bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemodynamic Effects of Pargyline in Hypertensive Patients
Authors: ONESTI GADDO , NOVACK PAUL , RAMIREZ OSVALDO , BREST ALBERT N. , MOYER JOHN H.
Published: June 2012

Pargyline exerts its antihypertensive effect via a predominant reduction in peripheral vascular resistance, whereas cardiac output is not altered significantly. The effect on renal blood flow is inconsistent, but a significant reduction in glomerular filtration rate does occur. Therefore the drug should be used with appropriate caution in patients with significant impairment of renal function. The hemodynamic response observed with pargyline is similar to that obtained with other MAO inhibitors.
Transient Myocardial Damage Secondary to Extravasation of Contrast Material during Left Ventricular Angiocardiography
Authors: KAWAI CHUICHI , ABELMANN WALTER H.
Published: June 2012

In a patient with moderate valvular aortic stenosis transient myocardial injury resulted from extravasation of contrast material into the posterolateral wall of the left ventricle during selective left ventricular cineangiocardiography via the transseptal approach. The patient developed anterior upper chest pain, runs of idioventricular rhythm followed by spontaneous return to sinus rhythm with elevated ST segments, and increase in serum transaminase levels. Lack of previous reports of transient myocardial damage secondary to extravasation of contrast material, increased possibility of such accidents with increased use of selective left ventricular angiocardiography, and possible preventive methods were emphasized.
The Coexistence of Acute Rheumatic Fever and Sickle Cell-Hemoglobin C Disease
Authors: IISKER SHELDON , FINKELSTEIN DAVID , SCHWARTZ STANLEY , MARULYALI KERIMAN , VALDES-DAPENA ANTONIO
Published: June 2012

The clinical and postmortem findings in a case of sickle cell-hemaglobin C disease complicated by acute rheumatic fever with accompanying carditis, and rheumatic pneumonitis are presented and discussed. This is believed to be the first such case reported.

The recent literature pertaining to the cardiac manifestations of SS and SC hemoglobinopathies is briefly reviewed.

A possible explanation for the failure of the rheumatic process to respond to conventional therapy in our patient is given.
Ethacrynic Acid
Authors: CANNON PAUL J. , HEINEMANN HENRY O. , STASON WILLIAM B. , LARAGH JOHN H.
Published: June 2012

Ethacrynic acid, a chemically different diuretic, has been evaluated in 82 patients. The drug was remarkably potent when administered intravenously (0.5 to 1 mg./Kg.) or by mouth (doses to 50 mg. four times per day). It proved particularly effective in patients with refractory edema, and in edematous states accompanied by azotemia or electrolyte disturbances. Its natriuretic effects added to those of other diuretics and potentiation actually appeared to occur when it was combined with a carbonic-anhydrase inhibitor.

Renal clearance data indicated that ethacrynic acid has a unique mode of action. There was little effect on glomerular filtration or renal plasma flow and its major action was to block sodium and chloride reabsorption probably in both proximal and distal portions of the renal tubules.

Ion exchange mechanisms seemed little affected by the drug because it characteristically increased both hydrogen and potassium ion excretion. In general the degree of induced potassium loss correlated well with the rate of endogenous aldosterone secretion. Furthermore, ethacrynic acid did not cause potassium loss in one adrenalectomized subject nor in another subject pretreated with an aldosterone antagonist.

Diuresis induced by ethacrynic acid was often accompanied by the development of systemic metabolic alkalosis. Factors in the development of this alkalosis were (1) urinary K
+
loss with hypokalemia, (2) urinary H
+
loss, and (3) in edematous patients the rapid large loss of relatively HCO
3
-
-free fluid from the extracellular fluid space. The systemic alkalosis was found to be accompanied by compensatory alveolar hypoventilation. These studies of the mechanisms of the alkalosis point to the occasional importance of the administration of chloride, of potassium, or of saline as corrective measures.

Diuresis with ethacrynic acid, like other diuretic agents, produced marked increases in the rate of aldosterone secretion of normal subjects. More variable effects were observed in patients with heart disease, possibly because improvement in their circulatory status operated to lower hormone secretion activity.

Ethacrynic acid had effects on urate excretion that resembled thiazide diuretics. Higher blood levels of intravenous administration were uricosuric. Lower blood levels of oral therapy caused renal urate retention and hyperuricemia.

Most of the problems associated with the use of ethacrynic acid appeared to be related more to its pharmacologic potency than to any truly toxic effect. Because of this it is suggested that the sensitivity and response pattern of each patient be determined in stepwise fashion. In most patients with edema an intermittent dosage schedule provides a more efficient diuretic response and allows time intervals for correction of any electrolyte imbalance. If used with a thorough understanding of its pharmacologic effects ethacrynic acid promises to be a most useful agent in the therapy of patients with difficult or refractory edema.
A Clinical Profile of Paroxysmal Hyperpnea in Cyanotic Congenital Heart Disease
Authors: MORGAN BEVERLY C. , GUNTHEROTH WARREN G. , BLOOM RONALD S. , FYLER DONALD C.
Published: June 2012

A large series of patients with cyanotic congenital heart disease and inadequate pulmonary blood flow who required a systemic to pulmonary artery anastomosis was reviewed, along with a small current series of patients unselected as to surgical intervention.

