bluuebunny/crossref_metadata_2025 huggingface dataset:
Termination of Left Superior Vena Cava in Left Atrium, Atrial Septal Defect, and Absence of Coronary Sinus
Authors: RAGHIB GUNAY , RUTTENBERG HERBERT D. , ANDERSON RAY C. , AMPLATZ KURT , ADAMS PAUL , EDWARDS JESSE E.
Published: June 2012

Eight cases of termination of the left superior vena cava in the left atrium are reviewed pathologically and clinically.

In three of the five patients who died, pathologic examination revealed three anomalies which, together, are considered to form a developmental complex. The anomalies are (1) termination of the left superior vena cava in the left atrium, (2) absence of the coronary sinus, and (3) an atrial septal defect lying in the postero-inferior angle of the atrial septum. In the two remaining fatal cases, the aforementioned anomalies were associated with persistent common atrioventricular canal. In this situation, the atrial septal defect of the latter malformation was confluent with the atrial septal defect of the anomalous complex described.

The coexistence of three anomalies-the left superior vena cava terminating in the left atrium, absent coronary sinus, and atrial septal defect-is considered to result from a single developmental abnormality. This takes the form of failure of complete formation of the left atriovenous fold, that fold which normally develops along the left side of the junction of the sinus venosus and the atrial portion of the heart.

Clinically, features of increased pulmonary blood flow, coupled with duskiness of the skin, were the significant abnormalities.

When cardiac catheterization was attempted through a right-sided vein, the data revealed a left-to-right shunt at atrial level, while levels of arterial oxygen desaturation were present.

Except in cases with coexistent ventricular septal defect, pulmonary hypertension was absent.

In each of the four patients in whom cardiac catheterization was performed through a left antecubital vein, the catheter was advanced into the left superior vena cava, left atrium, and left ventricle. This was substantiated by angiocardiography in three of the four patients. In our experience, angiocardiography was the most reliable procedure to substantiate the termination of the left superior vena cava in the left atrium.

The present study suggests that, in the absence of pulmonary hypertension, a left-to-right transatrial shunt associated with systemic arterial oxygen desaturation may indicate the presence of a persistent left superior vena cava terminating in the left atrium. Moreover, an atrial septal defect identified surgically as lying in the postero-inferior angle of the atrial septum should suggest that an additional anomaly may be present in the form of termination of the left superior vena cava in the left atrium.
Coronary Heart Disease in Chronic Schizophrenic Patients
Authors: HUSSAR ALLEN E.
Published: June 2012

An investigation of 1,275 autopsy protocols and available clinical records of white, male, chronic schizophrenic patients, 40 years or older, with an average length of hospitalization of over 20 years, showed that (a) the prevalence of coronary heart disease as a cause of death was as high in this group of schizophrenic subjects (31 per cent) as in the comparable section of the general population; (b) the fatality rate (66 per cent) of coronary heart disease, (c) the incidence of sudden death (64 per cent of all deaths from coronary heart disease), (d) the incidence of myocardial rupture (21.7 per cent of all fresh myocardial infarctions) and (e) the incidence of painless heart attacks were higher in schizophrenic patients (60 per cent) than in the general population; (f) myocardial aneurysm was found less commonly in schizophrenic patients (2 per cent of all patients who either died of coronary heart disease or other causes but showed old infarct or old occlusion), and (g) there was an almost complete absence of anginal syndrome preceding or following myocardial infarction.
Value of Chlorthalidone Plus Reserpine in Moderately Severe and Severe Hypertension
Authors: FINNERTY FRANK A. , KAKAVIATOS NIKOS , CHUPKOVICH VICTOR
Published: June 2012

One hundred nine patients with moderately severe hypertension and 12 patients with severe hypertension received the combination of 50 mg. of chlorthalidone plus 0.25 mg. of reserpine combined in a single tablet (Regroton) administered once daily for an average duration of 2 years.

The ease of administration (one tablet daily), the effectiveness (78-per cent good response), the lack of development of drug resistance over a 2-year period, and the small incidence of side effects would seem to make the combination of 50 mg. of chlorthalidone plus 0.25 mg. of reserpine the ideal treatment for most patients with hypertension. If a more rapid reduction in arterial pressure is indicated, as in patients with severe hypertension, or if a satisfactory therapeutic response has not been observed in 3 to 4 months in patients with moderately severe hypertension, suboptimal doses of other antihypertensive agents may be added.
Successful Replacement of "Parachute" Mitral Valve in a Child
Authors: PRADO SANTIAGO , LEVY MORRIS , VARCO R. L.
Published: June 2012

A Starr-Edwards mitral valve of orifice area 1.53 cm.
2
was successfully inserted to replace [see figure in the PDF file] [see table in the PDF file] a "parachute" mitral valve producing clinically significant mitral stenosis.
Congenital Familial Cardiac Conduction Defects
Authors: GAZES PETER C. , CULLER RODNEY M. , TABER ELSIE , KELLY THADDEUS E.
Published: June 2012

