bluuebunny/crossref_metadata_2025 huggingface dataset:
Radioelectrocardiography during Exercise in Patients with the Anginal Syndrome Use of Multiple Leads
Authors: BELLET SAMUEL , MULLER OTTO F. , LAVAN DONALD W. , NICHOLS GEORGE J. , HERRING ALLEN B.
Published: June 2012

The electrocardiographic alterations during the period of and immediately following exercise were studied by means of radioelectrocardiography, in 90 patients with angina pectoris. Three leads (II, V
4
, and V
6
) were utilized.

The criteria for abnormality were based on the findings of 229 "normal" subjects between the ages of 17 and 39 and 300 "normal" subjects between the ages of 40 and 60.

Sixty-eight of the 90 patients (76 per cent) with angina pectoris showed electrocardiographic abnormalities during and after the period of exercise. An additional seven patients (8 per cent) manifested alterations that were considered to be "probably abnormal." The incidence of false-negative tests was 10 per cent, those patients being excluded in whom the test had to be stopped early because of fatigue, leg pain, or other complaints.

The findings indicate that the recording of the electrocardiogram during exercise adds considerably to the value of the test. In some patients (12 per cent), the electrocardiogram was positive only during the period of exercise, and in 30 per cent the abnormal findings were obtained chiefly during this period.

The Master two-step test involves various technical and subjective difficulties such as interpretation of the alterations, wandering of the baseline, and lack of cooperation from the patient. In a certain percentage of patients with clinical angina pectoris false-negative tests are obtained. Also positive tests in subjects without definite anginal symptoms are not rare, but not enough long-term follow-up studies have been performed to delineate the significance of these findings.

In spite of some limitations, the exercise electrocardiogram, especially that taken during as well as after exercise, is an important adjunct in the diagnosis of angina pectoris.
Kidney Function after Renal Revascularization for Hypertension
Authors: SIMON NORMAN M. , DEL GRECO FRANCESCO
Published: June 2012

Kidney function was evaluated in 53 patients with renal arterial hypertension before and after renal revascularization and was correlated with changes in blood pressure. Data were derived from an analysis of personal observations and of findings reported by others.

Revascularization produced a significant decrease in blood urea nitrogen and serum creatinine in 13 azotemic patients. It did not significantly affect glomerular filtration rate when normal in 20 patients, but caused a rise in renal blood flow in three patients. Improvement in renal function was more closely correlated with preoperative functional status than with cure of hypertension.

Glomerular filtration rate and renal blood flow increased significantly in the revascularized kidney, but decreased in the contralateral kidney. Urine flow and sodium concentration in the revascularized kidney rose to levels equal to, or greater than, those in the contralateral kidney. The preoperative disparity in urine osmolality between kidneys was narrowed, whereas the concentration of nonresorbable urine solute became equal to, or lower than, that of its mate postoperatively. In most cases, the Howard test reverted to negative. The tubular rejection fraction ratio of sodium became normal or suggested contralateral renal arterial disease. The only functional differences between patients whose hypertension was cured and those whose blood pressure failed to respond to revascularization related to glomerular filtration rate and the Howard test.

Impairment of function of the contralateral uninvolved kidney was rarely observed after surgery. The revascularized kidney frequently exhibited excessive natriuresis and diuresis, independent of changes in systemic blood pressure or glomerular filtration rate.
Compensatory Adjustments in the Structure of Coronary Arteries of the Heart with Stenotic Atherosclerosis
Authors: ANITSCHKOW N. N. , WOLKOFF K. G. , KIKAION E. E. , POZHARISSKI K. M.
Published: June 2012

Adjustments within the coronary arterial system that compensate for stenotic atherosclerosis include hypertrophy of larger coronary arterial branches unaffected by atherosclerosis that undertake supply of blood to an anemic myocardial area; development of collateral circulation; extension of the "paravasal" bed; formation of short anastomoses; and wide recanalization of thrombi.

A combination of special technics devised for this investigation included fixation of coronary arteries with formol under pressure approximating the level of diastolic blood pressure, followed by their injection with an opaque mixture or colored gelatin; angiographic examination and dissection; and microscopic examination of numerous cross sections prepared from the whole length of major trunks and their branches. The size of atherosclerotic plaques and degree of luminal narrowing were then determined planimetrically, as a percentage of the original lumen.

These studies yielded objective evidence for assessing the influence exerted by varying degrees of luminal narrowing on blood supply to myocardium as well as on development of intercoronary anastomoses, and their compensatory significance. The principal conditions bringing about insufficiency of compensatory adjustments have also been considered: progression of coronary atherosclerosis involving arterial anastomoses in the process; successive deposition of lipids over the walls of wide channels through organized thrombi, resulting in their occlusion due to secondary thrombosis; and individually inadequate development of compensatory adjustments.
Acid-Base Management for Open-Heart Surgery
Authors: MORRIS LUCIEN E. , EDMARK K. WILLIAM , JONES THOMAS W. , LOGAN GORDON A. , SAUVAGE LESTER R. , THOMAS GEORGE I.
Published: June 2012

An important part of managing patients during open-heart surgery is continuous monitoring of the acid-base status prior to, during, and following cardiopulmonary bypass. The use of a thermostatically controlled triple electrode system whereby arterial pH, pCO
2
, and pO
2
can be measured and base excess or base deficit quantitated by special application of the Astrup-Andersen nomogram is enthusiastically endorsed.

