bluuebunny/crossref_metadata_2025 huggingface dataset:
The Combined Use of CPIB and Thyroxine in Treatment of Hyperlipoproteinemias
Authors: STRISOWER EDWARD H.
Published: June 2012

The combined effect of CPIB and levothyroxine on lipoprotein concentrations in 13 patients with various types of hyperlipoproteinemias has been investigated. Analysis of long-term observations indicates the following: (1) CPIB lowers Sf 20-10
5
concentrations profoundly regardless of the initial lipoprotein distribution. (2) Addition of levothyroxine to CPIB produces no further significant effect on Sf 20-10
5
concentrations. (3) The effect of CPIB on Sf 0-20 concentrations appears to depend on the initial lipoprotein distribution. In carbohydrate-sensitive hyperlipemias CPIB can markedly increase Sf 0-20 levels, whereas it has no such effect in other hyperlipoproteinemias. On occasion, a marked Sf 0-20 lowering effect occurs in patients with Sf 0-20 hyperlipoproteinemias. Two such instances are reported in detail. (4) In combined Sf 0-20 and Sf 20-10
5
hyperlipoproteinemias the combination of CPIB and thyroxine is often more effective than either agent used separately in reducing total lipoprotein concentrations.
Congenital Anomalies Involving the Coronary Sinus
Authors: MANTINI EMIL , GRONDIN CLAUDE M. , LILLEHEI C. WALTON , EDWARDS JESSE E.
Published: June 2012

A classification is presented of anomalies involving the coronary sinus. These anomalies are classified into four anatomic groups on the basis of (1) enlargement of the coronary sinus, (2) absence of the coronary sinus, (3) atresia of the right atrial coronary sinus ostium, and (4) hypoplasia of the coronary sinus. Anomalies involving the coronary sinus often are associated with other venous anomalies, either of the systemic or the pulmonary circulation. In some there is no basic disturbance of the circulation. Those conditions involving the coronary sinus which are of major functional significance participate in shunts, either left-to-right or right-to-left in nature. Enlargement of the coronary sinus in the absence of a shunt usually indicates that a systemic venous channel joins the coronary sinus anomalously.
Effects of Changes in Body Position on the Severity of Obstruction to Left Ventricular Outflow in Idiopathic Hypertrophic Subaortic Stenosis
Authors: MASON DEAN T. , BRAUNWALD EUGENE , ROSS JOHN
Published: June 2012

The circulatory responses to alterations in posture were determined in 10 patients with idiopathic hypertrophic subaortic stenosis. Tilting to a 45° head-up position augmented the subaortic gradient by an average of 35 mm Hg and intensified the obstruction to left ventricular outflow. In addition, the post-extrasystolic decrease of the arterial pulse pressure became more prominent. Tilting to a 20° head-down position reduced the gradient by an average of 11 mm Hg and tended to reduce the severity of the obstruction. Elevation of the lower extremities also resulted in a reduction of the intraventricular systolic pressure gradient, the reduction averaging 28 mm Hg, and apparently increased the dimensions of the obstructing orifice.

It is postulated that these effects on the obstruction to outflow induced by changes in posture result primarily from alterations in left ventricular volume secondary to changes in venous return. As a consequence, in the upright position, the size of the left ventricular outflow tract is reduced and the intraventricular pressure gradient is augmented while the cardiac output is reduced, resulting in an intensification of the obstruction. The opposite changes occur during the head-down tilt or during elevation of the legs.

These hemodynamic findings provide an explanation for the intensification of symptoms commonly experienced by patients with idiopathic hypertrophic subaortic stenosis in the erect position, and for the discrepancies between the symptoms and the severity of obstruction determined by cardiac catheterization carried out in the supine position. Assumption of the head-down, legs-up position is suggested as an emergency therapeutic maneuver for patients with hypertrophic subaortic stenosis.
Effects of Amyl Nitrite in Aortic Valvular and Muscular Subaortic Stenosis
Authors: HANCOCK E. W. , FOWKES W. C.
Published: June 2012

The effects of amyl nitrite inhalation were observed in 12 patients with aortic valve stenosis and five patients with muscular subaortic stenosis during left heart catheterization. In aortic valve stenosis the left ventricular systolic pressure always fell, although less than the brachial arterial pressure, and the transaortic systolic pressure gradient rose by an average of 25% due to the increase in left ventricular ejection rate. In muscular subaortic stenosis, the left ventricular pressure always remained the same or rose despite a marked fall in brachial arterial pressure, and the average increase in transaortic systolic pressure gradient was more than fourfold. This effect was associated with a significant increase in the degree of outflow tract obstruction. The increase in outflow tract obstruction is thought to be due to a decrease in left ventricular volume, causing the hypertrophied walls of the left ventricle to become more closely apposed.