Thirty-eight per cent of 190 patients in the first group had definite spells consisting of paroxysmal hyperpnea and increased cyanosis, frequently progressing to loss of consciousness. In the current group, 13 of 24 had spells. In the combined groups, there were three convulsions, eight cerebral vascular accidents, and six deaths due to the spell.

Age of onset varied from 1 month to 2 years, with the peak incidence between 2 to 3 months of age. The time of day at which spells occurred was recorded in only 15 patients in the large series: 11 occurred in the morning and four in the evening. In the smaller series, the patients who had only occasional episodes had them exclusively in the morning, whereas the severely affected patients had attacks at almost any time.

Precipitating factors, in order of over-all frequency, were crying, defecation, and feeding.

The most surprising finding was the lack of correlation of hyperpneic spells with resting arterial desaturation, although all arterial saturations obtained during attacks were quite low. Two patients with observed, typical paroxysms had arterial saturations under sedation of 93 and 98 per cent, in contrast to a patient with a 44-per cent saturation who had had no spells.
Effect of Body Build on the QRS Voltage of the Electrocardiogram in Normal Men
Authors: KILTY STANLEY E. , LEPESCHKIN EUGENE
Published: June 2012

Various sets of QRS voltages that are used in the diagnosis of left ventricular hypertrophy were determined from the electrocardiograms of 300 normal men judged to be free from cardiopulmonary disease, and these were correlated to body build expressed in terms of ponderal index. A correlation was found for all voltages studied and a highly significant correlation was found for the criteria "R
I
+ S
III
" "greatest R + greatest S in the precordial leads" and "greatest R + S in a single precordial lead." Age or activity did not appear to be specific factors in the population studied. Graphs were constructed for the latter three sets of voltages defining upper limits of normal for various values of the ponderal index. By using these sets of voltage criteria in conjunction with this index, one would hopefully improve both accuracy and specificity in the electrocardiographic diagnosis of early left ventricular hypertrophy.
Cor Triatriatum as a Problem of Adult Heart Disease
Authors: MCGUIRE LOCKHART B. , NOLAN THOMAS B. , REEVE RICHARD , DAMMANN J. FRANCIS
Published: June 2012

The occurrence of severe pulmonary venous obstruction due to the congenital anomaly known as cor triatriatum in a 19-year-old furniture mover is described. Relentless and massive hemoptysis led to pulmonary edema, and an attempt at surgical correction under unfavorable conditions was not successful.

Seven other cases of cor triatriatum in adults are reviewed. The hemodynamic abnormalities closely resemble mitral stenosis, except that pressures in the true left atrium were normal in the presence of elevated pulmonary capillary pressures. The availability of flow across the obstructing membrane during systole as well as diastole is probably the major element in the surprisingly good tolerance of severe degrees of anatomic obstruction for long periods of time. Slow increase in the degree of obstruction could also be a factor.

The clinical picture in these patients very closely resembles mitral stenosis. Hemoptysis appeared to be more frequent in cor triatriatum. Features suggestive of the correct diagnosis would include the absence of an opening snap, the absence of a typical murmur of mitral stenosis, regular rhythm, and lesser evidence of left atrial enlargement in the presence of obvious pulmonary hypertension. Five of these patients have undergone successful correction of their disease by operation.

Representative films from the first known angiograms in this condition in an adult are reproduced and discussed.
Hyperbaric Oxygen in Cardiovascular Disease
Authors: SALTZMAN HERBERT A.
Published: June 2012

In summary, hyperbaric oxygenation produces remarkable physiologic increases in oxygen transport to body tissues. However, potential benefit from hyperoxygenation in the treatment of ischemic disease appears dependent upon the presence of a partially intact capillary circulation. Improved means for prevention of oxygen toxicity and better technics of oxygen delivery to specific sites are required, if hyperbaric oxygenation is to fulfill present hopes for therapeutic application.
Fluid Retention Produced by Guanethidine
Authors: SMITH A. J.
Published: June 2012

Total exchangeable sodium and blood volume increased during the first year's treatment of seven hypertensive patients with guanethidine. Creatinine clearance values fell over the same period.

A similar change was seen in two patients receiving reserpine. It is suggested that the hemodynamic changes produced by hypotensive drugs are insufficient completely to explain the observations. A direct effect of guanethidine on sodium reabsorption in the kidney may also be involved.
Relation of Arterial Blood Pressure to the Transverse Diameter of the Heart in Compensated Hypertensive Heart Disease
Authors: RAMIREZ ELI A. , GARCIA PONT PEDRO H.
Published: June 2012

In 535 male hypertensive patients the correlation coefficient between the corrected transverse diameter of the heart and the systolic pressure was +0.301. With diastolic pressure the correlation coefficient was +0.209. Both coefficients were significant (
p
<0.001), but the association between the variables was quite small in both correlations. The correlation between the corrected transverse diameter and the systolic pressure was significantly better than with the diastolic pressure, (
p
<0.001). The correlation between the corrected transverse diameter and the systolic pressure was independent of age.
Experimental Large-Volume Hemodilution
Authors: GADBOYS HOWARD L. , LITWAK ROBERT S. , ISHIGURO JUNICHI , KAHN MELVIN
Published: June 2012

1. Large-volume hemodilution was experimentally performed with a standardized reservoir arteriovenous fistula preparation in which intra- and extracorporeal volumes were kept constant. Vasopressors, buffers, hypothermia, and overinfusion were not employed.

