bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Malformations of the Heart Associated with Splenic Agenesis
Authors: GILBERT ENID F. , NISHIMURA KINSUKE , WEDUM BERNICE G.
Published: June 2012

This paper presents a theory for the cause of congenital malformations of the heart and other structures associated with absence of the spleen. A colmplete review of the literature and the data of the authors' 5 cases lead to this proposal: a lethal factor, possibly the product of a faulty ovulation, specifically affects the germinal bed of the mesoblastic surface of the coelom at an ovulatory age of 24 to 28 days.
A Method for the Detection and Estimation of Aortic Regurgitant Flow in Man
Authors: BRAUNWALD EUGENE , MORROW ANDREW G.
Published: June 2012

When a diastolic murmur is present at the base of the heart, it may be difficult on clinical grounds to determine whether or not aortic insufficiency is present. Further, in patients in whom this lesion definitely exists, the magnitude of aortic regurgitant flow has been the subject of considerable speculation among both clinicians and physiologists. A technic has been devised that not only makes possible the detection of aortic insufficiency but also permits an estimate of the regurgitant volume to be made.
Studies on the Renal Humoral Mechanism of Chronic Experimental Hypertension
Authors: TAQUINI ALBERTO C. , BLAQUIER PEDRO , TAQUINI ALBERTO C.
Published: June 2012

The renin content of the kidneys from chronic renal hypertensive dogs rises when the kidneys are transplanted to the neck of a normotensive nephrectomized animal. This elevation precedes and accompanies the elevation of the blood pressure of the recipient. This type of experiment does not allow one to draw conclusions concerning the humoral mechanism of chronic renal hypertension.
Adrenal Factors in Hypertension
Authors: CONN JEROME W.
Published: June 2012

The relation of adrenal function to hypertension in man is discussed. It is pointed out that hypertension accompanying hyperaldosteronism may recur after removal of the tumor and correction of the electrolyte abnormality. The complex relationship between blood pressure, excretion of sodium loads, total body sodium and aldosterone excretion is emphasized. Results following bilateral adrenalectomy in man indicate a permissive role for the adrenal cortex; this is further supported by the occasional clinical observation that certain patients with Addison's disease who have an unusual pressor response to substitution therapy have had a prior hypertension or a prominent family history of this disease.
Electrocardiograms of Ninety Patients with Acrosclerosis and Progressive Diffuse Sclerosis (Scleroderma)
Authors: WINDESHEIM JOHN H. , PARKIN THOMAS W.
Published: June 2012

The records of all patients with scleroderma seen at the Mayo Clinic during the years 1949 through 1953 were reviewed. There were 90 who had electrocardiograms available for study. The diagnosis in 63 patients was acrosclerosis and 27 were diagnosed as having progressive diffuse sclerosis.
Prevention and Management of Cardiovascular Emergencies
Authors: SPRAGUE HOWARD B. , METCALFE JAMES , GASUL BENJAMIN M. , SOLOFF LOUIS A. , SOKOLOW MAURICE , WOLF STEWART G.
Published: June 2012

The Panel Discussion on prevention and management of cardiovascular emergencies was conducted at the Thirtieth Scientific Session of the American Heart Association held at the Sherman Hotel, Chicago, Illinois, on Friday afternoon, October 25, 1957.
Pulsus Alternans in Aortic Stenosis
Authors: COOPER THEODORE , BRAUNWALD EUGENE , MORROW ANDREW G.
Published: June 2012

Alternation in the strength of left ventricular contractions was noted relatively frequently in patients with acquired aortic stenosis, but not in patients with congenital aortic stenosis of similar severity. The product of left ventricular systolic pressure and heart rate, an index of the myocardial oxygen requirement, was significantly higher in those patients who exhibited persistent pulsus alternans.
Effect of Atherosclerosis and Age upon the Serum Mucoprotein and Hexosamine Levels in Man
Authors: SCHWARTZ COLIN J. , GILMORE HUGH R.
Published: June 2012

Serum mucoprotein and hexosamine levels have been determined in atherosclerotic, nonatherosclerotic, and young male subjects. A highly significant elevation of both fractions was noted in the atherosclerotic group. Elevations due to aging were also obtained. It is suggested that these results are consistent with the view that arterial wall mucopolysaccharide depolymerization plays a role in the pathogenesis of human atherosclerosis.
Plasma-Clearing Effect of Gastric Mucin in Healthy and Atherosclerotic Subjects under Basal Conditions
Authors: ROSSI BALDO , RULLI VINCENZO
Published: June 2012

Other substances, in addition to the heparin clearing factor, exert a plasma-clearing effect under experimental conditions. A mucin compound extracted from the pig gastric mucosa has recently been included among such substances. Its clearing effect, as evaluated by variations in plasma optical density, is as constant and evident as that of heparin, both in normal and atherosclerotic subjects under basal conditions. The resemblance in function between gastric mucin and heparin is accompanied by similarities in molecular structure between the 2 compounds. Gastric mucin may belong among the factors that under physiologic conditions regulate the transport and some phases of the intermediary metabolism of lipids.
A Reversible Nephrotic Syndrome Associated with Congestive Heart Failure
Authors: BURACK W. RICHARD , PRYCE JACK , GOODWIN JOHN F.
Published: June 2012

