bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac Motion in Patients with Pericardial Effusion
Authors: FEIGENBAUM HARVEY , ZAKY ADIB , GRABHORN LARRY L.
Published: June 2012

Diagnostic ultrasound was used to record the movement of the anterior and posterior heart walls in 23 patients with proven pericardial effusion. Fifteen of these patients demonstrated heart-wall motion that could not be distinguished from the normal pattern. Two patients with acute cardiac tamponade exhibited markedly reduced cardiac motion. The ultrasoundcardiograms obtained from the remaining six patients indicated posterior displacement of the entire heart during systole. The extent of this cardiac displacement varied. Five of the six patients with excessive cardiac motion had malignant pericardial effusion, and four of the six had clinical evidence of cardiac tamponade. The two patients with the most marked excursions exhibited electrical alternation.

The results of this study substantiate the theory that excessive cardiac motion may occur in some patients with pericardial effusion. Objective evidence is also provided in support of the positional etiology of electrical alternation associated with pericardial effusion. An attempt is made to identify some of the factors responsible for the observed abnormal cardiac motion, and some speculation is offered as to what role rotation might play in the cardiac displacement.

This study also serves as an example of the type of cardiovascular investigation that can be performed with diagnostic ultrasound.
Electrocardiographic Changes During Selective Coronary Cineangiography
Authors: MACALPIN REX N. , WEIDNER WILLIAM A. , KATTUS ALBERT A. , HANAFEE WILLIAM N.
Published: June 2012

Examination was made of standard lead III of the electrocardiogram recorded during selective right and left coronary artery injections of Hypaque-M 75% in 107 patients. Left coronary artery injection caused the mean frontal plane QRS vector to shift transiently to the left and T wave vector to shift toward the right. Right coronary artery injection caused shifts of the QRS and T wave vectors in the opposite directions. Occlusion of one main coronary artery caused these ECG changes to be minimal or absent. Transient sinus bradycardia was common with injection of either coronary artery. Serious arrhythmias were rare. The electrocardiogram recorded during selective coronary arteriography can give information useful to the angiographer during the procedure itself as well as during the subsequent interpretation of the angiogram.
Anatomic Findings in a Case of Ventricular Pre-Excitation (WPW) Terminating in Complete Atrioventricular Block
Authors: LEV MAURICE , LEFFLER WILLIAM B. , LANGENDORF RICHARD , PICK ALFRED
Published: June 2012

1. Electrocardiographic and detailed histological studies are presented of a case of ventricular pre-excitation with progressive A-V and intraventricular block terminating in complete A-V dissociation.

2. Whereas the demonstration of a tract which leads from the atrial septal musculature to the A-V bundle bypassing the A-V node explains the short P-R interval, the delta wave is accounted for by the demonstration of unusually copious Mahaim fibers from the A-V bundle to the posterior portion of the muscular ventricular septum.

3. Thus, this appears to be the first demonstration of Mahaim fibers responsible for A-V transmission in the pre-excitation syndrome.

4. The correlation of the data permitted reconstruction of anatomic changes preceding, and responsible for, the gradual progression of the atrioventricular and intraventricular conduction disorder.

5. On the basis of this correlation it would appear that the two characteristic criteria of ventricular pre-excitation, shortened P-R and the delta wave, may in some cases have a different anatomic background. A separation of these parameters permits an explanation of certain atypical and puzzling aspects encountered in the syndrome of ventricular pre-excitation and related conditions.
The Wolff-Parkinson-White (WPW) Syndrome with Supernormal Conduction Through the Anomalous Bypass
Authors: MCHENRY PAUL L. , KNOEBEL SUZANNE B. , FISCH CHARLES
Published: June 2012

An unusual case of WPW syndrome demonstrating a supernormal phase of conduction of the anomalous bypass is reported. It is suggested that the supernormality in the bypass tissue was due to concealed retrograde conduction into the bypass of the preceding normal ventricular wave of excitation.
Evidence of Concealed Atrioventricular Conduction in Man
Authors: CARLETON RICHARD A. , GRAETTINGER JOHN S.
Published: June 2012

The occurrence of 2:1 A-V block during right atrial pacing in man provided the opportunity to compare A-V conduction time with and without an intervening atrial depolarization at similar ventricular rates. The presence of the interposed atrial depolarization produced prolongation of the subsequent A-V conduction by 0.03 to 0.13 sec, and thus provided evidence of concealed conduction in the normal human heart.
Ineffectiveness of Quinidine in Preventing Atrial Fibrillation Following Mitral Valvotomy
Authors: MCCARTY RICHARD J. , JAHNKE EDWARD J. , WALKER WELDON J.
Published: June 2012

One hundred patients in sinus rhythm who underwent closed mitral commissurotomy were divided alternately into two comparable groups. One group received prophylactic treatment with quinidine immediately after operation for a period of 10 days. The incidence of atrial fibrillation was 16% in both the treated and the untreated groups. In patients more than 40 years of age, the incidence of postoperative atrial fibrillation was much higher (48%). However, in these older, more vulnerable patients quinidine prophylaxis was no more effective than it was in the younger age groups. The only operative death in the entire series occurred in the treated group and could have been due to quinidine. In this controlled, prospective study the use of quinidine in moderate dosage was ineffective in preventing postoperative atrial fibrillation following mitral commissurotomy. Its routine use is not recommended.
Atriogenic Diastolic Reflux in Patients with Atrioventricular Block
Authors: RUTISHAUSER WILHELM , WIRZ PIERRE , GANDER MARTIN , LÜTHY ERNST
Published: June 2012

