bluuebunny/crossref_metadata_2025 huggingface dataset:
Production of Prolonged Arterial Hypertension in Dogs by Chronic Stimulation of the Nervous System
Authors: TAYLOR ROBERT D. , PAGE IRVINE H.
Published: June 2012

We were unable to produce chronic arterial hypertension in dogs by severe cerebral ischemia induced by ligation of blood supply to the brain. Combining cerebral ischemia with the mechanical effect of a wire in the floor of the fourth ventricle and the thermal stimulus of heat generated in this wire by short wave diathermy resulted in hypertension that lasted as long as 10 months. Experiments are described which indicate that the arterial hypertension which accompanies increased cerebrospinal fluid pressure is in part the result of pressure on the brain and not entirely due to cerebral anemia.
Cerebral Circulation and Metabolism in Uremia
Authors: HEYMAN ALBERT , PATTERSON JOHN L. , JONES RUDOLPH W.
Published: June 2012

Data on 16 patients with uremia are presented. The cerebral blood flow was moderately decreased in patients with generalized vascular disease, but was normal in patients with minimal vascular involvement. In both groups the cerebral oxygen consumption (cerebral metabolic rate in terms of oxygen consumption, CMRO
2
) was reduced significantly and to the same degree. In contrast, total body metabolism was not demonstrably reduced. These facts emphasize the vulnerability of the brain to uremia. There was poor correlation between the cerebral oxygen utilization and the patient's mental state. No correlation was found between the cerebral oxygen consumption and the blood nonprotein nitrogen, the carbon dioxide capacity, or the sodium, potassium or chloride levels.
Observations on the Electrocardiogram and Ventricular Gradient in Complete Left Bundle Branch Block
Authors: PANTRIDGE J. F.
Published: June 2012

Electrocardiograms from 109 patients with left bundle branch block were divided into four major groups depending on differences in standard and unipolar precordial leads. These records were then studied to find if one can draw any conclusions relative to ventricular hypertrophy or myocardial infarction in the presence of left branch block. In addition, the ventricular gradient was estimated in twenty-three instances and its value discussed.
The Spatial Vectorcardiogram in Right Bundle Branch Block
Authors: ABILDSKOV J. A. , JACKSON C. E. , BURCH G. E. , CRONVICH J. A.
Published: June 2012

The spatial vectorcardiograms of 24 subjects with electrocardiographic evidence of right bundle branch block are described. Correlation of the vectorcardiographic patterns observed, with clinical and roentgenologic data, suggests that the recognition of ventricular hypertrophy in the presence of such a conduction defect may be improved by this method of study.
The Effect of Local Application of Glyceryl Trinitrate (Nitroglycerine) on Raynaud's Disease and Raynaud's Phenomenon
Authors: KLECKNER MARTIN S. , ALLEN EDGAR V. , WAKIM KHALIL G.
Published: June 2012

The authors investigated the effect of repeated inunction with 2 per cent glyceryl trinitrate in lanolin on the blood flow and skin temperature of the extremities in 14 cases of Raynaud's disease and in 8 cases in which Raynaud's phenomenon was associated with such vascular diseases as acrosclerosis (3 cases), chronic occlusive disease of the arteries (3 cases), occupational disease of the arteries (1 case) and livedo reticularis (1 case). The inunction almost invariably caused an increase in the blood flow and in the skin temperature of the digits in the 14 cases of Raynaud's disease.
The Initial Vibrations of the First Heart Sound
Authors: COUNIHAN TIMOTHY , LEE MESSER ADDISON , RAPPAPORT MAURICE B. , SPRAGUE HOWARD B.
Published: June 2012

The major component of the normal first heart sound is that due to valvular closure. Preceding this there occur low frequency, low amplitude vibrations commonly attributed to auricular systole. It has been shown in this study that such vibrations appear invariably even though the auricles are fibrillating, and in heart block when auricular systole is widely seperated from ventricular systole. It is concluded that the onset of ventricular contraction itself causes these vibrations through mechanisms unrelated to auricular contraction, and prior to the valvular component.
Cardiac Actinomycosis
Authors: ZOECKLER SAMUEL J.
Published: June 2012

Involvement of the heart by actinomycetes is rare. A case of actinomycosis, with involvement of the chest wall and clinical pericarditis, with recovery, is reported. The organism, Actinomyces bovis, was isolated from the lesion and accurately identified. The literature is reviewed and the modern concepts of pathogenesis and therapy are discussed.
The Effect of "Salt" Hypertension on Atherosclerosis in Chicks Fed Mash without a Cholesterol Supplement
Authors: STAMLER J. , KATZ L. N. , Johnson P.
Published: June 2012

Hypertension induced by adding sodium chloride to the diet (0.9 per cent) or drinking water (8 per cent) of chicks on plain mash did not intensify spontaneous atherosclerosis or lead to atherosclerotic lesions of the induced type.
Plasma Cholesterol Levels during Rapid Weight Reduction
Authors: WALKER WELDON J. , WIER JAMES A.
Published: June 2012

Twenty-seven obese individuals underwent rapid weight reduction by rigid caloric restriction. During this time there was a slight over-all drop in plasma cholesterol levels. Patients undergoing most rapid weight loss showed the greatest drop in plasma cholesterol. Fear of elevating the plasma cholesterol need not deter the physician from subjecting obese patients to rapid weight reduction
The Age Factor in Hypercholesteremia and Atheromatosis in the Chick
Authors: RODBARD S. , KATZ L. N. , BOLENE C. , PICK R. , LOWENTHAL M. , GROS G.
Published: June 2012