Attention is drawn to the occurrence of the nephrotic syndrome during chronic heart failure and to its reversibility over a period of months on a regimen of digitalis, lowsalt diet, and weekly, parenterally administered, mercurial diuretics. It is therefore concluded that the nephrotic syndrome was not caused by mercurial diuretics and is not a contraindication to their use. Reference is made to the poorly understood phenomenon of proteinuria in heart failure and its possible relationship to these cases.
Supravalvular Aortic Stenosis
Authors: DENIE J. J. , VERHEUGT A. P.
Published: June 2012

A case of supravalvular aortic stenosis is described. The diagnosis was suspected from pressure curves obtained at retrograde catheterization of the left ventricle. At operation a circular narrowing of the aorta 2 cm. above the valvular ring was seen. No attempt at surgical correction was made; the patient died at the end of the operation.
The Determination of Cardiac Output by the Dilution Method without Arterial Sampling
Authors: PRITCHARD WALTER H. , MACINTYRE WILLIAM J. , MOIR THOMAS W.
Published: June 2012

Technics for determining the cardiac output by recording the dilution curve of injected iodinated I
131
human serum albumin from precordial sites have been described. By viewing predominantly either the right or left side of the heart and by rapid delivery of the isotope, quantitation of the dilution curves for cardiac output has been possible without critical requirements for placement of the counter. In a series of 26 determinations in normal patients cardiac output values calculated from simultaneously recorded precordial curves and withdrawn arterial blood showed an average agreement within ± 8 per cent. In a smaller series of 8 determinations on patients in heart failure, an average deviation of ± 9 per cent was found.
Ballistocardiogram in Chronic Severe Anemia
Authors: SANGHVI L. M. , BANERJEE K.
Published: June 2012

Serial ballistocardiograms of 30 patients with chronic severe anemia were studied to assess the cardiovascular state in anemia and after the cure of anemia. The findings in the ballistocardiogram have been compared to those in the electrocardiogram and the roentgenogram. Significance of an abnormal ballistocardiogram, after the cure of anemia is stressed.
Clinical Study of Twenty-Three Cases of Ebstein's Anomaly of the Tricuspid Valve
Authors: SCHIEBLER GEROLD L. , ADAMS PAUL , ANDERSON RAY C. , AMPLATZ KURT , LESTER RICHARD G.
Published: June 2012

The clinical findings in 23 cases of Ebstein's anomaly are presented, together with a discussion of the diagnostic and surgical aspects of this defect. Attention is again drawn to the frequent occurrence of the Wolff-Parkinson-White electrocardiographic pattern in this anomaly.
A Case of Abnormal Cardiac Position (Levoposition)
Authors: ROWE G. G. , PAUL L. W.
Published: June 2012

Dextroposition and levoposition are both believed to be forms of cardiac malposition that arise in early fetal life. It is believed that this is the first case of levoposition reported.

When cardiac positions are grossly abnormal, special investigations are required to establish normality of cardiac function, since usual criteria for physical findings, electrocardiographic data, and radiographic determination of size and shape may not be applicable.
The Effect of the Dependent Position upon Blood Flow in the Limbs
Authors: WILKINS ROBERT W. , HALPERIN MEYER H. , LITTER JULIUS
Published: June 2012

The blood flow, as reflected by the arteriovenous oxygen difference, in the arms and legs is greater in the dependent position than in the horizontal position. The physiologic and clinical significance of this finding is discussed.
The Nature of Pressor Substances in Pheochromocytomas
Authors: PITCAIRN D. M. , YOUMANS W. B.
Published: June 2012

The actions of aqueous extracts of two pheochromocytomas are compared before and after the administration of the adrenergic blocking agent, Dibenamine. One tumor contained predominantly a substance which, like norepinephrine, had pressor actions after Dibenamine. The other tumor contained chiefly an epinephrine-like substance. The significance of the presence of norepinephrine in pheochromocytomas and its role in epinephrine metabolism are discussed.
Pathology of the Pulmonary Vascular Tree
Authors: CIVIN W. HAROLD , EDWARDS JESSE E.
Published: June 2012

The case to be reported is characterized by stenosis of the ostium infundibuli of the right ventricle and biventricular origin of the aorta. Certain of the anatomic features of the heart in this case are similar to those of the Eisenmenger complex. One difference between the two conditions is that in the case herewith reported subpulmonary (infundibular) stenosis existed, while in the Eisenmenger complex there is no anatomic barrier to pulmonary blood flow, either in the heart or great vessels. On these gross anatomic differences seem to depend the differences in structure of the intrapulmonary arteries in the two conditions.
A Synthetic Anticoagulant: A Polysulfuric Acid Ester of Polyanhydromannuronic Acid (Paritol)
Authors: SORENSON C. W. , WRIGHT IRVING S.
Published: June 2012

The effects of the use of Paritol administered intravenously to 35 individuals are herein reported. This synthetic anticoagulant produces a prolongation of the clotting time similar to that produced by heparin but of longer duration, if appropriate dosage is used. As with heparin, at therapeutic clotting time levels, the prothrombin time is slightly prolonged. Certain untoward effects have been noted and are described. Further studies with Paritol appear justified in order to evaluate its usefulness as a rapidly acting anticoagulant.
Effect of Choline and Inositol on Plasma and Tissue Lipids and on Spontaneous and Stilbestrol-Induced Atherosclerosis in the Chick
Authors: STAMLER J. , BOLENE C. , HARRIS R. , KATZ L. N.
Published: June 2012