In five patients with total A-V block studied by thermodilution, infusion of 10 to 25 ml of cold saline into the right ventricle over a period of several seconds resulted in lowering right atrial temperature usually 0.25 to 0.7 second after P waves not followed in normal temporal sequence by QRS complexes. In three of these patients, in whom left heart catheterization was performed, the same phenomenon could be detected during and after infusion of cold saline into the left ventricle while temperature was measured by a thermistor introduced by transseptal route into the left atrium. Isolated atrial contractions, although capable of partially closing the A-V valves as indicated by the higher ventricular than atrial pressure, lead to atriogenic reflux from the ventricle. Ventricular contraction, however, whether normal or extrasystolic, produced efficient closure of the A-V valves.
Studies in Clinical Shock and Hypotension
Authors: COHN JAY N. , LURIA MYRON H. , Eustace Ann
Published: June 2012

Hemodynamic studies were performed on 44 patients with nonhemorrhagic shock or hypotension in order to assess the degree of vasoconstriction and cardiac stimulation.

In 19 patients, reflex adrenergic discharge was characterized by elevated total peripheral vascular resistance, a high ratio of central blood volume to total blood volume, tachycardia, and clinical signs of skin vasoconstriction. Reduced total blood volume in most of these patients at the time of study could be explained as the result of fever, administration of vasopressor drugs, or prolonged reflex vasoconstriction.

Eight patients were hypotensive with low peripheral resistance usually associated with tachycardia and hypovolemia. The fact that all died within several hours suggests that this "irreversible" syndrome was related to local accumulation of acid metabolites with terminal failure of vasoconstriction.

In 17 patients, absence of reflex vasoconstriction despite hypotension was manifested by low or normal peripheral resistance, low ratios of central blood volume to total blood volume, warm skin, and normal total blood volume. While tachycardia often was absent in this group, heart rate was more closely related to body temperature than to vasoconstriction. Lack of intense adrenergic discharge in these hypotensive patients could be attributed either to the absence of a hypovolemic stimulus or to impairment of normal sympathetic nervous system pathways. The high incidence of alcoholism, cirrhosis, malignancy, pulmonary emphysema, and diabetes in these patients suggests the possibility that adrenergic insufficiency was a factor in the failure of vasoconstriction in at least some of them.

The frequency of hypovolemia in the patients with vasoconstriction stresses the need for recognition and correction of occult depletion of blood volume in shock of diverse etiologies.
Epidemiological Study of Sudden and Unexpected Deaths due to Arteriosclerotic Heart Disease
Authors: KULLER LEWIS , LILIENFELD ABRAHAM , FISHER RUSSELL
Published: June 2012

A study of sudden unexpected nontraumatic deaths was begun on June 1, 1964. A sample of all nontraumatic deaths in Baltimore residents between the ages of 20 and 64 from June 15, 1964, to June 14, 1965, was obtained. The deaths were then studied by reviewing all available medical information in order to determine: (1) whether the death was possibly sudden or not and (2) the accuracy of the diagnosis reported on the death certificate. The next of kin or other relative or friend of each deceased person who died suddenly was then interviewed.

For comparison, information was obtained on (1) a probability sample of the Baltimore population, and (2) deaths due to arteriosclerotic heart disease (ASHD deaths) that were found to be "not-sudden."

There were 1,857 deaths in the original sample, of which 589 were sudden according to the definition of sudden death. After adjustment for sampling, it was estimated that 1,178 (32%) of the total 3,648 deaths in Baltimore were sudden. Arteriosclerotic heart disease (ASHD) accounted for 58% and the cardiovascular group together for 69% of the sudden deaths.

Sixty per cent of all ASHD deaths were sudden. Of the 1,030 ASHD deaths in Baltimore City between the ages of 40 and 64, 20.6% occurred outside of a hospital and 46.2% represented deaths on arrival at a hospital. Only 18.9% of all ASHD deaths occurred after the first 24 hours of hospitalization.

By use of data provided in several crosssectional and prospective studies, it was estimated that 22% of new coronary events were sudden deaths and that the case-fatality rate was 31%.

In approximately half of the ASHD sudden deaths the deceased had a history of heart disease prior to death and in 24% the deceased had seen a physician within the week prior to death. Unfortunately we were not able to determine the reasons for these visits.