We believe that inhalation of amyl nitrite is superior to infusion of isoproterenol as a provocative test for muscular subaortic stenosis during cardiac catheterization and is probably the most potent stimulus available for this purpose.
The Second Sound-Mitral Opening Snap (A2-OS) Interval during Exercise in the Evaluation of Mitral Stenosis
Authors: DELMAN ABNER J. , GORDON GARET M. , STEIN EMANUEL , ESCHER DORIS J. W.
Published: June 2012

Cardiac catheterization and phonocardiography data were obtained from patients with mitral stenosis at rest and during exercise. There was a linear relationship between the percentage decrease of the interval from closure of the aortic valve to the mitral valve opening snap (A2-OS) and the percentage increase [see figure in the PDF file] of the left atrial mean pressure from rest to exercise. The duration of the A2-OS interval was an effective indicator of the level of the left atrial mean pressure during exercise. The duration of the A2-OS interval during exercise allowed separation of patients with mild stenosis from those with moderate or severe stenosis but could not be used to distinguish moderate stenosis from severe stenosis.
Validity of Indicator-Dilution Determinations of Cardiac Output in Patients with Mitral Regurgitation
Authors: SAMET PHILIP , BERNSTEIN WILLIAM H. , CASTILLO CESAR
Published: June 2012

A total of 532 groups of indicator-dilution determinations of cardiac index were performed in four groups of patients, many with mitral regurgitation. The indicator, indocyanine green, was injected into the right atrium and sampled from both the pulmonary and systemic arterial trees. The potential problem imposed by early recirculation of indicator particles was present in the latter but not the former dilution curves. The absence of physiologically significant differences between the two sampling sites demonstrates that even severe mitral regurgitation does not vitiate indicator-dilution determination of cardiac output after right heart injection and systemic arterial sampling if the downstroke of the primary dilution curve permits a straight line semilogarithmic extrapolation.
Heart Weight of Jamaicans
Authors: HAYES J. A. , LOVELL H. G.
Published: June 2012

The heart weight and the weights of the component parts have been measured in a group of 126 Jamaicans of African origin on whom autopsy was performed at the Pathology Department of the University of the West Indies. This series comprised 58 normal [see table in the PDF file] cases, 46 cases of hypertension, and 22 cases of chronic lung disease.

The mean heart weight for normal males was 294.5 g and for females 258.5 g. These figures are similar to those reported from Uganda but less than those from Britain and North America. The differences in heart weight are probably correlated with difference in body size.

Total heart weight in the hypertensives was greater than in normals because of left ventricular hypertrophy. In chronic lung disease total heart weight was greater than that of normals due to enlargement of the right ventricle and of the combined atria. Right ventricular weight was also increased in cases of hypertension.
Electrocardiograms of Dogs with Heart Homografts
Authors: LOWER RICHARD R. , DONG EUGENE , GLAZENER FREDERIC S.
Published: June 2012

Serial electrocardiograms from 50 dogs which survived 4 days to 12 months with orthotopic cardiac homografts have been evaluated. Although sinus rhythm is the basic mechanism in all homografted hearts, arrhythmias are frequently encountered early in the post-transplant period and later during episodes of threatened rejection. The decrease in QRS voltage which consistently accompanies impending rejection makes the electrocardiogram indispensable in monitoring the cardiac homograft.
The Cardiomyopathy of Progressive Muscular Dystrophy
Authors: PERLOFF JOSEPH K. , DE LEON ANTONIO C. , O'DOHERTY DESMOND
Published: June 2012

A prospective study was undertaken in order to examine the histories, physical signs, phonocardiograms, electrocardiograms, vectorcardiograms, X-rays, serum enzymes, pulmonary ventilatory findings, and hemodynamics in a group of 55 patients selected solely on the basis of one of the major types of progressive muscular dystrophy (table 9). The classification included: (1) the classic Duchenne type, (2) the limb girdle type, (3) the facioscapulohumeral type, and (4) a group of patients in whom clinical distinction between benign Duchenne dystrophy and limb girdle dystrophy with pseudohypertrophy could not be made. No patient had recognized heart disease prior to selection. Follow-up periods ranged from a few months to 5 years. The pertinent literature was extensively reviewed.

In all groups clinical evidence of heart disease had to be interpreted in the context of the influence of the somatic musculoskeletal defects on "cardiac" symptoms, cardiovascular physical signs, and radiological appearance of the heart. On the other hand, convincing evidence of intrinsic heart disease-subtle to overt-was found in each of the major categories of progressive muscular dystrophy. Detection of cardiomyopathy was simplest and most frequent in the classic Duchenne group because of the highly characteristic features of the scalar electrocardiogram which might direct attention to the systemic myopathy prior to its clinical recognition. However, the presence of heart disease in patients with forms of dystrophy other than the classic Duchenne deserves particular emphasis. Evidence of cardiomyopathy in these latter forms varied from subtle quadruple gallop rhythms in the limb girdle and facioscapulohumeral groups to cardiomyopathic death in the benign Duchenne and limb girdle-pseudohypertrophic group.