The lipotropic factors choline and inositol fail to influence cholesterolemia, lipemia, tissue lipid concentrations, spontaneous and stilbestrol-induced atherosclerosis in the chick.
An Empiric Approach to the Interpretation of the Low Frequency Critically Damped Ballistocardiogram
Authors: JONES RICHARD J. , GOULDER NORMAN E.
Published: June 2012

For the first time, the range of variation in amplitude and temporal relationships of the first four waves of the critically damped ballistocardiogram are presented for two groups of normal subjects. Characteristic deviations from this range are described in patients with vertical hearts, essential hypertension, coarctation of the aorta and aortic insufficiency. The relationship of the cardiac position to the first two patterns is reported. Explanation is found for these observations in current ballistocardiographic theory.
The Effect of Smoking upon Blood Flow in the Sympathectomized Limb
Authors: RAPAPORT SAMUEL I. , FRANK HUGH A. , MASSELL THEODORE B.
Published: June 2012

The effect of smoking upon the blood flow of a sympathectomized limb was examined in 19 patients. Sympathectomy was found to abolish the peripheral vasoconstriction produced by smoking. The constriction, therefore, is mediated by sympathetic vasomotor fibers and not by humoral agents such as adrenaline or posterior pituitary hormone. There is no difference in the response of patients sympathectomized for thromboangiitis obliterans, arteriosclerosis or severe vasospasm. The relation between the vasoconstrictor effect of smoking and the action of tobacco in thromboangiitis obliterans is discussed.
Effect of Acetylcholine on Pulmonary Vascular Resistance in a Patient with Idiopathic Pulmonary Hypertension
Authors: MARSHALL ROBERT J. , HELMHOLZ H. FREDERIC , SHEPHERD JOHN T.
Published: June 2012

Necropsy studies in cases of pulmonary hypertension of unknown cause show structural changes in the pulmonary vessels that are called irreversible. Acetylcholine chloride was infused at a rate of 2 mg. per minute into the outflow tract of the right ventricle of a 48-year-old woman who had pulmonary hypertension. The mean pulmonary artery pressure decreased from 56 to 25 mm. Hg and the pulmonary flow increased slightly. These findings are consistent with the theory that so-called idiopathic pulmonary hypertension may at some stage be maintained by vasoconstriction.
A Syndrome Featuring Defects of the Heart, Sternum, Diaphragm, and Anterior Abdominal Wall
Authors: CRITTENDEN I. HUNTER , ADAMS FORREST H. , MULDER DONALD G.
Published: June 2012

Three patients featuring a syndrome of defects of the heart, sternum, diaphragm, and anterior abdominal wall are presented. The striking similarity of the anomalies manifested by the 3 cases posed a question whether or not a recognized syndrome previously existed. In order to determine this, a search was made to find other such cases, and an attempt was made to establish a common embryologic pathogenesis. Review of the literature as well as extensive personal communication was carried out. Embryology of the involved organs was considered in order to determine a specific phase of defective development.
Primary Arteritis of Abdominal Aorta in Children Causing Bilateral Stenosis of Renal Arteries and Hypertension
Authors: DANARAJ T. J. , ONG WONG HEE
Published: June 2012

The clinicopathologic findings are described in 2 children in whom a localized arteritis of the abdominal aorta had occluded both renal artery orifices to produce hypertension. The relation to primary arteritis of the aortic arch or Takayashu's syndrome is discussed.
Electrocardiographic Studies in Pulmonary Disease
Authors: SPODICK DAVID H.
Published: June 2012

Criteria based on changes in P waves are proposed for the electrocardiographic detection of diffuse lung disease. In a "blind" evaluation of 100 consecutively admitted patients these proved highly accurate.
Chronic Idiopathic Pericardial Effusion without Tamponade
Authors: CONNOLLY DANIEL C. , DRY THOMAS J. , GOOD C. ALLEN , CLAGETT O. THERON , BURCHELL HOWARD B.
Published: June 2012

Persistent pericardial effusion in the absence of obvious preceding or concurrent disease presents a baffling problem. In such cases chylopericardium, cholesterol pericarditis, lupus erythematosus, malignant disease, myxedema, severe anemia, and scleroderma, must be considered. Six cases are reported with large effusions present for from 1 to 11 years. The diagnostic measures to be used, the results of histologic examination, and the effects of surgery on the clinical course are discussed.
Transventricular Mitral Valvotomy
Authors: GERBODE FRANK
Published: June 2012

In a consecutive series of 200 operations for relief of mitral stenosis, transventricular valvotomy was performed whenever digital valvotomy was found to be ineffective. The operative mortality was 12.5 per cent.

In a series of 17 second operations for mitral stenosis, the transventricular method was similarly used, with 2 operative deaths. A left lateral thoracotomy was employed, with reentry through the left atrium.