In considering the implications of these findings with regard to the prevention of ASHD deaths, it would appear that prevention of only a comparatively small percentage (8.2%) of ASHD deaths is completely dependent on primary prevention. For the remaining ASHD deaths a combination of both primary and secondary prevention may be effective. Because of the rapidity of death and the high frequency of these deaths either occurring outside of a hospital or being called deaths on arrival, hospital treatment may well have little effect on reducing the ASHD mortality, while, on the other hand, the combination of better and earlier diagnosis and intensive treatment in a hospital could conceivably re- duce the mortality.
Umbilical Vessel Cardiac Catheterization and Angiocardiography
Authors: LINDE LEONARD M. , HIGASHINO STANLEY M. , BERMAN GERALD , SAPIN SAMUEL O. , EMMANOUILIDES GEORGE C.
Published: June 2012

Cardiac catheterization and angiocardiography through the umbilical artery and vein were performed in the first 10 days of life on 50 infants with serious congenital heart lesions. This procedure has been diagnostically effective and presents minimal risk to the critically ill newborn. The methods, effectiveness, advantages, limitations, and complications of this procedure are discussed.
Vectorcardiographic Studies in Acquired Valvular Disease
Authors: TOSHIMA H. , CUETO J. , LILLEHEI C. WALTON
Published: June 2012

A vectorcardiographic study using the Schmitt-Simonsen (SVEC-III) method was done in 92 patients with mitral and aortic acquired valvular disease in which left ventricular hypertrophy and the valvular lesions were proven by means of right and left heart catheterization, operation, or autopsy, or by all methods. Significant differences were found among groups with aortic insufficiency, aortic stenosis, and mitral insufficiency. The magnitude of the 0.01 and 0.02-sec and maximal spatial vectors and the voltages of the Q
x
, R
x
, as well as R
z
waves were greatest in the group with aortic insufficiency. The greatest voltages of the 0.03-sec and 0.04-sec vectors were found in patients with aortic stenosis. In this study the smaller voltages after the 0.03-sec vector were found in the group with mitral insufficiency, and these voltages were significantly increased when aortic insufficiency complicated the picture. Groups with aortic insufficiency and mitral insufficiency, or aortic stenosis or insufficiency and mitral stenosis showed abnormal inferior orientation of the middle and terminal forces, which were explained upon the basis of the concomitant right ventricular hypertrophy. The authors believe that with the aid of the corrected orthogonal system of Schmitt and Simonsen (SVEC-III) the clinician will be able not only to make a more accurate evaluation of left ventricular hypertrophy, but also in many instances will find considerable assistance in arriving at a specific clinical diagnosis.
Some Pitfalls of Vectorcardiographic Diagnosis of Myocardial Infarction with Particular Respect to Emphysema
Authors: MURATA KAZUHIKO , MATSUSHITA SATORU , KURIHARA HIROSHI , SEKI MASUJI
Published: June 2012

Vectorcardiographic changes indicating old myocardial infarction were observed in eight of 288 patients who at autopsy did not show extensive myocardial disease. Of these eight patients four had been given a misdiagnosis of anteroseptal infarction, while four had been suspected of having anterolateral or anterior infarction on the basis of an abnormal configuration of the initial portion of the QRS loop. The possibility of overdiagnosis of myocardial infarction should be borne in mind in reading vectorcardiograms, especially in the absence of clear-cut history of the condition.

A prominent Q wave simulating anteroseptal or anterior infarction was observed in lead V
2
or V
3
, or in both in 12-lead electrocardiograms in all these eight cases. A high incidence of coronary sclerosis, scattered myocardial fibrosis and pulmonary emphysema was noted in these false positive cases at autopsy, but right ventricular hypertrophy, significant septal hypertrophy, or giant right atrium was not demonstrated.
The Dominant Pacemaker of the Human Heart
Authors: LISTER JOHN W. , DELMAN ABNER J. , STEIN EMANUEL , GRUNWALD RONALD , ROBINSON GEORGE
Published: June 2012

In 25 cases at open heart surgery, atrial and ventricular close bipolar electrograms, an atrial unipolar electrogram, and a lead-II electrocardiogram were simultaneously monitored throughout each procedure. In six cases the ventricles or atria, or both, were paced by electrical stimulation. Although atrial activity could frequently not be clearly delineated on the lead II electrocardiogram, the time relationship between atrial and ventricular depolarization could at all times be determined from the electrograms.

During ventricular premature beats and ventricular rhythms, retrograde A-V conduction and retrograde activation of the atria were common, and unidirectional retrograde A-V block was infrequent. In spontaneous and induced cardiac arrhythmias the fastest pacemaker of the heart, atrial, His bundle, or ventricular, usually activated the entire heart.
Occlusive Fibroelastosis of Coronary Arteries in the Newborn
Authors: MACMAHON H. EDWARD , DICKINSON P. C. TAYLOR
Published: June 2012

A developmental anomaly in the form of occlusive fibroelastosis of the proximal segments of both coronary arteries, leading to progressive myocardial infarction and death, was found in the course of an autopsy on a 6-week-old infant. Congenital malformations of the coronary arteries are not uncommon, but a report of one such as this has not been found in the literature.
New Technique for Determining Cardiac Output with Use of a Miniature Esophageal Scintillation Detector
Authors: HERNANDEZ ANTONIO , GOLDRING DAVID , TER-POGOSSIAN MICHEL , EICHLING JOHN
Published: June 2012