The development of atherosclerosis in very young chicks challenges the concept that atherogenesis depends upon senescence. Instead, the age period, rather than age, seems to be the more significant factor in atherogenesis. This is so since the regulation of the plasma cholesterol level is shown to vary at different age periods. During the first two months of life of the chick, a resistance to hypercholesteremia and atheromatosis is seen. At the eighth week, corresponding to the time of puberty, the plasma cholesterol rises markedly, despite an unchanged dietary regimen. The resistance to vascular lesions disappears and atheromatosis develops rapidly over the next few weeks. This indicates that endogenous mechanisms dependent upon the age period are important factors in the tendency to hypercholesteremia and atherogenesis.
An Exercise Test for Coronary Insufficiency
Authors: LITTMANN DAVID , RODMAN MELVIN H.
Published: June 2012

Any exercise tolerance test is intended to record the objective accompaniments of coronary insufficiency. The test must therefore be stressful to effect such insufficiency. Described in this report is an exercise test which is considered specific in demonstrating coronary inadequacy when present, and reliable in ruling it out, provided that the effects of tachycardia on the electrocardiogram are recognized.
Anatomic and Electrocardiographic Position of the Heart
Authors: FOWLER NOBLE O. , BRAUNSTEIN JOHN R.
Published: June 2012

Thirty-four patients were studied by electrocardiogram for electrical position of the heart, and by x-ray and angiocardiogram for anatomic position of the heart. A significant association between electrocardiographic and anatomic positions of the heart was found insofar as rotation about the anteroposterior and longitudinal axes is concerned. No association between electrocardiographic and anatomic positions was found with regard to rotation about the transverse axis.
The Clinical Diagnosis and Surgical Management of Ruptured Mitral Chordae Tendineae
Authors: MENGES HERMANN , ANKENEY JAY L. , HELLERSTEIN HERMAN K.
Published: June 2012

Six patients with mitral insufficiency secondary to ruptured chordae tendineae are presented. Each patient underwent surgical correction of the deformed valve. In two instances the posterior leaflet was involved while in four the anterior leaflet was affected. Three patients had definite bacterial endocarditis that appeared to be related to the onset of cardiac symptoms. In the two instances of posterior valve involvement there were an aortic thrill and a harsh systolic murmur, whereas in two of the four with rupture of the anterior leaflet an aortic systolic murmur was heard but no thrill was felt. The other two with anterior leaflet disease disclosed no murmurs in the aortic area. These findings are considered to be a result of the direction of the regurgitant jet and the area in which they strike the left atrium. None of the patients had hemodynamic evidence of aortic valve disease and in each instance the aortic systolic murmur decreased or disappeared after surgery. Each patient had gross left atrial enlargement. Although relatively uncommon, mitral insufficiency due to rupture of the mitral chordae tendineae is readily corrected surgically.
Measurement of Blood Flow in the Femoral Artery in Man at Rest and during Exercise by Local Thermodilution
Authors: GANZ V. , HLAVOVÁ A. , FRONĚK A. , LINHART J. , PŘEROVSKÝ I.
Published: June 2012

A new method is described for measuring blood flow in the femoral artery in man, based on local thermodilution. The method makes it possible to take 3 or 4 measurements per minute at rest and during muscular exercise of the investigated limb. The average blood flow in eight subjects at rest was 635.9±223.1 ml./min., or 6.0±2.3 ml./100 ml. limb volume/min.

Changes during graded and increased work loads were also measured in 5-minute periods (150, 200, and 250 Kg./min.). The rate of flow rise was faster at the start of a given period than in the latter half of the same period. After the end of the work load, the rate of return of blood flow to the baseline fell off rapidly with time, but by 30 minutes later baseline values had still not been attained.
Determination of Pulmonary Blood Volume by Single Intravenous Injection of One Indicator in Patients with Normal and High Pulmonary Vascular Pressures
Authors: DE FREITAS FLAVIO M. , FARACO EDUARDO Z. , NEDEL NORMELIO , DE AZEVEDO DECIO F. , ZADUCHLIVER JAIME
Published: June 2012

Determinations of the pulmonary blood volume were carried out in 12 patients with pulmonary hypertension and in 12 patients with normal pressures in the pulmonary circulation, by the use of a single intravenous injection of one indicator, blood sampling being made through catheters in the pulmonary artery and left atrium and connected with two densitometers of similar characteristics. Pulmonary blood volume measured by this technic includes the major portion of, or the entire left atrial volume. Values obtained from duplicate or triplicate determinations performed in each patient have shown that this technic provides very good reproducibility of the results expressed by an average percentile variation around the mean equal to 3.2±2.7. The mean pulmonary blood volume as referred to body surface area was 375±97 ml./M.
2
for patients with pulmonary hypertension, and 310±21 ml./M.
2
for patients with normal pulmonary intravascular pressures. This difference was found to be significant (
p
<0.05) but was attributed, at least in part, to a difference in the mean left atrial volume between the two groups studied.