The results of transventricular valvotomy were more satisfactory than when the usual commissurotomy through the left atrium was employed.
Adrenoglomerulotropin
Authors: FARRELL GORDON
Published: June 2012

The secretion of aldosterone by the zona glomerulosa of the adrenal cortex is controlled by a system which is not completely understood. Volume receptors are of importance although other receptors may be involved. The midbrain contains elements which influence the secretion of the steroid since lesions in this area of the brain stem reduce aldosterone output. A lipid factor, adrenoglomerulotropin, obtained from pineal extracts, selectively stimulates secretion of aldosterone; but a second factor, also from the pineal gland inhibits the output of aldosterone as well as of cortisol. It is suggested that the control of the secretion of aldosterone may be by an excitatory-inhibitory system involving the interplay of pituitary corticotropin, adrenoglomerulotropin and an anticorticotropin of pineal origin.
On the Hemodynamic Regulation of the Secretion of Aldosterone
Authors: BARTTER FREDERIC C. , GANN DONALD S.
Published: June 2012

Evidence is presented that the secretion of aldosterone in dogs may be considerably influeneed by hemodynamic factors. The experiments indicate that secretion of aldosterone may be decreased by expanding the "low pressure" system, and may be increased by reducing the amplitude of the pulse pressure in the carotid arteries. The decrease may be prevented by prior section of the vagi, the increase by prior denervation of the thyro-carotid arterial junctions.
Environmental Factors in Coronary Heart Disease
Authors: MATHUR KRISHNA S.
Published: June 2012

Various factors relating to coronary heart disease were investigated in 2 groups of patients: 553 patients with clinical coronary heart disease and 1,056 persons selected in a field survey of the general population.

The incidence of coronary disease was high in the urban population, in the upper socioeconomic classes, and in persons with highest amounts of total dietary fat and highest percentage of calories from dietary fat. Total serum cholesterol, serum phospholipid, and cholesterol/phospholipid ratio were higher in the coronary group.

Finally, it seemed that physical activity was less and emotional stress and strain greater in the patients with coronary disease.

No relation between coronary disease and smoking or alcohol was established.
Idiopathic Dilatation of the Pulmonary Artery
Authors: DESHMUKH MADHUKAR , GUVENC SULAHATTIN , BENTIVOGLIO LAMBERTO , GOLDBERG HARRY
Published: June 2012

Thirteen patients with idiopathic dilatation of the pulmonary artery are described and their clinical, roentgenologic, electrocardiographic, and hemodynamic features are elaborated. Absence or mildness of symptoms was the most significant finding in this series. A pulmonic systolic murmur was constantly present. The roentgenogram showed various degrees of dilatation of the pulmonary artery in the presence of normal heart size. The electrocardiogram was normal. The hemodynamic studies showed a mild systolic pressure gradient across the pulmonic valve in some cases in the presence of normal right ventricular pressure. A possible explanation of this finding is discussed. Idiopathic dilatation of the pulmonary artery is a benign lesion and does not affect cardiac function to any appreciable degree.
Ion Transport in the Gut
Authors: GILMAN ALFRED , KOELLE ETHOL S.
Published: June 2012

The in vitro preparation of the small intestine of the rat is well suited for studies of ion transport. Data from this preparation indicate that the passage of water and electrolytes across the intestinal epithelium depends on active transport. Glycolysis seems to be involved as a source of energy for the transport of ions from the mucosal to the serosal aspect of the intestinal wall.
Impending Myocardial Infarction
Authors: BEAMISH R. E. , STORRIE V. MARIE
Published: June 2012

Coronary occlusion with myocardial infarction is a common condition with a high mortality. The mechanism of coronary occlusion in such cases is not always clear, but thrombosis, either directly or indirectly, is a dominant process.

In many instances premonitory symptoms give warning that myocardial infarction is threatening. It is suggested that these symptoms form a recognizable pattern which permits recognition of impending myocardial infarction with a high degree of accuracy. Three common presentations are described.

Frequency of diagnosis of impending infarction may be increased by a program of patient education.

Frompt administration of anticoagulants appears to influence the outcome favorably, particularly in the first few days or weeks of symptoms.
Clinical Recognition of Tricuspid Stenosis
Authors: PERLOFF JOSEPH K. , HARVEY W. PROCTOR
Published: June 2012

Clinical criteria for the recognition of tricuspid stenosis were studied in 13 cases, all personally observed by the authors. The results suggest that application of these criteria not only allows a confident diagnosis of tricuspid stenosis in a substantial majority of cases, but also allows the lesion to be recognized relatively early in its natural history.
"Primary" Pulmonary Hypertension with Coexisting Portal Hypertension
Authors: NAEYE RICHARD L.
Published: June 2012

Six cases are described in which there was a coexisting pulmonary arterial and portal venous hypertension. In 5 of the cases, the pulmonary vascular lesions responsible for the pulmonary hypertension resembled those seen in cases of recurrent embolization. Three of the cases had portal venous thromboses. One of these also had thrombosis of esophageal varices. These thrombi may have been the site of origin for pulmonary emboli. Other possible causes of the pulmonary vascular lesions are also discussed. In one case, there was a severe necrotizing arteritis in the pulmonary arterial tree.
Hormones, Cholesterol, and Coronary Atherosclerosis
Authors: KURLAND GEORGE S. , FREEDBERG A. STONE
Published: June 2012

Various hormones have been shown to play an important role in lipid metabolism. Clinical and experimental observations implicate the thyroid, adrenal, gonadal, and pituitary glands in atherogenesis. The evidence is strongest that estrogens play a role in human atherosclerosis. The influence of hypothyroidism requires further study and clarification. Hormones and lipids are obviously not the only factors important in atherogenesis; hypertension, local tissue factors, and altered intravascular coagulation in all probability significantly influence the natural history of the disease.
The Direction of Blood Flow in Anomalous Left Coronary Artery Arising from the Pulmonary Artery
Authors: SABISTON DAVID C. , NEILL CATHERINE A. , TAUSSIG HELEN B.
Published: June 2012