A family in which several members of three separate generations have evidence of congenital familial conduction disturbance has been described. The occurrence of Adams-Stokes seizures with congenital AV block was also noted. From the available information it is clear that the conduction disturbance was congenital in two generations, and the family history suggests that three or four generations were probably involved. The data suggest that in this family the congenital cardiac conduction defects were transmitted as an autosomal dominant trait with incomplete penetrance.
Multiple Muscular Ventricular Septal Defects
Authors: FRIEDMAN WILLIAM F. , MEHRIZI ALI , PUSCH ALLEN L.
Published: June 2012

Defects in the muscular portion of the interventricular septum are frequently multiple. Although their incidence is significant, scant attention has been paid them as a distinct entity. This report concerns seven patients with multiple muscular ventricular septal defects seen between 1956 and 1962. The patients ranged in age from 4 months to 9 years; five were less than 2 years old. Symptoms and signs of growth retardation, failure to thrive, and marked cardiac decompensation were present in each case. Electrocardiographic evidence of combined ventricular hypertrophy and incomplete right bundle-branch block was noted in each instance. Right heart catheterization demonstrated marked pulmonary hypertension of the high-flow, low-resistance type. These routine studies could not distinguish multiple muscular ventricular septal defects from the more usual membranous septal defect. All patients had cardiac surgery. There was one survivor. In three instances difficulty in identifying all of the multiple fenestrations prevented complete surgical repair. Postmortem examination was done in six patients. The sievelike appearance of the muscular ventricular septum was the most striking gross finding in the majority of the cases. Histologic analysis of the pulmonary vascular structural alterations did not reveal marked changes in any of the cases.

In contrast to the widespread belief that most isolated muscular septal defects are innocuous, these seven examples of multiple muscular defects were associated with a picture of severe heart disease. Every effort should be made to diagnose the lesion prior to surgery. Recognition of the multiple nature of the defect is a necessary preliminary to successful therapy. It is hoped that preoperative left heart angiocardiography will successfully demonstrate the multiple lesions.
Ventricular Response in Atrial Fibrillation
Authors: LANGENDORF RICHARD , PICK ALFRED , KATZ LOUIS N.
Published: June 2012

The ventricular response in atrial fibrillation is determined by the long refractory period of the AV junction. Since an atrial impulse is always available for transmission to the ventricles, a regular ventricular rhythm would be expected, the rate of which would reflect the duration of a stable junctional refractory phase. The irregularity of the ventricular action associated with atrial fibrillation, therefore, indicates changes of refractoriness of the AV junctional tissues from cycle to cycle. This can best be attributed to varying degrees of penetration of "blocked" atrial impulses into parts of the AV junction, and to the effect of such concealed conduction on the propagation of subsequent impulses.

The following facts are pointed out and illustrated as evidence of concealed AV and VA conduction during atrial fibrillation: (a) Occurrence of a "compensatory pause" following a ventricular premature systole. (b) Failure of an AV nodal escape to appear at the expected time due to concealed discharge of a subsidiary AV nodal pacemaker by a penetrating atrial impulse. (c) Acceleration of the ventricular rate when atrial fibrillation changes to flutter (elimination of concealed conduction with slowing of the atria). (d) A tendency for two or more long cycles to occur in succession (each containing one or more concealed responses).

The reasons for the variations of the refractory period at different levels of the AV junction as a result of concealed conduction are analyzed. Their complex interplay may readily account for the over-all irregularity of the ventricular response associated with atrial fibrillation.
Postinfarction Ventricular Septal Defect
Authors: BARNARD PIETER M. , KENNEDY JOHN H.
Published: June 2012

A series of four patients who died following rupture of the ventricular septum due to myocardial infarction has been reported. One of these died of hemorrhage due to a defective clotting mechanism 8 hours after successful surgical repair.

The 13 cases of surgical repair of postinfarction ventricular septal defect reported by other authors are reviewed.

The time interval is important and preferably 3 to 6 months should elapse following myocardial infarction before surgery is undertaken.

Surgery should be considered in every patient diagnosed as having an acute septal rupture following myocardial infarction who fails to respond to vigorous medical treatment.
Exchangeable Sodium, Body Potassium, and Body Water in Previously Edematous Cardiac Patients
Authors: CARROLL HUGH J. , GOTTERER RITA , ALTSHULER BERNARD
Published: June 2012

Measurements have been made of total exchangeable sodium, total body potassium, and total body water in a group of 13 previously edematous patients with heart disease, and in 20 "control" patients. The data show that while both groups have the same quantity of water as the per cent of body weight and the same body potassium concentration, the cardiac group has an excess of exchangeable sodium when compared with the "controls." Since the excess sodium in the cardiac group cannot be attributed to the loss of potassium or the accumulation of water, the results of these studies are taken as evidence that osmotic inactivation of a considerable amount of some cation, probably sodium, has taken place. It is suggested that a likely site for cation binding is in the polyanionic constituents of the connective tissues.
Combined Ventricular Hypertrophy
Authors: MUSTER ALEXANDER J. , PAUL MILTON H.
Published: June 2012

An attempt has been made to uncover the vectorcardiographic spectrum of combined ventricular hypertrophy by studying a group of 82 patients with cyanotic tetralogy of Fallot representing right ventricular hypertrophy with normal or less than normal left ventricular muscle mass and 140 patients with tetralogy of Fallot and surgically created systemic-pulmonary shunts representing right ventricular hypertrophy combined with varying degrees of increased left ventricular muscle mass.