A miniature scintillation detector recently designed and constructed in this laboratory can be inserted into the esophagus and under fluoroscopic vision positioned so that radioactivity emitted from the blood in the descending aorta can be detected and a time-concentration curve recorded from which cardiac output can be determined. Twenty simultaneous determinations of cardiac output by the isotope-dilution method with the esophageal scintillation counter probe and the dye-dilution technique were done in 10 dogs. There was a good correlation between the two methods. Among the technical advantages of the isotope-dilution method over the dye-dilution method are avoidance of arterial puncture, only one sample of venous blood required, an easily performed procedure, and ability to permit repeated determinations of cardiac output with a minimum of manipulation and trauma.
Estimation of Left Ventricular Volume by One-Plane Cineangiography
Authors: GREENE DAVID G. , CARLISLE RAYMOND , GRANT COLIN , BUNNELL IVAN L.
Published: June 2012

One-plane cineangiographic measurement of left ventricular volume uses angiocardiograms taken in the right anterior oblique view. Its basic assumption is that the third (unvisualized) dimension, depth from septum to free wall, is of the same magnitude and behaves in the same way as the visualized short axis. Examination of this assumption with biplane x-ray equipment revealed that the unmeasured length averages 7% less and varies directly with the length of the measured short axis. Volumes measured correlate well with consecutive studies using serial biplane x-rays and are systematically somewhat larger than volumes obtained in autopsy specimens injected with barium sulfate paste. The method is tolerant of variations in positioning of the patient, is convenient, yields repeatable analyses from one experienced observer to another, allows 60 volume measurements per second so that rapid cardiac events can be studied, and the small doses of x-rays and contrast medium permit several observations at one catheterization session. This means that effects of drugs and other interventions can be studied by the informative techniques of semi-continuous volume measurement and pressure-volume analysis.
Ventricular Performance after Angiocardiography
Authors: RAHIMTOOLA SHAHBUDIN H. , DUFFY JOHN P. , SWAN H. J. C.
Published: June 2012

Ventricular performance was assessed before and after angiocardiography in 22 patients with normal left ventricle, mitral stenosis, aortic stenosis, and myocardial disease. The increased circulating blood volume known to occur after angiocardiography is a determinant of the increased ventricular pre-load. The after-load is unchanged. Patients with normal left ventricle and some patients with valve stenosis responded by an increase in the work performed and some had only a minimal or no increase. A group of patients with serious heart disease performed less work. If the ventricular response can be considered on the basis of the Frank-Starling principle, then the abnormal response of such patients is due to an altered length-tension relationship.
Studies in Clinical Shock and Hypotension
Authors: COHN JAY N. , LURIA MYRON H. , DADDARIO ROBERT C. , TRISTANI FELIX E.
Published: June 2012

Thirty-one patients with nonhemorrhagic shock or hypotension of diverse etiologies accompanied by low cardiac output and normal or low right atrial pressure were given a rapid infusion of dextran. Cardiac output returned to normal in 20 patients and shock or hypotension was corrected in 16.

In 10 patients with evidence of vasoconstriction and normal cardiac function, dextran reversed the circulatory abnormality, returning blood pressure, cardiac output, and peripheral vascular resistance to normal. Twelve patients with hypotension without evidence of reflex vasoconstriction were improved by dextran but the hypotension persisted occasionally. In nine patients, dextran revealed heart failure as manifested by a precipitous rise in right atrial pressure without much increase in cardiac output. Control hemodynamic observations and the response to dextran could not necessarily be predicted from the nature of the disease which precipitated the shock.

The efficacy of a rapid infusion of low molecular weight or clinical dextran associated with its freedom from significant toxicity should make it the treatment of choice in non-hemorrhagic shock of any cause associated with normal central venous pressure.
The Use of Angiotensin in the Assessment of Left Ventricular Function in Fixed Orifice Aortic Stenosis
Authors: PERLOFF JOSEPH K. , BINNION PETER F. , CAULFIELD WALTER H. , DELEON ANTONIO C.
Published: June 2012

Catheterization of the left heart permits sophisticated assessment of the mechanical problem in aortic stenosis. Selection of patients for surgical repair requires an additional judgment regarding the contractile state of the left ventricle. Angiotensin has recently been used to study the function of the unobstructed left ventricle by imposing controlled pressure loads on both compensated and failing human hearts. The present study was designed to determine whether angiotensin might be of value in characterizing left ventricular function in the presence of aortic stenosis. Accordingly, controlled amounts of the drug were infused during transseptal left heart catheterization in 12 patients in whom fixed obstruction to left ventricular outflow was the sole mechanical fault. Observations were made before and during a series of stepwise increments in systemic systolic pressure. The following information was obtained: cardiac rate, stroke volume, peripheral vascular resistance, left ventricular systolic and end-diastolic pressures, brachial arterial systolic and diastolic pressures, aortic gradient, left ventricular stroke work, systolic ejection period, and aortic valve area. Left ventricular function curves were constructed by relating stroke work to diastolic filling pressure. Rises in brachial systolic pressure exceeded rises in left ventricular systolic, regularly diminishing the gradients. Elevations in systemic arterial pressure consistently elevated left ventricular end-diastolic pressure, indicating that angiotensin can be used to impose a pressure load on the left ventricle despite the interposition of fixed obstruction. In an attempt to gain further information on the mechanical and myocardial factors that coexist in aortic stenosis, three types of observations were made regarding the hemodynamic response of the left ventricle to the graded pressure loads: (1) the directional changes in stroke volume accompanying the increments in ventricular stress, (2) the magnitude of the increase in left ventricular systolic pressure accompanying a given increment in diastolic filling pressure, and (3) the relation between ventricular end-diastolic pressure and stroke work (ventricular function curves). Although the individual responses did not uniformly distinguish mechanical from myocardial influences, when stroke volume, left ventricular end-diastolic pressure, and ventricular function curves were taken together, a clearer impression of the behavior of the left ventricle emerged. Such information may prove useful in view of the practical need to assess ventricular adequacy in aortic stenotic patients considered for corrective surgery.
Hemodynamic Effects of Aminophylline in Chronic Obstructive Pulmonary Disease
Authors: PARKER JOHN O. , ASHEKIAN PARSEGH B. , DI GIORGI SALVATORE , WEST ROXROY O.
Published: June 2012