2. Control studies with 10 ml/kg of various diluents revealed hemodynamic, volumetric, and biochemical stability of the experimental preparation.

3. Homologous blood exchange (100 ml/kg) with heart worm-free donors and recipients caused arterial hypotension, hepatic and pulmonary congestion, and depressed renal function.

4. All diluents tested produced hypotension and metabolic acidosis under the conditions of the experiment when used in amounts approximately equivalent to canine blood volumes. Ten per cent of the diluted animals expired from shock.

5. Blood pressure was initially better sustained with low molecular weight dextran, dextrose-Ringer's-albumin, and dextrose-Ringer's solutions, but the effect was short lived.

6. Cardiac outputs and total blood volumes did not change appreciably during the exchange infusions. Hematocrit changes reflected maintenance of intravascular volume. Peripheral resistance fell significantly, shortly after the onset of constant volume exchange.

7. Osmolality and oncotic activity of the diluents showed no clear-cut relationship to over-all stability of the infused animals.

8. The clinical advantages of hemodilution have been well established. Hemodynamic, volumetric, and biochemical differences between clinical perfusions and the experiments outlined herein attest to the roles of over-infusion, buffering, and hypothermia in ameliorating the experimentally observed sequelae.

9. The data suggest that the search should be continued for a more ideal blood substitute, as well as for low-prime, high-flow extra-corporeal systems.
Cardiopulmonary Bypass with Large Volume Nonblood Perfusate
Authors: NEVILLE WILLIAM E. , SCICCHITANO LEON , MABEN HAYWARD , BANUCHI FEDOR , PEACOCK HOWARD
Published: June 2012

Experimental and clinical data have been presented which support the efficacy of using a large-volume nonblood perfusate for cardiopulmonary bypass. Dogs have consistently survived hemodilution of 100 to 120 ml/kg body wt when manifest hypoxic acidosis has been ameliorated with THAM (tris [hydroxymethyl] aminomethane) or sodium bicarbonate.

Fifty-eight patients have undergone total bypass with the disc oxygenator totally primed with 2,500 to 3,000 ml of buffered Ringer's or Ringer's lactate solution. Normothermia and moderate hypothermia have been employed with a hemodilution of 33 to 60 ml/kg body wt and a mean perfusion hematocrit of 24%. Despite the decrease in oxygen-carrying capacity of the blood, acidosis has not been observed during prolonged perfusions at median flow rates. Following oxygenator reinfusion, the postoperative total blood volume has been normal. However, a decrease in red cell mass was observed which necessitated the administration of "packed red cells." With this technique, the clotting time was more readily restored to normal, and kidney function was markedly improved over a comparable series of patients perfused with donor blood.
Effects of Aortic Regurgitation on Left Ventricular Performance
Authors: MORROW ANDREW G. , BRAWLEY ROBERT K. , BRAUNWALD EUGENE , Seipp Harry W. , Cobb David E. , Montgomery Maxine P.
Published: June 2012

The volume of regurgitant blood flow and its effects on the performance of the left ventricle were assessed at operation in 14 patients with varying degrees of aortic regurgitation. Instantaneous forward and regurgitant flows in the ascending aorta were measured with a sine-wave electromagnetic flowmeter simultaneously with left ventricular and aortic pressures. In eight patients who had aortic regurgitation without associated stenosis, 63 to 75% of the total forward stroke volume regurgitated during the succeeding diastole. The calculated regurgitant orifice areas ranged from 0.13 to 0.44 cm
2
/m
2
. After replacement of the aortic valve with a Starr-Edwards prosthesis, the absence of regurgitant flow was proved in every patient, and the records of aortic blood flow closely resembled those seen in patients with normal aortic valves. Net forward blood flow increased by an average of 60%, total left ventricular stroke volume fell 42%, and the mean aortic pressure rose 29%. The pressure work of the left ventricle was elevated preoperatively in five of the eight patients (average 89 g-m/stroke/m
2
) and fell significantly to an average of 34 g-m/stroke/m
2
after valve replacement. Kinetic ventricular work was high in seven of the eight patients and comprised 10% of total work before replacement but only 4.8% afterward.

Similar observations were made in five patients with aortic stenosis and associated aortic regurgitation, ranging in severity from 24 to 72% of total forward stroke volume. In four patients in whom the valve was replaced, no residual regurgitation was present afterward, and net forward flow rose an average of 49%. Kinetic left ventricular work was extremely high in every patient and averaged 26% of total work preoperatively and 13% after valve replacement. In this group, pressure work was variable both before and after operation.

The studies described provide definitive information concerning the effects of aortic valve disease on left ventricular performance in man and document the favorable changes in flow, pressure, and left ventricular work which immediately follow aortic valve replacement.
The Changes in Cardiac Output with Reversion of Atrial Fibrillation to Sinus Rhythm
Authors: MORRIS JAMES J. , ENTMAN MARK , NORTH WILLIAM C. , KONG YIHONG , MCINTOSH HENRY
Published: June 2012

Twelve patients were reverted from atrial fibrillation to sinus rhythm by the technic of "cardioversion." Brief, light anesthesia was the only drug employed. Under conditions of comparable oxygen consumption cardiac output was measured first in atrial fibrillation and then in sinus rhythm. Eleven patients were studied at rest and five during exercise.