In the opinion of the authors, respiratory alkalosis is to be avoided throughout the entire operation and postoperatively, as this appears to result in a base deficit, which is subsequently revealed as a metabolic acidosis. Particular consideration is given to the bypass phase when hypothermia is employed, since "optimal" pH appears to vary with temperature.

Continued maintenance of good acid-base status with buffers is advocated. It is considered that buffer administration should be on a "titration" principle with frequent arterial blood gas analyses.

Possible reasons are presented for the improved postoperative morbidity when optimal acid-base status is maintained throughout the operation and postoperatively.
Hemodynamic Studies Two Weeks to Six Years after Repair of Tetralogy of Fallot
Authors: ALBERTAL GEORGE , SWAN H. J. C. , KIRKLIN JOHN W.
Published: June 2012

Hemodynamic studies were made 2 weeks after repair of tetralogy of Fallot in 18 cases and 2 months to 6 years after operation in 5 cases. Intracardiac and intravascular pressures, oxygen uptake, arteriovenous oxygen content difference, cardiac output, heart rate, stroke index, and pulmonary and systemic resistance were measured. Residual intracardiac shunts and residual pulmonary stenosis and incompetence were assessed. Results were compared with similar studies on postoperative days 1, 2, and 3. Further insight into patterns of convalescence as well as into the favorable hemodynamic state usually pertaining after repair are provided by these data.
The Determination of Coronary Flow Equivalent with Coincidence Counting Technic
Authors: BING RICHARD J. , BENNISH ARVIN , BLUEMCHEN GERHARD , COHEN ALBERTO , GALLAGHER JAMES P. , ZALESKI EDWARD J.
Published: June 2012

The coincidence counting technic was used to measure the clearance equivalent of rubidium-84 as a function of coronary flow by the human heart in vivo. This technic makes possible a distinction of radioactivity of the heart muscle from the surrounding tissue, eliminates lead collimation, and is more sensitive than the singles technic.

In experiments on isolated dog heart it was found that changes in rate of perfusion of the coronary arteries failed to influence the myocardial extraction ratio of rubidium-84. Alterations in heart rate were also without effect.

Nitroglycerin increased the clearance equivalent of rubidium-84 in patients without coronary heart disease. In patients with coronary artery disease the drug led to fall in clearance equivalent.

The method has been helpful in distinguishing between normal individuals and those with coronary artery disease.
Hemodynamics of Large and Small Vessels in Peripheral Vascular Disease
Authors: CONRAD MARGARET C. , GREEN HAROLD D.
Published: June 2012

To evaluate the hemodynamics of large and small vessels in patients with complete arterial occlusion and patients with vasospasm, digital flow, digital pulse contour, small-vessel resistance, flow-to-pulse ratio, large-vessel pressure drop, pulse velocity, and distensibility were compared to values found in normal subjects.

[see figure in the PDF file]

In the normal subject following orally administered alcohol, small-vessel resistance decreased but large-artery pressure drop, pulse velocity, and distensibility of the capacity vessels were not altered significantly.

In arterial occlusive disease, small-vessel resistance was essentially normal in the absence of small-vessel occlusion; a high large-artery pressure drop, rounded pulse contour, and decreased pulse amplitude were observed. These are interpreted as being due to the damping effect of the narrowed, elongated collateral flow pathway that develops around the site of the occlusion. Pulse velocity also was decreased whereas flow-to-pulse ratio was increased in patients with occlusive disease. Large-vessel hemodynamics were unchanged after alcohol, suggesting lack of effect of the dilator on the collateral vessels.

In vasospasm there was evidence of increased large-artery and small-vessel resistance and decreased distensibility of the capacity vessels, all of which returned toward but not completely to normal following alcohol.

Digital pulse amplitude was found not to correlate well with flow, particularly in patients with arterial occlusive disease.
Vertebral Grand Larceny
Authors: DAVES MARVIN L. , TREGER ALBERT
Published: June 2012

A case is presented of atresia of the aortic arch between the left common carotid artery proximally and the left subclavian artery and a patent ductus arteriosus distally. Collateral circulation including a pathway via the vertebral arteries maintained an adequate mean pressure in the descending aorta to produce a left-to-right shunt in the patent ductus, despite an elevated pulmonary arterial pressure.
Basic Hemodynamic Changes Produced by Aortic Coarctation of Different Degrees
Authors: GUPTA TRILOK CHAND , WIGGERS CARL J.
Published: June 2012

Basic hemodynamic studies on experimental coarctation of the aorta just beyond the left subclavian artery have revealed that hitherto unsuspected physical and physiologic factors are involved in creation of hypertension above a coarctation and in changes of pressure pulses below such a lesion. The effects are by no means explained by an increased resistance at the coarctation, as is generally believed. This communication analyzes the roles that changes in capacity and distensibility of the aortic compression chamber and increase in systolic discharge of the left ventricle play in the production of aortic hypertension, and discusses the physiologic compensations in blood flow by which an adequate return to the right heart is maintained despite extreme reduction in flow through the inferior cava. This communication also deals with the ways in which the pressure relations in the lower aorta and femoral artery are altered from the normal, emphasizing the relative shares that damping of the pulse wave and reduced input into the lower aorta play with different degrees of coarctation. The changing characteristics of the murmurs with progressive aortic constriction are also analyzed. The conclusion is reached that all the dynamic changes found in experimental and human coarctation are adequately explained without the assumption of accessory vasoconstriction through reflex or humoral agencies.
Cortisone Therapy in Acute Rheumatic Carditis: Preliminary Observations
Authors: HARRIS T. N. , ABRAMS W. B. , LEO T. F. P. , HUBBARD J. P.
Published: June 2012

