bluuebunny/crossref_metadata_2025 huggingface dataset:
A Simple Method for Intracardiac Acoustic Auscultation and Phonocardiography
Authors: FERUGLIO GEORGE A.
Published: June 2012

Acoustic auscultation of the cavities of the heart was carried out in 62 patients with normal hearts and with congenital or acquired heart disease. The type of instrument used is a special cardiac catheter with closed distal tip and with side openings near the tip covered by a thin latex cuff. Intracardiac sound vibrations are collected by the latex membrane, which transmits them to the column of air in the catheter and thereby to the outside of the body.

The catheter can be connected either with the tubing of a binaural stethoscope, for acoustic intracardiac auscultation, or with a microphone. In the latter instance, with the help of a specially designed preamplifier, simultaneous intracardiac sounds and pulse curves can be recorded. This has a two-fold advantage: that of locating the site of recording (by the shape of the intracardiac pulse) and of correlating acoustic and mechanical intracardiac events of the cardiac cycle.

The advantages of acoustic intracardiac auscultation (an aid in avoiding artifacts and locating the best area of sound production) and the practicality, reliability, and low cost of the new technic of intracardiac phonocardiography are stressed.
Prognosis in Dissecting Aneurysm of the Aorta
Authors: KUIPERS FRED M. , SCHATZ IRWIN J.
Published: June 2012

Of 26 patients with dissecting aneurysm of the aorta diagnosed at the Henry Ford Hospital from 1950 through 1962, 13 patients lived less than six weeks from the time of initial diagnosis. Of the other 13 patients, 2 had had successful operative repair of the aneurysm during the acute stage. The average survival of the remaining 11 patients was 26 months. Prognosis of this unselected group of patients was better than has been reported previously for this disease.

No significant correlation could be found between survival of the patient and the presence of past hypertension, associated recognized cardiovascular disease, or site of intimal rupture.
An Implantable, Synchronous Pacemaker for the Long-Term Correction of Complete Heart Block
Authors: NATHAN DAVID A. , CENTER SOL , WU CHANG-YOU , KELLER WALTER
Published: June 2012

An implantable, synchronous cardiac pacemaker for long-term correction of complete heart block has been developed. It has been successfully used in dogs for periods up to eight months. The performance of the pacemaker during normal sinus rhythm and atrial arrhythmias is illustrated with electrocardiograms. After implantation of the pacemaker, the dogs have returned to completely normal activity and have tolerated all physical exercises well.

[see figure in the PDF file]
Peripheral Ramification of the Cardiac Conducting System
Authors: ESMOND WILLIAM G. , MOULTON G. ALLEN , COWLEY R. ADAMS , ATTAR SAFUH , BLAIR EMIL
Published: June 2012

The study of the peripheral distribution of the right bundle branch in bovine, dog's, goat's, lamb's, and human hearts demonstrates an anatomical basis for the production of varying degrees of right bundle-branch block on operative incision of the anterior wall of the right ventricle.

The left branch of the cardiac conducting system, with its transventricular cavity conducting bundles to the papillary muscles and the ventricular wall in bovine, dog's, goat's, lamb's, and human hearts, offers an anatomical basis for varying degrees of disturbance in left ventricular conduction due to operative incision or instrumentation in the left ventricle. Comparative anatomical studies in man and animals show conducting fibers which traverse the ventricular cavities in structures previously termed pseudotendons or false chords.

In man, the existence of these transventricular cavity conducting bundles has not been emphasized, probably because of the traditional methods of opening the heart at autopsy.

The combined electrocardiographic and anatomical concepts provide a useful background for caution in open-heart operation, lest stretching during manipulative procedures or cutting these peripheral conducting bundles produces irrevocable conduction-damage.
New Flexible Vascular Adhesive for Use in Cardiovascular Surgery
Authors: BERNHARD WILLIAM F. , CUMMIN ALFRED S. , HARRIS PAUL D. , KENT EDWARD W.
Published: June 2012

1. Preliminary studies of polyurethane resins of the reactive prepolymer type indicate that they may be of considerable value in experimental and clinical cardiovascular surgery as adhesive agents.

2. These resins combine hardness, elastomeric (rubber-like) properties, and chemical inertness which persist unchanged for periods of at least six months.

3. The position and quantity of isocyanate groups in the prepolymer molecule, together with the molecular weights of the prepolymer and polyol, determine the physical properties of the final polymer obtained.

4. Exceptional adhesion between the polymer and blood vessel wall is a result of the reaction between available hydrogen atoms in the substrate tissue and the isocyanate groups in the prepolymer.
Studies of Myocardial Actomyosin and Myosin After Shock, Acute Hemorrhage, Acute Hypoxia, and Cardiopulmonary Bypass
Authors: CHO YOUNG W. , GALLETTI PIERRE M. , NELSON LEONARD
Published: June 2012

Decreases in cardiac efficiency have been observed in experimental endotoxic shock, acute hemorrhage, and cardiopulmonary bypass. Diminished coronary blood flow, tissue anoxia, or metabolic alteration may affect the contractile protein which, in turn, causes cardiac inefficiency. To test this hypothesis, cardiac actomyosin and myosin were extracted with Guba-Straub solution, and intrinsic viscosity, ATP (adenosinetriphosphate) activity, ATP sensitivity, the rate of ATP hydrolysis, and myosin-ATPase activity were determined. Under these experimental conditions, both myosin and actin were altered.