An analysis of the spatial orientation of the maximal QRS vectors has demonstrated a continuum of vectorcardiographic patterns. These extend starting with severe right ventricular hypertrophy through a series of ventricular hypertrophy patterns representing right ventricular hypertrophy with progressively increasing left ventricular potentials toward dominant left ventricular hypertrophy patterns of combined ventricular hypertrophy. An estimate of the relative contribution of the two ventricles to a given vectorcardiographic pattern of combined ventricular hypertrophy is possible by analysis of the direction of maximal spatial QRS vectors.
Evaluation of Multipolar Effects in the High-Fidelity Standard Electrocardiogram by Means of Factor Analysis
Authors: FLOWERS NANCY C. , HORAN LEO G. , BRODY DANIEL A.
Published: June 2012

The usefulness of factor analysis as a means of describing in both general and specific terms an equivalent cardiac generator has been explored. High-fidelity, high-frequency electrocardiograms and vectorcardiograms of 31 normal subjects have been analyzed. The information in the electrocardiogram was reduced by factor analysis to the minimum number of independent waveforms which could account for all of this information. Because the first three principal factors might or might not represent a simple dipole, the efficiency of these three principal factors to resynthesize the originally recorded electrocardiograms was compared with the efficiency of McFee vectorcardiographic leads to perform the same resynthesis. The first three principal factors contained more information than that contained in the vectorcardiographic leads, suggesting that the factors contain more than simple dipolar information. This would in turn suggest that a more complex generator than the dipole must be employed to explain the surface potentials derived from the standard electrocardiogram. With only two principal factors the precordial leads were rather easily reconstructed but reconstruction of leads I and V
F
was considerably more difficult. Because the principal factors represent the most commonly occurring waveforms in the group, the less perfect resynthesis of leads I and V
F
with two factors alone may result from lack of detection of multipolar component in the limb leads which have less in common with the precordial leads than the precordial leads do with each other.
Electrocardiogram after Chloroquine and Emetine
Authors: SANGHVI L. M. , MATHUR B. B.
Published: June 2012

Electrocardiographic abnormalities have been studied after administration of chloroquine in 25 patients, of emetine in 28 patients, and of emetine and chloroquine in 28 patients.

Abnormalities after chloroquine were less in severity and of shorter duration than after emetine. They were more severe, became maximum later after cessation of emetine therapy, and were much longer in duration after emetine and chloroquine than after emetine. These differences are attributed to combined effects of the two drugs.

Serum potassium levels showed some decrease after antiamebic therapy, the decrease being more after emetine than after chloroquine.

A case is reported in which severe abnormalities and muscular paralysis occurring after emetine and chloroquine were rapidly reversed by oral potassium administration.

Administration of potassium simultaneously with emetine and chloroquine often prevented or delayed the appearance or decreased the severity of abnormalities. Subsequent potassium administration usually reversed the abnormalities except in cases in which they were present before emetine therapy. It is concluded that the abnormalities are functional in nature and not due to organic myocardial damage.

It is suggested that some disturbance of potassium metabolism in the myocardium and skeletal muscles may be the cause of electrocardiographic abnormalities and emetine neuritis, respectively.
Coarse Atrial Fibrillation in Congenital Heart Disease
Authors: THURMANN MANFRED
Published: June 2012

Four cases of congenital heart disease that showed coarse atrial fibrillatory waves in V
1
and evidence of right atrial or biatrial enlargement were discussed. It is suggested that the coarse
f
waves may be due to distention of the atria.
Isotope Technics in Clinical Cardiology
Authors: LOVE WILLIAM D.
Published: June 2012

Scans of the cardiac blood pool are of practical value and are being widely used. Simple methods of measuring cardiac output and blood volume are available, but they have not yet been exploited by clinicians. With the rapid advances in nuclear technology, practical and innocuous methods for measuring regional blood flow in the heart and other areas will probably become available in the near future. Such methods will undoubtedly be used by clinical investigators. Their widespread clinical application will depend on whether or not they provide a practical way of solving a recognized medical problem.
The Electrocardiogram during Exercise
Authors: BELLET SAMUEL , MULLER OTTO F.
Published: June 2012

The electrocardiogram after exercise has proved to be an extremely valuable tool in the diagnosis of coronary artery disease. However, it fails to record the events during the actual period of exercise at the time of the greatest stress on the circulation. Recent technics have enabled us to take the electrocardiogram during the period of exercise. Data presented indicate that the electrocardiogram taken during this period of exercise adds much to the information obtained in the postexercise electrocardiogram; at times, this information may be crucial in determining evidence of abnormalities in the exercise study. The tracings may be solely positive or more markedly positive during the period of exercise. Evidence of such changes would be helpful in diagnosis and in the early termination of the exercise test. It is our belief that the complete electrocardiographic exercise study should include tracings taken both during and after exercise, and the data obtained during both of these periods should be available for evaluation.