Some possible advantages and limitations of the method, as well as the poor correlation between pulmonary blood volume and other variables, like pulmonary intravascular pressures, stroke volume, and cardiac output, were discussed.
The Apex Cardiogram in Left Ventricular Outflow Tract Obstruction
Authors: TAFURR EMILIO , COHEN LAWRENCE S. , LEVINE HAROLD D.
Published: June 2012

The use of the apex cardiogram offers a simple yet valuable aid in the diagnosis of obstruction of the left ventricular outflow tract. Characteristic changes in the ejection component of the apex cardiogram distinguish obstruction due to hypertrophic subaortic stenosis from obstruction due to valvular aortic stenosis. A second systolic wave is inscribed in the mid-ejection period of the apex cardiogram in hypertrophic subaortic stenosis. This wave reflects the development of the obstruction of the outflow tract of the left ventricle by the hypertrophied septum. This obstruction is not apparent in the apex cardiogram at the onset of ejection but becomes manifest as contraction progresses.

Although the apex cardiogram in patients with subaortic stenosis may appear normal at rest, isoproterenol may act as a provocative agent inducing the characteristic changes of this condition.

In valvular stenosis obstruction is reflected in the apex cardiogram from the very onset of ejection and is manifest throughout the total ejection phase as a sustained gradual sloping plateau.
Massive Thrombosis of the Left Ventricle
Authors: SHAPIRO RUBEN L. , OLIVETTI RENZO G.
Published: June 2012

A case of massive thrombosis of the left ventricle is reported. The thrombus had caused a pronounced restriction of the ventricular inflow with the signs and symptoms of "functional" mitral stenosis.
Electrocardiographic Pattern of Massive Myocardial Infarction without Pathologic Confirmation
Authors: MAMLIN JOSEPH J. , WEBER EMIL L. , FISCH CHARLES
Published: June 2012

A case of a 67-year-old patient with an electrocardiographic pattern of a massive myocardial infarction but with a normal heart at autopsy is described. The cause of death was purulent pneumonia complicated by peripheral vascular collapse.

The findings in our case simply reconfirm the well-established principle that the surface electrocardiogram mirrors the electrical phenomena of the heart, which may or may not parallel histologic changes.
Late Cardiac Complications of Chronic, Severe, Refractory Anemia with Hemochromatosis
Authors: ENGLE MARY ALLEN , ERLANDSON MARION , SMITH CARL H.
Published: June 2012

Four fifths of 49 patients with chronic, severe anemia from birth have manifested, usually during the second decade, signs of hemochromatosis with cardiac involvement. Nineteen patients had 33 attacks of pericarditis. Congestive cardiac failure with arrhythmias developed in 26 patients, and all but one died with this complication. Four others died of sepsis before heart failure was evidenced. Postmortem examination showed hemochromatosis with severe myocardial involvement.
Prenatal Narrowing or Closure of the Foramen Ovale
Authors: NAEYE RICHARD L. , BLANC WILLIAM A.
Published: June 2012

In the current study cases are presented in which a prenatally narrowed or closed foramen ovale was associated with left heart chambers of normal or near-normal size. Such infants develop an increased pulmonary arterial muscle mass with hypertrophy and dilation of the right cardiac chambers during fetal life. Much of the arterial muscle mass persists after birth and may well be responsible for the early neonatal death of the infants. The longer asymptomatic survival of one infant suggests that therapy may be possible.
Right Axis Deviation, Clockwise QRS Loop, and Signs of Left Ventricular Underdevelopment in a Child with Complete Type of Persistent Common Atrioventricular Canal
Authors: BAUM DAVID , ROTH GILBERT J. , CREIGHTON S. ALLISON
Published: June 2012

Clinical data and findings at necropsy are presented on a 2-year-old girl who had persistent complete common atrioventricular canal, hypoplastic left ventricle, and obstruction to the left ventricular outflow tract. Electro-cardiographic findings were atypical of common atrioventricular canal in that right axis deviation and a clockwise inscription of the QRS loop in the frontal plane were present. Findings in this case suggest that under-development of the left ventricle should be suspected when (1) displacement of the interventricular sulcus is noted on roentgenographic examinations and (2) predominant left-to-right shunting at ventricular level is found in the absence of electrocardiographic evidence of left ventricular overload.
Total Anomalous Pulmonary Venous Drainage into the Left Innominate Vein Associated with Transposition of the Great Vessels
Authors: WHITAKER WILLIAM , WATSON DAVID A. , KEATES PHILIP G.
Published: June 2012

The diagnosis of a patient with total anomalous pulmonary venous drainage into the left innominate vein associated with transposition of the great vessels is described. It is suggested that the characteristic "cottage-loaf" cardiovascular shadow is absent because transposition of the great vessels leads to pulmonary oligemia, in contrast with the increased pulmonary blood flow that is present when the great vessels are not transposed with this type of abnormal pulmonary venous drainage.
Cardiovascular Manifestations of the Hurler Syndrome
Authors: KROVETZ L. JEROME , LORINCZ ANDREW E. , SCHIEBLER GEROLD L.
Published: June 2012

Hemodynamic observations in 15 cases of the Hunter-Hurler syndrome are reported. Required premedication was two to three times that usually needed. No major complications or deaths occurred. As a group, these individuals tend to have slight elevations of pulmonary artery pressures and more definite elevations of systemic arterial pressures. They generally have normal cardiac outputs and, thus, elevations of total systemic, total pulmonary, and pulmonary arteriolar resistances. In only one case was there clinical and angiocardiographic evidence of valvular involvement, that case having aortic insufficiency. In another case there was only angiocardiographic evidence of mitral insufficiency. Only one child was in congestive heart failure at the time of the study. There was no evidence of coronary artery disease. The ascending limb right ventricular pressure curve was frequently notched and the pressure rise time of the left ventricle (dp/dt) was low. No case had a congenital malformation of the heart.

