. All were studied at autopsy. The 0.01-, 0.02-, 0.03-second, and maximum QRS vectors were compared with similar measurements in 60 control subjects previously reported. New criteria for the vector-cardiographic diagnosis of left ventricular hypertrophy have been outlined. Close agreement with earlier reported groups of patients with anteroseptal and anterolateral infarction was found, and findings by others in patients with left ventricular hypertrophy were confirmed.

The direction of the 0.02-second QRS vector allowed the separation of the infarct group from the left ventricular hypertrophy group and from the normal, whereas the direction of the 0.03-second and maximum QRS vectors separated left ventricular hypertrophy from the normal. The magnitude of the maximum QRS vector is another highly reliable indicator of left ventricular hypertrophy and also serves to separate this group from those with associated anterior wall infarct. The influence of associated right ventricular hypertrophy or posterobasal infarction on left ventricular hypertrophy has been discussed.

The accuracy of this technic of vectorcardiographic differentiation between left ventricular hypertrophy on the one hand and left ventricular hypertrophy with anterior infarction on the other in every instance was confirmed at autopsy. In all 12 patients whose electrocardiograms presented the dilemma of QS or rS complexes in leads V
1
to V
3
of the standard precordial electrocardiogram, the vectorcardiographic diagnosis was confirmed at autopsy. The Frank vectorcardiogram is a sensitive and reliable method to recognize left ventricular hypertrophy and may prove to be a useful adjunct to the ordinary electrocardiogram in cases where the electrocardiographic diagnosis is questionable.
Rupture of Aortic Valve Secondary to Aneurysm of Ascending Aorta
Authors: LEVY MORRIS J. , SIEGAL DAVID L. , WANG YANG , EDWARDS JESSE E.
Published: June 2012

A case of aneurysm of the ascending aorta, the result of cystic medial necrosis, is presented. The feature of peculiar interest is that as the diseased part of the aorta became elongated it stretched the attached aortic cusps. As a consequence, one cusp developed a gross fenestration, while the other ruptured and prolapsed.
Hemodynamic Effects of Isoproterenol Infusion in Patients with Normal and Diseased Mitral Valves
Authors: WHALEN ROBERT E. , COHEN ALLAN I. , SUMNER ROBERT G. , MCINTOSH HENRY D.
Published: June 2012

Hemodynamic effects of isoproterenol infusion were studied in 26 patients with and without mitral valve disease undergoing combined right and left heart catheterization. The heart rate and cardiac output rose while the left ventricular end-diastolic pressure, pulmonary vascular resistance, and total peripheral resistance fell, regardless of the status of the mitral valve. Infusion produced little change in the mean arterial blood pressure and the diastolic filling period per minute.

While the mean left atrial and pulmonary artery pressures fell in patients with normal or insufficient valves, these pressures rose in patients with mitral stenosis. Stroke volume tended to rise in all patients but those with mitral stenosis. In patients with combined mitral stenosis and insufficiency the insufficiency appeared to modify the hemodynamic response associated with mitral stenosis.

The presence of a lowered end-diastolic pressure in the left ventricle and an increased pressure in the left atrium in patients with stenosis suggests that isoproterenol has a direct or reflex effect on the left ventricle during diastole.
Physiologic Studies Following Surgical Correction of Ventricular Septal Defect
Authors: THEYE RICHARD A. , KIRKLIN JOHN W.
Published: June 2012

Sixteen patients were studied immediately and for 3 days following surgical closure of ventricular septal defect. In eight patients with absent or mild pulmonary vascular disease, convalescence was uneventful and only small deviations from normal in cardiac output, blood gas levels, and acid-base profile were observed. The remaining eight patients had pre-existing moderate or severe pulmonary vascular disease. Values for cardiac output were abnormally low at some time in the postoperative period in all but two of these eight patients.