Four patients with acute rheumatic carditis of moderate to severe degree were treated with cortisone. After a latent period of 5 to 15 days, there was fairly rapid subsidence in temperature, erytlhrocyte sedimentation rate and some other signs of inflammation. After cessation of the course of cortisone therapy, there was evidence of recrudescence of rheumatic activity in all four patients. In three of these the therapy was resumed, with quite unusually rapid decline in the fever and sedimentation rate. The cardiologic signs showed no improvement throughout the entire period of observation.
Adhesiveness of Blood Platelets in Arteriosclerosis Obliterans, Thromboangiitis Obliterans, Acute Thrombophlebitis, Chronic Venous Insufficiency and Arteriosclerotic Heart Disease
Authors: EISEN MILTON E. , TYSON MARY CATHERINE , MICHAEL SIDNEY , BAUMANN FRANCES
Published: June 2012

Total and adhesive platelet counts were made on normal individuals and on patients with myocardial infarction, thromboangiitis obliterans, and other peripheral vascular diseases. Tests were made in several cases while patients smoked and after abstaining from tobacco. Repeated tests were done while patients were receiving dicumarol anticoagulant therapy. A rise in adhesive platelet counts was found in cases of thromboangiitis obliterans, particularly with activity of the disease, and in cases of thrombophlebitis. Cessation of cigarette smoking in cases of thromboangiitis obliterans resulted in a significant decrease in platelet adhesiveness.
The Effect of Salt Loading and Salt Depletion on Renal Function and Electrolyte Excretion in Man
Authors: WIGGINS WALTER S. , MANRY CLAYTON H. , LYONS RICHARD H. , PITTS ROBERT F. , Barrett Martha , Dumas Bernice
Published: June 2012

Glomerular filtration rate (GFR), renal plasma flow (RPF), and electrolyte excretion were studied in 17 patients subjected to salt depletion and loading. Salt depletion led to maximal renal salt conservation with the average GFR and RPF slightly decreased. Salt loading produced increased excretion of sodium and chloride with the average GFR and RPF slightly increased. Since the decreased electrolyte excretion with salt depletion and increased electrolyte excretion with salt loading were essentially independent of the direction of change in GFR and RPF, it is inferred that tubular absorptive activity is a more significant factor in achieving electrolyte balance than are GFR changes.
Acute Nonspecific Pericarditis
Authors: CARMICHAEL DAVID B. , SPRAGUE HOWARD B. , WYMAN STANLEY M. , BLAND EDWARD F.
Published: June 2012

Acute nonspecific pericarditis has been recognized with increasing frequency in recent years although there is reason to believe that it was considered distinct from rheumatic pericarditis almost 100 years ago. The authors have been able to secure follow-up information on 50 cases seen between 1930 and 1949. A few have shown persistent electrocardiographic changes, and calcification of the pericardium occurred in 1 case. In general the prognosis appears excellent and we have not observed constrictive pericarditis as a sequela.
Effect of Choline upon Experimental Canine Arteriosclerosis
Authors: DAVIDSON J. D. , MEYER WALTER , KENDALL F. E.
Published: June 2012

Studies have been made of the effect of excess dietary choline upon the arteriosclerosis produced in dogs by a regimen of cholesterol and thiouracil feeding. The choline-fed animals did not differ significantly from the control animals with respect to serum lipid levels, degree of lipid infiltration of their livers or severity of arteriosclerotic involvement.
Mural Thrombosis and Arterial Embolism in Mitral Stenosis
Authors: JORDAN ROBERT A. , SCHEIFLEY CHARLES H. , EDWARDS JESSE E.
Published: June 2012

A clinicopathologic study of 51 cases of mitral stenosis with intracardiac mural thrombi is presented with particular reference to the locations of these thrombi and their relationship to the associated thromboembolic phenomena. In 27 cases the thrombi were present only in the left side of the heart, in 15 cases they were in both sides of the heart, and in 9 cases they were present only in the right atrium. Of 42 cases in which thrombi were located in the left side of the heart, in 20 the thrombi were limited to the left auricular appendage. In the remaining 22 cases in this group the thrombi in the left side of the heart were situated on the main atrial wall, in the auricular appendage and on the main atrial wall together, or in the left ventricle. Systemic arterial emboli occurred frequently regardless of the particular site in the left side of the heart at which the thrombus formed. Of 24 cases in which thrombi were situated in the right side of the heart, in 20 the thrombi were restricted to the right auricular appendage.
The Extremity and Circumferential Chest Lead Electrocardiogram in Induced Acute Coronary Insufficiency
Authors: CHESKY KENNETH , MASTER ARTHUR M. , ARAI HAROLD S. , PORDY LEON
Published: June 2012