Those individuals who have normal vascular bed resistances appear to live longer than those who have elevated resistances early in life. The prognosis is also better for the male Hurler of the sex-linked variety than for those cases due to autosomal recessive inheritance.
The Effects of Smoking on the Cardiac Output at Rest and during Exercise in Patients with Healed Myocardial Infarction
Authors: FRANKL WILLIAM S. , WINTERS WILLIAM L. , SOLOFF LOUIS A.
Published: June 2012

Smoking by subjects with healed myocardial infarction, in contrast to its effects on the normal subject, fails to provoke an increase in cardiac output or in stroke volume. On the other hand, smoking does increase the heart rate in subjects with healed myocardial infarction. This dissociation between the effect on heart rate and on cardiac output and stroke volume, which was also noted in the healthy subject pretreated with glucose, indicates that increase in heart rate is mediated by different factors than those that increase stroke volume and cardiac output.
Discrete Subaortic Stenosis Complicated by Aortic Valvular Regurgitation
Authors: MORROW ANDREW G. , FORT LYNN , ROBERTS WILLIAM C. , BRAUNWALD EUGENE
Published: June 2012

Four patients are described in whom combined aortic stenosis and regurgitation was evident on examination. In each of them obstruction to left ventricular outflow was shown to be due to congenital subaortic stenosis, and aortic regurgitation resulted from the sequelae of bacterial endocarditis. The presence of this unusual combination of congenital and acquired malformations was suggested by certain clinical findings, and results of the preoperative hemodynamic and angiographic studies that established the diagnosis are presented.

In three patients the subaortic membrane was resected, and aortic regurgitation was corrected by reconstruction or replacement of the aortic valve. All of the patients evidenced striking clinical improvement after operation, confirmed by the results of postoperative hemodynamic assessments. A fourth patient died before operation; the pathologic findings are presented in detail.
Results of Open-Heart Surgery in Patients with Pulmonic Stenosis and Intact Ventricular Septum
Authors: TANDON RAJENDRA , NADAS ALEXANDER S. , GROSS ROBERT E.
Published: June 2012

A group of 108 consecutive patients with moderate-to-severe pulmonic stenosis and intact ventricular septum, operated upon by means of a pump oxygenator between the years of 1957 and 1961, has been presented.

The total mortality of the series was 2.77 per cent, and an additional 1.8 per cent were left with residual neurologic complications.

Fifty per cent of the patients showed an excellent result as indicated by normal electrocardiograms or right ventricular pressure below 65 mm. Hg by cardiac catheterization. An additional 26 per cent had good results as indicated by the absence of symptoms, normal x-rays, mild electrocardiographic changes, and in three instances, slight right ventricular hypertension.

Ten per cent had unsatisfactory results based on significant residual abnormalities in the electrocardiograms, x-rays, or postoperative catheterization data.
Dynamics of the Collateral Circulation in Patients with Subclavian Steal
Authors: MARSHALL ROBERT J. , MANTINI EMIL L.
Published: June 2012

The occurrence of retrograde blood flow in the ipsilateral vertebral artery of patients with proximal occlusion of the subclavian or innominate artery has been amply demonstrated by selective angiography. However, since flow artifacts may be induced by the physical or chemical effects of injections of contrast media, it was thought desirable to employ a different method for physiologic demonstration of the reversed flow.

In the first case, cardio-green dye was injected into the innominate artery and a dilution curve was recorded from the left brachial artery. The early appearance of the dye (6 seconds) proved that a short circuit existed between the arterial injection and sampling sites, and confirmed the authenticity of the reversed vertebral flow shown in previous angiograms.

In the second patient, who had symptoms of cerebral ischemia during exercise of the left (affected) arm, dye injected into the left carotid artery did not appear early in the brachial artery of the resting left arm. When it was injected during a period of intense hyperemia of the left arm, a fraction of the dye did appear early. This confirmed that, when the demand of the arm increased, blood was shunted to it not only from the vertebral-basilar system but also from the carotid system.

The importance of anatomic factors was evident in another case in which absence of the anticipated retrograde flow was explained by the fact that the vertebral artery arose directly rectly from the aorta and did not communicate with the affected subclavian artery.

These observations illustrate how radiographic and hemodynamic technics may usefully be combined to assess the effects of acquired diseases of the major blood vessels.
A Study of the Q-1 Interval in Atrial Fibrillation with and without Mitral Stenosis
Authors: TAVEL MORTON E. , FEIGENBAUM HARVEY , CAMPBELL RICHARD W.
Published: June 2012

The Q-1 interval has been studied and plotted against cycle length (preceding R-R interval) in 41 patients with atrial fibrillation. Employed in such a manner, the Q-1 measurement is a useful adjunct in the study of atrial fibrillation when mitral stenosis is present or suspected. In patients with mitral stenosis, the usual finding was an inverse relationship between the Q-1 interval and the preceding cycle length, i.e., as the cycle length increased, the Q-1 interval decreased. Severe degrees of stenosis appeared to cause characteristic variation of the Q-1 interval even at relatively long cycle lengths, reflecting the longer persisting pressure gradient across the mitral valve. In the absence of mitral stenosis, there generally was no such Q-1 variation, particularly with cycle lengths of longer than 0.6 second.
Treatment of Acute Bacterial Endocarditis by Valve Excision and Replacement
Authors: WALLACE ANDREW G. , YOUNG W. GLENN , OSTERHOUT SUYDAM
Published: June 2012