Although the complete exercise test adds much to the diagnosis of coronary artery disease, the presence of a normal test does not necessarily exclude this state. Evaluation of the tracing taken during exercise is in its infancy. Much still needs to be done relative to (a) more adequate standardization of the type of exercise to suit the individual subject, (b) improvement of standardization of apparatus, (c) standardization of leads and their placement, and (d) more rigid standardization of criteria for normality and abnormality.
Surgical Management of Popliteal Aneurysms
Authors: EDMUNDS L. HENRY , G R. CLEMENT , LINTON ROBERT R.
Published: June 2012

Ninety-eight popliteal aneurysms are reported that occurred in 82 patients who were treated surgically during a 16-year period from 1948 to 1963. The presence of acute or chronic arterial occlusive symptoms prior to operation significantly influenced the results of surgical management. Arterial reconstruction salvaged more than one half of the limbs presenting with limb-threatening ischemia, but early and late results recommend excision and grafting of all asymptomatic popliteal aneurysms before such complications develop. In our opinion saphenous vein autografts are preferable to prosthetic replacement in the surgical management of popliteal aneurysms.
Intracardiac Phonocardiography
Authors: LUISADA ALDO A. , MACCANON DONALD M. , SLODKI SHELDON J.
Published: June 2012

A new system for recording intracardiac and intravascular sound during routine catheterization is described.

This system is based on the application of a flat, sonar-type, barium titanate microphone at the end of the catheter, so that the vibrations of the blood within the chambers of the heart and vessels are transmitted along the fluid in the catheter, and transduced by the microphone (fluid column transmitted phonocardiogram-FCT phonocardiogram).

Comparative studies between the response of the FCT system and other systems for intracardiac phonocardiography are made in normal dogs and in dogs with experimental aortic lesions. It is demonstrated that the FCT system gives a good response for vibrations between 25 and 400 cycles per second.

Representative phonocardiographic tracings in patients with congenital or acquired heart disease during routine cardiac catheterization are presented.
Bidirectional Shunting in a Coronary Artery-Right Ventricular Fistula Associated with Pulmonary Atresia and an Intact Ventricular Septum
Authors: SISSMAN NORMAN J. , ABRAMS HERBERT L.
Published: June 2012

A case of an anomalous arteriovenous-like communication between the right ventricle and a single right coronary artery with pulmonary atresia and an intact ventricular septum in a 6-year-old boy is presented. The dynamics of blood flow through the anomalous vessel are demonstrated for the first time in the literature by means of cineangiocardiography. Factors affecting the flow of blood through the vessel, theories of the embryologic etiology of the condition, and clinical features allowing diagnosis during life and determining therapeutic management are discussed.
Coincidence of Mycotic (
Histoplasma capsulatum
) Vegetative Endocarditis of the Mitral Valve and the Lutembacher Syndrome
Authors: KORNS MICHAEL E.
Published: June 2012

A case of Lutembacher syndrome in which there was vegetative endocarditis lenta of the mitral valve, caused by
Histoplasma capsulatum
, is presented.
Cardiac Perforation Following Left Ventricular Cineangiocardiography
Authors: LEVIN AARON R. , SPACH MADISON S. , ANDERSON PAGE A. W. , CAPP M. PAUL
Published: June 2012

A case of perforation of the left ventricle during selective cineangiocardiography in a 27-month-old child with aortic stenosis is reported. Perforation was visualized during the power injection, and subsequent cardiac tamponade developed. Immediate pericardiocentesis resulted in rapid improvement and the child made an uneventful recovery. At cardiac surgery for aortic valvotomy 5 days later no abnormalities of the pericardium were noted but there was a small area of discoloration on the posterior left ventricular free wall. Prevention of poor catheter positioning is suggested as the major preventive measure to avoid such complications during selective ventricular angiocardiography.
Cardiovascular Aspects of the Ehlers-Danlos Syndrome
Authors: BOPP PIERRE , HATAM KASSEM , BUSSAT PHILIPPE , GREDER GEORGES , DUCHOSAL PIERRE W.
Published: June 2012

The case of a 10--year-old boy is reported because of the association of the Ehlers-Danlos syndrome with bifidity of the pulmonary artery and anomaly of the aortic arch.

The cardiovascular aspects of this connective-tissue disorder are reviewed, and the possibility of another common feature with the Marfan syndrome is briefly discussed.
Long-Term Postoperative Follow-Up in Surgery for Congenital Aortic Valvular Stenosis
Authors: THOMSON NORMAN B. , FISHER FRANK C.
Published: June 2012

Twenty-three children with congenital aortic valvular stenosis have undergone operation prior to November 1964, without a hospital mortality. A 4-week-old infant who died at the induction of anesthesia is not included. There was one late death due to uncontrolled aortic regurgitation. The late death occurred at the time of the second operation for placement of aortic valve prosthesis in another institution.