In order to exclude the possible effect of hypoxia of the arterial blood upon the cardiac contractile system, acute hypoxia was produced in dogs and the physicochemical properties of actomyosin and myosin were studied. During acute hypoxia, the myosin-ATPase was affected, but actin appeared to remain unaltered.

These changes of actomyosin and myosin may cause insufficient energy utilization by the contractile system and thereby affect the cardiac efficiency.
The Transseptal Conduction Time in the Human Heart
Authors: KATZ ARNOLD M. , PICK ALFRED
Published: June 2012

Four unusual cases of bundle-branch block with a parasystolic rhythm originating in the blocked ventricle are described. Varying interference of natural and parasystolic impulses permits calculation of the transseptal conduction time in man by two independent methods. The physiologic basis of each method is discussed and its validity confirmed by application to data from animal experiments available in the literature. The normal transseptal conduction time in the human heart is estimated to be 0.06 to 0.07 second in both directions. This is about twice as long as in the dog. Under pathologic conditions, it may lengthen to at least 0.115 second.

A functionally "complete" bundle-branch block can result from a delay in impulse transmission down one of the bundle branches greater than the transseptal conduction time, and need not be due to total anatomic interruption of one bundle branch.
Complete Transposition of the Great Vessels
Authors: ELLIOTT LARRY P. , ANDERSON RAY C. , TUNA NAIP , ADAMS PAUL , NEUFELD HENRY N.
Published: June 2012

A correlative study of necropsy findings and electrocardiography in 54 cases of complete transposition of the great vessels was made to determine whether or not specific electrical patterns could predict the status of the ventricular septum. It became apparent that published criteria for distinguishing between patients with a ventricular septal defect and those with an intact ventricular septum were not uniformly reliable.

Rather than the location of a communication, the important factor in differentiation depended upon the size of the opening, be it between the ventricles or through a patent ductus arteriosus.

Cases were divided into two groups: In group I were those with a small communication, and in group II were those with a large communication between the greater and lesser circulations. The group with small communication showed a narrow or obliterated ductus arteriosus and an intact ventricular septum, or a small ventricular septal defect. In group II there was either a wide patent ductus arteriosus with an intact ventricular septum or a large ventricular septal defect.

In group I the electrocardiogram predominantly showed isolated right ventricular hypertrophy, whereas, in group II, biventricular hypertrophy was the usual finding.

Among the five patients in whom the mean manifest electrical axis was deviated to the left, two showed obstructive malformations of the aortic arch, and two left ventricular-right atrial communication. The fifth case was simply one of a large communication without complicating anomalies.
Traumatic Occlusion of the Internal Carotid Artery in a Child
Authors: THERKELSEN JØRGEN , HORNNES N.
Published: June 2012

Arteriographically verified traumatic thrombosis of the internal carotid artery in the neck of a boy 2 years and 10 months old was treated by thrombectomy. A preoperative right hemiparesis subsided within 5 days after the operation. Postoperative arteriography proved restored circulation.
The Role of Catecholamines in the Free Fatty Acid Response to Cigarette Smoking
Authors: KERSHBAUM ALFRED , KHORSANDIAN ROSTAM , CAPLAN RAYMOND F. , BELLET SAMUEL , FEINBERG LEONARD J.
Published: June 2012

The role of the adrenal glands and the sympathetic nervous system in the free fatty acid (FFA) rise after smoking was investigated.

In 11 subjects who smoked three cigarettes per hour for a 3-hour period, urinary free catecholamine excretion increased 2.5 µg./hr. (21 per cent) and total catecholamine excretion increased 3.1 µg./hr. (16 per cent). FFA elevations occurred in all subjects during the smoking period.

In three subjects, repeated control determinations of their FFA response to smoking were made and a rise was observed in each instance. Sympathetic ganglionic blockade was then induced with methaphan camphorsulfonate and the smoking tests were repeated. No rise in FFA after smoking occurred following blockade.

Eight patients, who had previously undergone bilateral adrenalectomy for the treatment of hypertension, were studied for their FFA response to smoking. In six subjects there was no significant elevation. In two subjects there was a minimal effect.

These findings indicate that for cigarette smoking to cause an increase in serum free fatty acids both the adrenal glands and the sympathetic nervous system must be functioning, probably to produce an effective level of circulating catecholamines.
Intrapericardial Aortico-Pulmonary Artery Shunt
Authors: REDO S. FRANK , ECKER ROGER R.
Published: June 2012

An operative procedure for the creation of an aorticopulmonary artery anastomosis with use of a Teflon prosthesis was developed.

After laboratory trial in animals, the operation was performed in six patients varying in age from 2 months to 14 years. In all but one instance the shunt remained patent. The longest observation in dogs is 1½ years. In this animal the shunt has remained open and there has been no evidence of pulmonary or cardiac embarrassment.

One child, 5 years of age, has lived 10 months after the operation. He has had marked improvement in his cyanosis and clubbing, his hematocrit value remains less than 50 per cent, and he is generally well.