An infant with anomalous origin of the left coronary artery from the pulmonary artery is presented, and the problem of the direction of blood flow in the anomalous vessel is discussed. Determinations of arterial pressure and oxygen saturation in the blood of the anomalous artery have demonstrated that the blood in this vessel flowed in a retrograde manner. It is concluded that in this condition oxygenated blood flows from the aorta into the normal right coronary artery and passes through collateral branches into the left coronary artery with ultimate drainage of the blood into the pulmonary artery. Ligation of the anomalous coronary artery with concomitant de-epicardialization appears to be a rational and effective method of therapy. For maximal effectiveness the operation should be performed prior to the onset of irreversible changes, and emphasis is placed upon the importance of early diagnosis and prompt treatment.
Common Circulatory Measurements in Smokers and Nonsmokers
Authors: BLACKBURN HENRY , BROZEK JOSEF , TAYLOR HENRY L.
Published: June 2012

Pulse rates and blood pressure, and circulatory responses to pressor stimuli were compared in habitual smokers and nonsmokers in an attempt to ascertain possible "chronic effects" of tobacco smoking on the circulation.

Several common cardiovascular measurements were made in 4 groups, a total of 1,093 men, ages 17 to 67, and comparisons made with reference to the cigarette smoking habit. Acute effects of smoking were eliminated and, when possible, effects of age and weight were eliminated statistically.

Relative body weight is consistently lower in the "heavy" cigarette smokers compared to those who "never" smoked.

Basal oxygen consumption is slightly higher in smokers than in nonsmokers. Pulse rate during work and recovery is significantly higher in one group of middle-aged men if pathologic cases in the group are considered.

In "normal" populations, somewhat preselected for absence of hypertension, no differences in resting blood pressures are found between smokers and nonsmokers. In the broader studies, involving samples of the working population, smoking is associated with lower systolic and diastolic pressures.

Circulatory responses to stimuli of the cold pressor test and carbon dioxide inhalation reveal a small but significant diminished diastolic pressure response to cold and possibly a greater systolic response to carbon dioxide in smokers.

Young student groups, with short duration of smoking habit, show no significant differences between smokers and nonsmokers for these circulatory parameters.

The associations found do not provide evidence for large or important differences in circulatory reactivity between groups of habitual smokers and nonsmokers. There is little evidence for deterioration of cardiovascular "fitness" in smokers performing work tests.

The small magnitude of the differences found in circulatory measurements, plus certain sources of bias which are discussed, preclude serious consideration at present of these factors as underlying causes of the increased mortality rate among smokers. Other questions unanswered concern the importance of individual circulatory responses, individual hypersensitivity to smoking, and the significance of acute pressor and other effects of smoking on persons with cardiovascular disease, latent or manifest.
Pulmonary Artery Banding
Authors: ALBERT HAROLD M. , FOWLER RICHARD L. , CRAIGHEAD CLAUDE C. , GLASS BERTRAM A. , ATIK MOHAMMAD
Published: June 2012

The technic of banding the pulmonary artery is described.

Twenty infants with intractable cardiac failure secondary to interventricular septal defects have had banding with one operative and one late death.

The operation is palliative, and definitive surgery probably must be done when the child is 3 to 5 years of age.

Banding the pulmonary artery is a relatively safe procedure but the mortality of banding plus ventricular closure and unbanding remains to be evaluated.
Intracardiac Knotting of the Catheter during Right Heart Catheterization
Authors: SKINNER JOHN F. , BURROUGHS JOHN T.
Published: June 2012

A complication of right heart catheterization is reported in which the catheter became knotted and entangled in the chordae tendineae of the tricuspid valve. Removal required open cardiotomy with hypothermia and temporary inflow occlusion.
A Hemodynamic Technic for the Detection of Hypertrophic Subaortic Stenosis
Authors: BROCKENBROUGH EDWIN C. , BRAUNWALD EUGENE , MORROW ANDREW G.
Published: June 2012

In the presence of valvular aortic stenosis or of discrete subvalvular stenosis, the narrowed orifice is constant and its size is not altered by changes in the force of ventricular contraction. In hypertrophic subaortic stenosis the orifice narrows during systolic contraction of the hypertrophied muscle in the left ventricular outflow tract and the orifice size therefore is a function of the force of left ventricular contraction. In 75 patients, proved to have the discrete, "fixed" type of aortic or subaortic stenosis the beats following the compensatory pause after a premature contraction were always characterized by higher left ventricular systolic pressures and larger systemic arterial pulse pressures than the normal beats, i.e., arterial pulse pressure varied directly with left ventricular systolic pressure and with the duration of diastole. In 12 patients proved to have hypertrophic subaortic stenosis, the beats following premature contractions always exhibited
lower
arterial pulse pressures than did the normal beats, i.e., arterial pulse pressure varied
inversely
with left ventricular systolic pressure and with the duration of diastole. The distinction between these two types of obstruction to left ventricular outflow may be established with confidence by this analysis of the effects of premature ventricular contractions on either the simultaneously recorded left ventricular and arterial pressure pulses, or on the arterial pressure pulses alone. The recognition of hypertrophic subaortic stenosis is essential in formulating a rational plan of treatment for all patients with obstruction to left ventricular outflow, and the hemodynamic technic described affords a simple but reliable diagnostic approach.
Effects of Reduced Glomerular Filtration Rate on Responsiveness to Chlorothiazide and Mercurial Diuretics
Authors: REUBI F. C. , COTTIER P. T.
Published: June 2012

Clearance experiments have been performed in 24 subjects with different levels of glomerular filtration, suffering from renal disease without edema, in order to compare the diuretic, saluretic, and kaliuretic responses to a single intravenous injection of meralluride, chlorothiazide, or both together. The inulin clearances of these patients ranged from 5.9 to 135 ml. per minute. The effects of the drugs were studied under constant loading with saline over 3 hours after injection.

