bluuebunny/crossref_metadata_2025 huggingface dataset:
High Energy Phosphates and the Force of Contraction of Cardiac Muscle
Authors: Taggart John V. , FURCHGOTT ROBERT F. , LEE KWANG SOO
Published: June 2012

This paper reviews studies performed by the authors and by others on the levels of high energy phosphate compounds—adenosine triphosphate (ATP), adenosine diphosphate (ADP), and creatine phosphate (CP)—of cardiac muscle under various conditions influencing contractile force. Interference with energy metabolism decreases both contractile force and high energy phosphates, especially CP. Certain types of experimental "failure" are associated with decreases in high energy phosphates; however, other types of "failure" occur without significant decreases in these phosphates. In addition, marked decreases or increases in contractile force, independent of significant changes in high energy phosphates, can be produced by drugs, by changes in heart rate, or by alterations in extracellular concentrations of cations. A decrease in force when levels of high energy phosphate are normal may be attributed to a deficiency in the utilization of these energy stores for mechanical work. The nature of this deficiency has been analyzed in isolated cat papillary muscles by simultaneously determining the activity oxygen consumption and contractile force per beat. In the case of decreases in contractile force due either to reduced heart rate or to spontaneous heart failure, the deficiency may be attributed almost completely to a loss in efficiency in the conversion of chemical energy in the high energy phosphates to mechanical energy (work). Cardiac glycosides, in restoring contractile force, do so by restoring the efficiency of this conversion. In the case of decreases in contractile force resulting from lowered extracellular Ca
++
, the deficiency may be attributed partly to a loss of efficiency in this conversion and partly to a reduction in amount of high energy phosphate utilized per beat.
Complete Atrioventricular Block due to Cardiac Metastasis of Bronchogenic Carcinoma
Authors: BUCKBERG GERALD D. , FOWLER NOBLE O.
Published: June 2012

A partial review of the literature indicates that the heart is not infrequently involved in patients who have malignant disease. The most common tumors metastasizing to the heart are bronchogenic carcinoma, breast carcinoma, malignant melanoma, and the group of hematopoietic malignant tumors. The clinical triad of myocardial insufficiency, cardiac arrhythmia, and pericardial effusion involving a previously normal heart should alert one to this possibility, especially in a patient with known malignant tumor.

Complete atrioventricular block is a rather uncommon manifestation of metastatic cardiac tumor. A case is reported in which complete heart block appeared as the sole clinical manifestation of metastatic involvement of the heart by bronehogenic carcinoma. Necropsy revealed cardiac involvement by tumor to be virtually limited to the interventricular septum.
Origin of the Right Pulmonary Artery from the Ascending Aorta
Authors: ARMER ROBERT M. , SHUMACKER HARRIS B. , KLATTE EUGENE C.
Published: June 2012

A case of anomalous origin of the right pulmonary artery from the ascending aorta with an associated patent ductus arteriosus has been described. Successful complete surgical correction was accomplished after physiologic and cineangiocardiographic studies had established the diagnosis. Postoperative evaluation demonstrated a return to nearly normal physiologic values. The unparalleled value of selective angiocardiography in the anatomic assessment of cardiovascular lesions is emphasized.
Effect of Antibiotics on the Serum Cholesterol Concentration of Patients with Atherosclerosis
Authors: STEINER ALFRED , HOWARD ELLIOTT , AKGUN SUAT
Published: June 2012

Oral neomycin, at the dose level of 0.5 to 2 Gm. daily, produced a significant fall in the level of serum cholesterol in all of 29 periods in 20 patients studied. The effect reached a maximum in approximately 2 weeks and persisted for the duration of the experiments up to 9 months. After the medication was discontinued, the serum cholesterol levels returned to control values within 2 weeks. No significant toxic reaction to oral neomycin was discernible. Neomycin by injection in excess of the amount calculated to be absorbed from the gastrointestinal tract failed to lower the serum cholesterol level. The mechanism of action of neomycin was not determined, but it is thought to be a local effect in the gastrointestinal tract or its contents.

Oral aureomycin and oral kanamycin had a similar but less marked and less consistent effect on the level of serum cholesterol in a number of patients. In a limited number of patients, oral achromycin, bacitracin, chloromycetin, streptomycin, and mycostatin did not have a significant effect on the serum cholesterol level; likewise, intramuscular penicillin and streptomycin failed to alter the serum cholesterol level.

The prior lowering of the serum cholesterol concentration by a low-fat diet did not prevent a further decrease in the serum cholesterol by oral neomycin.
Surgical Relief of Diffuse Subvalvular Aortic Stenosis
Authors: KIRKLIN JOHN W. , ELLIS F. HENRY
Published: June 2012

Direct surgical relief of diffuse subvalvular aortic stenosis has been accomplished in two cases by open operation through a left ventriculotomy.
Perinatal Vascular Changes in Coarctation of the Aorta with Distal Patent Ductus Arteriosus
Authors: NAEYE RICHARD L.
Published: June 2012

Infants with severe coarctation of the aorta and patent ductus arteriosus develop an increased pulmonary arterial muscle mass and hypertrophy of the right ventricle during fetal life. Much of this arterial muscle mass is retained after birth. The development of the systemic arterial bed is normal during both periods.
The Use of Cinefluorography in Acquired Heart Disease
Authors: JORGENS JOSEPH , LIEBER ARTHUR
Published: June 2012

The additional important information obtained through cinefluorography warrants the use of this method in acquired heart disease. It is superior to all other methods for recording cardiac pulsations and calcifications. Its unique advantage for recording fat lines about the heart is extremely important. As the equipment improves, biplaned cinecardioangiography will be part of the armamentarium of all cardiac laboratories.
The Risk of Interrupting Long-Term Anticoagulant Treatment
Authors: SISE HERBERT S. , MOSCHOS CHRISTOS B. , GAUTHIER JACQUES , BECKER ROBERT
Published: June 2012

From a series of 310 patients on long-term anticoagulant treatment for various conditions 136 instances were collected in which treatment was interrupted. This was because of bleeding in 45 instances, for permanent reasons in 53 instances, and for temporary reasons in 38 instances.