The extremity and circumferential chest lead electrocardiogram (twenty-two leads) was studied in 8 patients with generalized coronary insufficiency induced by exercise. Over the right chest, posteriorly and laterally, there was noted RS-T elevation similar to but less pronounced than that occurring in lead aV
R
. These leads probably represent true or mixed cavity potentials. Standard leads revealed more marked RS-T alterations after exercise than did aV leads. In the left anterior chest leads, the greatest RS-T depression occurred in the left unipolar precordial leads representing the maximal voltage of the R wave—usually V
4
or V
5
. The practical application of these findings is discussed in relation to routine two step exercise tests.
The Effect of Vegetable Fat Ingestion on Human Serum Cholesterol Concentration
Authors: HILDRETH E. A. , MELLINKOFF S. M. , BLAIR G. W. , HILDRETH D. M.
Published: June 2012

In 3 healthy male physicians a reduction of dietary fat produced a significant fall in the serum cholesterol concentration. Subsequently, when a diet containing normal quantities of fat but very low in cholesterol was taken, a rise in serum cholesterol concentration occurred in all 3 subjects.
Kidney Function in Cor Pulmonale
Authors: FISHMAN ALFRED P. , MAXWELL MORTON H. , CROWDER CHARLES H. , MORALES PABLO
Published: June 2012

Renal hemodynamics and sodium excretion were investigated in two groups of patients with cor pulmonale: group 1 was in heart failure at the time of study, and group 2 had previously been in heart failure. These subjects, who were virtually or potentially in heart failure, were exposed to various levels of oxygenation in order to aggravate acutely or relieve their chronic anoxia. The compensatory adjustments in kidney function to these changes in oxygen tension and their implications constitute the substance of this report.
Blood Pressure in the Unanesthetized Rat. I
Authors: OLMSTED FREDERICK , CORCORAN A. C. , PAGE IRVINE H.
Published: June 2012

Methods of indirectly determining blood pressure in the rat are reviewed and their drawbacks noted. A new method is described which has the advantage of objectivity and provides permanent graphic record of each determination. The end point used is the reappearance of pulsation in the foot distal to a slowly deflating leg cuff. Application of the method is described and its use compared with tail plethysmography.
Blood Pressure in the Unanesthetized Rat
Authors: OLMSTED FREDERICK , CORCORAN A. C. , PAGE IRVINE H.
Published: June 2012

Heating is commonly used in indirect determinations of blood pressure in the rat. Its effect on arterial pressure is determined at short sequential intervals by a method which permits rapid measurements. Spontaneous variations in the rat's blood pressure are noted and analyzed. A plan is suggested which minimizes the effect of these variations by setting up criteria of significance of blood pressure change as between control and experimental periods.
Postural Electrocardiographic Changes in Healed Myocardial Infarction
Authors: BROFMAN BERNARD L. , FEIL HAROLD , HELLERSTEIN HERMAN K. , JONES A. MORGAN
Published: June 2012

An electrocardiographic study of 110 patients with old myocardial infarction was made. Change of posture, by causing rotation of the heart on its axes, frequently altered the evidence of infarction. These changes were most evident in posterior infarction. The "labeled" area did the following with respect to the exploring electrode: (1) disappeared, (2) if absent in the supine posture, the evidence appeared in one or more of the other postures, and (3) shifted from one exploring electrode position to another.
Abnormal Cardiac Rhythms Caused by Acetylcholine
Authors: SCHERF DAVID , CHICK FORRIS B.
Published: June 2012

The effect of topical administration of acetylcholine on the auricular and ventricular surface of the dog's heart was studied. The experiments show the appearance of variform arrhythmias, particularly auricular fibrillation. The tendency for the development of these arrhythmias is diminished, but not abolished by atropinization. The experiments confirm previous results of the authors according to which auricular flutter is due to a rapid stimulus formation in a center. They help explain the occasional appearance of extrasystoles and paroxysmal tachycardias during vagus stimulation in experimental and clinical observations.
The Effect of Priscoline on Peripheral Blood Flow in Normal Subjects and Patients with Peripheral Vascular Disorders
Authors: VAN ITALLIE THEODORE B. , CLARKE CHARLES W.
Published: June 2012

Using the venous occlusion plethysmograph the authors have studied the peripheral circulation of normal subjects and persons with peripheral vascular disease. It is demonstrated that the vasodilating agent Priscoline (2-benzyl-4,5-imidazoline hydrochloride) frequently increases peripheral blood flow to a degree comparable to that produced by either sympathectomy or indirect body heating. In addition, the combined use of plethysmography and a vasodilating procedure is shown to be of value in the diagnosis of peripheral vascular disorders.
Pressure Curves from the Right Auricle and the Right Ventricle in Chronic Constrictive Pericarditis
Authors: HANSEN A. TYBJAERG , ESKILDSEN P. , GÖTZSCHE H.
Published: June 2012

Characteristic patterns of the pressure curves from the right auricle and the right ventricle have been found in chronic constrictive pericarditis by various investigators. It has been uncertain, however, whether or not the findings were pathognomonic, and whether they were reliable pictures of the pressure conditions or artefacts. Consequently the views upon the underlying mechanism have been different too. It is concluded from the studies here presented that the pressure curves are pathognomonic when in their most pronounced form, and that they are not artefacts and thus furnish a proper basis for inferences as to the hemodynamics in chronic constrictive pericarditis.
Unipolar Bronchial Electrocardiographic Exploration of the Heart in Man
Authors: GOLDSTEIN ISAC , PORDY LEON , CHESKY KENNETH , ARAI HAROLD S. , SNYDER EUGENE R. , FEUERSTEIN SIDNEY
Published: June 2012