Failure to survive was clearly related to a low cardiac output in four of the five nonsurvivors. Reduction in cardiac output observed in this group of patients is believed to be based in major part on the pre-existing increased resistance to blood flow through the pulmonary vascular bed and also to impaired right ventricular function following operation. No evidence was obtained to suggest that major changes in pulmonary vascular resistance occurred in the immediate postoperative period in patients with moderate or severe pulmonary vascular disease following closure of ventricular septal defect. Right ventricular function following atriotomy or transverse ventriculotomy was less impaired than after vertical ventriculotomy.
Serum Glutamic Oxaloacetic and Pyruvic Transaminases in a Case of Cardiac Arrest Resuscitated by External Cardiac Massage
Authors: ADROUNY ZAVEN A. , STEPHENSON MAX J. , STRAUBE KURT R. , DOTTER CHARLES T. , GRISWOLD HERBERT E.
Published: June 2012

Serial serum transaminase determinations were made before and following cardiac arrest encountered during retrograde left ventricular catheterization and successfully managed by external cardiac massage. Prompt, significant elevation of serum glutamic oxaloacetic transaminase and slight rise in serum pyruvic transaminase occurred without evidence of myocardial infarction. Skeletal muscle trauma appeared the most likely cause.
Surgical Treatment of High Pressure Patent Ductus Arteriosus
Authors: TSUJI HAROLD , SHAPIRO MORSE , MAGIDSON OSCAR , DUNNE EDWARD , DYKSTRA PETER , KAY JEROME HAROLD
Published: June 2012

Thirteen patients with high pressure patent ductus arteriosus were operated upon. There was no operative mortality in this group. Twelve patients have shown remarkable clinical improvement, and there was a decrease in the pulmonary arterial pressure at the time of recatheterization in 11 of these patients restudied. One patient developed severe pulmonary hypertension and died six and one-half years after operation.

The pulmonary arterial systolic pressure dropped minimally in two patients, despite marked clinical improvement. Both patients had associated lesions: a large ventricular septal defect in one and severe congenital aortic stenosis in the other. Both patients are to be operated upon.

All patients with a predominant left-to-right shunt and a patent ductus arteriosus should have division of the patent ductus arteriosus. If a concomitant lesion requiring open-heart operation, such as a ventricular septal defect or aortic stenosis, is present, it should be corrected at a later date.
Experimental Experience With a Micromodule Pacemaker Receiver Sutured Directly to the Left Ventricle
Authors: STOECKLE HARRY , SCHUDER JOHN C.
Published: June 2012

It has been demonstrated that it is possible to transmit sufficient energy to pace a heart by means of inductive coupling between an external coil and a very small pacemaker receiver attached directly to the left ventricle. By the use of such a method in dogs, it has been found that the energy requirements for pacing are not dependent upon the total duration of pacing, but rather depend upon the tissue reaction occurring around the electrodes or pins. Electrode erosion, on the other hand, is related to the pacing process and dependent upon electrode material.

The operative implantation of this module is simpler than the other systems presently employed. However, the selection of suitable persons for wearing this unit has not been determined.
Effects of Deep Femoral Thrombophlebitis on the Circulation of the Lower Extremities
Authors: HALLER J. ALEX
Published: June 2012

Studies of the patterns of venous collateral circulation in patients with acute iliofemoral venous thrombosis and in patients with chronic postphlebitic limbs secondary to iliofemoral venous thrombosis show a close similarity to the collateral circulation which develops in experimental iliofemoral venous thrombosis. Serial phlebograms indicate that the collateral circulation will disappear only if the originally thrombosed deep system is returned to functional patency. This reconstitution of function to the venous valves is accomplisbed by early thrombectomy. Thrombectomy may, therefore, be the best protection against the development of a chronic postphlebitic limb.
Use of Intravenous Mannitol in Postperfusion Oliguria-Anuria
Authors: ATTAR SAFUH , BORGES FRANCIS J. , COWLEY R. ADAMS , ESMOND WILLIAM G. , HOLLINGSWORTH NORMAN , BLAIR EMIL
Published: June 2012