Rebound thromboembolic complications were observed significantly more frequently in those who stopped treatment for bleeding. The cause of the rebound effect could not be ascribed to vitamin K
1
administration, transfusions, or overt ischemic effects from blood loss although the latter might have been contributory to a small extent. The observations suggested a hypercoagulable state induced directly in some obscure way as a result of the bleeding.

Interruption of treatment for reasons other than bleeding was not associated with early complications. The risk of interruption of treatment for short periods was relatively small (three nonfatal complications in 38 instances). In those who stopped permanently, complications were most often seen after 2 months.
The Surgical Significance of Aberrant Renal Arteries in Relation to Systemic Hypertension
Authors: DERRICK JOHN R. , TYSON KENNETH R. T.
Published: June 2012

Three cases of hypertension associated with vascular insufficiency of aberrant renal arteries are presented. Two patients were subjected to revascularization procedures. The types of pathologic processes associated with aberrant renal arteries in production of segmental renal ischemia are discussed. Considerations of diagnosis and therapy of such lesions are reviewed.
Effect of Thiazide Diuretics on Plasma Volume, Body Electrolytes, and Excretion of Aldosterone in Hypertension
Authors: GIFFORD RAY W. , MATTOX VERNON R. , ORVIS ALAN L. , SONES DONALD A. , ROSEVEAR JOHN W.
Published: June 2012

A study has been made at the Mayo Clinic of the results of treatment in 28 hypertensive patients receiving thiazide diuretics. The use of these agents produced a significant but very temporary reduction in plasma volume in most patients. The plasma volume reverted to or toward normal after the first week of treatment; therefore, hypovolemia could not explain the prolonged hypotensive effect of these drugs. Administration of thiazide diuretics did not deplete the body of its sodium stores, as measured by isotope studies in five patients on an unrestricted diet. Therapy with thiazides did not produce a persistent increase in urinary aldosterone excretion in the nine patients studied for this possibility.
Simultaneous Determination of Temperatures of Skin and Muscle before and after Lumbar Sympathectomy
Authors: ROEDLING HERBERT A. , ROTH GRACE M. , MACCARTY COLLIN S. , SHICK RICHARD M.
Published: June 2012

A group of 26 patients who had peripheral occlusive arterial disease of the lower extremity were studied before and after chemical or surgical unilateral lumbar sympathectomy. The temperatures of the gastrocnemius muscle and of the skin of the sural area were determined simultaneously preoperatively and postoperatively. Only patients who had undergone successful unilateral lumbar sympathetic denervation based on the postoperative area of anhidrosis were included. The data were obtained under basal conditions among the 26 patients, and the persons studied were divided into two groups. Group 1 was composed of 17 patients (65 per cent) who had a definite parallel increase of 1.2 C. in the temperature of the gastrocnemius muscle and the skin after unilateral sympathectomy. In group 2 (nine patients or 35 per cent) the temperature of the gastrocnemius muscle and the skin of the sural area was unchanged after unilateral sympathectomy. Since none of these patients were suitable for surgical bypass arterial-grafting procedures and all were in the older age group, not too much could be expected from the standpoint of an increase in temperature. However, when the temperature of the skin after operation increased, the temperature of the gastrocnemius muscle also increased.
The Influence of Standard of Living on Blood Pressure in Fiji
Authors: MADDOCKS IAN
Published: June 2012

A group of Indian men in Suva, Fiji, selected for their relatively high standard of living had average systolic and diastolic blood pressures higher than those of the sample of the local rural Indian male population. There is gradation in the incidence of high blood pressure among several races of the Pacific Islands that parallels the degree to which they have been influenced by Western culture.
Corrective Surgery for Tetralogy of Fallot
Authors: KAY EARLE B. , NOGUEIRA CID , MENDELSOHN DAVID , ZIMMERMAN HENRY A.
Published: June 2012

Fifty patients with tetralogy of Fallot have had surgical correction of their complex defects made possible by the open technic during the past 5 years. The overall 5-year operative mortality was 18 per cent. This was reduced to 15 per cent during the past 2 years in 20 patients. Forty-one of the patients are alive, asymptomatic, and have normal physical activity. Ffteen patients have had cardiac evaluation studies including cardiac catheterization from 1½ to 3 years postoperatively. Thirteen patients had normal cardiac hemodynamics. In only two patients was there evidence of incomplete hemodynamic improvement even though marked clinical improvement was gained.
Myocardial Metabolism in Progressive Muscular Dystrophy
Authors: SUNDERMEYER J. F. , GUDBJARNASON S. , WENDT V. E. , DEN BAKKER P. B. , BING R. J.
Published: June 2012

Myocardial metabolism was studied in 11 patients with progressive muscular dystrophy. Coronary blood flow was measured in four, the cardiac output in six patients. The blood concentrations of oxygen, glucose, inorganic phosphate, pyruvate, and lactate, and the serum activities of malic dehydrogenase and aldolase were determined in simultaneously drawn coronary sinus and arterial blood samples.