Our results indicate that over a wide range (15 to 20 ml. per minute up to normal values) a permanent reduction of the glomerular filtration rate has little influence on the diuretic and saluretic effects of meralluride or chlorothiazide. Below 15 to 20 ml. per minute a further reduction results in a sharp decrease in the diuretic and saluretic actions. This can be best explained by assuming that the diuretic agents block an increasing fraction or the tubular reabsorption of water, sodium, and chloride related to the decrease in glomerular filtration rate. This fraction, however, seems to be limited to 30 to 40 per cent of the filtered load. Some dispersion in the glomerulo-tubular activity may account for the splay of the experimental curves.

The kaliuretic effect of chlorothiazide is proportional to the glomerular filtration rate. This effect can be blocked by meralluride.

At high levels of glomerular filtration the diuretic and saluretic actions of meralluride and chlorothiazide are additive. At lower levels of filtration, such a summation effect is not demonstrable. Apparently, both drugs given together cannot block the reabsorption of more than 30 to 40 per cent of the filtered load.

A single injection of chlorothiazide does not lower the arterial blood pressure of hypertensive subjects, loaded with saline, but produces a slight decrease in the glomerular filtration rate, averaging 7 per cent.
The Association of Complete Heart Block and Adams-Stokes Syndrome in Two Cases of Mobitz Type of Block
Authors: KAUFMAN JEROME G. , WACHTEL FRED W. , ROTHFIELD EDWIN , BERNSTEIN ARTHUR
Published: June 2012

Two cases exhibiting the Mobitz-type of second-degree atrioventricular heart block are reported.

This rhythm may be unstable, and progression to complete heart block and Adams-Stokes seizures has been observed.
Congenital Mitral Insufficiency
Authors: TALNER NORMAN S. , STERN AARON M. , SLOAN HERBERT E.
Published: June 2012

The clinical and hemodynamic findings in 10 patients with mitral insufficiency on a congenital basis are described.

Six of these patients have had repair of the defects with dramatic clinical improvement noted. The findings at the time of surgical repair have been summarized.

The severity of the symptoms and the benefits to be derived from surgical repair should encourage vigorous attempts to establish the correct diagnosis. This is best accomplished by either recording the typical left atrial pressure pulse of mitral insufficiency during left heart catheterization or by left ventricular angiography to demonstrate the regurgitation of contrast material into the left atrium.
Aneurysms of the Previously Ligated Patent Ductus Arteriosus
Authors: ROSS RICHARD S. , FEDER FREDERICK P. , SPENCER FRANK C.
Published: June 2012

Five cases of postoperative aneurysm of the ductus arteriosus are presented and discussed, together with 12 from the literature. The ductus had become recanalized in all 17 patients. Infection was present in 11, having existed preoperatively in only two of these cases. The evidence suggests that contamination at the time of surgery was responsible for the infection in at least seven cases.
Effect of Exercise on Electrocardiograms of Patients with Low Serum Potassium
Authors: GEORGOPOULOS A. J. , PROUDFIT W. L. , PAGE IRVINE H.
Published: June 2012

Twelve adult patients (10 hypertensive and two normotensive) with low serum potassium levels but without electrocardiographic signs diagnostic of hypokalemia were subjected to nonstrenuous exercise.

Electrocardiographic signs of hypokalemia appeared following exercise in all but the two hypertensive patients receiving digitalis. The severity of the changes and the duration correlated with the degree of hypokalemia present prior to exercise. The results were similar in the normotensive and hypertensive patients and in those made chronically or acutely hypokalemic. Following potassium repletion, exercise did not produce electrocardiographic changes of hypokalemia.

The frequency with which S-T segment and T-wave changes occurred following exercise during potassium depletion suggested that hypokalemia can introduce an error in interpreting results of exercise tolerance tests in patients receiving thiazide compounds, when serum potassium is at the low normal or borderline level.

These results may reflect intracellular myocardial potassium depletion brought on by exercise.
Plasma Heparin Levels in Normal Man
Authors: ENGELBERG H. , Dudley Anne
Published: June 2012

Endogenous plasma heparin levels were determined in duplicate in 153 males and 103 females.

Heparin is normally present in human plasma in values ranging from 10 to 24 units per cent (1 to 2.4 mg. per liter). The range of average values was from 1.53 to 1.77 mg. per liter.

No age or sex difference was found.
The Surgical Therapy of Extracardiac Anomalous Pulmonary Drainage
Authors: VETTO ROY R. , DILLARD DAVID H. , JONES THOMAS W. , WINTERSCHEID LOREN C. , MERENDINO K. ALVIN
Published: June 2012

The English surgical literature was reviewed for a 10-year period between 1950 and 1960. A total of 166 patients with anomalous pulmonary venous drainage treated surgically was found. Of this number, 65 patients had total anomalous pulmonary venous drainage (40 per cent). Ninety-five patients (57 per cent) had anomalous venous drainage via
extracardiac channels.
The over-all survival rate for 166 patients was 74 per cent. The single lesion with the lowest survival rate (35 per cent) was total anomalous pulmonary venous drainage via a persistent left anterior cardinal vein. Of the 34 patients in this category, only three (9 per cent) had a complete repair of the anomalous drainage with survival.