We have applied the principle of acute functional renal failure in the management of the oliguric-anuric state encountered in 19 of 158 patients undergoing open-heart operations. Mannitol was administered to nine patients who experienced acute renal failure, with successful diuresis and restoration of kidney function in eight.
Neural Responses Following Autotransplantation of the Canine Heart
Authors: WILLMAN VALLEE L. , COOPER THEODORE , CIAN LOUIS G. , HANLON C. ROLLINS
Published: June 2012

Orthotopic autotransplantation of the canine heart is followed by loss of direct sympathetic and parasympathetic neural regulation. Stimulation of the vagus nerve or stellate ganglion fails to alter cardiac rate.

Myocardial catecholamines are depleted and [see figure in the PDF file] hypersensitivity to exogenous
l
-norepinephrine is present for months.

One year after the operation, there is evidence of cardiac reinnervation and return of normal responses to catecholamines.
Collateral Circulation and Survival Related to Gradual Occlusion of the Right Coronary Artery in the Pig
Authors: LUMB GEORGE D. , HARDY LAWRENCE B.
Published: June 2012

Studies of survival following ligation and gradual occlusion of the right coronary artery 5 mm. from its ostium have been made in 95 pigs. The pig was selected for the experiments because its coronary artery distribution closely resembles that of the human.

Gradual occlusion was produced by constrictors made of a hygroscopic plastic. Survival following gradual occlusion is considered to be due to the development of collateral circulation.

Comparisons of survival have been made in untreated animals and in animals treated with an orally administered, long-acting nitrate (pentaerythritol tetranitrate). Increased survival in the animals which received medication is thought to be due to the drug's acting as an aid to collateral circulation.
Transatrial Approach to Total Correction of Tetralogy of Fallot
Authors: HUDSPETH ALLEN S. , CORDELL A. ROBERT , JOHNSTON FRANK R.
Published: June 2012

A transatrial approach to total correction of the tetralogy of Fallot is presented which utilizes: (1) anteroposterior incision of the right atrium near the right atrioventricular groove; (2) circumferential detachment of the septal leaflet of the tricuspid valve near the annulus; (3) pulmonary arteriotomy with valvuloplasty, if necessary; (4) retrograde displacement and resection of the stenosed infundibulum through the right atrium; (5) closure of the ventricular septal defect; (6) closure of the incision in the tricuspid valve; and (7) closure of the atriotomy.

Clinical application to 10 consecutive patients, varying from acyanotia to severely cyanotic, has confirmed the advantages and simplicity of this method. Coronary arterial division, ventriculotomy, and external enlargement of the pulmonary outflow tract have been unnecessary. Relief of pulmonary stenosis has been adequate in each instance. The ventricular septal defect has been well exposed in each patient, and its closure has presented no special problem.

There have been no complications associated with the method, and postoperative cardiac function has been good. Operative as well as clinical features of the method are still under investigation; however, experience thus far has led to its establishment as a routine for total correction of the tetralogy of Fallot in this clinic.
The Need for Systemic-Pulmonary Artery Shunts in the Surgical Management of Tetralogy of Fallot
Authors: HARRIS PAUL D. , BERNHARD WILLIAM F. , GROSS ROBERT E. , NADAS ALEXANDER S.
Published: June 2012

When managing infants and small children with severe enough symptoms to require operative intervention, there can be no doubt that the establishment of a shunt is highly efficacious. Total repair can be contemplated some years later. If technically feasible, a shunt of the Blalock-Taussig type is the desired form of procedure. When dealing with very small infants, a Potts anastomosis has a higher probability of remaining patent and is therefore more desirable, even though it might be more difficult to obliterate at the second operation.