Ten of the 11 patients studied at rest showed a reduced arteriovenous oxygen difference with sinus rhythm and seven of the 11 increased cardiac output 0.6 L./min. or greater, an average increase of 34 per cent. All five patients studied at exercise decreased the arteriovenous oxygen difference with sinus rhythm and cardiac output rose 1.1 L./min. or greater in all, an average increase of 17 per cent.
The Circulatory Effects of Intravenous Phentolamine in Man
Authors: TAYLOR S. H. , SUTHERLAND G. R. , MACKENZIE G. J. , STAUNTON H. P. , DONALD K. W.
Published: June 2012

Circulatory observations have been made on six normal subjects and six hypertensive patients before and after the acute intravenous injection of 5 mg. of phentolamine.

The drug caused a prompt reduction in systemic vascular resistance which resulted in a rapid fall in systemic blood pressure in spite of an increase in heart rate and cardiac output.

Evidence is presented that the predominant vascular activity of the drug is to cause a direct relaxation of vascular smooth muscle, an effect far more potent than its antagonism of circulating catecholamines or its very much weaker sympathetic-blocking action. This direct depressor effect on vascular smooth muscle unaccompanied by any but slight sympathetic blocking activities endows the drug with theoretically ideal antihypertensive properties.

Phentolamine caused a transient but significant reduction in oxygen uptake in the majority of individuals. It is suggested that this may be due to a direct inhibition of cellular oxidative mechanisms.

An appraisal of the circulatory activities of the drug with particular regard to its use as a diagnostic test for pheochromocytoma leads to serious doubts, not only with regard to the precision with which the results of such tests can be interpreted, but also to the validity of the use of the drug as a reliable screening test for excessive circulating catecholamines.
Rheumatic Nephrosclerosis
Authors: BRUETSCH WALTER L.
Published: June 2012

Three instances of rheumatic nephrosclerosis are described in patients with chronic rheumatic valvular heart disease. The underlying mechanism of this renal lesion consists of an obliterating rheumatic endarteritis, involving mainly medium-sized and small arteries of the renal cortex. The arterioles take relatively little part in these changes. The widespread occlusive vascular disease gives rise to innumerable microscopic infarctions, resulting in a coarsely granular external surface of the kidneys.

A similar granular appearance of cerebral convolutions may or may not occur in these cases, depending on whether the small meningeal and cortical vessels of the brain are extensively involved.
Cineradiographic Studies of the Early Systolic Click in Aortic Valve Stenosis
Authors: EPSTEIN ELLIS J. , CRILEY J. MICHAEL , RAFTERY EDWARD B. , HUMPHRIES J. O'NEAL , ROSS RICHARD S.
Published: June 2012

An early systolic click and a normal or accentuated aortic second sound have been found in cases of aortic valve stenosis characterized cineradiographically by a mobile, dome-shaped valve. Impaired valve mobility was usually associated with a systolic click of low intensity, and in the presence of an immobile aortic valve there was no systolic click. The aortic second sound was correspondingly diminished or absent.

Early systolic clicks and loud aortic closure sounds were also present in patients in whom a diseased aortic valve had been replaced by three Teflon prosthetic leaflets. In most of these patients there was no systolic click before insertion of the prosthesis.

In the patients studied, the systolic click occurred at the end of the opening movement of the aortic valve at the onset of left ventricular ejection. It followed the crossover point of the left ventricular and aortic pressure pulses by a time interval ranging from 15 to 45 msec. (average 33 msec.).

The opening movement of the valve was thought to produce the systolic click by causing sudden tension of the valve membrane or sudden alteration in the velocity of blood flow. By analogy with the opening snap in mitral stenosis, the early systolic click may be regarded as the "opening snap" of the aortic valve. A systolic click is clinical evidence of a mobile aortic valve in patients with aortic valve disease.
The Use of the I
131
-Hippuran Renogram in the Detection of Disparate Kidney Function in Hypertensive Patients
Authors: WEDEEN RICHARD P. , LITTMAN EDWARD , LEVITT MARVIN F. , GOLDSTEIN MARVIN H.
Published: June 2012

The reliability of the radioisotope renogram in detecting functional disparity in the separate kidneys of hypertensive patients with unilateral renal disease was investigated. Renograms recorded in 33 hypertensive patients without unilateral renal disease were employed for establishing control criteria. The physiologic basis for the three types of positive renograms found in the presence of unilateral renal dysfunction has been discussed. The renogram appears to be a valuable method for demonstrating significant disparity in separate kidney function while avoiding the hazards and technical difficulties of bilateral ureteral catheterization.
A Method for the Detection and Quantification of Impaired Sodium Excretion
Authors: BRAUNWALD EUGENE , PLAUTH WILLIAM H. , MORROW ANDREW G.
Published: June 2012