The operation should carry no more risk than a Blalock-Taussig or Potts procedure and is thought to be another, perhaps better, method for increasing pulmonary blood flow in cyanotic infants and children.
The Clinical Usefulness of Hydrogen Gas as an Indicator of Left-to-Right Shunts
Authors: HUGENHOLTZ PAUL G. , SCHWARK THOMAS , MONROE R. GRIER , GAMBLE WALTER J. , HAUCK ANNA J. , NADAS ALEXANDER S.
Published: June 2012

In 60 patients with congenital heart disease 210 observations with hydrogen gas as an indicator for left-to-right shunts were recorded at cardiac catheterization. All but nine had other definite evidence of the presence or absence of left-to-right shunting. In these nine, 21 early hydrogen arrival times formed the only conclusive evidence of left-to-right shunting.

Although hydrogen and oxygen may form a highly explosive mixture, pure hydrogen used with proper precautions is a safe, reliable, and extremely simple indicator, eminently suited as a rapid screening procedure or as a supplementary tool in cases in which left-to-right shunts are difficult to prove.
Spatial Magnitude, Orientation, and Velocity of the Normal and Abnormal QRS Complex
Authors: YANO KATSUHIKO , PIPBERGER HUBERT V.
Published: June 2012

Curves of spatial magnitude, orientation, and velocity of the QRS complex were obtained by digital computation from 252 normal and 328 abnormal orthogonal electrocardiograms (Frank system). An attempt was made to evaluate the diagnostic usefulness of this type of spatial data display. Because of interindividual variability in QRS duration it was not possible to compare accurately individual records with normal standards. Normalization in time was, therefore, necessary by dividing each QRS complex in time in 10 equal parts. Mean curves were computed for the normal control group and eight pathologic entities. Although differences in configuration between the various groups became evident, a large overlap between the various ranges prevented an efficient classification for diagnostic purposes.

A point-by-point separation between normal ranges and individual curves showed high recognition rates for abnormalities without specific diagnostic classification. The highest information content appeared to be present in curves of spatial orientation.

Since time-normalization and numerical statistical analysis of multiple points are not feasible with presently available analog computers, the question is raised whether digital computation is not more efficient in diagnostic classification of electrocardiograms.
The Medical Management of Clinical Endocardial Fibroelastosis
Authors: MANNING JAMES A. , SELLERS FRANK J. , BYNUM RUFUS S. , KEITH JOHN D.
Published: June 2012

Fifty-six patients with the clinical diagnosis of primary endocardial fibroelastosis have been reviewed. There was an over-all mortality rate of 44 per cent and a long-term survival of 56 per cent. Of 31 long-term survivors, 27 are without cardiac symptomatology or cardiomegaly. The method and rationale of therapy are reviewed.
Evaluation of Myocardial Blood Perfusion in Man with Radioactive Potassium or Rubidium and Precordial Counting
Authors: DONATO LUIGI , BARTOLOMEI GIANCARLO , GIORDANI ROBERTO
Published: June 2012

The myocardial clearance of potassium may be obtained by precordial counting after a single intravenous injection of K
42
Cl or Rb
86
Cl. The theoretical foundations of the method and the technic developed have been presented and discussed.

The distribution of the values obtained in normal subjects and in subjects with coronary insufficiency is in agreement with the clinical expectancy, and changes of the observed MCK after nitroglycerin agree with the results obtained by other investigators who measured coronary blood flow by the indirect Fick method.

In agreement with the observations of other investigators in rats and dogs, the amount of K
42
or Rb
86
in the myocardium was found to change very little for an appreciable time interval after the first circulation, despite the significant recirculation and the decreasing arterial concentration. This observation and the fact that MCK values in normal subjects closely agree with the accepted values for coronary blood flow confirm Sapirstein's findings in rats and dogs, and support the view that the organ uptake of Rb
86
or K
42
immediately after single intravenous injection reflects the fractional organ blood flow.

As obtained with the present technic, and similarly with the indirect Fick method, MCK reflects the flow per gram of myocardium and not the total coronary blood flow. MCK, however, has the advantage that every unit volume of myocardium, no matter how well it is perfused or through which vessels it is drained, contributes to the precordial counting rate in variable proportions determined by the efficiency of the counting method.
Recording the Electrocardiogram during the Performance of the Master Two-Step Test: I
Authors: ROSENFELD ISADORE , MASTER ARTHUR M. , ROSENFELD CAMILLA
Published: June 2012

Various technics for recording the electrocardiogram while the patient was exercising on the Master two-step apparatus were evaluated. Satisfactory tracings were obtained both by radiotelemetry (when the apparatus was properly aligned) and a direct hook-up technic that requires only standard equipment. Recommended electrodes are described, electrode positions discussed, and possible pitfalls of the technics enumerated. It is concluded that for the specific purpose of monitoring the two-step test, radiotelemetry is unnecessary and perhaps less desirable than direct hook-up monitoring.
Effects of Small Oral Doses of Reserpine on Vascular
Authors: ABBOUD FRANCOIS M. , ECKSTEIN JOHN W.
Published: June 2012