The cardiac outputs were elevated in all patients. Myocardial extractions of pyruvate and lactate were negative in two patients. Inorganic phosphate concentrations in blood were elevated. Malic dehydrogenase and aldolase were released by the heart in several patients. Differences in oxidation-reduction potential between arterial and coronary venous blood were positive, suggesting glycolysis in the heart muscle. This was accompanied by increased myocardial extraction of glucose. Apparently aerobic glycolysis occurred, since sufficient oxygen was present to account for all glucose extracted.

Stimulation of glycolysis by inorganic phosphate was suggested by the relationship between the elevated inorganic phosphate concentration in blood and the myocardial glucose extraction. This suggests the possibility of uncoupling of oxidative phosphorlyation in the myocardium.
Arteriosclerotic Vascular Disease and Testicular Fibrosis
Authors: DALLDORF FREDERIC G.
Published: June 2012

The autopsy protocols and sections of the testes were examined in a group of 199 men over the age of 35 years who were free of known causes of either vascular disease or testicular fibrosis. In 44 (22 per cent) of the cases, testicular sections showed marked fibrosis of the peritubular membranes or complete hyalinization. Testes of the remaining men showed minimal or no signs of testicular fibrosis. Of these 155 patients with normal or minimally fibrotic testes, 47 (30.7 per cent) had complications of arteriosclerotic vascular disease (i.e., myocardial or cerebral infarcts, arteriosclerotic aneurysms, etc.) and in 36 cases (23.5 per cent) those complications were considered to be the cause of death. Of the 44 cases with advanced testicular fibrosis, four (9.1 per cent) had complications of arteriosclerotic vascular disease and only one patient (2.2 per cent) died of the disease. An interpretation of these findings is presented.
Direct Communication of a Pulmonary Artery with the Left Atrium
Authors: LUCAS RUSSELL V. , LUND GEORGE W. , EDWARDS JESSE E.
Published: June 2012

Direct communication of a pulmonary artery with the left atrium is described and considered a variant of pulmonary arteriovenous fistula.

A 3-year-old girl presented with clinical evidence of a lesion of the central nervous system. The history revealed that she had been cyanotic and had had clubbing of the digits and polycythemia. A rounded mass was noted in the region of the right pulmonary hilus in the posteroanterior thoracic roentgenogram. A pulmonary arteriovenous fistula was suspected, but the patient succumbed with a cerebral abscess before definitive diagnostic studies and therapy were undertaken.

Anatomic examination revealed an unusual variant of pulmonary arteriovenous fistula, namely, direct communication of the right lower pulmonary artery with the left atrium and absence of the middle and lower lobes of the right lung.

It is important that pulmonary arteriovenous fistulas be suspected clinically, since definitive diagnosis and therapy are now possible. While the hemodynamic effects of this type of lesion are usually not severe, untreated patients suffer a high morbidity and mortality through systemic arterial oxygen desaturation, paradoxic embolization, cerebral abscess, and rupture of the fistula.
A Technic for Taking Down the Potts' Anastomosis
Authors: SIRAK HOWARD D. , BRITT CLARENCE I.
Published: June 2012

A technic is described for definitive repair of patients with tetralogy of Fallot whose previously constructed aorticopulmonary (Potts') anastomosis has remained functional. Hypothermia without interruption of the circulation has been used to protect the patient during the brief interval after the shunt is obliterated and until cardiopulmonary bypass is established for the definitive intracardiac repair. The results in three children, followed up to 2 years, are reported.
Spontaneous Hemorrhage with Anticoagulants
Authors: JAQUES LOUIS B.
Published: June 2012

When dicumarolized animals are subjected to various types of stress, a high mortality from spontaneous internal hemorrhage occurs. This phenomenon is observed with various combinations of the treatments—Dicumarol, phenylindanedione, heparin, frostbite, insulin convulsions, hypertonic saline intraperitoneally, adrenalectomy, adrenocorticotropic hormone, corticosteroids, histamine, adrenalin, salicylates, P
32
, reserpine. Hemostasis depends on blood coagulation, platelets, and vascular integrity. Experimental results demonstrate that spontaneous hemorrhage results when any two of these mechanisms are deranged simultaneously. Hormonal and neural factors affect the blood vessels and in this way determine spontaneous hemorrhage with anticoagulants. Spontaneous hemorrhage has a multiple causation.
Transseptal Left Heart Catheterization
Authors: BROCKENBROUGH EDWIN C. , BRAUNWALD EUGENE , ROSS JOHN
Published: June 2012

Experiences with 450 transseptal left heart catheterizations are reviewed. There were no mortalities in this series, and the only significant complication was accidental puncture of the aorta in three patients. The equipment and technic employed in the current method, by which a radiopaque catheter of large caliber is introduced into the left ventricle, are described in detail. The advantages of this modification are outlined.
Chemistry of Synthetic Angiotensin
Authors: SCHWYZER R.
Published: June 2012