The method for exploring cardiac potentials through the bronchial tree is described in detail. It consists of obtaining unipolar bronchial leads by inserting a thin No. 4 French catheter into the secondary branches of the bronchial tree as near as possible to the surface of the heart. By this method, electrocardiograms can be obtained on the right side which resemble right auricular endocardiograms. On the left side, left ventricular epicardial and cavity potentials are recorded and these are similar to direct left ventricular surface leads, left intraventricular cavity potentials and esophageal leads at the same level. No arrhythmias or serious reactions occurred during or after this procedure. Preliminary findings in 8 cases are discussed in detail.
Hemodynamic Events during the Development of Cyanosis and Heart Failure in a Patient with Large Ventricular Septal Defect
Authors: BLISS HARRY A. , MOFFAT JEAN E.
Published: June 2012

A patient with large ventricular septal defect experienced cardiac failure in childhood but improved and participated vigorously in competitive athletics during adolescence. Subsequently exertional dyspnea gradually developed, followed by increasing cyanosis and cardiac failure.

Repeated cardiac catheterizations during the latter period showed that cardiac output into both the pulmonary and the systemic circuits gradually fell to very low levels while vascular resistance rose progressively. The ratios of flows, pressures, and resistances in the two circuits did not change. Left-to-right shunting always predominated. Right atrial pressure rose but pulmonary artery "wedge" pressure remained unaltered.

Progressive reduction in output from both sides of the heart explained the appearance of reduced arterial oxygen saturation, increased cyanosis, and the manifestations of cardiac failure.
Non-surgical Retrieval of a Broken Segment of Steel Spring Guide from the Right Atrium and Inferior Vena Cava
Authors: THOMAS JOHN , SINCLAIR-SMITH BRUCE , BLOOMFIELD DENNIS , DAVACHI ASGHAR
Published: June 2012

The recovery of a broken segment of a steel spring guide from the right atrium and inferior vena cava without surgical intervention has been reported. The ready accessibility of an adequate instrument for retrieval of such intravascular bodies is recommended. It is possible that such an instrument may be also designed for myocardial biopsy. The relative ease of breakage probably points to a defect in the guides and a re-evaluation of the design and manufacture seems to be indicated.
The Stimulus to Hypertrophy of the Myocardium
Authors: BADEER HENRY S.
Published: June 2012

Opinion is still divided concerning the fundamental nature of the stimulus to myocardial hypertrophy in various clinical and experimental conditions. Some of the current hypotheses, such as nutritional deficiency of the myocardium, excessive hormonal secretion, increased external work, myocardial dilatation, and increased myocardial energy expenditure were discussed, and an attempt was made to identify a unifying concept. The hypothesis that chronic increase in myocardial metabolic rate per beat per unit mass of tissue constitutes the stimulus was favored most on the grounds that it was more inclusive than any other in explaining hypertrophy. This view was far from proved, however, and deserves serious attention and experimental verification by future investigators in this field.
Vascular Mechanisms Pertaining to the Intrinsic Regulation of the Cerebral Circulation
Authors: MCHEDISHVILI GEORGE I.
Published: June 2012

A review is given of recent work on the vascular mechanisms that participate in the intrinsic control of the cerebral circulation. The main emphasis is given to studies carried out at the Department of Pathophysiology, Institute of Physiology of the Georgian Academy of Sciences in Tbilisi (USSR). Physiologic as well as pathophysiologic mechanisms are considered. Emphasis is given to the important role of the large arteries carrying blood to the brain—the internal carotid and the vertebral arteries (major arteries of the brain)—in the regulation of cerebral circulation. These vessels differ in several respects from the smaller cerebral (pial) arteries in their functional and vasomotor behavior. The pial arteries have mainly a "nutritive" role as demonstrated during, for example, changing demands of blood supply for the cerebral tissue. Some recent data are presented that stress the important role played by the vasomotor innervation and by humoral factors for different parts of the cerebral vascular system during normal and pathologic events. A survey is also given of mechanisms pertaining to the cerebral venous system in the various compensatory vascular reactions during pathologic states of the brain.
Studies on Starling's Law of the Heart
Authors: ROSS JOHN , BRAUNWALD EUGENE
Published: June 2012

The acute circulatory responses to impeding venous return to the heart by the inflation of a balloon in the inferior vena cava were determined in 14 patients undergoing left heart catheterization. In the five patients without clinical or hemodynamic evidence of impaired left ventricular function, left ventricular end-diastolic pressure fell, and the decrease was accompanied by reductions in the cardiac index, left ventricular stroke volume, and left ventricular stroke work. In nine patients with impaired left ventricular function, directionally similar responses were noted, although the left ventricular function curves relating left ventricular end-diastolic pressure to left ventricular stroke work were generally flatter and lower than those in the patients without left ventricular disease. In none of the patients did a significant increase in cardiac index, stroke volume, or left ventricular stroke work occur during inflation of the balloon. It is concluded that the Starling relationship appears to operate in a directionally similar manner both in the normal and the depressed human left ventricle, and that the left ventricles of patients with impaired function are not on a descending limb of the curve. However, a descending limb of the left ventricular Starling curve may become apparent when an additional work load is imposed on the diseased ventricle.
Endocardial Fibroelastosis
Authors: MOLLER JAMES H. , LUCAS RUSSELL V. , ADAMS PAUL , ANDERSON RAY C. , JORGENS JOSEPH , EDWARDS JESSE E.
Published: June 2012

A clinical and pathologic study of 47 cases with endocardial fibroelastosis is presented. These cases have been classified according to the associated cardiac anomaly and the anatomic condition of the left ventricle. In so doing, a better understanding is had of the role the cardiac anomaly associated with endocardial fibroelastosis plays in the production of cardiac signs and symptoms.