Experiments were done to see if reserpine, in small oral doses, alters the responses to tyramine and norepinephrine in man. Each of seven normotensive subjects was studied on three occasions. The first and third sessions served as pre- and post-treatment control sessions; the second session was held after oral administration of reserpine (0.25 to 1 mg. per day) for 2 weeks. Blood pressure was measured with a sphygmomanometer, and forearm blood flow was measured with a water plethysmograph. Reserpine reduced resting blood pressure and heart rate but forearm blood flow did not change. The pressor, forearm vasoconstrictor, and bradycrotic actions of intravenous tyramine were suppressed by reserpine, but the pressor, vasoconstrictor, and bradycrotic actions of three intravenous doses of norepinephrine were not augmented significantly. The results indicate that oral administration of small doses of reserpine may cause depletion of endogenous catecholamines in man as suggested by the suppressed response to tyramine. The decreased response to tyramine was not accompanied by hypersensitivity to exogenous norepinephrine. In equipressor doses norepinephrine produced greater forearm vasoconstriction and more reflex bradycardia than did tyramine.
Comparison of the Hemodynamic Effects of Mercurial Diuretics and Digitalis in Congestive Heart Failure
Authors: RADER BERTHA , SMITH WARREN W. , BERGER ADOLPH R. , EICHNA LUDWIG W.
Published: June 2012

The non-xanthine-containing mercurial diuretic mercaptomerin (Thiomerin), a noncardiotonic agent, was given repeatedly to 14 patients with congestive heart failure until all edema fluid had been eliminated. There resulted relief of subjective symptoms and removal of the characteristic physical signs of circulatory congestion to the point where subjects were considered in "cardiac compensation"; reduction of the elevated intracardiac pressures, in the right atrium, right ventricle, and pulmonary artery; variable changes in cardiac function (cardiac output) and cardiocirculatory (arterial-mixed venous oxygen difference) function, with improvement toward normal in half of the patients and no change in the other half.

In subjects in whom full mercurial diuresis alone improved the cardiac and cardiocirculatory functions, subsequent digitalization produced no further improvement in these functions. These patients were in a first or second episode of cardiac decompensation.

In subjects in whom full diuresis alone did not alter the cardiac and cardiocirculatory dynamics, subsequent digitalization produced an increase in cardiac output and a decrease in A-V oxygen difference toward normal values. These subjects usually had had one or several previous episodes of congestive failure.

When there was persistent chronic congestive heart failure, neither mercurial diuretic nor digitalis therapy altered the low cardiac output or the high A-V oxygen difference. Removal of the edema and vascular congestion by diuresis alone nevertheless produced subjective improvement.

In those patients in whom an increase in cardiac output occurred as the mercurial diuretic eliminated edema and lowered the elevated intracardiac pressures, the response may be considered consistent with Starling's law of the heart in man in congestive heart failure.

The data clearly make the point that it is the circulatory congestion that produces the symptoms and the physical signs traditionally considered characteristic of congestive heart failure. Removal of the circulatory congestion, however accomplished, relieves the symptoms and physical signs of congestive heart failure, regardless of whether or not cardiac function is improved toward the normal.

Circulatory congestion does not necessarily indicate, nor correlate with, the status of cardiac function.
Physiologic Studies of Pulmonary Edema at High Altitude
Authors: HULTGREN HERBERT N. , LOPEZ CESAR E. , LUNDBERG EINAR , MILLER HARRY
Published: June 2012

Cardiac catheterization studies have been performed in four patients during acute pulmonary edema at an elevation of 12,300 feet in the central Peruvian Andes.

Pulmonary hypertension, low cardiac output, arterial unsaturation, and low normal pulmonary artery wedge pressures were observed. Oxygen breathing was accompanied by a prompt, marked fall in pulmonary artery pressure and a slight rise in wedge pressure, indicating the presence of anoxic pulmonary arteriolar constriction.

In one patient, pulmonary artery wedge pressures were not elevated during added hypoxia nor during exercise. The blood pressure response to the Valsalva maneuver was normal.

Similar studies were carried out in four subjects after recovery from pulmonary edema. One 9-year-old boy had persisting pulmonary hypertension. None had evidence of underlying cardiac disease. An abnormal rise in pulmonary artery pressure during induced hypoxia was observed in three of four patients.

It is concluded that pulmonary edema at high altitude is a unique form of pulmonary edema produced by hypoxia under certain conditions of exposure at high altitude. Severe pulmonary hypertension due to anoxic pulmonary arteriolar constriction is present. There is no evidence that pulmonary venous constriction and cardiac failure are causative mechanisms.
Intracardiac Oximetry in Congenital Heart Disease
Authors: ENSON YALE , JAMESON A. GREGORY , COURNAND ANDRÉ
Published: June 2012

A fiberoptic reflection oximeter has been adapted to the diagnostic study of patients suspected of having congenital heart disease. The results of 10 successive catheterizations with use of this technic are reported and compared with the results obtained in the same subjects with a standard sampling technic.

A large number of determinations was possible without blood loss. The results were immediately available for use in directing the manipulation of the catheter. Freedom from the distortions attendant upon catheter sampling permitted precise observation of the nature of flow across a ventricular septal defect and of the relationship between blood oxygen saturation in the main pulmonary artery and the pulmonary arterial wedge position.
The Q-II Interval
Authors: SHAH PRAVIN M. , SLODKI SHELDON J.
Published: June 2012

A study of the second heart sound in 112 normal adults ranging in age from 21 to 50 years is presented, along with results, in 15 patients with advanced systemic hypertension.

A detailed analysis of the Q-II
A
and Q-II
P
intervals, as related to heart rate, respiration, age, and blood pressure had been performed. A linear dependence on the √RR interval was noted in both groups.

With advancing age, a statistically significant decrease in the Q-II
P
was noted in the normal subjects.

A decreased mobility of the Q-II
A
and Q-II
P
intervals with respiration was described.