Thirteen of the 23 patients have an audible postoperative diastolic murmur. In two this murmur was present preoperatively. Eight of the 13 are considered to have mild aortic regurgitation, four moderate, and one severe. Of the 18 patients with competent valves or mild regurgitation, all have normal electrocardiograms. Ten of these 18 patients had electrocardiographic evidence of left ventricular hypertrophy before surgery. Four of the five patients with moderate or severe regurgitation have electrocardiographic evidence of left ventricular hypertrophy. These patients have all been followed from 3 to 5½ years. There is no evidence that the amount of regurgitation has either decreased or increased since surgery. The gradients measured at cardiac catheterization before operation range from 138 to 56 mm. Hg, with an average of 89 mm. Postoperatively, these gradients ranged from 45 to zero, with an average of 27. Pressures measured at the time of operation before and after valvulotomy agree favorably with the pressures measured at the time of cardiac catheterization before and after valvulotomy.

The development of postoperative regurgitation was found to be related to the incision of a rudimentary raphe which made an anatomically bicuspid valve tricuspid. It is also related to the position of the patient in the series, the regurgitation occurring most frequently in the first half of the series. Comparison with another series with a high residual gradient, but a lower incidence of the severity of regurgitation, suggests that the optimal gradient reduction may be purchased at the expense of an unavoidable amount of aortic regurgitation. This aortic regurgitation, however, is not necessarily hemodynamically significant.
The Effects of Nitroglycerin and Amyl Nitrite on Arteriolar and Venous Tone in the Human Forearm
Authors: MASON DEAN T. , BRAUNWALD EUGENE , Bullock Frederick A. , King Clara V.
Published: June 2012

The effects of sublingual nitroglycerin and inhaled amyl nitrite on the arteriolar and venous beds of the forearm were studied in 11 normal subjects. Forearm blood flow was measured with a strain-gauge plethysmograph, and venous tone was determined both by an acute occlusion technic, and by several equilibration technics. Nitroglycerin reduced systemic arterial pressure, elevated forearm blood flow, lowered forearm vascular resistance and decreased venous tone. Amyl nitrite diminished arterial pressure, elevated forearm blood flow, markedly decreased forearm vascular resistance, but in contrast to nitroglycerin augmented venous tone strikingly. This venoconstriction was abolished or diminished when adrenergic activity was impeded by administration of either guanethidine or reserpine.
Removal of Iatrogenic Foreign Bodies within Cardiac Chambers and Great Vessels
Authors: LILLEHEI C. WALTON , BONNABEAU RAYMOND C. , GROSSLING SERGIO
Published: June 2012

This paper reports six cases (age range 8 months to 69 years) of iatrogenic foreign bodies lodged within the heart or great vessels. Four cases were produced during left heart catheterization by breakage of a metal stylet, and two after the insertion of a Pudenz valve (for hydrocephalus) which embolized into the right ventricle and pulmonary artery.

In five of these patients, the foreign body was intracardiac (three in the left ventricle and two in the right ventricle and pulmonary artery) and the open-heart surgery was utilized for successful removal. In the sixth patient, the stylet was removed from the innominate artery via a closed procedure. Five of the six patients survived (including the youngest and oldest) and their postoperative course was uneventful. The one death followed removal of the right-left atrial foreign body and total aortic valve replacement for calcific stenosis, and failure appeared related to the basic disease rather than to the foreign body.

Such complications have rarely been reported in the literature. The high ratio of success, if treatment is prompt before the formation of clots (which is rapid), needs full appreciation, and emphasis is given to the benefits of prompt surgery for removal.
The Origin of an Immediate Diastolic Murmur in Atrioventricular Defects
Authors: SOMERVILLE JANE , RESNEKOV LEON
Published: June 2012

The origin of an audible immediate diastolic murmur in 10 of 22 patients with atrioventricular defects was investigated by intracardiac phonocardiography. It was shown to arise at the site of the atrial septal defect, and all other possible causes of such a murmur were excluded.

The production of the murmur depended on the combination of mitral regurgitation and an atrial septal defect of such a size as to permit an interatrial pressure gradient in early diastole.
Impaction of Cardiac Catheter in Coronary Vein
Authors: ANDERSON RAY C. , VARCO RICHARD L.
Published: June 2012

A complication of right heart catheterization is described in which the tip of the catheter became impacted in a vein connecting to the coronary sinus, requiring thoracotomy and removal under direct vision. This occurred in a 2-year-old patient with an anomalous inferior vena cava with azygos continuation, and it is suggested that this anomalous course may well have contributed to the development of this complication.
Prolonged Bed Rest in the Treatment of the Dilated Heart
Authors: BURCH G. E. , WALSH J. J. , FERRANS V. J. , HIBBS R.
Published: June 2012

In addition to the clinical disadvantages of progressive congestive heart failure, thromboembolic phenomena, and rhythm disturbances there are hemodynamic effects of considerable magnitude that arise from cardiac dilatation. While fully cognizant of all these factors, we are also aware of the limitations of conventional therapy in effecting return of heart size to normal. Prolonged complete bed rest in conjunction with conventional forms of therapy is being utilized in patients with idiopathic myocardial disease and cardiac dilatation in an effort to unload the heart. It is thought that the minimization of cardiac work, a good diet, and avoidance of alcohol, pregnancy, infection, and the like have permitted recovery and return of heart size to normal in approximately half of the patients treated thus far. Continuation of therapy and close observation by the physician after ambulation and discharge from the hospital cannot be overemphasized.
The Rebound Phenomenon-Fact or Fancy?
Authors: VAN CLEVE ROBERT
Published: June 2012