A short review is given of the development of synthetic angiotensin. Also discussed are enzymic experiments, showing that production of the synthetic substance leads to valyl-5-angiotensin-II, in which all amino acids are completely in the
l
-configuration. Small amounts of diastereoisomers in intermediates, like
l
-valyl-
d
-tyrosyl-
l
-valyl-
l
-histidyl-
l
-prolyl-
l
-phenylalanine which was isolated and identified, are completely eliminated during the synthetic process. Valyl-5-angiotensin II-aspartyl-β-amides are very slowly hydrolyzed in aqueous solution to valyl-5-angriotensin II and a small amount of the heptapeptide, H·Arg-Val-Tyr-Val-His-Pro-Phe·OH, with negligible decrease in pressure activity of the solution.
Importance of Amino Acid Side Groups for Biologic Activity of Angiotensin II
Authors: BUMPUS F. M. , SMEBY R. R.
Published: June 2012

The requirements for biologic activity of angiotensin II may be summarized from available data as follows: (1) a free C-terminal carboxyl group, (2) a phenyl group as a side group of amino acid number 8, (3) a phenolic group on amino acid number 4, (4) proline in position 7, (5) possibly a definite degree of spatial order, (6) at least 6 amino acids from the C-terminus, (7) possibly the imidazole of histidine in position 6.
Some Contributions to the Pharmacology of Synthetic Angiotensin
Authors: GROSS F. , BOCK K. D.
Published: June 2012

The examination of synthetic valyl-5-angiotensin II-amide in the conscious dog revealed the following:

1. Both the arterial and the central venous pressure responses exhibit tachyplylaxis when high doses of angiotensin II are administered, althoug not when medium or low doses are given. Cross-tachyphylaxis can be demonstrated between renin and angiotensin II but not between either of these and norepinephrine. These results suggest that tachyphylaxis to renin is due to tachyphylaxis to angiotensin.

2. Angiotensin II and norepinephrine provoke a dose-dependent increase in central venous pressure. The threshold dose is about 10 times higher than that necessary for the effect on arterial pressure. In doses eliciting the same increase of arterial blood pressure, norepinephrine is about twice as active on the venous pressure as angiotensin II.

3. Anesthesia and atropinization both reduce or abolish the effect of angiotensin II as well as that of norepinephrine on the venous pressure, indicating the reflex nature of the underlying mechanism.

4. In endotoxin hypotension, the pressor response to angiotensin II and to norepinephrine is diminished, and the venous pressure response becomes gradually depressed until it is completely abolished.

5. During hemorrhagic hypotension, the response to angiotensin II may be retained or even enhanced and is less likely to have an adverse effect on the myocardium than norepinephrine.
Angiotensin II Studies in Hypertension
Authors: MENDLOWITZ MILTON , WOLF ROBERT L. , GITLOW STANLEY E. , NAFTCHI NOSRAT E.
Published: June 2012

1. In primary hypertension, the digital blood vessels are more reactive than normal to angiotensin II as well as to
l
-norepinephrine.

2. In terms of weight, the potency of angiotensin II in constricting digital blood vessels is 10 times that of norepinephrine in both normotensive and hypertensive subjects.

3. The turnover of angiotensin II-I
131
is slower than normal in patients with primary hypertension.

4. Digital vascular reactivity to both
l
-norepinephrine and angiotensin II is normal in "pure" renal hypertension.

5. Angiotensin II-I
131
turnover, in contrast, in the case of renal hypertension studied, was slower than in the normal group and was similar to that in the case of primary hypertension.
Angiotensin Skin Tests
Authors: JABLONS BENJAMIN
Published: June 2012

The studies reported above indicate that the angiotensin skin test (A.S.T.) is a simple practical measure which has proved of value in differentiating between normotensive and hypertensive individuals. The duration of the blanching of skin by the test differs significantly in normotensives as compared with hypertensives. The test has served as an index [see figure in the PDF file] of differentiation between an emotionally induced elevation of blood pressure and one which may go on to an established hypertensive state. The A.S.T. is a more reliable test in the diagnosis of the latent, labile, or prehypertensive state than is the cold pressor test. Angiotensin-induced hypertension induces a prolongation of the A.S.T. as compared with control periods.
Radioelectrocardiography during Exercise in Patients with Angina Pectoris
Authors: BELLET SAMUEL , ELIAKIM MARCEL , DELIYIANNIS STAVROS , LAVAN DONALD
Published: June 2012

The electrocardiographic changes during exercise were examined by means of the radio-electrocardiograph and compared with the changes in the postexercise period in 70 patients with coronary artery disease. This method permitted the recording of one-lead tracings during exercise with a stable baseline and minimal interference. In addition, it has the advantage of permitting free exercise because of the absence of wire connections between the patient and the recording machine. Tracings may be taken on patients performing exercise at a distance of up to several hundred feet from the electrocardiograph.

The criteria for abnormality based on double Master two-step tests in 127 normal individuals below the age of 40 years were appearance or increase in ischemic S-T-segment depression of 1 mm. or more, appearance or increase of S-T-segment elevation of 1 mm. or more, inversion of a positive or reversion of a negative T wave, frank inversion of the U wave, widening or narrowing (of a previously widened) QRS complex, and appearance of multiple premature beats.