In hypertensive subjects, a significant prolongation of both the Q-II
A
and Q-II
P
intervals without variation in the II-
A-P
interval (splitting) as compared to the normal subjects was found. The effect of respiration on the splitting of the second sound was also found to be comparable to the normal for the same age group.

The relationship of changes in ventricular dynamics to systemic hypertension are discussed on the basis of these findings.
Absence of the Pulmonary Valve
Authors: CHILDERS RODERICK W. , MCCREA PATRICK C.
Published: June 2012

A case of the Marfan syndrome with congenital absence of the pulmonary valve, ventricular septal defect, and aneurysms of the pulmonary artery and sinus of Valsalva is described. The literature is reviewed and a classification of this rare anomaly is offered.
Congenital Stenosis of the Pulmonary Artery Branches
Authors: BAUM DAVID , KHOURY GEORGE H. , ONGLEY PATRICK A. , SWAN H. J. C. , KINCAID OWINGS W.
Published: June 2012

Eighteen cases of stenosis of the branches of the pulmonary artery, seen at the Mayo Clinic, have been reviewed and subdivided into two main types: Type I, stenosis of the main branches of the pulmonary artery, 11 cases, and type II, stenosis of multiple peripheral branches of the pulmonary arteries, seven cases. Of special interest were two cases in which thrombosis occurred as a complication and one case in which surgical relief of multiple areas of stenosis in the peripheral branches of the pulmonary arteries was accomplished.

Unexplained pulmonary hypertension necessitates further investigation, which includes cardiac catheterization for measurement of intracardiac pressure and frequently selective angiocardiography.

Main branch or peripheral pulmonary artery stenosis should be suspected when a continuous murmur is heard or when poststenotic dilatations of the pulmonary artery branches or areas of decreased pulmonary vasculature can be perceived in the roentgenogram. Angiocardiography is the only technic that permits detailed anatomic evaluation of the entire pulmonary vasculature, especially in the cases associated with severe infundibular or valvular pulmonic stenosis.

Stenosis of the branches of the pulmonary artery must be taken into account, when surgical repair of associated cardiovascular defects is considered. These lesions also might complicate anastomotic procedures involving the pulmonary artery in cyanotic patients.
Atrial Fibrillation in Flying Personnel
Authors: LAMB LAWRENCE E. , POLLARD LAWRENCE W.
Published: June 2012

Sixty cases of atrial fibrillation from the USAF flying population are reported. Follow-up information in 59 subjects averaged 41.2 months.

Only three cases of persistent atrial fibrillation were detected and two of these had normal sinus rhythm prior to the onset of atrial fibrillation.

There were 21 cases of recurrent paroxysmal atrial fibrillation and 36 cases of isolated acute atrial fibrillation associated with a variety of precipitating factors. Thyrotoxicosis was notable by its absence in any of these cases of atrial fibrillation.

Symptomatology either related to the primary disorder precipitating atrial fibrillation or secondary to the arrhythmia itself was frequently observed.

The hemodynamic effects of atrial fibrillation on cardiac output, and cerebral artery spasm with diminished cerebral blood flow are important aeromedical considerations.
Localization of the Aortic Valve by Intracavitary Electrocardiography
Authors: UNDERHILL WILLIAM L. , HELLERSTEIN HERMAN K. , TREDWAY JOHN B. , D'ANGELO GEORGE J.
Published: June 2012

The intracavitary electrocardiogram was studied in the aortic outflow tract during left heart catheterization to determine its usefulness in accurately locating the aortic valve.

Twenty-eight of 31 cases studied showed a significant electrocardiographic change at the valve which was not observed elsewhere. Changes noted included decrease in QRS voltage, qualitative QRS change, and P-wave change.

The routine use of the intracardiac electrocardiogram in conjunction with other technics is advocated.
Idiopathic Hypertrophic Subaortic Stenosis: III. Intraoperative Studies of the Mechanism of Obstruction and Its Hemodynamic Consequences
Authors: PIERCE GEORGE E. , MORROW ANDREW G. , BRAUNWALD EUGENE , Seipp Harry W. , Cobb David E. , Montgomery Maxine P.
Published: June 2012

Pressures in the left ventricle and central aorta were recorded together with instantaneous aortic blood flow at the time of operation in 9 patients. Four patients had IHSS, 4 had valvular or discrete subvalvular aortic stenosis, and 1 was considered to have a normal aortic valve and left ventricular outflow tract. In each of the 4 patients with IHSS, the pattern of aortic blood flow was distinctly abnormal when significant obstruction was present and nearly 80% of total flow took place in the first half of systole. In contrast, [see figure in the PDF file] the distribution of flow was symmetrical in all patients with discrete aortic stenosis.

When flow and the pressure gradient were related at brief intervals during systole, and the orifice size calculated, it was found that the orifice was always greatest at the onset of contraction, diminished rapidly in size, and often became totally obliterated toward the end of the ejection period in patients with IHSS. The size of the orifice remained constant during systole in the patients with discrete obstruction. The abnormalities of instantaneous aortic blood flow, and the rate of systolic narrowing of the subvalvular orifice were exaggerated following premature ventricular contractions, after the administration of pharmacologic agents with positive inotropic effects (isoproterenol and calcium chloride), and after reduction of the circulating blood volume. With valvular and discrete subaortic stenosis, however, these interventions did not change the symmetrical pattern of blood flow and the orifice area was constant. Augmentation of the circulating blood volume or partial occlusion of the ascending aorta decreased the severity of outflow obstruction in every patient with IHSS and converted the abnormal flow pattern to one characteristic of discrete stenosis.