Ten patients with chronic obstructive pulmonary disease without complicating cor pulmonale were studied by 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 19.7 mm Hg to 14.8 mm Hg, right ventricular end-diastolic pressure from 3.4 mm Hg to 1.4 mm Hg, left ventricular end-diastolic pressure from 6.5 mm Hg to 2.9 mm Hg, and the brachial artery mean pressure from 96.7 mm Hg to 86.2 mm Hg. The heart rate, oxygen consumption, and cardiac index increased. There was a significant fall in both peripheral and pulmonary vascular resistance. Evidence is presented to suggest that the decrease in pulmonary artery and systemic pressures was due to pulmonary and peripheral arteriolar dilatation.
Anomalous Mitral Arcade
Authors: LAYMAN THOMAS E. , EDWARDS JESSE E.
Published: June 2012

Described in three infants is an anomaly of the mitral valvular mechanism which has the following characteristic: connection of the left ventricular papillary muscles to the anterior mitral leaflet, either directly or through the interposition of unusually short chordae. The condition has been named "anomalous mitral arcade." The anatomic aberration appears to cause incompetence of the mitral valve.
Hereditary Factors in Atrial Septal Defect
Authors: NORA JAMES J. , MCNAMARA DAN G. , FRASER F. CLARKE
Published: June 2012

One hundred families ascertained through a proband's having atrial septal defect (ostium secundum) were studied. Selection of certain pedigrees from the overall data could lead to the conclusion that atrial septal defect is inherited as a Mendelian dominant or a Mendelian recessive, depending on the pedigrees selected. Analysis of the overall data from this study and from the literature suggests multifactorial inheritance of atrial septal defect as the explanation most consistent with available observations. The distinction between inheritance of a defect through single factor or multifactorial modes is of more than academic interest. From the point of view of genetic counseling, the risk to the newborn is not fixed in multifactorial inheritance but increases with the number of affected relatives. From the point of view of prevention, environmental hazards such as drugs and illnesses may play an important role in the production of defects showing multifactorial inheritance.
Observations on the Natural History of Varicosity of Pulmonary Veins
Authors: HIPONA FLORENCIO A. , JAMSHIDI AHMED
Published: June 2012

Pulmonary vein varix was diagnosed by roentgen studies in three patients. One showed enlargement of the lesion in 7 years with progression of heart disease and regression of the varix after correction of the mitral insufficiency. The other two patients without associated heart disease demonstrated no change in the varicosity of the pulmonary vein after 4 and 15 years.
Quantitation of Precordial Movement
Authors: SUTTON GEORGE C. , CRAIGE ERNEST , GRIZZLE JAMES E.
Published: June 2012

Precordial displacement records of 39 patients with mitral regurgitation have been analyzed using a new method of quantitation. Three groups of patients were studied, and the data from each group have been compared in a number of different ways to those obtained from a control group. The optimal method of discrimination is a graphic representation involving the two variables of the height of the outward movement in systole and the height of the rapid-filling wave. This method allows discrimination between normal persons and patients with mitral regurgitation in a high proportion of cases.

It is postulated that the increase of systolic outward movement in patients with mitral regurgitation is related to an increase in stroke volume of the left ventricle, and the increase in the height or the slope of the rapid-filling wave represents increase in flow and rate of flow into the ventricle in early diastole. The importance of consideration of the functional status of the ventricle in the assessment of precordial movement is stressed.
Cardioversion Following Prosthetic Mitral Valve Replacement
Authors: SEMER HOWARD , HULTGREN HERBERT , KLEIGER ROBERT , BRANIFF BLAINE
Published: June 2012

Direct current conversion of atrial fibrillation has been attempted in 60 consecutive patients following prosthetic mitral valve replacement (Starr-Edwards prosthesis). Sinus rhythm was attained and persisted for at least 24 hours after the procedure in 68% (41 patients) and 40% of the entire group (24 patients) were still in normal sinus rhythm an average of 10 months later. Successful initial conversion and persistence of sinus rhythm occurred most frequently in patients whose duration of atrial fibrillation was less than 5 years and who had a small left atrium.