Long-term anticoagulant therapy (coumadin) was gradually tapered over a 6-week period in 63 patients, and stopped abruptly in 71. All of these patients had been on coumadin following myocardial infarction. A careful follow-up showed that there was no difference in the incidence of thrombotic events in the first 6 weeks after discontinuation of therapy, whether this was stopped abruptly or gradually. These results suggest that clinically recognized "rebound" thrombosis does not occur after long-term coumadin therapy is stopped. There appears to be no hazard inherent in stopping long-term coumadin therapy abruptly. A possible exception to this is patients whose therapy must be stopped because of bleeding episodes.
Salt Loading in Hypertension due to Renal Artery Stenosis
Authors: LOWE HAROLD M. , SINGELYN MICHAEL
Published: June 2012

Acute salt loading was performed in three groups of patients, a normal group, a group with essential hypertension, and a group with hypertension due to renal arterial stenosis.

Patients with hypertension due to renal arterial stenosis were found to excrete an acute salt load in a qualitatively and quantitatively similar manner to normal individuals, in marked contrast to the exaggerated natriuretic response of individuals with essential hypertension.

Of measures in which significant differences were found, the test urine volume, per cent of administered sodium excreted, and the ratios of clearance of sodium in the test and baseline periods yielded a clear separation of patients with essential renal hypertension.

The results of this study indicate that acute salt loading in hypertensive patients may have diagnostic and prognostic value.

The test procedure is simple, rapid, free from morbidity, and requires a minimum of laboratory analyses.
Work Speed as a Measure of an Equivalent Exercise Stress in Subjects of Different Weights
Authors: VAN LINGEN B. , SEAWARD P. D. , ODENDAAL W. A. , Kennedy I. M.
Published: June 2012

The use of work speed, as opposed to work load, as a predictive variable for heart rate during steady state submaximal exercise, increased the correlation and decreased the standard error of the prediction around the regression line. In addition, the relationship of pulse rate and work speed was shown to be independent of body weight, while the relationship of pulse rate and work load was influenced by the body weight.

The establishment of a submaximal exercise test, which would be an equivalent physiologic stress in subjects of different weights, would require that they perform exercise at a similar work speed rather than at a constant work load. Such recommendations, in addition, are at variance with those previously made in regard to subjecting individuals of different weights to an equivalent exercise stress.
Coronary Calcification
Authors: EGGEN DOUGLAS A. , STRONG JACK P. , MCGILL HENRY C.
Published: June 2012

Measurements of the per cent of the surface with calcified lesions have been made for the three main coronary arteries from 1,242 consecutive necropsies of whites and Negroes between the ages of 30 to 69 years.

Calcified lesions were most prevalent and most extensive in the left anterior descending branch and occurred with greatest frequency at 2 to 3 cm. from the orifice. Whites had greater involvement than Negroes and males had greater involvement than females. Prevalence and extent of calcification have been compared in four cause-of-death or disease categories; cases dying of coronary heart disease had greater involvement than the other three groups.

The prevalence of ischemic myocardial lesions, complicated coronary lesions, or stenotic lesions was greater for cases with calcified lesions, and this prevalence increases with increase in extent of calcified lesions. The significance of the presence of coronary calcified lesions for the diagnosis of advanced coronary atherosclerosis is greatest for younger individuals.
Ventricular Septal Aneurysms
Authors: EDELSTEIN JOSEF , CHARMS BERNARD L.
Published: June 2012

Two cases of ventricular septal aneurysm are reported, one in the membranous septum and one in the muscular portion. The diagnosis was made by selective left ventricular angiography. It is suggested that these cases represent spontaneous closure of a ventricular septal defect with weakness and aneurysmal [see table in the PDF file] formation due to the high left ventricular pressure. Both are asymptomatic and hemodynamically within normal limits. Surgical repair of the aneurysms is not considered necessary.
The Development of Hypertension after Rupture of a Kidney
Authors: GIRL J. , TUHÝ J.
Published: June 2012

Two cases of kidney rupture associated with hypertension are described, and the multiform traumatic changes causing it are surveted Renal arteriography is recommended not only in the early but also in the late stages of hypertension of this type, which responds to definitive treatment.
Coronary Artery-Atrioventricular Fistula and Ventricular Septal Defect due to Penetrating Wound of the Heart
Authors: JONES ROBERT C. , JAHNKE EDWARD J.
Published: June 2012

A patient with an unusual combination of lesions secondary to gunshot wound of the heart is presented. The predominant abnormality was a large fistula between the right coronary artery and the floor of the right atrium. The right coronary also communicated with the cavity of the right ventricle, and there was an associated posttraumatic ventricular septal defect. The presence of an arteriovenous fistula was suspected, based on the presence of a continuous precordial murmur. This diagnosis was confirmed by arteriography. Findings at surgery and the technic of repair are illustrated. Reference is made to three other patients with traumatic communication between the coronary artery and the atrium. Attention is directed to coronary artery atrio-ventricular fistula as another anatomic type of deformity to consider in patients with penetrating wounds of the heart. The probable recurrence of the fistula 3 weeks after what appeared to be a successful repair illustrates one of the problems to consider in evaluating such patients for surgery.
Elective Countershock in Unanesthetized Patients with Use of an Esophageal Electrode
Authors: MCNALLY E. M. , MEYER E. C. , LANGENDORF R.
Published: June 2012

A new electrode arrangement for the administration of elective direct-current countershock was studied, in which one electrode was placed in the esophagus, adjacent to the heart, and the other on the precordium.