These studies provide the first evidence of the instantaneous changes which occur within the outflow tract of the left ventricle in patients with IHSS, and provide information concerning the various mechanisms by which the intensity of obstruction may be modified.
Controlled Observations on the Effect of Low Sodium Dietotherapy in Essential Hypertension
Authors: CORCORAN A. C. , TAYLOR ROBERT D. , PAGE IRVINE H.
Published: June 2012

The effectiveness and practicality of low sodium diets are tested in groups of in- and outpatients. The data indicate that roughly one-fourth with severe essential hypertension can respond favorably to prolonged restriction of sodium intake to less than 0.5 Gm. daily. The rice diet is found to be in effect a simple low sodium diet. Under the conditions of outpatient practice, low sodium dietotherapy is usually impractical and must be controlled by frequent analyses of urinary sodium.
Cavity Potentials of the Human Ventricles
Authors: ZIMMERMAN HENRY A. , HELLERSTEIN HERMAN K.
Published: June 2012

Intracavitary potentials of the human left ventricle were studied in 8 patients by the technic of retrograde ulnar artery or, in one case, pulmonary vein catheterization. The intracavitary potentials from the left ventricle were of the QS variety and confirm Wilson's concept of the earlier depolarization of the intraventricular septum from left to right.
Characteristics of the Unipolar Precordial Electrocardiogram in Normal Infants
Authors: ZIEGLER ROBERT F.
Published: June 2012

The electrocardiogram should have as much clinical value in infants and children as in adults. Such value, as in adults, must depend upon an accurate knowledge of normal standards which change progressively during infancy and early childhood. Some of the more important measurements in the precordial leads of normal infants are presented and discussed. These measurements, the amplitude and the time of inscription of the intrinsic deflection, are believed to indicate the changing relationship between the mass of the right and left ventricles, and on the basis of these data it is also believed that an earlier and more accurate diagnosis of ventricular hypertrophy can be made at any age.
Digital Vascular Resistance in Normal, Polycythemic and Hypertensive States
Authors: MENDLOWITZ MILTON
Published: June 2012

The relationship between blood pressure and flow in the digital circulation has been found to be rectilinear. This makes it possible from a single pressure-flow determination to measure (1) digital vascular configuration volume index, (2) initial digital arterial caliber, (3) resistance in dyne second/cm.
5
, (4) resistance in dynes and (5) resistance in dynes/cm.
2
. The normal variations in these values and the deviations from the normal found in hypertension and polycythemia are presented.
The Q-T Interval in Chronic Cor Pulmonale
Authors: ALEXANDER JAMES K. , FERRER M. IRENÉ , HARVEY RÉJANE M. , COURNAND ANDRÉ
Published: June 2012

In 13 patients in whom the diagnosis of chronic cor pulmonale was made after careful physiologic studies, the Q-T interval was found to be within normal limits regardless of the presence or absence of cardiac failure. The finding is in sharp contrast to the prolongation of this interval in the more common types of heart disease, as exemplified by a group of 14 patients with hypertensive and arteriosclerotic heart disease. Measurement of the Q-T interval therefore may be useful in differentiating pure chronic cor pulmonale from other types of heart disease with congestive failure.
The Heart in Progressive Muscular Dystrophy
Authors: ZATUCHNI JACOB , AEGERTER ERNEST E. , MOLTHAN LYNDALL , SHUMAN CHARLES R.
Published: June 2012

A case of progressive muscular dystrophy with cardiac involvement in a young Negro man is reported. The presenting problem was cardiomegaly and congestive heart failure. It was not until compensation was achieved that the underlying myopathy became apparent. Death was unexpected and presumably sudden. An unusual finding at the postmortem examination was the marked thickening of the endocardium. The literature in regard to the clinical and pathologic manifestations of cardiac involvement in this myopathy is reviewed.
Cardiopulmonary Dynamics in Patients with Anastomosis of the Superior Vena Cava to the Right Pulmonary Artery
Authors: CANENT RAMON V. , SPACH MADISON S. , YOUNG W. GLENN
Published: June 2012

The cardiopulmonary dynamics of the circulation through the right lung were studied in six patients with severe cyanotic congenital heart disease who had undergone surgery with anastomosis of the superior vena cava to the right pulmonary artery. Pressure gradients across the right lung varied with respiratory changes in a way opposite from normal in that increasing intrathoracic pressure was associated with increased pressure gradients across the right lung. Radiocardiographic and cinefluorographic studies indicated that periods of changing intrathoracic pressure (spontaneous breathing and intermittent positive-pressure respiration) augmented flow, whereas absence of respiratory motion or sustained increased intrathoracic pressure (Valsalva maneuver) impeded flow through the right lung. The diminution of flow through the right lung during periods of sustained increased intrathoracic pressure occurred in the presence of an increased pressure gradient between the right pulmonary artery and left atrium.
Anomalous Origin of the Left Coronary Artery from the Pulmonary Trunk with Special Reference to the Occurrence of Mitral Insufficiency
Authors: NOREN GEORGE R. , RAGHIB GUNAY , MOLLER JAMES H. , AMPLATZ KURT , ADAMS PAUL , EDWARDS JESSE E.
Published: June 2012

Nine cases of anomalous origin of the left coronary artery from the pulmonary trunk, involving patients ranging in age from 2 months to 7 years, have been reviewed. In six patients, mitral insufficiency was a prominent feature and, in three of these patients, mitral insufficiency presented the major problem, clinically.