This report describes a 45-year-old man who developed acute bacterial endocarditis involving the aortic valve due to Klebsiella type 19. Consequent to the infection the patient developed aortic insufficiency and congestive heart failure. The patient failed to respond adequately to antibiotic therapy alone and rapid clinical deterioration required that the aortic valve be replaced despite the presence of active infection. Excision of the aortic valve appears to have removed the site of infection and replacement with a Starr prosthesis has corrected the aortic insufficiency. The patient has been followed for 15 months since the operative procedure, during which time he has returned to his work as a bricklayer. The encouraging result obtained in this patient suggests that in selected instances, valve excision and replacement under antibiotic coverage provide a possible therapeutic approach to certain difficult cases of active bacterial endocarditis.
Clinical Features of Fluid Retention Complicating Treatment with Guanethidine
Authors: SMITH A. J.
Published: June 2012

Forty-four (32.8 per cent) of 134 patients [see figure in the PDF file] treated continuously with guanethidine for a period of at least 12 months developed recognizable fluid retention.

Previous edema may be a predisposing factor and fluid retention occurred more commonly in women. Neither of these factors offers a complete explanation of this side effect.

No evidence has been found to suggest that fluid retention occurs preferentially in patients with renal or cardiac insufficiency. The findings are compatible with a universal fluidretaining influence of guanethidine presenting as a graded phenomenon.
Postural ST-T Wave Changes in the Radioelectrocardiogram Simulating Myocardial Ischemia
Authors: LACHMAN ALAN B. , SEMLER HERBERT J. , GUSTAFSON ROBERT H.
Published: June 2012

Six hundred and seventy-six healthy subjects between 5 and 77 years of age have been studied by radioelectrocardiography. These subjects were studied before exercise, during a Master's two-step test, and after exercise. Orthostatic ST-T changes occurred in 32 of 200 subjects (16 per cent). The results indicate that the positioning of the bipolar chest leads is crucial in eliminating "abnormal" ST-T changes caused by changes in posture and position. Criteria for orthostatic ST-T changes have been presented. It is concluded that more rigid criteria for "definitely abnormal" ST-T changes during radioelectrocardiography should be developed, so that coronary artery disease will not be overdiagnosed, nor will significant ST-T changes be regarded as "normal variants" occurring with activity.
Abnormal Communication between the Aorta and Left Ventricle
Authors: COOLEY ROBERT N. , HARRIS LEONARD C. , RODIN ALVIN E.
Published: June 2012

A case is presented of a 16-month-old white boy with a communication or tunnel between the right sinus of Valsalva and the outflow tract of the left ventricle. The presence of a murmur at birth and the subsequent clinical course suggest that the tunnel was congenital. The physical, electrocardiographic, phonocardiographic, and aortographic findings were quite similar to those of "aortico-left ventricular tunnel" as described by Levy et al.
1
The tunnel was occluded surgically, but failure to appreciate the presence of severe aortic stenosis contributed to a fatal outcome.

Postmortem study was carried out, and the relationship of the findings of aortico-left ventricular tunnel to aneurysm of the sinuses of Valsalva and the Marfan syndrome is briefly discussed.
Mycotic False Aneurysm of the Aorta Following Aortic Valvular Prosthesis
Authors: BABA NOBUHISA , MCKISSICK TREVOR L.
Published: June 2012

A case of a mycotic false aneurysm of the ascending aorta and aortic sinus caused by coagulase-negative staphylococcal endocarditis following the placement of a Starr-Edwards prosthesis for rheumatic aortic stenosis is reported. The formation of the aneurysm caused aortic insufficiency, and terminally the prosthesis was torn from the aorta. The occurrence of mycotic aneurysms in the aorta and their etiology and pathogenesis are discussed. Cases of postoperative false-aneurysm formation of the ascending aorta are reviewed.
Late Results of Operation for Acquired Aortic Valvular Disease
Authors: MCGOON DWIGHT C. , ELLIS F. HENRY , KIRKLIN JOHN W.
Published: June 2012

Of the 614 open-heart operations performed at the Mayo Clinic for acquired aortic valvular disease, 130 were performed on patients who also required repair of other valves. Review of the remaining 484 operations resulted in the following observations.

Operation for acquired aortic valvular disease may now be accomplished with a hospital mortality rate of 4%. The incidence of late death and failure of patients to improve has averaged 44% for previously employed techniques of valvular repair. Failure of the valve or prosthesis to function properly was the most common cause of late failure after operations in which these earlier methods were used. In the 138 more recent cases, in which operations employing the aortic ball valve (Starr-Edwards prosthesis) were used, the incidence of late failure has been reduced to 14%, and failure of the prosthesis to function properly has not yet occurred in the absence of infection. Late bacterial endocarditis and thromboembolism were the most serious problems associated with use of the ball-valve prosthesis. In contrast with the late results of the former techniques, use of the ball valve has resulted in improvement for 79% of the patients; in the great majority of these there has been a dramatic return to normal living.