An oral sodium tolerance test was devised to detect and quantify impaired Na excretion in patients with heart failure. Following a 4-day period during which daily Na intake was limited to 10 mEq., 80 mEq. of Na were administered daily for 4 days and 150 mEq. for another 4 days. The total urinary Na excretion during the 8-day test period was determined. Thirteen normal subjects excreted between 550 and 734 mEq. of Na. Of 41 patients with heart disease, 31 excreted subnormal amounts of Na, between 10 and 550 mEq. and only 10 excreted normal quantities. An alternate plan, in which 320 mEq. of Na was administered in 8 days, was also utilized in patients in whom the standard 920-mEq. Na load was considered inadvisable. There was no correlation between the impairment of Na excretion, as estimated by the Na tolerance test, and the etiology of the heart disease, the glomerular filtration rate, or any hemodynamic variable. Patients with marked functional disability excreted less Na than those with few symptoms, and the patients with the most severe impairment of Na excretion all had a history of edema. Striking improvement in Na tolerance followed corrective cardiac operations. The Na tolerance test was found of particular usefulness in the evaluation of patients in whom clinical examination and hemodynamic studies gave no conclusive evidence as to the presence or absence of congestive heart failure.
Single Left Coronary Artery with Fistula to Right Ventricle
Authors: HALLMAN GRADY L. , COOLEY DENTON A. , MCNAMARA DAN G. , LATSON JOSEPH R.
Published: June 2012

The case of an 8-year-old girl with a single coronary artery is presented. This vessel arose as a left coronary artery and followed the distribution of one coronary artery. The long circumflex branch traveled in the atrioventricular groove and continued as a vessel occupying the position usually held by the right coronary artery. It ended as a fistula to the outflow tract of the right ventricle. A continuous murmur was present clinically. Cardiac catheterization and selective angiocardiography demonstrated the anatomy of the lesion and the presence of a left-to-right shunt. Operation consisted of ligation of the fistula and anastomosis of the right ventricular portion of the coronary artery to the aorta with a Dacron tube graft. This latter maneuver established a dual inflow into the coronary arterial system and should overcome the disadvantage of a single coronary artery in the event that arteriosclerotic occlusive lesions develop in later life. Furthermore, the procedure demonstrated the feasibility of grafting technics that may find application in the treatment of anomalous origin of a coronary artery from the pulmonary artery.
Hemodynamics of the Upper Extremities in Subclavian Steal Syndrome
Authors: CONRAD MARGARET C. , TOOLE JAMES F. , JANEWAY RICHARD
Published: June 2012

Digital flow, digital artery systolic pressure, resistance, pulse volume, pulse contour, and delay between right and left pulses were evaluated in the upper extremities of four patients with the subclavian steal syndrome. Studies were made preoperatively in all patients and following surgical reconstruction of the subclavian in three cases.

Digital artery pressures were consistently lower on the side with the subclavian occlusion.

Flow on the occluded side was equal to or higher than that in the opposite extremity except when a second, more distal occlusion was present.

In each case there was a delay in the foot of the digital pulse on the occluded side and a more marked delay in the pulse peak. Distal to the occlusion the pulse amplitudes were decreased and the contours were abnormal.

The amplitude of the digital pulse was markedly decreased with exercise of the affected extremity.

The pulse delay and the disappearance of pulse in the radial artery during exercise previously described clinically has been confirmed by measurement.
Hemodynamic Studies Following Pericardiectomy for Constrictive Pericarditis
Authors: KLOSTER FRANK E. , CRISLIP RODNEY L. , BRISTOW J. DAVID , HERR RODNEY H. , RITZMANN LEONARD W. , GRISWOLD HERBERT E.
Published: June 2012

Fourteen patients underwent right heart catheterization 5 to 86 months after pericardiectomy for constrictive pericarditis. Twelve had preoperative catheterizations, all with findings typical of constrictive pericarditis.

All patients showed marked hemodynamic and symptomatic improvement after operation. Three patients had persistent mild elevation of right heart and pulmonary artery pressures; one of these had a low cardiac output. Two other patients developed pulmonary hypertension with exercise, and one man showed an inadequate increase in cardiac output with exercise. Twelve patients were asymptomatic postoperatively and two had exertional dyspnea.

Patients with incomplete pericardiectomy over the ventricles had abnormal hemodynamic results, while decortication of the atria and venae cavae made no difference in the postoperative findings. A left anterolateral thoracotomy incision provided adequate exposure for pericardiectomy, and continues to be the incision of choice at this hospital. Younger patients and those who progressed from recognized acute pericarditis to pericardial constriction more frequently had normal results at cardiac catheterization after operation. Certain preoperative liver-function tests correlated well with the postoperative hemodynamic findings. The role of myocardial disease in producing residual hemodynamic abnormalities remains unresolved.

It is concluded that excellent clinical results and normal hemodynamic findings can be achieved by pericardiectomy in most patients with constrictive pericarditis.
Effects of Changing Heart Rate in Man by Electrical Stimulation of the Right Atrium
Authors: ROSS JOHN , LINHART JOSEPH W. , BRAUNWALD EUGENE
Published: June 2012

A technic is described for controlling the heart rate in patients with normal atrioventricular conduction by means of an electrical pacemaker catheter that stimulated the right atrium. When the heart rates of 17 patients in the resting state were elevated from an average of 80 to 121 beats/min., the cardiac indices remained virtually unchanged and averaged 3.67 and 3.72 L./min./M.
2
, respectively. Further increases in the heart rates resulted in small reductions in the cardiac indices to an average value of 3.21 L./min./M.
2
at 148 beats/min. The stroke volumes, ejection periods, and mean rates of ejection decreased as heart rate was increased.