In each of the specimens available for review, a change of the mitral valve was present that rendered it insufficient. Those cases grouped as primary endocardial fibro-elastosis had this as the only abnormality present, other than the endocardial fibroelastosis. Many of the clinical and laboratory findings in this group could be explained on the basis of mitral insufficiency, and one cannot necessarily assign the cardiac signs and symptoms to the endocardial process itself. In those cases with associated cardiac anomalies the hemodynamic consequences appear to be a summation of the combined effects of the mitral insufficiency, endocardial fibroelastosis, and the associated cardiac anomaly.

In this review, we were unable to distinguish, by either gross or microscopic methods, between primary and secondary endocardial fibroelastosis. Since use of these terms suggests etiologic relations, it is preferable to classify cases of endocardial fibroelastosis on the basis of the structural abnormalities present.
Constrictive Pericarditis Complicating Disseminated Lupus Erythematosus
Authors: YURCHAK PETER M. , LEVINE SAMUEL A. , GORLIN RICHARD
Published: June 2012

A case of constrictive pericarditis complicating disseminated lupus erythematosus is reported in a 58-year-old man. Hemodynamic studies documented the diagnosis and also confirmed the clinical suspicion of coexistent atrial septal defect. Measurement of left ventricular volume by a thermodilution technic augmented information available from routine studies. Pericardiectomy and closure of the atrial septal defect relieved the mechanical lesion.

The case is also unique in its documentation of the coexistence of three different forms of heart disease—congenital atrial septal defect, pericardial constriction from lupus erythematosus, and rheumatic valvular disease.
Interventricular Septal Defect
Authors: WALKER WELDON J. , GARCIA-GONZALEZ EFRAIN , HALL ROBERT J. , CZARNECKI STEPHEN W. , FRANKLIN ROBERT B. , DAS SUNIL K. , CHEITLIN MELVIN D.
Published: June 2012

Four hundred fifteen patients with interventricular septal defect, proved at cardiac catheterization, have been followed for 1,407 patient years. As a group, they demonstrated marked growth failure in early childhood, which was more striking for weight than height. Ninety patients had serial hemodynamic studies without intervening cardiovascular surgery. Eight demonstrated spontaneous functional closure of their defect; only one progressed to the Eisenmenger syndrome. No patient with initially normal pressure developed pulmonary hypertension. Patients with initial pulmonary hypertension more commonly demonstrated regression than progression of the hypertension. Six patients developed bacterial endocarditis; all recovered. There was a frequent association (11 per cent) between interventricular septal defect and right ventricular outflow obstruction. Some patients developed increasing right ventricular outflow obstruction during the study. Eighteen patients with predominant right-to-left shunt were studied. Seventeen were cyanotic at the time of the initial study. The incidence of cyanosis was equal in the two sexes but females developed it later in life than males.

Twenty-nine patients have died. Twenty-two deaths resulted from operative procedures; seven from the natural course of the disease. The principal factors associated with operative mortality was the presence of pulmonary hypertension and surgical repair before age 5. There were no operative deaths in patients with pulmonary artery systolic pressure below 65 mm. Hg. One patient died of progressive pulmonary hypertension 6 years after successful surgical closure of his defect.

There is a great need for more information concerning the natural course of this disease in all age groups, both in the unoperated patient and in patients whose defects have been surgically closed.
A New Technic for the Detection of Left-to-Right Cardiac Shunts by Use of an Esophageal Geiger-Müller Tube
Authors: IRA GORDON H. , ORGAIN EDWARD S.
Published: June 2012

A new technic is described for the detection of left-to-right shunts. A miniature Geiger-Müller tube is placed in the esophagus behind the left atrium and positioned by the electrocardiogram. In this position the G-M tube measures radioactivity from the left atrium. Curves are then recorded simultaneously from the precordium, lung, and left atrium. Methods of injection, monitoring, and recording are presented that provide greater diagnostic accuracy over those external detector technics currently in use.

Of 23 patients studied, 11 presented left-to-right shunts. Eight of these 11 patients were submitted to surgery; all were studied preoperatively and seven were studied postoperatively. Seven of the 11 shunts were detected by both precordial and esophageal technics. Four of the 11 shunts were missed by conventional precordial technics but were correctly diagnosed preoperatively by the esophageal detector. In addition, one shunt, which remained open postoperatively, was demonstrated clearly by the esophageal technic but was not indicated by the precordial curves. In no instance was the precordial curve positive for left-to-right shunt when the esophageal curve was negative.