Thirty-seven of the 70 patients (53 per cent) showed electrocardiographic abnormalities during the period of exercise (single Master two-step test), while only 24 (34 per cent) had similar changes in the postexercise period. Twenty-three of the 70 patients had normal resting electrocardiograms. Of these, 11 (48 per cent) had abnormal alterations during, and six (26 per cent) after exercise. Forty-seven of the 70 patients had abnormal resting electrocardiograms. Twenty-six of these (55 per cent) had abnormal changes during exercise and 18 (38 per cent) after exercise.

The advantage of recording the electrocardiogram during exercise is shown by the fact that in 17 of the 37 patients with abnormal responses, the changes were limited to the actual period of exercise and the immediate postexercise period, and would probably be missed were the postexercise tracing taken alone. Possible improvements in technic aimed at increasing the incidence of positive responses are discussed. It is suggested that the recording of the electrocardiogram both during and after exercise should replace the presently used technic in the Master two-step test.
The Spectrum of Coronary Heart Disease in a Community of 30,000
Authors: SPIEKERMAN RALPH E. , BRANDENBURG JOHN T. , ACHOR RICHARD W. P. , EDWARDS JESSE E.
Published: June 2012

The high rate of necropsy in deaths among permanent residents of Rochester, Minnesota, provided a unique opportunity to study the prevalence of coronary heart disease and the frequency and mode of death resulting from this disease. In this community of approximately 30,000 population, necropsy was done in 73 per cent of all resident deaths during the years 1947 through 1952. Included in this group were 691 necropsies that represented 67 per cent of the 1,026 deaths of persons 20 years of age or older.

Coronary heart disease caused death in 221 patients (23 per cent of all necropsies and 32 per cent of all necropsies on adults). These 221 coronary deaths in adults represented 41 per cent of the men and 22 per cent of the women. The coronary deaths were attributed to acute coronary failure (sudden death) in 94 patients (43 per cent), acute myocardial infarction in 87 patients (39 per cent), congestive heart failure in 32 patients (14 per cent) and thromboembolism in eight patients (4 per cent). The 87 patients dying during acute myocardial infarction died of congestive heart failure (30 per cent), myocardial rupture (24 per cent), acute coronary failure (23 per cent), and thromboembolism (14 per cent), with the remaining 9 per cent dying of a combination of acute myocardial infarction and additional serious systemic disease.

The greatest number of deaths from coronary heart disease occurred during the seventh decade of life in men and the eighth decade in women. At least one coronary artery exhibited from 25 to 100 per cent obstruction from atherosclerosis in 513 hearts (74 per cent of the adult necropsies).

These necropsies, representing two thirds of all deaths in adults in this community, disclosed that significant coronary-artery disease was present in three of four adults and was the cause of death in four of 10 men and two of 10 women.
Aortic Origin of the Right Pulmonary Artery
Authors: GRIFFITHS SYLVIA P. , LEVINE O. ROBERT , ANDERSEN DOROTHY H.
Published: June 2012

The clinical course and pathologic findings in three cases of anomalous origin of the right pulmonary artery from the ascending aorta are described. The malformation is characterized by (1) absent right branch of the pulmonary artery, (2) a single large vessel arising from the ascending aorta, entering the hilus of the lung and constituting its sole arterial blood supply, and (3) normal size and structure of the right lung. A review of the literature indicates the rarity of this lesion as an isolated anomaly; patent ductus arteriosus is the most frequently described additional defect.

Histologic examination of the right and left lungs reveals bilateral and symmetrical pulmonary vascular changes, despite the difference in their arterial supply. Some pathophysiologic observations based on the necropsy findings in these cases are discussed.

Early diagnosis and surgical correction are imperative, since this malformation may lead to irreversible congestive heart failure and death in infancy. Surgical repair may be accomplished by transplanting the anomalous right pulmonary artery from the aorta to the main pulmonary trunk.
A Clinicopathologic Study on the Feasibility of Direct Surgical Treatment of Occlusive Coronary Arterial Disease
Authors: SWEDLUND HARRY A. , ACHOR RICHARD W. P. , EDWARDS JESSE E.
Published: June 2012

The coronary arteries of 112 patients with an antemortem diagnosis of coronary arterial disease were studied at necropsy with regard to the feasibility of coronary endarterectomy for direct relief of the luminal narrowing. The patients ranged in age at the time of death from 40 to 87 years. The condition of the coronary arteries in 20 cases (18 per cent) was classed as pattern 1 (theoretically operable), in 58 cases (52 per cent) as pattern 2 (theoretically capable of palliation), and in 34 cases (30 per cent) as pattern 3 (theoretically inoperable). The youngest man who had a pattern 1 condition was 54 years of age, and of 26 men studied who were less than age 60 years, two had pattern 1 conditions, 12, pattern 2, and 12 pattern 3. Of the four women less than 65 years of age, none had pattern 1 conditions, two had pattern 2, and two had pattern 3.

An impression gained from this study was that in general the most severe and diffuse lesions observed at necropsy are seen in the younger men who give clinical evidence of coronary arterial disease. Certain clinical features were analyzed in an attempt to find a correlation between these factors and the anatomic state of the coronary arteries. No clearly defined correlation could be discovered in this series.

