bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of the Phonocardiogram in Evaluation of the Severity of Mitral Stenosis and Detection of Associated Valvular Lesions
Authors: SURAWICZ BORYS , MERCER CHARLES , CHLEBUS HENRYK , REEVES JOHN T. , SPENCER FRANK C.
Published: June 2012

The phonocardiogram was correlated with hemodynamic measurements and with the results of surgical exploration in 141 patients with pure or dominant mitral stenosis. The study revealed the following results:

1. A diastolic murmur at the apex was absent in only two of 141 patients.

[see figure in the PDf file]

2. The opening snap (OS) was absent in 29% of all patients and in 10% of patients with pure mitral stenosis and noncalcified mitral valve. The most important single factor contributing to the absence of an OS was calcification of the mitral valve. Other factors included young age and associated aortic stenosis or mitral insufficiency.

3. There was no significant correlation between the (Q-1)-(2-OS) interval (PCG index) and the diastolic pressure gradient across mitral valve at rest. The correlation between the PCG index and the calculated mitral valve area (MVA), and the diastolic pressure gradient across the mitral valve during exercise was significant (
P
<0.05).

4. The PCG index correctly predicted whether the MVA was smaller or greater than 1.2 cm
2
in 85% of patients with pure mitral stenosis but in only 57% of patients with associated lesions. The MVA was less than 1.2 cm
2
in 36 of 39 patients with pure mitral stenosis in whom the PCG index ranged from +2 to +6. Of 42 operated patients with pure mitral stenosis, the PCG estimate was correct in 36. The PCG index did not underestimate MVA in any of the operated patients.

5. In a group of patients with the same left atrial (LA) pressure, the 2-OS interval was longer in patients with low cardiac output. The relation between the 2-OS interval and the cardiac output could explain in part the lack of correlation between LA pressure and 2-OS interval and the smaller number of correct estimates of MVA made by the 2-OS interval as compared to the Q-1 interval and the PCG index.

6. There was no significant correlation between the amplitude of the first sound at the apex and the severity of mitral stenosis. Several patients with associated mitral insufficiency had a first sound of high amplitude.

7. There was no significant correlation between the amplitude of the sound of pulmonary valve closure (P
2
) and the pulmonary artery pressure. P
2
amplitude was significantly greater in slender patients.

8. An apical systolic murmur was recorded in 48% of patients with pure mitral stenosis. The longer the murmur, the greater was the likelihood of associated mitral insufficiency. A pansystolic murmur at the apex usually indicated an associated mitral or tricuspid insufficiency.
Internal Jugular Venous Oxygen Tension as an Index of Cerebral Blood Flow During Carotid Endarterectomy
Authors: VIANCOS JAIME G. , SECHZER PHILIP H. , KEATS ARTHUR S. , DEBAKEY MICHAEL E.
Published: June 2012

From published data which related cerebral blood flow (CBF) to arterial carbon dioxide tension (Pa

co
co2

) and related CBF to internal jugular venous oxygen tension (Pv

o
o2

), the relationship Pv

o
o2

=1.20 Pa

co
co2

-4.9 was derived. This relationship was based on the documented changes in CBF induced by alterations in Pa

co
co2

in normal man anesthetized with halothane. The validity of using Pv

o
o2

as a measure of CBF in clinical situations was tested in 29 anesthetized patients from whom 90 paired values of Pa

co
co2

and Pv

o
o2

were obtained during reconstructive carotid artery surgery. A significant relationship, Pv

o
o2

=1.08 Pa

co
co2

+3.6 was obtained over a wide range of Pa

co
co2

values, indicating that Pv

o
o2

was a reliable measure of CBF under these circumstances. No significant differences were found to result from the various anesthetic agents used, the age of patients, and the period of sampling. Samples obtained during the use of a temporary internal carotid artery shunt indicate that the shunt provides blood flow sufficient to maintain cerebral circulation normally responsive to hypercarbia.
Serial Electrocardiographic Findings in a Prospective Epidemiological Study
Authors: OSTRANDER LEON D.
Published: June 2012

The prevalence of classified electrocardiographic items among the adult population of Tecumseh, Michigan, during two examinations approximately 4 years apart is reported. Changes in the prevalence rates of certain items are probably due to reader differences, the effect of prior ingestion of glucose in the first series of examinations, and possibly the treatment of abnormalities detected during the first examinations.