Results differed little whether conversion was attempted 7 to 21 days or 1 to 15 months after open valve replacement. Atrial disease associated with a long period of antecedent atrial fibrillation and marked left atrial enlargement appeared to be the most important factors responsible for persistence of atrial fibrillation or early relapse. Attempts at cardioversion are recommended for all patients with persistent atrial fibrillation following mitral valve replacement in view of the high success rate and the safety of the procedure.
Pressure-Flow Studies in Man During the Valsalva Maneuver with Observations on the Mechanical Properties of the Ascending Aorta
Authors: GREENFIELD JOSEPH C. , COX RONNIE L. , HERNANDEZ RAFAEL R. , THOMAS CORINNA , SCHOONMAKER FRED W.
Published: June 2012

The pressure-gradient technique was used to obtain continuous measurements of both blood pressure and flow in the ascending aorta of eight normal subjects who were performing a standardized Valsalva maneuver. From these recordings the beat-to-beat changes in stroke volume, peak blood flow, peripheral vascular resistance, duration of ejection, and an index of total systolic duration were calculated. Stroke volume and peak blood flow were not changed with the onset of straining (phase I), but were decreased to approximately 50% of control values immediately prior to release (phase II). During the overshoot period (phase IV) stroke volume and peak flow were increased above control levels. Both the duration of ejection and the duration of systole were shortened during straining (phase II). The concomitant changes in blood pressure in these subjects were similar to previously reported pressure recordings. An estimate of the pressure-radius relationships in the ascending aorta of these patients was obtained angiographically. The mean cross-sectional area of the ascending aorta changed by 17% during the Valsalva maneuver.
Basal Lamina of Abdominal Skeletal Muscle Capillaries in Diabetics and Nondiabetics
Authors: VRACKO RUDOLF , STRANDNESS DONALD E.
Published: June 2012

In a "blind" study, skeletal muscle biopsies were obtained from the trunk of 13 nondiabetics, eight chemical diabetics, and four overt diabetics of comparable age. On electron micrographs of 20 capillaries from each case, the areas of various components of the capillary structure were measured with a planimeter. The area of the basal lamina was expressed as a percentage of the total vessel area. This method for measuring objectively the relative thickness of capillary basal lamina considered the vessel size, plane of sectioning, and the function state of the vessel. The theoretical validity of the method is discussed.

The widths of the basal lamina of the capillaries of the trunk skeletal muscles of both diabetics and nondiabetics were identical. Morphological differences between the two groups were not present. The discrepancies in results of investigations concerned with the quantity of basal lamina in capillaries of skeletal muscle may be due to naturally occurring regional differences, or because capillary beds of different organs or tissues may be affected differently in diabetes mellitus.
Pulmonary Blood Volume and Pulmonary Capillary Blood Volume in Valvular Heart Disease
Authors: GAZIOGLU KUDDUSI , YU PAUL N.
Published: June 2012

Measurements of pulmonary blood volume (PBV) and pulmonary capillary blood volume (V
c
) and hemodynamic studies were made in a series of 106 patients with valvular heart disease (62 with predominant mitral lesions and 44 with predominant aortic lesions). The results were compared with the data obtained from 14 "normal" patients and nine normal subjects. In 14 "normal" patients, the PBV varied from 204 to 315 ml/m
2
with a mean value of 269 ml/m
2
, while in nine "normal" patients and nine normal subjects the V
c
ranged from 39 to 66 ml/m
2
with a mean value of 54 ml/m
2
.
Heart Size of Adults in a Natural Population-Tecumseh, Michigan
Authors: OBERMAN ALBERT , MYERS ALLEN R. , KARUNAS THOMAS M. , EPSTEIN FREDERICK H.
Published: June 2012

Roentgenological determinations of the transverse diameter and cardiothoracic ratio in 3,985 subjects aged 20 years or more, from Tecumseh, Michigan, represent the first report on the measurement of heart size in a total community. The influence of cardiovasular abnormality, height, and weight on heart diameter and cardiothoracic ratio is determined across all age and sex divisions for the entire adult population. A consistent hierarchy of heart diameter, independent of age, height, and weight, has been demonstrated so that the diameter of the hearts of abnormal males > normal males > abnormal females > normal females. Heart diameter, especially in the males, distinguishes the abnormal segment of the population more effectively than the cardiothoracic ratio, but an age and sex-specific cardiothoracic ratio may be the most valuable in the clinical situation. Both measurements relate directly to age, sex, and weight, but the relation to height is dependent on weight. Study of heart size in a general population reveals that measurements as simple as heart diameter and cardiothoracic ratio may be effectively applied to clinical and epidemiological cardiovascular evaluations.
Relation of Body Weight to Development of Coronary Heart Disease
Authors: KANNEL WILLIAM B. , LEBAUER E. JOSEPH , DAWBER THOMAS R. , MCNAMARA PATRICIA M.
Published: June 2012

Interrelationships between weight change, serum cholesterol, blood pressure levels, and the risk of developing coronary heart disease have been explored in 5,127 men and women who have been followed over 12 years for signs of initial development of coronary heart disease. Antecedent relative weight and weight gain after age 25 years proved to be strongly related to risk of angina pectoris and sudden death but were unassociated with development of myocardial infarction. An excess risk of angina pectoris and sudden death appeared to exist in obese men both with and without elevations of blood pressure and serum cholesterol, indicating an independent contribution of obesity to the rate of development of these manifestations of coronary heart disease. Unless accompanied by an increase in blood pressure and serum cholesterol level, obesity appeared to play a negligible role in women. Subjects with both these predisposing factors and obesity had a pronounced increase in risk, greater than that associated with either factor alone. The data suggest that overweight may be instrumental in bringing out symptoms of angina pectoris or in precipitating sudden death by imposing an increased workload on a heart with an already compromised coronary circulation.
Effect of Aminophylline on Urinary Excretion of Epinephrine and Norepinephrine in Man
Authors: ATUK NUZHET O. , BLAYDES M. CARY , WESTERVELT FREDERIC B. , WOOD J. EDWIN
Published: June 2012