Currently available information on the heart in muscular dystrophy has as a rule depended upon retrospective studies, upon reviews of published reports of incompletely classified cases, upon discussions of individual cardiovascular features, or upon observations of individual types of dystrophy. The present prospective study was undertaken to obviate some of these shortcomings. Comprehensive assessment of a large and carefully classified group of dystrophic subjects has provided additional information regarding the clinical spectrum of dystrophic cardiomyopathy.
Staged Correction of Total Transposition of the Great Vessels
Authors: REED WILLIAM A. , LAUER RONALD M. , DIEHL ANTONI M.
Published: June 2012

Proper selection of palliative operation for transposition of the great vessels must be based on a careful anatomical and physiological diagnosis. Subsequent correction, utilizing the interatrial baffle technique, is possible with low risk in selected patients.

Details of the clinical course of four patients with transposition from birth to total correction are presented.
Clinical Considerations in the Surgical Management of Strokes
Authors: THOMPSON JESSE E. , KARTCHNER MARK M. , AUSTIN DALE J. , WHEELER CLARENCE G. , PATMAN RALPH D.
Published: June 2012

Four hundred carotid endarterectomies were performed on 320 private patients with cerebrovascular insufficiency during an eight-year period. Patients are classified into four groups: frank stroke (135 patients), transient cerebral ischemia (151 patients), chronic cerebral ischemia (13 patients), and asymptomatic bruit (21 patients). Over-all operative procedure mortality was 3.5%. In frank strokes it was 7.4%; in transient ischemia, 1.02%; and in the other two groups was zero. As a safety factor during operation, the routine use of an inlying bypass shunt is advocated.

Of 60 long-term deaths, six (10%) were due to strokes. Among frank stroke survivors, 42.8% are normal, and 48.4% are improved. One patient had a mild subsequent stroke. In transient ischemia survivors, 88.4% are normal, and 7% are improved. Three patients had strokes due to unoperated lesions. Surgery appears to have lowered the incidence of strokes in these groups. There were no strokes in the other two groups.

Indications for and timing of operative procedures are suggested on the basis of the clinical results. Transient ischemia, chronic ischemia, and asymptomatic bruit patients may be operated upon electively unless an imminent total occlusion demands emergency operation. Acute and rapidly progressing strokes should not be operated upon as an emergency, but allowed to stabilize and be considered for surgery at a delayed time.

The concept of total cerebral blood flow is discussed in relation to its therapeutic implications and the reversibility of neurological deficits. Carotid endarterectomy is a safe, definitive therapy in selected patients with cerebrovascular insufficiency.
Femorotibial Bypass
Authors: TYSON R. ROBERT , DELAURENTIS DOMINIC A.
Published: June 2012

Fourteen cases of arterial bypass, utilizing autogenous saphenous vein, have been presented in which the distal anastomosis was to one of the three major vessels in the lower leg. There were two early failures. The remaining ten are functioning satisfactorily today. In some of these cases, the preservation of the extremity, as well as restoration of function, was quite dramatic. The technique has been generally that used for arterial surgery in other parts of the body. This technique permitted anastomoses in small blood vessels measuring 1.5 to 3 mm in diameter.
Experimental Microvascular Suture Anastomosis
Authors: GREEN GEORGE E. , SOM MAX L. , WOLFF WILLIAM I.
Published: June 2012

To evaluate the limits imposed by blood vessel size on success or failure of vascular anastomosis by suture techniques, tiny vessels in young CFN rats were anastomosed by microsuture technique, using the Zeiss operating microscope at 16 and 25 magnifications. In series I aortae averaging 1.3 mm external diameter prior to manipulation were divided transversely and rejoined by suture anastomosis. In series II inferior venae cavae averaging 2.7 mm external diameter prior to manipulation were similarly treated. In series III both of these procedures were performed in each animal. There were ten animals in each group.

Of 40 consecutive anastomoses only three were not patent when the animals were sacrificed three weeks after surgery. Two of the failures were arterial, and one was venous. This high success rate was achieved only when certain refinements in technique had been perfected.

The feasibility of suture anastomosis of extremely small veins as well as arteries has been demonstrated.
Hemodynamic Effects of a Totally Corrective Procedure in Transposition of the Great Vessels
Authors: KIDD LANGFORD , MUSTARD WILLIAM T.
Published: June 2012

1. The hemodynamic findings in four children with transposition of the great vessels who have been completely corrected are described and contrasted with the findings before and after the initial creation of an atrial septal defect.

2. All four cases exhibit full arterial oxygen saturation and have normal atrial pressures. The pressure tracings in the atria suggest that the pericardial baffle does not interfere with their function.

3. It is suggested that the left ventricle in transposition of the great vessels may assume the compliance characteristics of a normal right ventricle.