A series of 10 patients with anomalous venous drainage via
extracardiac
channels operated on with the aid of extracorporeal circulation is reported. There were three deaths. Drainage occurred via the superior vena cava (six patients), the coronary sinus (two patients), and a persistent left anterior cardinal vein (two patients). Included in the series is a fourth instance of successful complete repair of total anomalous pulmonary venous drainage via a persistent left anterior cardinal vein. The clinical features, methods of repair, and perfusion data are reviewed.

An important aspect of treatment for total anomalous pulmonary venous drainage is the realization that impedance of pulmonary venous outflow is extremely hazardous. It is suggested that pulmonary venous pressure be monitored when complete repair is contemplated. If complete occlusion of decompressive channels causes a significant increase in the pulmonary venous pressure, some avenue of decompression should be left; otherwise, venous infarction of the lungs with probable fatality will result.
Congenital Communication of a Coronary Artery with a Cardiac Chamber or the Pulmonary Trunk ("Coronary Artery Fistula")
Authors: NEUFELD HENRY N. , LESTER RICHARD G. , ADAMS PAUL , ANDERSON RAY C. , LILLEHEI C. WALTON , EDWARDS JESSE E.
Published: June 2012

Anatomic, clinical, hemodynamic, and roentgenographic findings in six patients with congenital communication of a coronary artery with a cardiac chamber or the pulmonary trunk are presented. The literature is reviewed.

A coronary artery may communicate anomalously, with any of the cardiac chambers, more commonly with those on the right side. In the six cases presented, the right coronary artery communicated with the right atrium in one case and with the right ventricle in another. The left coronary artery communicated with the right atrium and right ventricle in one case each, and with the pulmonary trunk in two cases.

The most striking feature observed clinically was a continuous murmur. If a continous murmur is localized in an area atypical for patent ductus arteriosus, the diagnosis should be suspected. Conventional roentgenographic and electrocardiographic studies yielded no specific diagnostic features. The results of cardiac catheterization may reveal a left-to-right shunt, but they are diagnostically useful only when correlated with clinical findings.

The only precise method of demonstrating the abnormality is by means of selective aortography performed by injecting medium into the very origin of the aorta.

Cure is possible by surgical interruption of the fistulous tract.
The Mechanism of Respiratory Variation in Splitting of the Second Heart Sound
Authors: CASTLE ROBERT F. , JONES KENNETH L.
Published: June 2012

This study of 68 normal children has shown that in the supine position and under conditions of normal respiration splitting of the second sound averages .02 second in expiration and .04 second in inspiration. Inspiratory increase in splitting of the second sound is the result not only of a delay in pulmonic valve closure but also of earlier aortic closure. Movement of the aortic component is responsible, on the average, for 35 per cent of the difference in splitting of the second sound in inspiration and expiration.
Coagulation Tests and Platelet Economy in Atherosclerotic and Control Subjects
Authors: MURPHY E. A. , MUSTARD J. F.
Published: June 2012

Blood coagulation was studied in 31 atherosclerotic male subjects and in 44 control male subjects.

The mean platelet adhesive index was significantly greater in the atherosclerotic group and the plasma thromboplastin time was significantly shorter. These two tests are measures of the activity of the early stages of coagulation. The other in vitro tests of coagulation showed no significant differences.

At present, platelet consumption is probably the only available measure of the activity of the early stages of coagulation in vivo. Platelet survival and daily turnover was accordingly determined with DFP
32
. Mean platelet survival was shorter and mean platelet turnover was greater in the atherosclerotic group.

Division of the groups according to family history of atherosclerosis proved important. The most clearly separated groups were the atherosclerotic group with a positive history and the controls with a negative history. The remaining two subgroups are much more alike. This was true of both in vitro and in vivo tests.

Despite the high experimental error, the in vivo tests correlate well with the in vitro tests of the early stages of clotting though poorly with tests of the later stages. It is concluded that differences exist between atherosclerotic and control subjects in the early stages of coagulation, and that in vitro tests are satisfactory indices of this difference. In their present form, none of these tests is suitable for diagnostic or prognostic purposes in the individual.
Auscultatory and Phonocardiographic Signs of Ventricular Septal Defect with Left-to-Right Shunt
Authors: LEATHAM AUBREY , SEGAL BERNARD
Published: June 2012

Ventricular septal defect with low pulmonary vascular resistance and left-to-right shunt is well known to be closely associated with a pansystolic murmur caused by the regurgitant shunt of blood at high velocity across the defect. With very high flows a pulmonary ejection murmur is superimposed on the pansystolic murmur and is occasionally the only systolic murmur if the ventricular septal defect is so large that the velocity of the shunt is small. In two patients thought to have small ventricular septal defects the shunt murmur was confined to early systole, probably because the defect was in the muscular septum and was closed by systolic contraction of the ventricle.