In older or larger children with the pink tetralogy, total correction in one stage can be advised with an acceptably low mortality rate. However, in older subjects with severe cyanosis, it is now our policy in nearly all cases to employ a two-stage attack in the form of a preliminary systemic-pulmonary arterial shunt, proceeding with complete correction some years later.
An Evaluation of Total Correction of Tetralogy of Fallot
Authors: MALM JAMES R. , BOWMAN FREDERICK O. , JAMESON A. GREGORY , ELLIS KENT , GRIFFITHS SYLVIA P. , BLUMENTHAL SIDNEY
Published: June 2012

Forty-one consecutive patients, ranging in age from 41/2 to 27 years, were operated upon for complete repair of tetralogy of Fallot without an operative mortality. Postoperative catheterization of 25 patients permitted objective evaluation of the results which were, by the criteria adopted, excellent in 16 patients, good in 5, and poor in 4, including the 2 late deaths.

Surgical experience has shown the necessity for extensive resection of the right ventricular outflow tract. Prosthetic patches are considered necessary for closure of most of the ventricular septal defects encountered, but are infrequently needed for reconstruction of the right ventricular outflow tract. Its use is indicated in certain patients with hypoplasia of the pulmonary annulus or artery.

Age has been an important factor in patient selection. It is suggested that symptomatic patients under five years of age may benefit from a systemic-to-pulmonary arterial anastomosis before definitive correction is undertaken later in childhood.
Development of Viral Diseases and a Viral Disease-Like Syndrome After Extracorporeal Circulation
Authors: HOLSWADE GEORGE R. , ENGLE MARY ALLEN , REDO S. FRANK , GOLDSMITH EDWARD I. , BARONDESS JEREMIAH A.
Published: June 2012

In 170 consecutive patients with congenital or acquired cardiac disease who survived openheart operations, 14 patients (8 per cent) developed a syndrome characterized by malaise, fever, normal or low white blood count, lymphocytosis, and, in most cases, splenomegaly and hepatomegaly. The onset was usually delayed from three to six weeks after operation. Although this syndrome clinically resembled infectious mononucleosis, this diagnosis could be clearly established in only one case by heterophile antibody determinations. Nevertheless, the presence of virocytes and other similarities suggest a viral etiology for the other 13 cases.
Serum Tocopherol, Cholesterol, and Triglyceride in Coronary Heart Disease
Authors: NIKKILÄ ESKO A. , PELKONEN RISTO
Published: June 2012

The plasma tocopherol, cholesterol, and triglyceride were estimated in 175 male survivors of myocardial infarction and in control subjects. The control subjects comprised 214 blood donors (without healthy control) and 70 healthy persons. The coronary group derived from two sources: Group I had had myocardial infarction 4 to 6 weeks before the study; group II was composed of persons who had experienced a myocardial infarction 6 to 30 months before the study.

A tocopherol-loading test with 2 Gm. of tocopherol acetate was performed in 101 coronary subjects and in 34 control subjects. The 24-hour plasma tocopherol was estimated after the tocopherol load.

Ninety per cent of the young control subjects (20 to 35 years of age) had plasma to-copoherol below 15 mg./L., cholesterol below 290 mg./per 100 ml., triglyceride below 140 mg./100 ml., and 24-hour tocopherol below 24 mg./L. In reference to these concentrations, 53 per cent of the whole coronary group had an elevated plasma tocopherol level, 62 per cent had an elevated serum cholesterol level, and 56 per cent showed hypertriglyceridemia. The 24-hour plasma tocopherol level in normal subjects was exceeded by 77 per cent of the subjects with coronary heart disease.

The mean lipid levels were all slightly higher in group I (recent cases) than in group II (old cases). The difference was significant, however, only for triglycerides.

The whole coronary group was divided according to age in two subgroups (age below and over 50). No significant difference existed in the two groups.

The regression analyses of the lipids showed that none of the lipid measurements appeared to be fully independent variables. A highly significant regression was present for cholesterol versus tocopherol. The relationship between triglyceride and tocopherol was not so striking, although the regression was significant also here except the coronary group II.