4. It is concluded that with this procedure it is possible to restore normal cardiac function and systemic oxygenation in children with complete transposition of the great vessels.
Role of Atelectasis in Surfactant Abnormalities Following Extracorporeal Circulation
Authors: GUEST JAMES L. , SEKULIC SRBOLJUB M. , YEH THOMAS J. , ELLISON LOIS T. , ELLISON ROBERT G.
Published: June 2012

Surface activity of lung extracts was determined in 36 patients and 28 dogs following extracorporeal circulation. Normal results were usually found. Abnormal surface tension was demonstrated only in a few samples obtained from grossly atelectatic or congested portions of lung, normal surface tension being present in adjoining areas of the same lung. Sources of error in surface-tension measurements and factors to be considered in the interpretation of results are discussed. A possible explanation for the discrepancies in results obtained by various investigators is presented.
Experimental Study and Clinical Use of Epinephrine for Treatment of Low Cardiac Output Syndrome
Authors: COFFIN LAURENCE H. , ANKENEY JAY L. , BEHELER EDWARD M.
Published: June 2012

Epinephrine in doses of 0.5 to 1.0 µg/kg/ min has been shown experimentally to augment cardiac output, with increases in both hepatosplanchnic and peripheral blood flow. At these concentrations, the primary effect of epinephrine is cardiotonic, without measurable vasoconstriction. Larger doses produce significant vasoconstriction with a decrease in cardiac output and a reduction in peripheral venous return. The mean rate of excess lactate accumulation was noted to be increased during epinephrine administration in animals with intact circulation, in spite of increased peripheral and hepatosplanchnic blood flow and oxygen consumption. With the heart and lungs functionally excluded by a pump oxygenator, low doses of epinephrine produced no "excess lactate," even though peripheral constriction was measured. Clinical experience indicates that continuous infusion of 0.1 to 0.5 µg/kg/min of epinephrine is effective in the treatment of postoperative low cardiac output syndrome.
Use of Corticosteroids During Cardiopulmonary Bypass: Possible Lysosome Stabilization
Authors: REPLOGLE ROBERT L. , GAZZANIGA ALAN B. , GROSS ROBERT E.
Published: June 2012

1. These studies suggest that massive doses of dexamethasone may stabilize the lysosome membrane during periods of circulatory stress.

2. Some of the postoperative complications following cardiopulmonary bypass may be related in part to lysosome damage incurred during bypass.
Epicardiac Radiofrequency Cardiac Pacemaker Implant
Authors: ANAGNOSTOPOULOS C. E. , GLENN WILLIAM W. L. , HOLCOMB W. G. , VAN HEECKEREN D. W. , Hogan James , Katz Marvin
Published: June 2012

A newly designed epicardiac radiofrequency (RF) pacemaker implant is described. The technique allows for a possible two-month battery life and is more efficient and practical than previous RF epicardiac pacemakers. Preliminary studies on 20 animals show that stimulation with the conventional external RF unit, although difficult for prolonged periods in the canine (for anatomical reasons), is possible. Studies on electrode size and configuration were done, and the reasons for selecting a platinum peg electrode are discussed.
Demonstration of Intercoronary Anastomoses in Human Hearts with a Low Viscosity Perfusion Mass
Authors: ROBBINS S. L. , SOLOMON M. , BENNETT A.
Published: June 2012

The coronary arteries of 120 nonselected human hearts were perfused with a low viscosity radiopaque medium comprising essentially a suspension of barium sulfate in agar. In each of four groups of 30 hearts, one major artery was perfused, that is, right coronary, left main coronary, left anterior descending trunk, or left circumflex trunk. Anastomoses were detected either by cross-filling of unperfused vessels or by direct stereoscopic visualization. Anastomoses were demonstrable in 84% of the entire series, but the frequency varied between the four groups (right coronary 93%, left main coronary 90%, left anterior descending 90% and left circumflex 60%). The presence of stenotic disease did not seem to affect the frequency of demonstrable stenosis since 84% of the hearts virtually free of arterial disease contained recognizable stenoses as compared with 92% of hearts with a stenosis of more than 50% of the arterial lumen. Neither did age, hypertension or left ventricular hypertrophy produce any alteration in the frequency rates. There were seven hearts with occlusive disease; only five contained demonstrable anastomoses. The 19 hearts in the total series in which anastomoses could not be found were derived from patients, some of advanced age, some young, some having occlusive arterial disease and some hypertension.

The results of the study suggest that anastomoses are present in most hearts unrelated to clinical disease. They may be increased in size or number by factors that affect coronary hemodynamics, but the present study does not investigate this possibility.
Diagnostic Signs in Compressive Cardiac Disorders
Authors: LANGE RAMON L. , BOTTICELLI JAMES T. , TSAGARIS THEOFILOS J. , WALKER JOHN A. , GANI MUKHTAR , BUSTAMANTE RODRIGO A.
Published: June 2012

Thirty patients with primary cardiac compression due to constrictive pericarditis, lax effusion, or cardiac tamponade and an additional seven patients with spurious evidence of cardiac compression or with pericardial effusion playing an unimportant role in the circulatory disorder were studied. Rather stringently defined physical findings were sought which might allow discrimination between cardiac disorders. The following conclusions are drawn from the results.

1. Constrictive pericarditis is associated with venous and auscultatory phenomena which do not allow separation from other forms of heart disease causing congestive heart failure. Kussmaul's sign is present in less than 40%; pulsus paradoxus as classically defined is rare.

2. In lax pericardial effusion, Kussmaul's sign and Friedreich's sign, along with third heart sounds, are not present. Pulsus paradoxus is inconstant with tranquil breathing but is regularly induced by deep inspiration. There is inspiratory decrease in venous pressure and pericardial pressure. Cardiac index is normal and venous pressure is less than 12 mm Hg. Circulatory distress is not apparent.