The second heart sound is abnormally widely split in the majority of patients, even with small defects. The mechanism is difficult to elucidate but there appears to be slight shortening of the left ventricular isometric time (early A
2
) and delay in contraction of the right ventricle (late P
2
). The splitting of the second sound is a useful way of differentiating the large defects with left-to-right shunt from the Eisenmenger group of large defects with equal pulmonary and systemic vascular resistances and a loud single second sound.

The auscultatory differential diagnosis of ventricular septal defect is discussed.
Two Cases of Total Anomalous Pulmonary Venous Return of the Supracardiac Type with Stenosis Simulating Infradiaphragmatic Drainage
Authors: KAUFFMAN SHIRLEY L. , ORES CELIA N. , ANDERSEN DOROTHY H.
Published: June 2012

Two patients who died during the neonatal period with congestive heart failure and marked pulmonary congestion were found at autopsy to have total anomalous pulmonary venous return of the supracardiac type with stenosis of the pulmonary vein. The narrowing was the result of an unusual course of the vein, which passed between the left pulmonary artery and left main bronchus and was stenosed at this point. It is emphasized that the clinical and x-ray findings were indistinguishable from those of total anomalous pulmonary drainage below the diaphragm.
External Electrical Termination of Supraventricular Arrhythmias in Congenital Heart Disease
Authors: PAUL MILTON H. , MILLER ROBERT A.
Published: June 2012

Persistent supraventricular arrhythmias of the flutter or fibrillation-flutter type have been terminated by elective external electric countershock in three patients after drug therapy had been unsuccessful.

It is suggested that this technic is a relatively safe and effective treatment for supraventricular as well as ventricular arrhythmias when anti-arrhythmic drugs have proved ineffective.
Recurrent Stenosis of the Mitral Valve
Authors: DE JESUS JOSE R. , BRENEMAN GERALD M. , KEYES JOHN W.
Published: June 2012

Forty-three patients with suspected restenosis of the mitral valve are reported. Forty of these occurred in a series of 672 mitral commissurotomies. A significant degree of recurrent stenosis was found in 40 of the 43 cases at the time of the second operation. The clinical features and findings in these patients are discussed, as well as the probable etiologic factors. Left heart catheterization is indicated in many of these cases to define precisely the hemodynamic status, particularly in those individuals with suspected concomitant mitral incompetency or myocardial disease. Open-heart surgery should significantly improve the results of a repeat mitral commissurotomy.
The Effect of Venous Occlusion on Serum Cholesterol and Total Protein Concentration—A Warning
Authors: PAGE IRVINE H. , MOINUDDIN M.
Published: June 2012

Serum total cholesterol and total protein concentrations are increased with venous occlusion lasting longer than 2 minutes probably due to hemoconcentration. The range of per cent increase in cholesterol and total protein is as large as 19.8 and 41.0 and 20.0 and 33.5 respectively at the end of 5- and 10-minute periods of venous occlusion. This error introduces serious mistakes in the measurement of this important component of the mechanism of atherogenesis.
Analysis of the Normal and Abnormal Vectorcardiogram in Its Own Reference Frame
Authors: PIPBERGER HUBERT V. , CARTER THOMAS N. , Pipberger Hanna A.
Published: June 2012

Vectorcardiograms from 296 patients with a variety of ECG abnormalities were compared with normal standards obtained from 249 subjects without evidence of heart disease. A reference frame based on the spatial orientation of QRS loops rather than on conventional plane projections was used. Burger's polar vector and Schellong's QRS plane form the main parameters of such a reference frame. Spatial QRS orientation is defined by one term, the polar vector, which is perpendicular to the QRS plane. The direction of this vector can be determined through rotation of the QRS loop into its principal plane by means of a VCG lead resolver. Further analysis of QRS in its principal plane then becomes independent of inter-individual variability in spatial QRS direction. Separation between normal and abnormal was used as an indicator for the diagnostic quality of various measurements. Two corrected orthogonal lead systems designed by Schmitt and Frank were used for the study. These systems did not differ appreciably in the extent of normal ranges nor in the discrimination between normal and abnormal.

The polar vector appeared as the best indicator for abnormalities. In 65 per cent of the pathologic cases this parameter was found outside normal limits. Measurements derived from the contour and principal axes of QRS planes improved the recognition rate for abnormalities. Ratios expressing the degree of QRS planarity, however, contributed little to diagnostic accuracy. The QRS-T angle obtained in the QRS plane improved the recognition rate mainly in the series with ventricular hypertrophies. It could be demonstrated that without evaluation of time and voltage criteria between 85 and 100 per cent of all pathologic records could be recognized as abnormal when the vectorcardiograms were analyzed in their own reference frame. Thus, it appeared that this method of analysis has a considerable diagnostic potential and compares favorably with those used more commonly in clinical electrocardiography and vectorcardiography.
Acute Pulmonary Edema of Altitude
Authors: FRED HERBERT L. , SCHMIDT ALEXANDER M. , BATES TALCOTT , HECHT HANS H.
Published: June 2012

Three separate episodes of acute pulmonary edema are described that developed in two otherwise healthy individuals during heavy exertion at high altitudes. Detailed physical examination and laboratory studies failed to demonstrate pulmonary infection or cardiac disease. Data obtained by cardiac catheterization during one of these episodes revealed elevation of the pulmonary artery pressure and a normal left atrial pressure.

This syndrome appears to be the consequence of pulmonary vascular obstruction distal to the capillary bed, presumably in the pulmonary veins. It is brought about by exposure of susceptible individuals to high altitudes, and is completely reversed by oxygen administration.