The role of heart rate in the circulatory response to exercise was examined in seven patients. When the heart rates were controlled by electrical stimulation at rates comparable to those previously achieved spontaneously during exercise, it was observed that cardiac output rose normally with exercise and that this rise was accomplished entirely through an increase in the stroke volume. In five patients the effects of isoproterenol infusion were also studied before and during control of the heart rate at the level reached spontaneously during isoproterenol administration. Again, when the heart rate was not permitted to rise, the increases in cardiac output with isoproterenol were mediated through increases in the stroke volume. These studies indicate that in the absence of augmented metabolic requirements, homeostatic mechanisms maintain cardiac output relatively constant despite large induced changes in the heart rate. However, when metabolic demands are increased by muscular exercise, or the circulation is stimulated by catecholamines, cardiac output can rise through an increase in stroke volume, even when alterations in the heart rate are prevented.
The Electrocardiogram after Mastectomy
Authors: LAMONTE CHARLES S. , FREIMAN ALVIN H.
Published: June 2012

The electrocardiograms before and after operation have been compared in 20 patients undergoing left mastectomy and in 19 patients undergoing right mastectomy.

There are highly significant increases in the amplitude of the QRS complexes recorded over the precordium after left mastectomy, except in lead V
6
.

There are highly significant increases in the amplitude of the QRS complexes of leads V
3R
and V
1
after both left and right mastectomy.

These data are not completely explained by a diminution of distance between the recording electrode and the myocardium or of electrical resistance following the excision of soft tissue.

The possible relationship is suggested between the precordial voltage changes and the altered thoracic volume conductor.
Origin of Both Great Vessels from the Right Ventricle Associated with the Trisomy-18 Syndrome
Authors: ROGERS TERRY R. , HAGSTROM JACK W. C. , ENGLE MARY ALLEN
Published: June 2012

Origin of both great vessels from the right ventricle in association with a ventricular septal defect was found in seven of nine autopsied patients with the clinical features of the trisomy-18 syndrome. In four of these patients trisomy-18 was confirmed by chromosomal analyses. This experience indicates that origin of both great vessels from the right ventricle may in fact be an additional component of the trisomy-18 syndrome. Human Genetics, for chromosomal analyses and for consultation.
Ventricular Septal Defect
Authors: RITTER DONALD G. , FELDT ROBERT H. , WEIDMAN WILLIAM H. , DUSHANE JAMES W.
Published: June 2012

Records of 273 cases of ventricular septal defect from five participating institutions were studied. Insignificant hemodynamic disturbance (Roger's) was found in 11 per cent, moderate to large left-to-right shunts in 55 per cent, and severe pulmonary vascular disease ("Eisenmenger's") in 8 per cent. Because of insufficient data, 26 per cent of the cases were not classified hemodynamically. Thus, a spectrum of severity ranging from mild to severe was noted.

There was evidence of congestive heart failure in infancy in 78 cases and a significant mortality occurred in this group, whether treatment was medical (mortality, 27 per cent) or surgical (mortality, 46 per cent). Six patients had hemodynamic evidence of severe progressive pulmonary vascular disease, three when they were less than 8 years old. Correlations of hemodynamic severity with clinical symptoms, roentgenographic findings, and electrocardiographic changes were reasonably good at the extreme ends of the severity spectrum but only fair in the middle range. Over-all mortality was high (28 per cent) for the 163 patients treated surgically, but mortality was also high (18 per cent) for the 110 patients treated medically. Ten of the 20 deaths in the medical group occurred in patients who had had congestive heart failure in infancy. Further study of the natural history of ventricular septal defect is clearly indicated for establishment of improved criteria for selection of cases for operation.
Tricuspid Stenosis
Authors: SANDERS CHARLES A. , HARTHORNE J. WARREN , DESANCTIS ROMAN W. , AUSTEN W. GERALD
Published: June 2012

The present report concerns ten patients with significant tricuspid stenosis and atrial fibrillation. The diagnosis could be made clinically in only two patients and by pullback record from right ventricle to right atrium in three, including the two mentioned previously. Careful hemodynamic assessment of tricuspid valve function by using simultaneously recorded right atrial and right ventricular pressures resulted in the detection of significant tricuspid stenosis in the nine patients on whom these measurements were made. The influence of atrial fibrillation and respiration on the tricuspid gradient and the role of exercise and amyl nitrite in augmenting barely detectable resting gradients are demonstrated.
Effective Closure of the Mitral Valve without Atrial Systole
Authors: BRAUNWALD EUGENE , ROCKOFF S. DAVID , OLDHAM H. NEWLAND , ROSS JOHN
Published: June 2012

There has been considerable dispute concerning the role of atrial contraction in the closure of the atrioventricular valves. Selective angiocardiograms with left ventricular [see figure in the PDF file] opacification in 43 patients having a variety of arrhythmias that resulted in the absence of atrial systole, or in an abnormal temporal relationship between atrial and ventricular contractions, revealed no evidence of mitral regurgitation. From this observation it is concluded that a properly timed atrial contraction is not always essential for effective closure of the mitral valve in man.
Measurement of Renal Artery Pressures by Catheterization in Patients with and without Renal Artery Stenosis
Authors: CARTER STEFAN A. , RITCHIE GORDON W.
Published: June 2012

Pressures were successfully measured by catheterization in 13 out of 18 renal arteries with stenosis and in 15 out of 16 vessels without stenosis. The pressures were measured via a small-bore, radiopaque nylon catheter threaded through a curved polyethylene catheter whose tip was placed in the renal vessel. The position of the catheters was confirmed by injections of small volumes of angiographic dye and documented by spot films. Use of the small-bore catheter was necessary to avoid alteration of the measured pressure. Strict attention to technical details is mandatory in order to obtain satisfactory pressure recordings.