3. Tamponade induces signs of circulatory distress and is regularly characterized by pulsus paradoxus but Friedreich's sign, a third heart sound, as well as Kussmaul's venous sign, are absent. The venous pressure exceeds 12 mm Hg. There is an inspiratory decrease in venous pressure and pericardial pressure. The low cardiac index is usually relieved by tap. When aortic stenosis is present, respiratory variation in left ventricular systolic pressure may not be reflected by clinical pulsus paradoxus.

4. Spurious signs of cardiac compression may be due to (1) respiratory disease, (2) severe myocardial disease and incidental effusion, or (3) obesity. In the respiratory disease pulsus paradoxus, normal cardiac index, low venous pressure, and venous and pericardial-pressure decrease with inspiration are present. The second group does not show pulsus paradoxus and the elevated venous pressure, diastolic dip, and third heart sounds are due to heart failure. Obesity may cause pulsus paradoxus and increased peripheral venous pressure, which does not reflect central venous pressure. These findings seem related to inspiratory collapse of extrathoracic vessels.
Blood Viscosity and Fibrinogen Concentration Following Cerebral Infarction
Authors: EISENBERG SEYMOUR
Published: June 2012

The viscosity of blood is significantly increased in persons with recent cerebral infarction. This is particularly true at slower rates of shear. This increase in viscosity is undoubtedly linked to an increase in fibrinogen concentration and erythrocyte concentration.
The Pulmonary Capillary Bed in Various Forms of Pulmonary Hypertension
Authors: MCCREDIE R. MICHAEL
Published: June 2012

Pulmonary diffusing capacity for CO (D
L
), membrane diffusing capacity (D
M
), and pulmonary capillary blood volume (V
c
) were measured in 44 patients with various forms and severity of pulmonary vascular disease, and these measurements were compared with hemodynamic data obtained at cardiac catheterization, with clinical disability, and, in 27 patients, with the results of corrective cardiac surgery. In 11 of these patients, D
L
, D
M
, and V
c
were remeasured up to 8 months after cardiac surgery.

In general, the diffusing characteristics and pressure-volume relationships in this larger group confirmed the previously reported findings in mitral valve disease.
1
D
M
was impaired in almost all cases regardless of etiology or severity. Most of the 11 patients restudied showed no change in D
L
, D
M
, or V
c
up to 8 months after surgery. Reduction in V
c
correlated well both with clinical disability and with surgical results.

Two patients with primary pulmonary hypertension and three of the four patients with equally severe pulmonary hypertension due to mitral valve disease had high V
c
relative to pulmonary vascular resistance. If the measurements of V
c
are not falsely high, then it appears that the capillary bed makes relatively and absolutely less contribution to the total rise in pulmonary vascular resistance in these patients. This could be explained by intense precapillary vasoconstriction in the presence of a relatively normal pulmonary capillary bed.
Pulmonary Venous and Arterial Hypertension due to Chronic Fibrous Mediastinitis
Authors: BOTTICELLI JAMES T. , SCHLUETER DONALD P. , LANGE RAMON L.
Published: June 2012

A patient with chronic fibrous mediastinitis presented with bronchial, superior vena caval, and pulmonary venous obstruction, pulmonary hypertension, and pulmonary fibrosis. Pulmonary venous obstruction was confirmed at surgery and explains the hemodynamic findings of elevated pulmonary artery and pulmonary wedge pressures despite low left atrial pressure. Pulmonary function studies showed marked alterations in ventilation-distribution, diffusion, work of breathing, and fixed airway resistance.

It is concluded that the pulmonary arterial hypertension was due, in large part, to the pulmonary venous hypertension caused by pulmonary venous obstruction. Unsuccessful surgical intervention has been followed by 10 months of observation during which aldosterone inhibition together with use of chlorothiazide has prevented recurrence of heart failure and pleural effusion.

The relationship between the physiological abnormalities and the patient's symptoms is discussed along with the possible relationship between pulmonary venous obstruction and pulmonary fibrosis.
Physiological Alterations in the Pulmonary Capillary Bed at Rest and During Exercise
Authors: KRUMHOLZ RICHARD A. , BRASHEAR RICHARD E. , DALY WALTER J. , ROSS JOSEPH C.
Published: June 2012

The reactivity of the pulmonary capillary bed during exercise as estimated by change in the pulmonary diffusing capacity (D
l
co
) has been shown to be dependent upon at least two separate mechanisms. The initial (0 to 10 second) D
l
co
rise with exercise appears to be volume-pressure dependent and may be altered by mechanisms influencing these factors in the lungs. The later elevation of D
l
co
with exercise was demonstrated to be primarily independent of the initial rise and uninfluenced by factors affecting peripheral venous return, that is body position and ganglionic blockade.
Cardioversion and Digitalis
Authors: KLEIGER ROBERT , LOWN BERNARD
Published: June 2012