The role of direct surgical attack on the coronary arteries for relief of atherosclerosis does not appear to be an encouraging one from this study of clinical features and the final pathologic anatomy.
The Splitting of the Second Heart Sound in Normal Subjects and in Patients with Congenital Heart Disease
Authors: AYGEN MAURICE M. , BRAUNWALD EUGENE
Published: June 2012

The characteristics of the second heart sound were analyzed in 350 phonocardiograms recorded from patients in all of whom the diagnosis was proved either at operation or by detailed catheterization studies. A
2
-P
2
during expiration averaged 10.6 msec. in normal subjects. Q-A
2
changed little during inspiration, with an average decrease of only 5.2 msec., while Q-P
2
increased by an average of 32.6 msec. The average increase of A
2
-P
2
during inspiration was therefore 37.8 msec. In patients with ASD, A
2
-P
2
during expiration averaged 50.2 msec. and the inspiratory change in Q-P
2
averaged only 4.6 msec. In 115 of 118 patients with ASD the inspiratory increase of A
2
-P
2
ranged from 0 to 10 msec. Following successful surgical closure 29 patients with ASD developed the normal inspiratory augmentation of A
2
-P
2
; in the two patients in whom the defect was not completely closed the relatively constant A
2
-P
2
noted preoperatively persisted.

Release of the Valsalva maneuver exaggerated the inspiratory increase of A
2
-P
2
observed in normal subjects but did not modify this interval in patients with ASD. Analysis of the effect of release of the Valsalva maneuver on A
2
-P
2
was helpful in separating patients with ASD from normal subjects. Evidence was presented that the relative constancy of the splitting of the second heart sound in patients with ASD is due to reciprocal changes in the magnitude of the left-to-right shunt and the systemic venous inflow into the right ventricle during respiration.

In patients with moderate or severe pulmonary stenosis, A
2
-P
2
during expiration was longer than in normal subjects and in the same range as in patients with ASD. However, patients with PS showed a normal augmentation of A
2
-P
2
during expiration. In patients with congenital AS, and those with PDA, left ventricular ejection tended to be prolonged with reversal of the normal sequence of semilunar valve closure or simultaneous closure of these valves during expiration.
Multiple Small Pulmonary Arteriovenous Fistulas
Authors: SANDERS J. S. , MARTT J. M.
Published: June 2012

The condition of multiple small pulmonary arteriovenous fistulas is discussed with regard to diagnosis, complications, and possible etiology. The lesions are believed to be either congenital in origin or secondary to cirrhosis of the liver with portal hypertension. Surgical therapy has not been attempted in this condition because of the diffuse nature of the lesions.

A case is discussed wherein the diagnosis of diffuse small pulmonary arteriovenous fistulas was made by cardiac catheterization. The catheter was passed through an atrial septal defect into a pulmonary vein. Difference in oxygen saturation between the pulmonary vein and pulmonary capillaries (pulmonary vein wedge) revealed conclusive evidence of a right-to-left shunt in this area. Etiologic and therapeutic considerations are discussed in view of recent literature on this subject.
Simulated 2:1 Left Bundle-Branch Block
Authors: SCHAMROTH LEO , CHESLER ELLIOT
Published: June 2012

A case is presented of end-diastolic ventricular extrasystoles occurring in bigeminal rhythm during left bundle-branch block; this results in fusion complexes that normalize the bundle-branch block pattern and simulate 2 :1 left bundle-branch block.
The Pulse Wave Velocity as an Early Indicator of Atherosclerosis in Diabetic Subjects
Authors: WOOLAM G. L. , SCHNUR P. L. , VALLBONA C. , HOFF H. E.
Published: June 2012

The arterial pulse wave velocity was measured in 87 healthy individuals and in 52 diabetic patients who did not have clinical evidence of atherosclerosis or hypertension. A significant increase in the pulse wave velocity was found in the diabetic subjects. This increase was not correlated with the duration of their illness as judged from clinical history. It is very likely that the high values of pulse wave velocity were indicative of an incipient process of diffuse atherosclerosis and that the measurement of the pulse wave velocity brought this into evidence earlier than the classic signs and symptoms. Serial measurements of the pulse wave velocity in diabetic subjects may permit early detection of atherosclerosis in these patients.
Ruptured Congenital Aneurysms of the Sinuses of Valsalva
Authors: SZWEDA J. A. , DRAKE E. H.
Published: June 2012

Two cases operated upon for ruptured sinus of Valsalva aneurysm are presented and discussed. Operations done previously for this condition are noted. Aspects of the deformity that are pertinent to its recognition and treatment are briefly reviewed.
The Mechanism of the Generation of the Third and Fourth Heart Sounds
Authors: CREVASSE LAMAR , WHEAT MYRON W. , WILSON JAMES R. , LEEDS RICHARD F. , TAYLOR W. JAPE
Published: June 2012

A simple unitarian concept of the mechanism of third and fourth sounds is presented. This study demonstrates that the third sound occurs during early rapid diastolic ventricular filling at a time when atrial pressure exceeds ventricular pressure. It is recorded within the ventricle and on the ventricular wall. It coincides with ventricular muscle vibrations. The fourth sound is demonstrated to consist of two components, both occurring when atrial pressure exceeds ventricular. The first component coincides with the peak of atrial contraction, is recorded within the atria, and is inaudible. The second component, which is audible (25 to 70 cycles per second) and follows the first by 0.01 to 0.02 second, is recordable within the ventricle coinciding with the impact of blood from atrial systole against the ventricular wall. These observations demonstrate that the audible third and fourth heart sounds have a common origin in the ventricles and have the same temporal and hemodynamic relationships regardless of etiology.
Atrial Tachycardia with Block Treated with Digitalis
Authors: MORGAN WILLIAM L. , BRENEMAN GERALD M.
Published: June 2012

Fifteen cases of atrial tachycardia with block were seen at the Henry Ford Hospital in 1 year. In nine cases the arrhythmia was not a result of digitalis excess. One of these nine patients has had the arrhythmia for 5 years, and two others had not received prior digitalis. In four cases, stopping digitalis and adding potassium did not affect the arrhythmia. Two patients experienced a brief episode of the arrhythmia while continuing digitalis. The addition of digitalis or a continued maintenance dose was necessary to control congestive heart failure or a rapid ventricular rate in all nine patients. The six remaining patients with atrial tachycardia with block had digitalis intoxication.