In patients without angiographic evidence of stenosis, pressure in the renal arteries did not differ consistently from the aortic pressure. Differences of more than 15 mm Hg in the systolic pressure are probably abnormal.

Abnormal systolic pressure gradients between the aorta and the renal artery were found in some patients with renal artery stenosis, but not in others. In the patients with gradients, good correlation was obtained between the gradient and the dimensions of the stenosis measured on the angiographic films and expressed as L
s
/(D
s
/D
N
),
2
where L
s
is the length of the narrowing, and D
s
and D
N
are respectively the diameters of the lumen of the stenotic and nonstenotic parts of the vessel in a frontal projection.

Our experience suggests that more preoperative pressure measurements by catheterization across renal artery stenosis and correlation relation with angiographic and renal function studies and with the results of operation are warranted.
Serial Cardiac Output and Blood Volume Studies Following Cardiac Valve Replacement
Authors: KLOSTER FRANK E. , BRISTOW J. DAVID , STARR ALBERT , MCCORD COLIN W. , GRISWOLD HERBERT E.
Published: June 2012

The cardiac output and blood volume were measured preoperatively and sequentially during the early postoperative period in 45 patients undergoing cardiac valve replacement. Most patients showed a prompt, highly significant increase in cardiac output. Those with uncorrected valvular disease, even though apparently trivial, had lower cardiac outputs. The blood volume was sharply reduced from the preoperative level in almost every patient. When this was associated with low cardiac output, replacement of the blood volume deficit was usually accompanied by a prompt increase in cardiac output. Failure to respond in this way occurred only in patients with residual valvular lesions or myocardial disease.
Open-Heart Surgery on the Elderly
Authors: BOWLES L. THOMPSON , HALLMAN GRADY L. , COOLEY DENTON A.
Published: June 2012

Data on 54 patients, 60 years of age or more, who had open-heart surgery are reported. This series is comprised of all patients in this age group who were treated surgically from January 1, 1957, to December 31, 1964. Eighty-two per cent were operated on in the past 2 years.

The most common indications for operation were left ventricular aneurysm and aortic valve disease (39 patients). The ages of the patients in this series ranged from 60 to 73 years, with a mean age of 63. Operative mortality was 20% for the entire series and 11% in the last year reported (1964).

It is concluded that advanced age should not be a deterrent to the selection of surgical therapy for elderly patients with heart disease provided that the proper indications exist. Open-heart surgery may be performed in the elderly with mortality that compares favorably with that encountered in younger individuals with similar lesions.
Atherosclerotic Gangrene: Improved Results of Treatment
Authors: PEARCE CHARLES W. , SCHRAMEL ROBERT J. , HEWITT ROBERT L. , SMITH PRENTISS E. , CREECH OSCAR
Published: June 2012

Advanced atherosclerosis of the lower limb often necessitates major amputation unless arterial flow can be restored. To improve results of treatment on the Tulane Surgical Unit at Charity Hospital, we decided in 1964 to extend indications for restoration of arterial flow to all patients who faced possible loss of a lower limb and who had a patent distal segment of artery to which anastomosis could be made. The general condition of the patient was not held to be a deterrent if operation could be done with use of a local anesthetic.

From July 1, 1957 to July 1, 1964, an average of 21 operations was performed each year for restoration of arterial flow to the lower limb: two-thirds for femoropopliteal occlusive disease and one-third for aortoiliac occlusive disease. In contrast, 108 operations were performed from July 1, 1964 to July 1, 1965: three-fourths for femoropopliteal occlusive disease and one-fourth for aortoiliac occlusive disease. The fatality rate for operative restoration of arterial flow to the lower limb was 4.1% for the first seven years and 5.5% for the eighth year.

An average of 79 major amputations of the lower limb was done for atherosclerosis each year from 1957 to 1964, whereas only 53 amputations were done during the 1964-1965 period. The annual number of major amputations was thus reduced by 33%. The increased number of digital and transmetatarsal amputations from an average of 22 each year during the period 1957-1964 to 42 during 1964-1965 reflects our increased effort to avoid major amputation. Our recent experience suggests that the criteria for restorative operations in patients faced with loss of limbs may safely be extended and that a positive attitude toward operation for advanced atherosclerosis will result in preservation of more limbs.
Adjunctive Use of a Surface-Active Agent in Extracorporeal Circulation
Authors: MIYAUCHI YOSHIMASA , INOUE TAKAYUKI , PATON BRUCE C.
Published: June 2012

1. A nonionic surfactant, Pluronic F68, was used in prolonged experimental and clinical extracorporeal circulation, and data are presented which support the efficacy of the use of this agent.

2. Hemolysis and fat embolism resulting from prolonged cardiopulmonary bypass with a bubble oxygenator were greatly reduced by use of the surfactant.

3. The surfactant markedly prevented and improved the intravascular "sludging." 4. The surfactant also reduced the fibrin deposition on the filter of the oxygenator.