The electrocardiograms before and immediately after cardioversion of 100 consecutive patients with chronic atrial fibrillation treated at the Peter Bent Brigham Hospital have been analyzed. Evidence of digitalis intoxication in the precardioversion tracing was associated with a significant increase in the incidence of serious ventricular ectopic activity following electrical shock. The role of digitalis in post-cardioversion arrhythmias is reviewed. The measures to reduce the incidence and gravity of such arrhythmias are outlined.
Bilateral Simultaneous Sphygmomanometry
Authors: TOOLE JAMES F. , TULLOCH E. FRANK
Published: June 2012

A series of 30 normal persons and four patients with proved subclavian steal were studied by use of a standard exercise test and an instrument devised by us for measuring blood pressure in the two arms simultaneously. No significant differences were found in the blood pressures in the arms of the normal persons in the base-line or exercise state, but in the patients with subclavian steal, exercise of the involved limb produced rapid fatigue and always reduced the blood pressure on the involved side. In one case, pulse pressure was lost completely so that there was no detectable blood pressure. In these four cases the radial pulse which had been palpable [see table in the PDF file] before the exercise test was either absent or barely palpable, and a definite pulse delay was detected on the involved side. The exercise test may serve to accentuate borderline differences in blood pressure and substantiate a clinical diagnosis of subclavian steal.
The Diastolic Murmur of Atrial Septal Defects as Detected by Intracardiac Phonocardiography
Authors: WENNEVOLD ALF
Published: June 2012

Intracardiac phonocardiography was performed in 18 patients with the secundum type of atrial septal defect.

In eight patients a delayed diastolic murmur was recorded in the inflow tract of the right ventricle and was probably due to the increased flow through the tricuspid valve; the murmur was audible at external auscultation in five of the patients.

In 13 patients a diastolic murmur was recorded in the right atrium; eight patients had an early diastolic murmur, two patients had a delayed diastolic murmur, and the remaining three patients had both kinds of murmurs.

The early diastolic murmur did not correspond in time to the murmur found in the right ventricle and was probably due to the flow through the defect. The delayed diastolic murmur could be due either to the flow through the tricuspid valve or through the defect. None of the atrial diastolic murmurs were audible at external auscultation.
Ligation of the Main Pulmonary Artery and Systemic-Pulmonary Arterial Anastomosis
Authors: BRAUNWALD EUGENE , MORROW ANDREW G. , FRIEDMAN WILLIAM F.
Published: June 2012

A new palliative operation is suggested for certain patients with transposition of the great arteries and ventricular septal defect. A systemic-pulmonary artery shunt is created, and the main pulmonary artery ligated. The operation converts transposition of the great arteries to a functional equivalent of truncus arteriosus with normal or nearly normal pulmonary blood flow, a malformation in which the functional derangement of the circulation is not as severe as it is in transposition. The hemodynamic consequences of the procedure were initially evaluated in two patients with pulmonary atresia and transposition, and both improved after shunts were created. The procedure was then carried out in a patient with transposition of the great arteries, ventricular septal defect, mild subpulmonic stenosis, and increased pulmonary blood flow. Postoperatively, the patient has exhibited considerable clinical improvement and significant elevation of arterial oxygen saturation.
An Unusual Late Complication of Pulmonary Artery Banding
Authors: OSBORN JAMES R. , HALL ROBERT J. , WINN DEAN F. , CAPPER ROBERT S. , BLAKE HU A.
Published: June 2012

An unusual case is reported in which severe cyanosis developed many months following banding of the pulmonary artery. The obstruction resulted from a thrombus which originated beneath the band and eventually almost completely occluded the main pulmonary artery. The late onset of severe cyanosis following a banding procedure should suggest this rare complication and prompt definitive hemodynamic and angiographic studies.
The Syndrome of Familial Defects of Heart and Upper Extremities (Holt-Oram Syndrome)
Authors: MASSUMI R. A. , NUTTER D. O.
Published: June 2012

Two families with familial defects of the heart and upper extremities and two sporadic cases of skeletal anomalies of the same type are reported.

In the most complete and prototypal form the syndrome consists of a secundum atrial septal defect of moderate size and the so-called radial defect of the upper extremities. However, less complete forms exhibiting cardiac anomalies alone, skeletal defects alone, or a combination of certain features of both, have been observed. Formes frustes undoubtedly occur.

The mode of inheritance seems to be autosomal dominant and of a high degree of penetrance.

Chromosome studies have suggested an abnormality in the pair 16.

Study of palm and sole prints have shown the abnormalities to be secondary to musculoskeletal defects and not likely to be genetically determined.

The syndrome is probably much more common than is realized. Identification of cases leading to the affected families depends upon awareness of pediatricians and orthopedists of its existence and inclusion of a careful examination of the upper extremities in all instances of atrial septal defect.
Infarction of Papillary Muscles and Mitral Insufficiency Associated with Congenital Aortic Stenosis
Authors: MOLLER JAMES H. , NAKIB AHMAD , EDWARDS JESSE E.
Published: June 2012

Study of the papillary muscles in 11 infants dying in the first year of life with congenital aortic stenosis and normal coronary arteries demonstrated infarction of the left ventricular papillary muscles in each. Lesions were more extensive in the posteromedial than in the anterolateral papillary muscle.