Despite the highly satisfactory results of current methods, the fact that 14% of patients have already died after an initially successful operative result, and that another 12% have suffered complications causing their late result to be less than totally satisfactory, indicates that the policy of recommending for operation only those patients who have significant and progressive cardiac disability should be continued.
Heart Homotransplantation in Puppies
Authors: KONDO YOSHIO , GRÄDEL FRANZ , KANTROWITZ ADRIAN
Published: June 2012

A satisfactory technique for orthotopic homotransplantation of the heart, under profound hypothermia without a pump-oxygenator, has been presented. Of the 40 puppies in our series, 24 lived more than one day; 13 lived more than seven days. One is well and active on the 112th day. The rhythm of the transplanted hearts was often somewhat irregular shortly after surgery, but usually became fairly regular on the following day and maintained a constant rate even after exercise. Long survivors steadily gained weight and showed a proportional increase in heart size. The fate of the transplant could be forecast in some instances from the follow-up electrocardiograms. Although the histological findings were not uniform, acceptance of the homogous heart greatly exceeded our expectations. Unpredictable histocompatibility may possibly explain the long survivors.
Evaluation of the Development of Athero-Arteriosclerosis in Autogenous Venous Grafts Inserted into the Peripheral Arterial System
Authors: PENN ISRAEL , SCHENK ERIC , ROB CHARLES , DEWEESE JAMES , SCHWARTZ SEYMOUR I.
Published: June 2012

Athero-arteriosclerosis was produced in dogs by performing a total thyroidectomy and supplementing the diet with a high-cholesterol intake and large amounts of vitamin D. Segments of the femoral and carotid arteries were excised and replaced with autogenous venous grafts. Well-marked athero-arteriosclerotic lesions developed in the arterial system, but none developed in the venous grafts, which showed a marked tendency to develop mural thrombi. These results indicate that autogenous venous grafts, when inserted into the arterial system, are relatively resistant to the development of athero-arteriosclerosis.
Clinical and Hemodynamic Observations After Combined Aortic and Mitral Replacement
Authors: BRISTOW J. DAVID , FARREHI CYRUS , MCCORD COLIN W. , STARR ALBERT , GRISWOLD HERBERT E.
Published: June 2012

Twelve patients have been observed from 6 to 19 months after combined aortic and mitral valvular replacement with Starr-Edwards prostheses. Eleven patients have had postoperative right- and left-heart catheterizations. The clinical and hemodynamic findings are described. Nine patients are well. Three others have less than satisfactory results, although one of these is improved. It is concluded that bivalvular replacement is now practical in selected patients and provides gratifying results in most individuals so treated.
Plasma Renin Activity in Acute Tubular Necrosis and Other Renal Diseases Associated with Hypertension
Authors: TU W. H. , Dawson Margaret
Published: June 2012

By in vitro and in vivo bioassay methods, activity of plasma renin was studied in patients with acute tubular necrosis, polyarteritis, systemic lupus erythematosus, or the terminal stage of chronic renal disease.

Plasma renin activity was increased during the oliguric phase of acute tubular necrosis, polyarteritis, or systemic lupus erythematosus; it was not increased during the diuretic phase of acute tubular necrosis and in the terminal stage of chronic renal disease.

Acute reversible hypertension, observed in some patients during the oliguric phase of acute tubular necrosis, vas associated with a marked increase in plasma renin. A similar association was observed in hypertensive patients with polyarteritis or systemic lupus erythematosus, but not in hypertensive patients with the terminal stage of chronic renal disease. These data suggest that the renin mechanism may participate in the acute hypertension of acute tubular necrosis, polyarteritis, and systemic lupus erythematosus, but not in chronic hypertension in the present study.
Hemodynamic Changes in Patients with Acute
Authors: THOMAS MICHAEL , MALMCRONA RAOUL , SHILLINGFORD JOHN
Published: June 2012

The hemodynamic changes following acute myocardial infarction have been studied in patients in an intensive care unit. Serial determinations of cardiac output and blood pressure have shown a wide range of hemodynamic patterns in severely ill patients varying from a low cardiac output and high peripheral resistance to a high cardiac output and low peripheral resistance. The progression of changes during the illness and their relation to the clinical findings have been discussed.
Studies of Male Survivors of Myocardial Infarction
Authors: LITTLE J. ALICK , SHANOFF HENRY M. , ROE ROBERT D. , CSIMA ADELE , YANO RUTH
Published: June 2012

This study examined life expectancy and serum lipids in 120 men with atherosclerotic coronary heart disease. Five-year survival from onset of infarction was 79 per cent. No relationship could be demonstrated between survival and the level of the total serum cholesterol, Std. S
f
0-12, 12-20, 20-100, and 100-400 lipoproteins. Survival for patients with an infarct less than 6 months before entry into the study was shorter, despite serum lipid levels the same as the remainder of the group.

Although the age of onset of coronary disease is influenced by serum lipid levels, survival subsequent to infarction is not. This paradox suggests that serum lipids affect rate of atherogenesis in the long preclinical stage but in the short clinical stage other factors determine survival.
Persistent Common Atrioventricular Canal
Authors: FRATER R. W. M.
Published: June 2012

The mitral valve anatomy of endocardial cushion defects is reviewed and compared with the anatomic requirements for normal mitral valve function. It is shown that very often mitral valve anatomy is such that function should be not at all or only minimally affected. Evidence is quoted that this is indeed so.