The excretion of catecholamines and the changes in plasma concentration of free fatty acids during aminophylline administration were explored. The relationships between cardiac arrhythmia, cardiac rate, and change in blood pressure under the conditions of these experiments were defined. Eighteen experiments were performed on eight volunteers. Blood pressures and heart rates before and during aminophylline infusion were recorded at frequent intervals, and urine and blood were collected during the control and infusion periods and in some subjects after the infusion. Loading with ethanol, glucose, or placebo before administration of aminophylline was used.

These studies demonstrated that intravenous infusion of aminophylline increases the urinary excretion of epinephrine and norepinephrine in man, the rate of excretion of epinephrine being greater than that of norepinephrine. This increase was accompanied by an increase in the concentration of free fatty acids in the plasma.
Primary Myocardial Disease and Alcoholism
Authors: TOBIN JOHN R. , DRISCOLL JOHN F. , LIM MANUEL T. , SUTTON GEORGE C. , SZANTO PAUL B. , GUNNAR ROLF M.
Published: June 2012

The course of primary myocardial disease (PMD) was observed in 39 alcoholics. After initial examination 3 years or more before this report, we classified the severity of each patient's illness as stage I, II, or III. Stage I patients had minimal symptoms and normal-sized hearts. Stage II patients had evidence of concentric left ventricular hypertrophy and clinical manifestations like those of hypertensive heart disease. Stage III patients had left, and frequently right, ventricular hypertrophy and dilatation associated with persistent congestive heart failure, and clinical manifestations typical of patients with PMD. Only the duration of congestive heart failure differed significantly between stages II and III. Eight patients had exploratory mediastinotomy and myocardial biopsy. Gross and microscopic findings supported the diagnosis of PMD and our classification of severity and revealed diffuse interstitial fibrosis. Fifteen patients have been observed for 3 or more years; 10 have died and 14 have disappeared. These studies emphasize alcoholism's importance in the genesis of this form of PMD. Correlations were positive between abstention from alcohol and waning of clinical severity, and between persistent drinking and waxing of clinical severity.
Bilateral Bundle-Branch Block
Authors: SCHLOFF LEONARD D. , ADLER LAWRENCE , DONOSO EPHRAIM , FRIEDBERG CHARLES K.
Published: June 2012

The electrocardiograms and salient clinical features of seven patients with electrocardiographic evidence of various types of bilateral bundle-branch block (BBBB) have been presented. When the complexes change in form and the P-R interval varies, the mechanisms are usually best interpreted by using the concepts of first degree, second degree, and third degree bundle-branch block with or without block in the higher conduction system. The etiology of BBBB in many cases is idiopathic fibrosis of both bundles. The diagnosis of BBBB by ECG is important because of its relation to the subsequent development of complete heart block or Adams-Stokes syndrome, or both. In this series five of seven patients with BBBB had Adams-Stokes syndrome and three of seven had complete heart block.
Surgical Correction of Tetralogy of Fallot with Previous Systemic to Pulmonary Artery Shunts
Authors: MEYER BERT W. , LINDESMITH GEORGE G. , STANTON ROBERT E. , JONES JOHN C.
Published: June 2012

Fifty-four patients with previous Blalock (32) and Potts (22) systemic artery-pulmonary artery shunts and subsequent total correction for tetralogy of Fallot are reported. A separate posterolateral approach was employed to obliterate the Potts shunt. There were seven operative deaths and two late deaths. Infundibular stenosis with a normal pulmonary valve gave the best results. In comparison with our concomitant series without a shunt, the presence of a Blalock or Potts anastomosis did not affect the over-all result. Postoperative bleeding was a major complication, requiring reoperation in seven. An excellent result with probable cure was obtained in 30, and there was good improvement in ten of the 54 patients.
Surgical Treatment of Muscular Subaortic Stenosis
Authors: COOLEY DENTON A. , BLOODWELL ROBERT D. , HALLMAN GRADY L. , LASORTE ANTONIO F. , LEACHMAN ROBERT D. , CHAPMAN DON W.
Published: June 2012

The results of surgical treatment of 26 patients with muscular subaortic stenosis are presented. Left ventricular septectomy was performed in 16 patients, and septal myocardiectomy via a right ventriculotomy was employed in the last ten patients. There were five hospital deaths among these patients, yielding a mortality rate of 19%.

Hemodynamic studies after operation in six patients showed relief of functional left ventricular outflow obstruction in all but one patient. This patient subsequently underwent successful right ventricular septectomy.