Infarction of papillary muscles is considered the basis for the common occurrence of mitral insufficiency in symptomatic infants with congenital aortic stenosis. Congenital aortic stenosis, infarction of left ventricular papillary muscles, and mitral insufficiency are so interrelated as to constitute a syndrome.
Action of Bradykinin on Human Pulmonary Circulation
Authors: DE FREITAS FLAVIO M. , FARACO EDUARDO Z. , DE AZEVEDO DECIO F. , LEWIN ISAAC
Published: June 2012

Twenty-one patients with pulmonary hypertension secondary to rheumatic mitral valve disease were submitted to right and left heart catheterization and received a continuous intravenous infusion of synthetic bradykinin (average dose, 0.98 µg/kg/min).

The drug elicited an appreciable fall of the systemic vascular resistance simultaneously with a decrease of the mean systemic arterial pressure and an increase of the cardiac output in all cases. The rise in cardiac output derived mainly from an increase in heart rate, since the modifications of the stroke volume were generally of low magnitude.

In the pulmonary circulation, the increase in blood flow was coincident with a rise of the mean arterial and venous (left atrial) pressures in 19 and all patients, respectively. The pulmonary vascular resistance fell in 19 patients, but no appreciable modifications were noted in pulmonary blood volume.

The changes in the lesser circulation were interpreted as expressing secondary effects, either mechanical or reflex, consequent to the action of bradykinin on the systemic vessels and heart rather than a direct effect of the drug on the pulmonary vessels.
The Medial Wall of the Right Atrium
Authors: WALMSLEY ROBERT , WATSON HAMISH
Published: June 2012

The correct orientation of the heart in situ has been stressed and the anatomic relationships of the medial wall of the right atrium have been described and illustrated.

Each atrium lies behind and to the right of its corresponding ventricle and, as the plane of the septa is angled at approximately 45° to the median plane, the right atrium lies as much in front of the left atrium as alongside it.

The area of overlap between the atria is small in both the anteroposterior and lateral views and the interatrial septum, which constitutes
only
the posterior half of the medial wall of the right atrium, is most accessible in the right anterior oblique projection.

The anterior half of the medial wall of the right atrium is closely related from above downward to the first part of the aorta including the aortic valve, and to the left ventricular outflow tract through the membranous part of the interventricular septum. The right coronary artery and the right ventricular outflow tract are also important anterior relations.

Transverse sections of the thorax in all age groups have shown that only one aortic valve cusp is truly anterior and it is suggested that the terms
anterior,
and
right
and
left posterior
should be used to designate the cusps and sinuses of the aortic valve.
The Electrocardiogram in Muscular Subaortic Stenosis
Authors: WIGLE E. DOUGLAS , BARON ROBERT H.
Published: June 2012

The electrocardiograms of four patients with muscular subaortic stenosis, in whom there was angiographic evidence of ventricular septal hypertrophy (confirmed at surgery in three), revealed pathological Q waves in the limb leads (except aV
R
) and the left precordial leads, as well as tall R waves in the right precordial leads. Three patients underwent surgical correction of the stenosis. The left anterior septal ventriculomyotomy abolished the Q waves and diminished the right precordial R waves while at the same time producing left axis deviation believed to be due to severing of the anterior division(s) of the left bundle branch. In the fourth patient the left precordial and limb lead Q waves and right precordial R waves increased following spontaneous development of complete right bundle-branch block. These observations support the belief that the Q-wave and R-wave abnormalities in the electrocardiogram in patients with muscular subaortic stenosis are the result of septal depolarization commencing at the left septal surface and may be related to the overall hypertrophy of the septum, the bizarre myocardial fiber hypertrophy or premature activation of the base of the septum, or all three.
Bacterial Endocarditis in a Patient with Idiopathic Hypertrophic Subaortic Stenosis
Authors: LINHART JOSEPH W. , TAYLOR W. JAPE
Published: June 2012

A rare case of subacute bacterial endocarditis, due to a streptococcus viridans organism, is reported in a patient with idiopathic hypertrophic subaortic stenosis (IHSS). Subacute bacterial endocarditis prophylaxis is recommended for patients with IHSS.
Intrinsic Properties of Uncorrected and Highly Corrected Leads
Authors: BRODY DANIEL A. , ARZBAECHER ROBERT C. , Phillips Harry A.
Published: June 2012

An improved experimental method was employed to determine the dipolar and nondipolar sensing characteristics of various lead connections in an electrically homogeneous human torso model. The intrinsic properties of the cube and tetrahedron leads were compared with those of an ideal vectorcardiographic system. The conventional precordial leads, V
1
through V
6
, were analyzed anatomically and electrically with respect to corresponding ideal unipolar leads, with similar treatment of the augmented unipolar extremity leads. Finally, methods of constructing highly corrected anteroposterior and transverse vectorcardiographic leads were developed.