When one first encounters this arrhythmia, the possibility of digitalis intoxication should immediately be considered. Digitalis and diuretics should be stopped and potassium added. If the arrhythmia persists despite this therapy, digitalis intoxication becomes less likely and the administration of the drug may be indicated.
Hourly Changes in Serum Cholesterol Concentration
Authors: PETERSON JOHN E. , KEITH ROBERT A. , WILCOX ALAN A.
Published: June 2012

Further evidence has been obtained to indicate that the concentration of serum cholesterol can vary widely during the course of a few hours in certain individuals.

The data are consistent with a hypothesis that changes in the concentration of serum cholesterol may relate to the anticipation of an event as well as to the event itself.

Similarity in the hourly variation in serum cholesterol concentration occurring among eight carefully selected subjects, during control as well as during test periods, is note-worthy.
Conduction Disturbances in Patent Ductus Arteriosus
Authors: MIROWSKI M. , AREVALO F. , MEDRANO G. A. , CISNEROS F. A.
Published: June 2012

A study of conduction disturbances in 200 patients with patent ductus arteriosus was carried out.

The atrioventricular (AV) conduction was found generally disturbed as compared with normal cases. A significant delay in AV conduction was demonstrated by the high incidence (10.5 per cent) of first-degree AV block, by the elevated percentage of high values of the P-R index and by a high mean P-R index in the whole series (0.85 versus 0.75 in normal subjects).

After surgery a significant improvement in AV conduction was noted. First-degree AV block disappeared in 79 per cent of the cases, and in some instances the block decreased in intensity. In cases without diagnosis of AV block the improvement, as manifested by the diminution of the P-R index, was observed in 62 per cent of the cases. The improvement in AV conduction was greater in those groups with higher preoperative P-R index. The impression was that a large number of cases with high values of the P-R index, although still below the upper limit of normal (1.00), actually have first-degree AV block, undiagnosed by the usual criteria. The mean P-R index after surgery for the whole group was 0.79.

It was suggested that the AV conduction disturbances in patent ductus arteriosus are related, in some way, to the hemodynamic conditions of this entity and particularly to the left-to-right shunt between aorta and pulmonary artery.

Six cases (3 per cent) of incomplete right bundle-branch block and five (2.5 per cent) of incomplete left bundle-branch block were found. These disturbances did not change after surgery.
Studies on Starling's Law of the Heart
Authors: GLEASON WILLIAM L. , BRAUNWALD EUGENE
Published: June 2012

The applicability of Starling's law of the heart to the circulation of intact human subjects was studied by means of serial biplane angiocardiography utilizing injections into the left ventricle in nine patients, four of whom were unanesthetized. The end-diastolic and end-systolic volumes of the left ventricle were determined from the angiocardiograms by the method described by Dodge, and stroke volumes were calculated by subtracting the end-systolic from the end-diastolic volumes. In four patients large beat-to-beat variations in left ventricular end-diastolic volume occurred. These were accompanied by changes in stroke volume which varied directly with the preceding left ventricular end-diastolic volume. In four patients the left ventricular end-diastolic volume remained about constant, and in these patients the stroke volume showed little or no change. From these observations it was concluded that the ventricular stroke volume is a function of the end-diastolic volume and that therefore Starling's law of the heart is applicable to man.

In the ninth patient pulsus alternans occurred; this was accompanied by concordant alternation of the left ventricular end-diastolic volume; i.e., the larger end-diastolic volumes resulted in larger stroke volumes and higher systolic pressures than did the smaller end-diastolic volumes. These observations are compatible with the concept that alternation of ventricular contraction can be explained by alternation of end-diastolic volume.
Ruptured Papillary Muscle Following Myocardial Infarction with Long Survival
Authors: BRENEMAN GERALD M. , DRAKE ELLET H.
Published: June 2012

Two cases of rupture of a papillary muscle of the left ventricle are presented. We believe that these are the two longest recorded survivals of this complication of acute myocardial infarction.