Recently we have employed a right ventriculotomy for excision of septal myocardium during digital exploration of the left ventricular outflow tract. Freedom from serious complications and effectiveness in relieving the subaortic stenosis recommend this technique for patients with obstructive cardiomyopathy.
Results of Operation for Atrial Septal Defect in Patients Forty-five Years of Age and Older
Authors: DAICOFF GEORGE R. , BRANDENBURG ROBERT O. , KIRKLIN JOHN W.
Published: June 2012

1. The results of closure of atrial septal defects in 155 patients over 45 years of age have been reviewed.

2. The over-all operative mortality rate was 6.5%; the operative mortality rate in the last 48 patients was 2.1%.

3. The late results of operation were considered excellent in 83% and good in 13% of the patients.

4. Long-term follow-up studies suggest that patients have significantly longer survival with closure of their defects.

5. It is concluded that operation for atrial septal defect in the older patient may be done at a low risk with an excellent prospect of a good, long-term result in almost all cases.
Effect of Total Cardiopulmonary Bypass on Human Lung Elastic Properties
Authors: BLAIR EMIL , HEDSTRAND ULF , WESTERHOLME CARL-JOHANN , BJÖRK VIKING O.
Published: June 2012

Quasi-static elastic properties and dynamic compliances were measured in a series of patients undergoing open-heart surgery with total cardiopulmonary bypass for periods up to 2 hours. The data revealed that in half of the patients no alterations occurred, and in the other half there appeared a distinct improvement in lung mechanics, as indicated by the elastic properties. The reasons for this improvement are not known but may be related in part to changes in pulmonary blood volume. Artificial perfusion per se for around 2 hours causes no significant impairment in the elastic component of lung mechanics.
Early Clinical Experience with Homotransplantation of the Aortic Valve
Authors: NELSON RONALD J. , MOHRI HITOSHI , WINTERSCHEID LOREN C. , DILLARD DAVID H. , MERENDINO K. ALVIN
Published: June 2012

Twenty-five patients with predominant aortic valvular disease have had replacement with a homograft aortic valve inserted after the fashion of Barratt-Boyes. Recently used valves have been stored at -80 C, allowing prolonged storage and rapid reconstitution. There were five early deaths (20%), none of which was directly attributable to the choice of valve. Of three late deaths (12%) in up to 18 months follow-up, two were found to be due to complications of the valve resulting in aortic regurgitation-one secondary to a peripheral leak, the other to a fungal endocarditis.

All 17 survivors are greatly improved. All 11 patients who have survived over four months have returned to their former occupations. Five (29%) have no murmurs and 12 (71%) have no diastolic murmur. The five that have diastolic murmurs all show evidence of improvement. Tailoring the recipient annulus to fit the donor valve by means of "V" excision of the noncoronary sinus has been very important in minimizing the problem of valvular insufficiency.

Recatheterization at one year has revealed no systolic gradient in four patients. Aortic regurgitation was minimal in one patient. There has been no thromboembolism, although anticoagulants are not used. These promising early results support continued use and evaluation of the homograft aortic valve.
Factors Affecting Thromboembolism Associated with Prosthetic Heart Valves
Authors: DUVOISIN GEORGE E. , BRANDENBURG ROBERT O. , MCGOON DWIGHT C.
Published: June 2012

The incidence of thromboembolism after insertion of prosthetic cardiac valves is related to the type of prosthesis and in the cases reviewed here was highest for the ball-valve prosthesis.

The risk of thromboembolism was studied by constructing actuarial curves showing the proportion of patients with embolism at increasing time intervals postoperatively. Such curves for the patients studied suggest that the risk of thromboembolism diminishes with time, particularly by the third postoperative year. The risk was remarkably similar for patients having aortic, mitral, and multiplevalve replacements, being 15% for the first 6 postoperative months, another 8% for the next 6 months, and another 20% for the next 2 years.

Emboli lodged in cerebral, coronary, renal, and other sites in these patients in diminishing frequency. The risk of fatality averaged 15%. None of the nonfatal embolisms resulted in significant continuing disability, save for 7% of the cerebral embolisms.

A beneficial effect of anticoagulation was demonstrated for patients having replacement of the aortic valve with a ball-valve prosthesis, particularly when this treatment was carefully controlled. In the latter group, the risk of thromboembolism was less than 5% 2 years postoperatively.
An Electrocardiographic, Anatomic, and Metabolic Study of Zonal Myocardial Ischemia in Coronary Heart Disease
Authors: HERMAN MICHAEL V. , ELLIOTT WILLIAM C. , GORLIN RICHARD
Published: June 2012

An integrated approach, utilizing cine coronary angiography, the standard 12-lead and post-exercise electrocardiograms, and regional myocardial lactate metabolism, is presented for detection of regional myocardial ischemia in patients with coronary heart disease. The normal electrocardiogram was of no predictive value and was present with extensive coronary disease and myocardial production of lactate. The abnormal electrocardiogram gave an accurate indication of a portion, but not all zones of ischemia. Multiple electrocardiographic abnormalities were invariably associated with severe coronary artery disease, although in most patients many more coronary lesions were present than electrocardiographic abnormalities. The regional lactate pattern was very helpful in localizing myocardial ischemia and significant coronary artery lesions. Regional lactate abnormalities may have a great practical value in the selection of patients for myocardial revascularization surgery and in their postoperative evaluation.