5. The function of the pump oxygenator was not affected.

6. No adverse physiological effects resulting from the Pluronic were discovered. It may, therefore, have widespread application in extracorporeal circulation.
Anomalous Left Coronary Artery Arising from the Pulmonary Artery in an Adult
Authors: LIKAR IVAN , CRILEY J. MICHAEL , LEWIS KENNETH B.
Published: June 2012

The 29-year-old woman with anomalous left coronary artery arising from the pulmonary trunk whose case is presented is at the time of writing, the oldest patient on record in whom this condition has been diagnosed during life. The diagnosis was made by aortic cineangiography and confirmed by selective injection of contrast material into the right coronary artery. The collateral pathways between the right and the anomalous left coronary artery were thus defined. Vectorcardiographic and electrocardiographic patterns of anterolateral myocardial infarction with periinfarction block have not been observed in any of the previously reported adults with this type of rare congenital anomaly.

The 27 cases of ligation of the aberrant left coronary artery arising from the pulmonary artery reported in the literature have been reviewed and the results of this operation discussed.

Diagnosis of the anomalous left coronary artery in adult life is possible if it is considered in patients presenting with a continuous murmur at the base and electrocardiographic evidence of myocardial infarction.
Clinical Evaluation of Blood Flow to the Hand
Authors: EJRUP BORJE , FISCHER BOGUSLAV , WRIGHT IRVING S.
Published: June 2012

One hundred fifty individuals of different ages without evidence of peripheral vascular impairment (100 normal persons and 50 patients with history of cerebral vascular disease) were examined with the Allen test; the radial and ulnar arteries were examined in both hands. A false-positive test could easily be obtained spontaneously or be provoked by intentional hyperextension of the hand more than 20° beyond the straight position. In the straight position of the hand, the time for appearance of rubor after opening of the hand exceeded 5 seconds in 34% of the normal persons. When a relaxed slight flexion at the wrist joint was used, the flush after opening the hand appeared at an average of 3 seconds for the ulnar artery and 2.75 for the radial artery. In 50 normal individuals examined with optimal technique described, no individual artery required more than 6 seconds for the flush to appear after opening of the hand.

The authors recommend that the Allen test be performed with the patient's hand slightly flexed and relaxed.
Differential Renal Function Studies During Mannitol Diuresis in Hypertension
Authors: SIMON NORMAN M. , DEL GRECO FRANCESCO , O'CONOR VINCENT J.
Published: June 2012

Differential renal function studies during mannitol diuresis were performed in patients with essential hypertension and hypertension secondary to main renal artery stenosis. Brisk urine flow rates with reproducible flow ratios between the two kidneys were obtained in most studies. Functional differences of more than 15% between the kidneys were demonstrated in 56% of the patients with essential hypertension. Nevertheless, the mean differences for urine flow, osmolality, osmolal clearance, total solute excretion, creatinine and sodium concentrations in urine, sodium and potassium excretion rates, and tubular rejection fraction of sodium were significantly less than those seen in renal artery hypertension. All the latter patients showed excessive water and sodium reabsorption by the ischemic kidney and were sharply differentiated from patients with essential hypertension.
Evoked Cortical Potentials in Patients with Stroke
Authors: LARSON SANFORD J. , SANCES ANTHONY , BAKER JOHN B.
Published: June 2012

The evoked somatosensory potentials recorded from 24 patients with stroke are described. The changes seen in the evoked responses can be correlated with the clinical observations during the acute phase in most instances, although improvement in sensory perception is not accompanied by a parallel recovery of evoked potential amplitude. Cerebral diaschisis may be responsible for bilateral depression of evoked somatosensory potentials in the presence of unilateral infarct.
The Use of Hyperbaric Oxygenation in the Treatment of Cerebral Ischemia and Infarction
Authors: HEYMAN ALBERT , SALTZMAN HERBERT A. , WHALEN ROBERT E.
Published: June 2012

The therapeutic usefulness of hyperbaric oxygenation in cerebral vascular disease was evaluated in 22 persons with recent neurologic deficits caused by cerebral embolism, thrombosis, hemorrhage, or arteriographic complications. Hyperoxygenation produced a significant elevation in content and tension of oxygen in blood and increased the reservoir of oxygen available for utilization by neurons. Remarkable and dramatic improvement in neurologic function occurred in four patients. The improvement persisted in two patients. In two others the neurologic deficit recurred a few hours after removal from the hyperbaric chamber; repeated exposure to high oxygen pressures was associated with only temporary improvement. In six other patients there was some evidence of clinical recovery immediately after onset of hyperoxygenation, but the neurologic deficit returned during decompression. The remaining 12 patients did not improve during hyperbaric oxygenation.

These observations indicate that in some patients neuronal structures remain viable for some hours after loss of function in acute cerebral ischemia. In such instances an increase in oxygen delivery may reverse cellular ischemia and prevent death of cerebral tissues. Hyperbaric oxygenation may provide supportive therapy in some patients with acute cerebral ischemia, thereby permitting the removal of the occlusive lesion by surgery or other methods.
Simple Optical Methods for the Recognition of Atrial Flutter, Especially at Slow Atrial Rates
Authors: RYTAND DAVID A. , FRANK ARTHUR , PROFANT GENE R.
Published: June 2012

Simple optical methods, particularly the use of a cylindrical lens, are described which facilitate the examination of electrocardiograms and the differentiation of atrial flutter from atrial tachycardia with block. Results of utilizing the methods indicate that what may seem to be an isoelectric line of the latter is sometimes but an optical illusion, especially at slow atrial rates. Continuous atrial electrical activity of flutter has been detected at atrial rates as slow as 88 per minute. Some of these findings are relevant to certain considerations on the mechanisms of atrial arrhythmias.