The potential harm that may result from indiscriminate suturing of mitral valve clefts and careless repair of the septal defects is described. Principles for the repair of the mitral valve in these cases are enunciated. A small series of cases that have had preoperative and 1-year postoperative assessments of mitral valve function is presented to illustrate some of these points.
Idiopathic Myocardiopathy of the Puerperium (Postpartal Heart Disease)
Authors: WALSH JOHN J. , BURCH GEORGE E. , BLACK WILLIAM C. , FERRANS VICTOR J. , HIBBS RICHARD G.
Published: June 2012

It should be clearly understood that no evidence was uncovered to indicate an unequivocal etiology for this uncommon disease. One is tempted to qualify "uncommon" in that it no longer connotes the same extreme degree of rarity that would appear from medical literature. Over the same period that these cases were collected an equal number were recognized but unavailable for study for various reasons.

Unfortunately, the size of our series precludes statistical analysis. The apparent tendencies to hypercholesteremia, blood-group predilection, and increased incidence of abnormal hemoglobin types are in need of further exploration. One would be remiss not to note at this point that at least one report
20
related several instances of familial incidence of postpartal heart disease.

We are more certain of the significance of malnutrition as a factor in the genesis of this syndrome, although we are unable to assign a precise role. Similarly, the deleterious effects on such patients of hypertension, pyelonephritis, and full-term pregnancy have impressed us, although we can make no judgment as to their frequency of occurrence. Probably, as so often happens, we are most certain of our single pre-investigatory premise that postpartal heart disease is a serious and pernicious syndrome, quite different from that described in most of the literature. That prolonged bed rest is not a panacea is obvious. It is of sufficient merit, however, to warrant use in all such patients, for periods up to 1 year at least.
Results of Surgical Treatment of Patients with Diffuse Subvalvular Aortic Stenosis
Authors: FRYE ROBERT L. , KINCAID OWINGS W. , SWAN H. J. C. , KIRKLIN JOHN W.
Published: June 2012

Sixteen patients with diffuse hypertrophic subaortic stenosis have been treated surgically. Thirteen of 14 patients undergoing excision of hypertrophied muscle from the left ventricular outflow tract via left ventriculotomy or aortotomy have survived. Operation has provided excellent symptomatic relief, associated with eradication or significant reduction of the systolic pressure gradient between the left ventricle and the aorta while the patient is at rest. Operation is recommended for those patients with this disease who are experiencing significant and limiting symptoms related to obstruction of the left ventricular outflow tract.
Relationship between Polycythemia and Surgical Mortality in Patients Undergoing Total Correction for Tetralogy of Fallot
Authors: LEACHMAN ROBERT D. , HALLMAN GRADY L. , COOLEY DENTON A.
Published: June 2012

"Complete" surgical correction of Fallot's tetralogy carries a much higher risk in patients with a hemoglobin concentration greater than 18 Gm. per cent (31 per cent mortality) than in those whose hemoglobin concentration is less than 18 Gm. per cent (10 per cent mortality).

The successful reduction of hemoglobin concentration from greater than 18 Gm. per cent to less than 18 Gm. per cent through systemic-pulmonary anastomosis greatly reduces the surgical risk associated with "complete correction." The mechanism by which this reduces surgical mortality is not known but may be related to (1) decreasing the hemorrhagic tendency associated with polycythemia and (2) conditioning of the pulmonary vascular bed and "left heart" in preparation for their new role when definitive repair has been accomplished.

The hemoglobin concentration can be used to grade the severity of Fallot's tetralogy. Such grading would provide a basis for valid appraisal of surgical mortality rates among otherwise comparable series of cases.
Hemorrhagic Necrosis of the Gastrointestinal Tract and Its Relation to Cardiovascular Status
Authors: MING SI-CHUN
Published: June 2012

Seventy-five cases of hemorrhagic necrosis of the gastrointestinal tract were analyzed and compared with the entire autopsy population as control. The disease occurred most frequently in association with shock, which was present in 80 per cent of the cases with the gastrointestinal lesions.

The incidence of heart disease was higher in the cases of hemorrhagic necrosis than in the control group. The role of cardiac dysfunction in the etiology of hemorrhagic necrosis is emphasized as are the roles played by the bacterial toxins and shock. All three conditions have been shown to result in marked reduction of the intestinal blood flow and venous stasis.

Hemorrhagic necrosis of the gastrointestinal tract probably represents a conglomeration of microinfarcts of the mucosa secondary to markedly decreased local blood flow. Vasopressor agents have produced no beneficial effect; the effect of vasodilators remains to be determined.
The Phonocardiographic Differentiation of Pulmonic and Aortic Insufficiency
Authors: SCHWAB ROBERT H. , KILLOUGH JOHN H.
Published: June 2012

A phonocardiographic technic for differentiating the murmurs of aortic and pulmonic insufficiency is described. Four patients with diastolic "decrescendo" murmurs are presented to illustrate this technic.
Studies of Contractile Force in Man
Authors: AUSTEN W. GERALD
Published: June 2012

Forty-five patients undergoing open-heart surgery for acquired aortic valve disease were studied with measurements of left ventricular contractile force. The data presented clearly indicate that coronary perfusion afforded, on the average, better protection to left ventricular contractility as recorded by a strain-gage arch than did hypothermia. This was particularly true in the usual case, which required an hour or longer of aortic occlusion.

Patients who required 40 minutes or less of aortic occlusion demonstrated approximately identical decreases in contractile force with hypothermia or coronary perfusion.