Thirteen patients with chronic atrial fibrillation were converted to sinus rhythm by the esophageal technic. Though the majority were, on clinical grounds, difficult cases for conversion, 11 were converted with shocks of 40 watt-seconds or less, and two with 60, after 40 failed. Five patients were defibrillated by both the esophageal and the conventional, anteroposterior chest technics; the energy requirement with the esophageal method averaged less than one third of that with the conventional one. Four patients received 40, and one 30 watt-second shocks without anesthesia; all five tolerated the shocks well, and three of four who had had countershock previously under anesthesia, expressed preference for the esophageal technic without anesthesia in the future. All patients were observed carefully for any symptoms suggestive of esophageal injury or dysfunction. None such occurred, either immediately or within 4 months.

We conclude that this technic may have a place in elective countershock in that it may allow cardioversion to be undertaken in many patients who would otherwise require anesthesia.
Lymphatics of the Heart
Authors: JOHNSON ROBERT A. , BLAKE THOMAS M.
Published: June 2012

The anatomy of the cardiac lymphatic system of pigs, dogs, and humans has been studied by topical application of hydrogen peroxide and also by injection technics. In general, all three species have extensive subepicardial and subendocardial networks with collecting channels directed toward large ducts in the AV sulcus continuous with the main cardiac lymph duct. The subepicardial and subendocardial systems in dogs and pigs communicate via transmyocardial channels and channels in the supporting structures of the AV valves; in humans these communications have not been identified with certainty. Lymphatics are seen in both AV valves of dogs and pigs but have been seen only in the mitral valves of humans. The possible significance of these observations has been discussed.
Hemodynamic Effects of Aminophylline in Cor Pulmonale
Authors: PARKER JOHN O. , KELKAR KUMAR , WEST ROXROY O.
Published: June 2012

Nine patients with cor pulmonale due to chronic obstructive pulmonary disease were studied by means of right and left heart catheterization. Hemodynamic and respiratory observations were made during a control period and during the infusion of 1 g of aminophylline.

Aminophylline produced a significant reduction in mean pulmonary artery pressure from 39.4 to 25.4 mm Hg, in right ventricular end-diastolic pressure from 8.6 to 2.1 mm Hg, in left ventricular end-diastolic pressure from 7.9 to 3.0 mm Hg, and in brachial artery mean pressure from 95.3 to 85.6 mm Hg. The heart rate and oxygen consumption increased, but there was no change in cardiac index. The alveolar ventilation increased significantly from 2.1 to 2.9 L/min/m
2
(BTPS).

Evidence is presented to suggest that the decrease in pulmonary artery pressure was due to pulmonary arteriolar dilatation.
Etiologic Considerations in Peripheral Vascular Diseases of the Lower Extremity with Special Reference to Diabetes Mellitus
Authors: BLUMENTHAL HERMAN T. , BERNS ALINE W. , GOLDENBERG SIDNEY , LOWENSTEIN PAUL W.
Published: June 2012

A histopathologic and immunopathologic study of changes in small vessels has been carried out on 168 amputated lower extremities. No difference was found in respect to the frequency of thrombotic or atheromatous lesions among the various clinical disease categories necessitating amputation. An increased frequency of inflammatory lesions of small vessels was found only in cases of osteomyelitis. The frequency of hemodynamic lesions was highest in nondiabetic subjects with arteriosclerosis, and second highest in diabetic subjects with arteriosclerosis, followed by thromboangiitis obliterans. Proliferative endothelial lesions were encountered most frequently in diabetes with arteriosclerosis, in osteogenic sarcoma, and in osteomyelitis. Such proliferative lesions were encountered in 80 per cent of diabetic subjects and in 20 per cent of nondiabetic individuals.

Fluorescent insulin binding by small vessels was found in 70 per cent of diabetic subjects with proliferative vascular lesions and in only 30 per cent of diabetic individuals without this proliferative microangiopathy. Such insulin binding was observed in 54 per cent of diabetic subjects and in only about 15 per cent of nondiabetic patients. The binding of fluorescent rabbit antihuman globulin was observed in 56 per cent of diabetic subjects and in 22 per cent of nondiabetic patients.

These findings are discussed in relation to the thesis that there may be diseases of immune origin primarily involving small peripheral vessels. The peripheral vascular disease of diabetes is particularly stressed here because it is probably the most common form of such disease of immune origin. Such pathologic processes in small vessels may secondarily involve large cognate system arteries, either by creating an increased peripheral resistance to the flow of blood or when lesions involve the vasa vasorum, there may be impairment of local nutrition. Either or both of these phenomena could intensify the development of arteriosclerosis of large trunk arteries.