The study of the cube and tetrahedron systems confirms in strict quantitative terms that they are not suited for accurate vectorcardiographic registration. The defects of existing Z leads are greatly minimized by the use of a grid system in which the electrodes of the anteriorly applied array are individually weighted. An X lead of similar quality was achieved by a transverse grid in which the left-sided electrodes, including the arm connection, were also weighted individually. These two corrected leads, together with a previously described vertical connection, form a vectorcardiographic system whose inherent properties approach those of an ideal system.

Analysis of the precordial unipolar leads demonstrates that they are in fact proximity electrodes and some of them are approximately unipolar in their behavior. Leads aV
R
and aV
L
are classed as semi-remote, and lead aV
F
as remote.

Thoracic structures are not electrically homogeneous or isotropic. Nevertheless, lacking definitive information on the manner in which these factors influence the electrocardiographic transfer properties of the body, the study of electrolyte-filled models remains a valid experimental basis for lead analysis and synthesis.
Application of a Theoretic T-Wave Model to Experimentally Induced T-Wave Abnormalities
Authors: BURGESS MARY JO , HARUMI KENICHI , ABILDSKOV J. A.
Published: June 2012

A series of experiments was performed to test the validity of a theoretic T-wave model. This model was based on the sequence of depolarization and on multiple action potentials taken in appropriate time phase. The previously introduced concept of the component gradient vector was extended so that this quantity included base-line and local gradient vectors. Component gradient vectors were defined as those vectors produced by a disparity in the configuration of coexisting action potentials. They were directed along the same axis as the depolarization vectors in the area where the component gradient existed. The magnitude of the component gradient vectors was determined by the degree to which the plateau durations and downstrokes of coexisting action potentials differed. Those component gradient vectors that arose from the normal disparity in configuration of ventricular action potentials were defined as base-line gradient vectors, while vectors that arose from a deviation from that state were defined as local gradient vectors. In the experiments reported, the predicted T-wave changes occurred. The maximal T vector tended to move along an imaginary line that was perpendicular to the line closing normal activation fronts in the area in which the local gradient was introduced. In a quantitative test of the model, FRP was measured and used as an indirect measure of the duration of the action potential plateau. The observed changes in T area were proportional to the magnitude of changes in functional refractory period (FRP). The results of these limited experiments indicate that the model should be useful in accounting for the configuration of T waves in states in which localized alterations of action potential configurations occur.
Paroxysmal Atrial Tachycardia with Exit Block
Authors: DRESSLER W. , JONAS S. , JAVIER R.
Published: June 2012

A case of atrial tachycardia with A-V block is reported with a basic cycle length of 0.40 sec corresponding to an atrial rate of 150/min. Pauses of various length in atrial activity [see figure in the PDF file] were observed, and each was a multiple of 0.20 sec. These were attributed to the effect of an exit block. It was postulated that the actual atrial rate was 300/min, that is, double the manifest rate. In fact, doubling of the manifest atrial rate was temporarily produced by vagus stimulation and was observed also in spontaneous attacks which mimicked closely atrial flutter. These observations underline the difficulty of separating paroxysmal atrial tachycardia and flutter.
The Anatomy of the Atrioventricular Conduction System in Ventricular Septal Defect and Tetralogy of Fallot: Correlations with the Electrocardiogram and Vectorcardiogram
Authors: FELDT ROBERT H. , DUSHANE JAMES W. , TITUS JACK L.
Published: June 2012

The atrioventricular conduction system was studied by a technique of selected serial histological sections in examples of tetralogy of Fallot and ventricular septal defect to correlate the anatomic findings observed with the electrophysiological findings as manifested by the vectorcardiographic pattern. Eight hearts were studied; two examples of each anomaly had electrocardiographic and VCG patterns in the frontal plane similar to A-V canal defects and two examples of each had ECG and VCG patterns usually associated with these lesions.

Of the four examples of tetralogy, the two examples with VCG patterns similar to the A-V canal pattern differed from the other examples in that the distance between the A-V node and the origin of left bundle branching was shorter and the fibers destined to become the right bundle branch took an elongated course. The VSD examples offered less striking differences. A short distance from the A-V node to the onset of left bundle branching was seen in both examples with VCG patterns similar to the A-V canal pattern, but one example of VSD with a representative VCG pattern had a similar anatomic configuration. When measurement ratios were compared, the right bundle took its origin at a relatively greater distance from the A-V node in the examples with VCG patterns similar to the A-V canal pattern.

The anatomic configuration of those examples of tetralogy and VSD with VCG patterns similar to the A-V canal pattern was such that relatively early conduction to the left bundle branch system could occur.
Complete Heart Block Induced During Cardiac Catheterization of Patients with Pre-existent Bundle-Branch Block
Authors: STEIN PAUL D. , MATHUR VIRENDRA S. , HERMAN MICHAEL V. , LEVINE HAROLD D.
Published: June 2012

The hazard of complete atrioventricular block during cardiac catheterization of patients with pre-existent bundle-branch block is described. A catheter-induced bundle-branch block, during catheterization of the ventricle opposite that which was already the site of bundle-branch block, would produce complete heart block in the form of bilateral bundle-branch block. Five patients in whom this complication occurred are described.