A presumptive clinical diagnosis is possible from the characteristic history of sudden deterioration together with the development of a loud apical systolic murmur. The differential diagnosis and the possibility of corrective surgery in a patient who survives the acute event are discussed.
Blood Coagulation and Thrombotic Disease
Authors: ALEXANDER BENJAMIN
Published: June 2012

The role of blood coagulation in the pathogenesis of thrombotic disease as well as atherosclerosis is receiving renewed attention, and has been greatly extended into the area of therapy. The clotting mechanism has been delineated in accordance with most recent information, with particular reference to the early phases and the coagulation balance. The close relationship between clotting and proteolytic phenomena is considered, and the concept of hypercoagulability is critically scrutinized. Experimentally induced thrombosis by means of serum factors is reviewed in support of this concept. Also discussed is the place of lipids in coagulation and atherosclerosis in an attempt to embrace the lipid theory of the pathogenesis of atherosclerosis with current concepts of clotting. Finally, certain aspects of anticoagulant action are covered.
Left Atrial Pseudotumor
Authors: KLEIN RUBIN , ALTMAN ADELE R. , SCHWARTZ SOLOMON S.
Published: June 2012

In 29 per cent of unselected anteroposterior chest tomograms a portion of the left atrium presents as an apparent mass below the right intermediate bronchus. Criteria for its identification and differentiation from significant tumors are presented.
Hypertension due to Renal Artery Stenosis Caused by Abdominal Aortic Aneurysm
Authors: ABRAHAMS D. GORDON , PARRY E. H. O.
Published: June 2012

An extensive aneurysm of the thoracic and abdominal aorta involving the left renal artery was found in a 21-year-old Nigerian man who presented with abdominal pain and hypertension. Nephrectomy was followed by a significantly lower pressure. The etiology of the aortic aneursym is discussed briefly.
Congenital Defect of the Pericardium
Authors: FOWLER NOBLE O.
Published: June 2012

A 20-year-old woman with partial absence of the parietal pericardium is described. Radiologically, there was unusual prominence of the pulmonary are segment and the entire heart appeared to be shifted to the left. The electrocardiogram showed abnormal right axis deviation and suggested right ventricular hypertrophy. Right heart catheterization showed no evidence of pulmonary hypertension. Following the induction of left pneumothorax, air appeared in the right pleural space and in the pericardial space. A diagnosis of partial absence of the parietal pericardium was made. The recognition of this disorder is of importance because pulmonary hypertension or pulmonary valve stenosis with post-stenotic dilation of the pulmonary artery may be simulated, both radiologically and electrocardiographically.
Renal and Adrenal Relationships in Refractory Edema
Authors: KESSLER EDWARD , HILTON JAMES G. , LEVY M. ROBERT
Published: June 2012

The relationships between the excretion of sodium and water and adrenal activity in patients with refractory edema have been investigated.

Experiments have been performed over a prolonged period with varying doses and combinations of spironolactone, prednisone, hydrochlorothiazide, Su4885, and ACTH. In four patients with Laennec's cirrhosis with ascites the effects of prednisone on the excretion of water and solute were studied during maximum water diuresis.

The results indicate that diuretic agents may increase the excretion of sodium without water within certain undefined limits. This effect probably resulted from the delivery to the concentrating segment of an amount of sodium inadequate to dissipate the gradients favoring water reabsorption.

Prednisone appeared to have a dual effect: one on the excretion of water, the other on the excretion of sodium. The effects on sodium and water did not appear to be related.

The effects of prednisone on the excretion of water support the concept that the glucocorticoids exert an effect on water in the renal tubules rather than on the posterior pituitary.

Prednisone enhanced sodium excretion only when given together with another diuretic agent. It is suggested that the failure of prednisone alone to increase sodium excretion resulted from a blockade of ACTH secretion and, thereby, the adrenal synthetic pathway of aldosterone, whereas the renal aldosterone-stimulating pathway continued to function. The potentiating effect of prednisone on the excretion of sodium becomes apparent only when aldosterone activity is overcome in the renal tubules by the natriuretic effects of various diuretics.

It is considered possible that renal aldosterone-stimulating hormone acts only under more intense stimuli to edema formation.
Evaluation of Mitral Annuloplasty for Mitral Regurgitation
Authors: ANDERSON ARTHUR M. , COBB LEONARD A. , BRUCE ROBERT A. , MERENDINO K. ALVIN
Published: June 2012

Eleven patients seriously disabled by mitral regurgitation were re-evaluated 4 to 41 months following mitral annuloplasty (average 19.4 months). Preoperative and postoperative comparative data are presented. One patient was unimproved or worse. The rest were subjectively better.

Mean changes were transverse cardiac diameter -17.8 mm. (median 15 mm.) (
p
< .005); resting stroke index +9 ml./beat/M.
2
(median 9 ml./beat/M.
2
,
p
< .05); resting cardiac index +0.5 L./min./M.
2
(
p
= .20); mean pulmonary artery pressure -7.2 mm. Hg, or 29 per cent (median 8 mm. Hg,
p
< .03); and arteriovenous oxygen difference -12 ml./L. (median 13 ml./L.,
p
< .005). Abnormally prolonged mixing, as shown by indicator-dilution curves, was decreased in all patients (
p
< .05). Exercise testing showed varying degrees of improvement in six of the nine so studied.

In six patients mitral regurgitation by angiocardiographic measurements postoperatively represented 0, 0, 21, 24, 35, and 46 per cent of the total left ventricular stroke volume. Two patients had increased end-systolic left ventricular volume as evidence for postoperative left ventricular failure. The other four were probably normal.

Ten of the 11 patients showed postoperative improvement that was felt to be significant in two or more of the above objective measures. Striking x-ray improvement in heart size occurred in two patients, eight others showed decreases in transverse diameter of up to 17 mm. One developed an increase in heart size.

Although probably improved over their preoperative status, two patients had significant mitral stenosis at the time of re-evaluation. Another showed evidences of progressive mitral regurgitation after an initial period of improvement.

Mitral annuloplasty is a palliative procedure with considerable potential for effecting a reduction in regurgitant volume and improving the clinical status of carefully selected patients.