Although the accuracy of any radioisotope detection technic with external counting may not approach that of direct cardiac catheterization, this method, because of its relative simplicity and accuracy, is useful in the demonstration of left-to-right shunts both preoperatively and postoperatively.
The Effect of Angiocardiographic Contrast Medium on Circulatory Dynamics in Man
Authors: BROWN RICHARD , RAHIMTOOLA SHAHBUDIN H. , DAVIS GEORGE D. , SWAN H. J. C.
Published: June 2012

The cardiovascular response to angiographic contrast medium was studied in 28 patients undergoing diagnostic angiocardiography under anesthesia. A transient phase of hypotension and tachycardia similar to that described by other authors was noted. Cardiac output was increased initially by 50 per cent and returned to the base line in 20 minutes. Peripheral blood flow increased by 100 per cent, apparently due to the direct effect of the hyperosmotic solution on the vascular smooth muscle. Hemodilution, maximal 2 to 4 minutes after injection of contrast medium, suggested a transient increase in circulating blood volume. Increased ventricular filling pressures, which were thought to be due to hypervolemia, were associated with increased left ventricular stroke work.
Cardiovascular Abnormalities in Osteogenesis Imperfecta
Authors: CRISCITIELLO MODESTINO G. , RONAN JAMES A. , BESTERMAN EDWIN M. M. , SCHOENWETTER WILLIAM
Published: June 2012

Three adults with osteogenesis imperfecta and associated cardiovascular lesions are reported. Two presented with aortic insufficiency due to dilatation of the aortic root for which none of the usual causes is apparent. The third patient was found to have lesions involving pulmonary, aortic, and mitral valves in addition to microscopic changes in the pulmonary artery and aorta. It is suggested that in osteogenesis imperfecta, as in other heritable disorders of connective tissue, cardiovascular defects may become apparent after the passage of time and play a dominant role in the natural history of the disease process.
Total Correction of Tetralogy of Fallot
Authors: LANDTMAN BERNARD , WOLF MURIEL D.
Published: June 2012

The material comprised the data of 146 patients with tetralogy of Fallot treated by corrective intracardiac surgery. Electrocardiograms were recorded in all cases before and in 108 cases after operation. The majority of the patients were between 5 and 20 years of age at the time of surgery and have been followed for an average of 1.5 years.

Arrhythmias, mostly extrasystoles, were recorded in eight cases before operation and in 14 cases on the last follow-up examination. The amplitude of the P wave in lead II decreased by 1 mm. or more after surgery in one third of the cases.

Seventeen patients developed complete AV block postoperatively, seven died; of the 10 who survived operation, in all but two the electrocardiogram reverted to normal sinus rhythm.

The electrocardiogram showed right axis deviation and right ventricular hypertrophy in the majority of cases. A balanced axis and signs of combined ventricular hypertrophy were commonest in acyanotic patients and more common in cyanotic patients who had had previous shunt procedures than in cyanotic patients who had had no previous shunt. Two patients showed electrocardiographic signs of left ventricular hypertrophy. After corrective cardiac surgery, the mean electrical axis and the pattern of the QRS complex in V
1
and V
6
changed toward normal in the eight patients in whom intraventricular conduction defects did not appear and in the 26 patients with incomplete right bundle-branch block.

Two of nine surviving patients in whom a small coronary artery was divided at surgery developed the pattern of myocardial infarction in the postoperative electrocardiogram.

Conduction disturbances frequently appeared during operation; they were considered to be caused mainly by direct trauma to the conduction system during closure of the ventricular septal defect or during infundibulum resection. Complete right bundle-branch block appeared in 74 (69 per cent) and incomplete right bundle-branch block developed in 20 (19 per cent) of surviving patients. Only eight patients showed no disturbances of conduction after surgery. The right bundle-branch blocks persisted throughout the follow-up period. The conduction disturbances have not adversely affected the postoperative course, nor have they caused any discomfort to the patients.
Electrocardiographic "Peri-Infarction Block"
Authors: CASTLE C. HILMON , KEANE WILLIAM M.
Published: June 2012

Detailed analysis for the presence and type of heart disease was made in 96 deceased patients who had electrocardiographic "peri-infarction block." Evidence for disease of the left ventricle was found in 80 per cent of these patients. Left ventricular hypertrophy and diffuse scarring of the left ventricle were the most common abnormalities on pathologic examination. Definite myocardial infarction was found in only 12 of the 55 patients (22 per cent) subjected to postmortem examination. Electrocardiographic "peri-infarction block" was therefore not specific for myocardial infarction although it was often associated with it. Use of the term should be restricted to left intraventricular conduction defect of the "peri-infarction block type."

In spite of the nonspecificity of this type of intraventricular conduction defect, it can be a useful clinical sign. If chronic obstructive airway disease and emphysema can be excluded, the presence of some type of left ventricular disease is almost assured.
Obstructive Lesions of the Left Ventricular Outflow Tract
Authors: COOLEY DENTON A. , BEALL ARTHUR C. , HALLMAN GRADY L. , BRICKER DONALD L.
Published: June 2012

Currently available diagnostic methods and surgical technics now allow accurate assessment and effective correction of the majority of lesions producing obstruction of the left ventricular outflow tract. On the basis of anatomic location these lesions can be divided into supravalvular, valvular, and subvalvular stenosis, and valvular lesions further can be subdivided into congenital and acquired categories. Temporary cardiopulmonary bypass with a pump oxygenator provides sustained support of the circulation for operation, while surgical technics employed are selected on the basis of etiology and location of the lesion. Experience gained in operations on 296 patients with obstructive lesions of the left ventricular outflow tract since 1956 now has demonstrated that these operations usually can be performed with acceptable risk and with excellent functional results.
Biochemical Studies of Myocardium and Blood During Extracorporeal Circulation in Man
Authors: COOPER THEODORE , JELLINEK MAX , WILLMAN VALLEE L. , GANTNER GEORGE A. , HANLON C. ROLLINS
Published: June 2012