Although no attempt has been made here to justify or negate the existence of thromboangiitis obliterans as a disease entity, it has been pointed out that at least some cases with this diagnosis may have a similar immune origin.
Infarction Patterns in Endocardial Fibroelastosis
Authors: LINTERMANS JOHN P. , KAPLAN EDWARD L. , MORGAN BEVERLY C. , BAUM DAVID , GUNTHEROTH WARREN G.
Published: June 2012

Three cases of endocardial fibroelastosis with vectorcardiographic findings suggestive of an anterior myocardial infarct are presented. It had been previously reported that such vectorcardiographic features were diagnostic of anomalous origin of the left coronary artery. We conclude that the two diseases cannot be differentiated on the basis of electrocardiography or vectorcardiography alone.

Two of the cases presented were in identical twins; serial scalar electrocardiograms and vectorcardiograms were obtained during the development and progression of endocardial fibroelastosis.
Evaluation of the Severity of Mitral Stenosis and Regurgitation
Authors: LIBANOFF ALBERT J. , RODBARD SIMON
Published: June 2012

Indices have been developed that provide an improved means for evaluation of the degrees of severity of mitral stenosis and regurgitation. The severity of anatomic mitral valve disease found at surgery or autopsy was considered to be the determinant of the state of the valve. An index of the time for the diastolic atrioventricular pressure gradient to fall to half its value multiplied by 100 and divided by the cardiac index was shown to be comparable to the severity of anatomic stenosis. This index ranged from 5.7 to 10 in mitral stenosis, 0.4 to 0.8 in normal subjects, and 0.6 to 2.0 in patients with predominant mitral regurgitation.

Mitral regurgitation was estimated by an index of the rate of the atrial pressure rise during ventricular systole in mm. Hg/0.02 second multiplied by 10, and divided by the cardiac index. In predominant mitral regurgitation, this index ranged from 8.0 to 15; in mitral stenosis these values were 3.7 to 6.3, and normal subjects had an index varying from 2.5 to 3.7.

Both indices were significantly elevated in patients in whom stenosis and regurgitation were present at surgery. Mitral stenosis complicated by a mild degree of regurgitation gave significantly elevated stenotic indices, while the regurgitation indices were normal or slightly elevated. These indices facilitate the evaluation of either mitral stenosis or regurgitation even when both processes are present together.

The significance of these indices in the evaluation of the degree of invalidism in patients with valvular disease is also discussed.
Intercoronary Anastomoses in Congenital Heart Disease
Authors: BLOOR COLIN M. , KEEFE JOHN F. , BROWNE MARIE J.
Published: June 2012

Thirty-five cases of congenital heart disease were investigated for the frequency and size of intercoronary anastomoses. Studies of control hearts showed normal intercoronary anastomoses to range to 74 µ in diameter. In those congenital hearts not subjected to surgical procedures, the anastomoses did not differ in size from the control group, even in the presence of anemia, cardiac hypertrophy, and cyanosis. However, the mean age of the cyanotic group was significantly less than the acyanotic group. Even though the size and frequency of the anastomoses were significantly increased in the operated group, surgical trauma alone was an unlikely stimulus, since the size and frequency of anastomoses in those dying within 48 hours of operation and in those surviving for more than 5 weeks were similar. There was also a significant increase in the frequency and size of the intercoronary anastomoses in cases greater than 5 years of age, implying that intercoronary communications in congenital heart disease increase in size with increasing age.
Epidemiological Study of the Electrocardiographic Diagnosis of Left Ventricular Hypertrophy
Authors: OSTRANDER LEON D.
Published: June 2012

Electrocardiograms from 5,129 examined persons, 2,449 men and 2,680 women, 16 years of age or older, were classified according to the Minnesota code of Blackburn and associates.
19
The R wave amplitude criteria for possible left ventricular hypertrophy were fulfilled in 193 tracings from 135 men and 58 women. Age and sex matched controls were randomly selected from the remainder of the examined population for similar measurement. Those with high amplitude R waves and their controls were grouped according to age, sex, and possible cause for anatomical left ventricular enlargement. Precise measurements were made of all the amplitudes and intervals necessary for the application of a variety of other differential items from current diagnostic criteria. The prevalence of the various differential items in the high amplitude and control groups and the frequency with which each was associated with a cause for enlargement indicated their relative sensitivity and specificity.

Among the individuals with electrocardiographic evidence of left ventricular hypertrophy according to the Minnesota criteria, there were more persons in the upper and lower quintiles of the relative weight distributions, more hypertensives, more persons with roentgenographic evidence of cardiomegaly, and fewer persons in congestive heart failure than among the controls, but the differences were slight.

Most QRS amplitude items were too nonspecific to be of much diagnostic value among young men, and the same items apparently lack sensitivity when applied to the tracings from older women. The items which constitute the Minnesota criteria are useful for screening purposes.

Single items are unreliable for the detection of left ventricular hypertrophy and certain combinations are suggested to improve diagnostic accuracy. Still the electrocardiogram is often an inexact method for the recognition of left ventricular hypertrophy and the diagnosis should be based on careful physical and roentgenographic examinations as well.