Of the five patients who died, necropsy was done in four. In each, healed infarction of the posterior papillary muscles of the left ventricle was demonstrated and, in two, the anterior papillary muscles were also involved.

The clinical picture was that of an acyanotic patient with nonspecific respiratory complaints and retardation of growth. In five patients, there were symptoms (although a presenting complaint in only one) which are considered classic for this anomaly. These symptoms included episodes of pallor, dyspnea, and perspiration. Eight patients experienced cardiac failure in infancy and response to digitalis was effective in each.

In this study, endocardial fibroelastosis, without associated cardiac malformations other than mitral insufficiency, presented difficulty in the differential diagnosis. The vectorcardiogram in the horizontal plane was most helpful in the diagnosis of anomalous origin of the left coronary from the pulmonary trunk. The QRS sÊ loop in the horizontal plane in this anomaly was oriented posteriorly to the left and its direction was clockwise, in contrast to the counterclockwise direction of the loop in endocardial fibroelastosis.

Selective ascending aortography or selective right coronary arteriography established the diagnosis in seven cases.
Effects of Norepinephrine on the Coronary Circulation in Man
Authors: YURCHAK PETER M. , ROLETT ELLIS L. , COHEN LAWRENCE S. , GORLIN RICHARD
Published: June 2012

The effect of norepinephrine infusion on the coronary circulation has been studied in 21 subjects. In doses ranging from 2 to 17 µg. base per minute norepinephrine caused a pari passu rise in perfusing pressure and coronary flow of 16 per cent above the control state. Despite an increase in cardiac oxygen consumption, coronary vascular resistance was unchanged, suggesting no vasodilatation in the coronary bed. On the contrary, oxygen extraction across the heart increased, implying that oxygen needs were inadequately met by rise in flow. An increase in vascular tone induced by norepinephrine is inferred from the unchanged coronary resistance at a higher perfusion pressure.

Responses of the normal and failing left ventricle groups were qualitatively the same as for the group as a whole. The failure group showed greater tendency to meet oxygen needs by increased extraction than did the normal hearts.

Although these observations are not strictly applicable to the role and effects of norepinephrine in states of clinical shock, nonetheless it seems likely that norepinephrine induces a suboptimal rise in coronary flow that may set the stage for ultimate myocardial ischemia, particularly when coronary perfusion pressure is inadequate.
Study of the Right Atrial Pressure Pulse in Functional Tricuspid Regurgitation and Normal Sinus Rhythm
Authors: RUBEIZ GEORGE A. , NASSAR MUNIR E. , DAGHER IBRAHIM K.
Published: June 2012

Six patients having mitral stenosis, functional tricuspid regurgitation, and normal sinus rhythm were studied.

All patients had a systolic murmur at the lower left sternal border that increased with inspiration. Five patients had right heart catheterization while all six had right atrial pressure-pulses obtained by direct puncture of the right atrium with a 20-gage needle during right thoracotomy. Functional tricuspid regurgitation was proved by subsequent digital exploration of the tricuspid valve. The right atrial pressure pulses obtained were analyzed. The curves taken with the needle-puncture of the right atrium were comparable to those obtained at right heart catheterization. The X descent was well preserved in all six cases. In five patients the X descent was deeper than the Y descent, while in only one patient was the X descent equal to the Y descent. There was no exaggeration of the V wave in any of the curves. The role played by the compliance of the right atrium in preserving the normal contour of the right atrial curve, in spite of tricuspid regurgitation, is discussed.

It is concluded that in functional tricuspid regurgitation with normal rhythm the normally preserved X descent followed by a normal V wave may persist in the right atrial curve. The application of this finding to the clinical study of the jugular venous pulse in functional tricuspid regurgitation and normal rhythm is evident.
Pathological Anatomy of Acute Hypertension of Pregnancy
Authors: MCCARTNEY CHARLES P.
Published: June 2012

With the possible exception of a unique glomerular lesion, the morphological changes in patients dying with convulsions, coma, and other complications of acute hypertension are not specific for a pathological entity initiated by aberrations peculiar to the pregnant state. Renal biopsies afford a means for classifying pregnant patients with acute hypertension. The glomerular lesion, believed to be pathognomonic of preeclampsia, was not found in 25% of 63 primiparas who fulfilled the clinical criteria for preeclampsia; chronic renal disease was present without the toxemic lesion in 30% of 214 pregnant patients with acute hypertension. These findings suggest that chronic renal disease plays a more important role in the acute hypertension of pregnancy than current statistics indicate, and that data pertaining to the hypertensive disorders of pregnancy must be interpreted with caution when their differentiation is based upon clinical criteria alone.
The Normal Apex Cardiogram
Authors: TAFUR EMILIO , COHEN LAWRENCE S. , LEVINE HAROLD D.
Published: June 2012