We have studied samples of myocardium from 40 patients with congenital heart disease for catecholamine, histamine, and glycogen content. Blood samples obtained before, during, and after cardiopulmonary bypass in 53 patients were assayed for total protein, osmolality, catecholamines, histamine, lactic acid dehydrogenase activity, and cholinesterase activity. The data show that (1) adequate cardiopulmonary bypass is accompanied by increased sympathetic activity, (2) myocardial damage, indicated by elevated plasma lactic acid dehydrogenase activity, may occur during operation, and (3) depletion of myocardial catecholamine content may be a concomitant of heart disease with chronic congestive failure.
Surgical Repair of the Partial Form of Persistent Common Atrioventricular Canal, with Special Reference to the Problem of Mitral Valve Incompetence
Authors: RASTELLI G. C. , WEIDMAN WILLIAM H. , KIRKLIN JOHN W.
Published: June 2012

A total of 131 patients with the partial form of common atrioventricular canal were operated on between March, 1955 and January, 1964. The over-all hospital mortality rate was 3.8%; no deaths occurred in patients who had no or only mild incompetence of the mitral valve. Permanent heart block has not occurred in the last 93 cases. Results have been good in general, although there is evidence of residual mitral valve incompetence in many patients. In the few who had severe incompetence at the mitral valve before repair, the results have been considerably less satisfactory than in the group as a whole; therefore, further work is needed on this aspect of the problem.
Apical Left Ventriculotomy in Subaortic Stenosis due to a Fibromuscular Hypertrophy
Authors: JULIAN ORMAND C. , DYE WILLIAM S. , JAVID HUSHANG , HUNTER JAMES A. , MUENSTER JOSEPH J. , NAJAFI HASSAN
Published: June 2012

A total of five patients were operated upon for subaortic stenosis due to fibromuscular hypertrophy, using a generous left ventriculotomy centered on the apex. There were no deaths or serious complications, and all patients showed a completely satisfactory functional result in the postoperative periods of 19, 17, 11, 8, and 7 months. Three patients recatheterized 16, 11, and 7 months after surgery were found to have a virtual abolition of the gradient. Pressure measurements made at the completion of surgery in all patients, indicated satisfactory removal of the obstruction. The excellent exposure afforded by this ventriculotomy and the absence of complications arising from its use, recommend it for continued trial. It must, however, stand comparison with other techniques on the basis of the durability of the relief of obstruction.
Natural History of Pulmonary Hypertension in Surgically Treated Patent Ductus Arteriosus
Authors: ANABTAWI ISAM N. , ELLISON ROBERT G. , ELLISON LOIS T.
Published: June 2012

One hundred consecutive surgically treated patients with patent ductus arteriosus underwent preoperative and/or pulmonary artery and aortic pressure measurements at the time of surgery, prior to and following temporary occlusion or division of the ductus. Patients with persistent elevation in pressure following division of the ductus subsequently underwent single or multiple catheterizations at various intervals ranging between one and four years following surgery.

Pulmonary hypertension prior to division was present in 35 patients (35%). This was mild in 19, moderate in nine, and severe in seven. The pressure returned to normal immediately after division of the ductus in 13, indicating that in this group the pressure elevation was hyperkinetic. In 22, the pressure remained elevated immediately after division, pulmonary hypertension being mild in seven, moderate in eight, and severe in seven. In the mild group, the pressure subsequently returned to normal in all but one. In the moderate group, the pressure failed to return to normal in six out of eight, indicating the presence of vaso-occlusive changes in the pulmonary bed. The pressure usually exceeded 60 mm Hg systolic. In seven patients with severe pulmonary hypertension, division was performed in four. Two died in the immediate postoperative period, and two survived. Follow-up cardiac catheterization showed a return of pressure to normal in one and persistent elevation in the other. Of three patients in whom division was not performed, two are living and well two and seven years later, respectively, and one has been lost to follow-up.

Although the rate of blood flow and vaso-constriction contributed considerably to the elevation of pulmonary arterial pressure, the blood pressure failed to return to normal in the majority of patients whose systolic pressure was elevated in excess of 60 mm Hg after division of the ductus, indicating pathological pulmonary vascular alterations.
Hemodynamic Effects of Cerebral Arteriovenous Aneurysms
Authors: WALLACE JOHN M. , NASHOLD BLAINE S. , SLEWKA ANTHONY P.
Published: June 2012

The hemodynamic alterations produced by large cerebral arteriovenous aneurysms are qualitatively similar to those caused by arteriovenous aneurysms elsewhere in the body. Congestive heart failure was not observed in our eight patients; it appears to be unusual in adult cases.

By comparing cardiac outputs with a control group the mean aneurysm blood flow in six patients was estimated to be 2,804 ml. per minute at rest. Isoproterenol increased cardiac output relatively more than the estimated aneurysm flow.

Implications of the present data with respect to the concept of "central" blood volume are discussed.

Progressive mental and neurologic deterioration is the rule with large cerebral arteriovenous aneurysms. Repeated bleeding episodes, which may not be obvious clinically, appear to be partially responsible.