Bilateral coronary perfusion did not usually afford much additional left ventricular protection as compared to unilateral left coronary perfusion. In a small number of patients with significant coronary arterial occlusion, bilateral coronary perfusion appeared to give better left ventricular protection.
Renal Performance in Patients Undergoing Replacement of the Aortic Valve
Authors: MIELKE JOHN E. , MAHER FRANK T. , HUNT JAMES C. , KIRKLIN JOHN W.
Published: June 2012

Renal performance of seven patients undergoing replacement of the aortic valve was investigated. The initial portion of cardiopulmonary bypass was characterized by low arterial blood pressure and anuria. With a subsequent rise in arterial pressure during bypass, urine flow suddenly increased in five patients. In two patients urine flow did not resume until immediately after cardiopulmonary bypass. The high rate of urine flow at these times is thought to be partially due to a glucose-induced osmotic diuresis. The glomerular filtration rate (inulin clearance) and the effective renal plasma flow (PAH clearance) fell with induction of anesthesia and opening of the chest, but there was no further drop in these functions as a result of total body perfusion. Urine osmolality fell significantly during and immediately after cardiopulmonary bypass. The changes in urine osmolality are thought to be due in part to the osmotic diuresis and in part to a temporary reduction in the renal medullary hyperosmolality secondary to hemodynamic changes. All of the alterations in renal function were reversible in the patients studied.
Anomalous Pulmonary Venous Return
Authors: BLAKE HU A. , HALL ROBERT J. , MANION WILLIAM C.
Published: June 2012

One hundred and thirteen selected anomalous pulmonary venous returns have been well documented anatomically. Twenty-seven variations were seen. With the use of simplified diagrams, these have been correlated with related cases in the literature. Emphasis has been placed on transitional forms with one anomaly shading off into the next, rather than upon a series of neat, compartmentalized, classic types of anomalous pulmonary venous return. It is hoped that the broad anatomic spectrum shown will promote additional understanding and interest.
A Nomogram for Estimation of the Cardiac Valve Areas
Authors: WONG PETER C. Y. , SANDERS CHARLES A.
Published: June 2012

A nomogram for the estimation of cardiac valve areas by the Gorlin formula has been described. The advantages of the nomographic approach are four-fold: (1) it results in considerable time saving in doing mathematical calculations; (2) it lessens the chance of mathematical error; (3) it provides a rapid means of checking the accuracy of a valve area calculated in the conventional manner; (4) it facilitates the understanding of the relationships between the various factors employed in the valve area formula.

As a result, the nomogram will be a useful adjunct in the operation of the cardiac catheterization laboratory and in the education of its physician personnel.
The Effect of Stethoscope-Applied Pressure in Auscultation
Authors: HOWELL WILLIAM L. , ALDRIDGE C. FOSTER
Published: June 2012

The effect of pressure against the chest wall in the use of the stethoscope for both the bell and the diaphragm chest piece is discussed.

A modified diaphragm chest piece in a single head designed to increase the auscultatory discrimination is discussed.

Comparison of the modified and conventional diaphragm chest pieces on an artificial precordium and with the employment of accepted engineering principles in the study of sound revealed the superiority of the modified diaphragm.
The Effect of Digoxin in the Splanchnic Circulation in Ventricular Failure
Authors: FERRER M. IRENÉ , BRADLEY STANLEY E. , WHEELER HENRY O. , ENSON YALE , PREISIG RUDOLPH , HARVEY RÉJANE M.
Published: June 2012

Splanchnic hemodynamics were examined in 22 patients with heart disease, 16 of whom had evidence of ventricular insufficiency at the time of study. The response of the splanchnic vasculature to the exhibition of intravenous digoxin was also studied in nine of these subjects.

Ventricular insufficiency was associated with splanchnic vasoconstriction proportional to a generalized increase in peripheral vascular resistance. Splanchnic blood volume was disproportionately increased with respect to total blood volume in patients having visceral congestion with right ventricular failure and combined ventricular failure. A significant relationship between central venous pressure and splanchnic blood volume was demonstrated in these cases. The greater elevation of the former than of the latter suggested the presence of splanchnic venoconstriction.

The vascular readjustment to digoxin resulted in a relative intensification of the already existing vasoconstriction of the splanchnic bed as compared to the diffuse systemic vasodilatation which occurred at the same time as the consequence of the inotropic action of the drug: estimated splanchnic blood flow and splanchnic blood volume diminished at a time when systemic flow rose and peripheral vascular resistance decreased. The ultimate distribution of the volume of blood translocated out of the splanchnic bed during this process remains to be determined.
Ruptured Papillary Muscle
Authors: AUSTEN W. GERALD , SANDERS CHARLES A. , AVERILL JAMES H. , FRIEDLICH ALLAN L.
Published: June 2012

A case of severe mitral regurgitation secondary to myocardial infarction and rupture of the anterior papillary muscle is presented. Mitral valve replacement resulted in striking improvement.
Anatomic and Physiologic Considerations in Measurements of Myocardial Blood Flow
Authors: ROSS RICHARD S. , FRIESINGER GOTTLIEB C.
Published: June 2012

Indicators can be used to measure myocardial blood flow if the myocardial circulation can be isolated from other segments of the systemic circulation.

Methods of measuring myocardial blood flow can be divided into groups according to the technic employed to provide "isolation" of the myocardium.

There is no practical method of proved accuracy whereby coronary blood flow can be measured in man in absolute terms of ml./min.

All the so-called clearance methods measure myocardial blood flow in flow/volume units or ml./min./100 Gm.

Myocardial blood flow measurements in these flow/volume units have not proved useful in separation of normal individuals from those with ischemic heart disease at rest, but have been useful in the study of acute intervention such as exercise or the administration of drugs.