The configuration of the apex cardiogram and its temporal relationship to the electrocardiogram, phonocardiogram, carotid pulse, and jugular venous pulse were analyzed in 25 normal subjects. In two patients with rheumatic valvular disease simultaneous electrocardiograms, phonocardiograms, left intraventricular pressure and apex cardiograms were obtained. In all cases the apex cardiogram showed a characteristic and reproducible contour in both its systolic and diastolic components. The curves of the apex cardiogram display all consecutive phases of the cardiac cyle; contraction-and-emptying and relaxation-and-filling. It bears a constant relationship to the phonocardiogram and is more useful as a reference tracing for acoustic events than the electrocardiogram, carotid pulse, or jugular venous pulse. The onset of the systolic wave of the apex cardiogram precedes the rise of left intraventricular pressure and mitral valve closure. The maximal systolic peak of the apex cardiogram occurs simultaneously with the onset of left ventricular ejection and the rise of the carotid pulse pressure. Small deflections are frequently inscribed on the apex cardiogram at the time of mitral, tricuspid, and aortic valve closure.

The wave form of the apex cardiogram is caused primarily by movements of the left ventricle against the chest wall. It is thus a translation of the sequence of hemodynamic events occurring in the underlying left ventricle. The inaccuracy of the jugular venous pulse for timing right- and left-sided cardiac events is emphasized.
Pulmonic Regurgitation Following Staphylococcal Endocarditis
Authors: LEVIN HUGH S. , RUNCO VINCENT , WOOLEY CHARLES F. , RYAN JOSEPH M.
Published: June 2012

Isolated pulmonic regurgitation was found in a 30-year-old man 5 years after an episode of bacteriologically proved and successfully treated staphylococcal endocarditis. Intracardiac phonocardiography was useful in confirming the diagnosis, and simultaneous intracardiac pressure and sound recording afforded a plausible explanation for the unusual murmur of organic pulmonic insufficiency.
Asymmetric Division of the Pulmonary Artery
Authors: GIKNIS FRANCIS L. , BAISCH BRUCE F.
Published: June 2012

Asymmetric division of the pulmonary artery is reported in two cases. The right pulmonary artery arose immediately above the right cusp of the pulmonary valve, from a dilated trunk, which, although mistaken for main pulmonary artery, actually represented the proximal portion of the left pulmonary artery. A large interventricular septal defect, biventricular hypertrophy, and aortic hypoplasia complete the syndrome.

In one case the malformation was not recognized at the time of a banding procedure. The infant died, and the unprotected lung showed marked congestion at autopsy.

The nature of the pulmonary artery division may be such that an effective single band is technically impossible. Our case 1 suggests that unilateral banding in such an instance could be fatal if not immediately recognized and revised. Bilateral simultaneous banding would appear to be the palliative procedure of choice.
Repetitive Ventricular Arrhythmia Resulting from Artificial Internal Pacemaker
Authors: TAVEL MORTON E. , FISCH CHARLES
Published: June 2012

We have presented a case summary of a patient in whom several periods of repetitive ventricular arrhythmia—at times indistinguishable from fibrillation—were induced by artificial internal pacemaker stimuli falling in the T wave of a preceding cycle (the vulnerable period). Ours is the third such case to be reported and, although this repetitive response is said to be rare, the exact incidence remains to be determined. The theoretical and clinical implications are discussed and possible explanations are given for why such small artificial stimuli are capable of evoking such serious arrhythmias in certain patients. We also have suggested measures that might reduce the likelihood for this complication to arise.
Cardiac Output as a Function of Ventricular Rate in a Patient with Complete Heart Block
Authors: GAAL PETER G. , GOLDBERG STANLEY J. , LINDE LEONARD M.
Published: June 2012

Hemodynamic effects of varying heart rate and activity have been studied in a young woman in good health except for complete heart block. As cardiac rate was increased from 50 to 110 beats per minute by means of an external cardiac pacemaker, cardiac output and stroke volume were found to reach maximum values at a rate of 75. Stroke volume increased 43 per cent with exercise when heart rate was fixed at 68 beats per minute. The ability of this patient to increase stroke volume with exercise, in contrast to average normal subjects, may be related to her past experience with chronically increased volume loads on the heart secondary to heart block.
Atheromatous Embolism
Authors: ELIOT ROBERT S. , KANJUH VLADIMIR I. , EDWARDS JESSE E.
Published: June 2012

From ulcerated atheromatous arterial lesions, crystals of cholesterol (cholesterol embolism) or larger fragments of atheromas (atheroembolism) may be dislodged. Such emboli may originate either in the aorta or in any of the major systemic arteries and lodge in their small ramifications.

Atheromatous embolism may yield states varying from those of subclinical nature to those of obvious arterial occlusion. Myocardial ischemia or infarction, small strokes, cutaneous nodules, splenic infarction, gastrointestinal bleeding, pancreatitis, hypertension, renal failure, and peripheral gangrene are among the clinical manifestations when arteries are occluded by emboli originating in atheromas of the aorta. Syndromes resembling polyarteritis nodosa and bacterial endocarditis may result from widespread embolism to small arteries.
Double-Outlet Right Ventricle with Intact Interventricular Septum
Authors: MACMAHON H. EDWARD , LIPA MICHAEL
Published: June 2012

This case is one of a 3-month-old infant showing complete transposition of the aorta, with both great vessels arising from the right ventricle. Of particular interest was the absence of a patent interventricular septum. A single but quite inadequate opening in the interatrial septum was the only visible means by which oxygenated blood from the lungs could reach the systemic circulation. No identical case has been found in the literature.