Among the cohort of 3,745 persons who had classified electrocardiograms on both examinations, the Q and QS items were relatively stable, the more marked ST and T items were less stable, and the minor ST or T classifications were extremely variable. Still, 31% of persons whose second electrocardiogram revealed codable Q or QS items for the first time had classified ST-segment or T-wave items in their previous electrocardiogram and another 9% had nonspecific QRS abnormalities, either high amplitude R waves or left axis deviation.

The Minnesota code is a useful system for the classification of large numbers of electrocardiograms, but for accurate identification of new events, tracings exhibiting category I, IV, or V items must be examined serially.
An Epidemiological Assessment of Bundle-Branch Block
Authors: EDMANDS ROBERT E.
Published: June 2012

Complete bundle-branch block was found in 57 of 1,560 (3.7%) electrocardiograms routinely recorded on members of a retirement community. Of this number, 19 were identified as left bundle-branch block (LBBB), while 38 fulfilled the criteria for right bundlebranch block (RBBB).

Individuals with LBBB were found to have cardiomegaly more frequently than did individuals with normal electrocardiograms. Individuals with RBBB, regarded as a homogeneous group, also demonstrated a greater prevalence of cardiomegaly than did the control group, but the difference from normals was less striking than in the case of LBBB. Neither LBBB nor RBBB was significantly associated with hypertension, as defined in the text.

When the common, uncomplicated RBBB was regarded as a separate entity, the prevalences of hypertension and cardiomegaly were indistinguishable from those of a control group with normal electrocardiograms. The RBBB variant, regarded as a possible manifestation of left ventricular disease secondary to hypertrophy or myocardial infarction, was found to be frequently associated with hypertension, cardiomegaly, and the need for digitalis therapy. RBBB with left axis deviation, regarded as a complication of the common RBBB due to left ventricular hypertrophy or myocardial infarction, was similarly associated with a high prevalence of cardiovascular disease. None of the 38 cases of RBBB fulfilled the criteria for classic RBBB.

It is suggested, therefore, that the chronic uncomplicated RBBB in the adult may indeed bear a less ominous portent than has previously been ascribed to it. This is suggested only in relation to the parameters evaluated, however; prospective evaluation is clearly necessary to assess the validity of such an inference.
Plasma Fibrinogen Patterns in Patients with Coronary Atherosclerosis
Authors: HAMPTON JAMES W. , MANTOOTH JAMES , BRANDT EDWARD N. , WOLF STEWART G.
Published: June 2012

Plasma fibrinogen determinations in 46 coronary patients and 49 healthy individuals were made over a period of about 33 months. The mean fibrinogen levels were calculated and shown to increase with age. The fibrinogen levels in the younger patient group were elevated and resembled the levels of the older control subjects. The statistical test of the variance was significantly greater in the patient group. The inclusion of episodes of infections, bleeding, and surgery, all of which are known to raise the plasma fibrinogen levels, did not significantly alter the greater fibrinogen variance in the patient group. Comparison of a group of patients receiving anticoagulant orally to a group not receiving the drugs failed to indicate that the anticoagulants restored the lower variance seen in the controls. Of the four patients whose deaths were documented as due to recurrent coronary events, all had greater fibrinogen variances than a comparable group of patients who survived. The fibrinogen variance may not only reflect an unstable clotting mechanism in patients with coronary thrombosis but may also have prognostic significance for the recurrence of myocardial infarction.
Correlations of Microradiographic and Histological Findings in the Pulmonary Vascular Bed
Authors: REEVES JOHN T. , TWEEDDALE DUANE , NOONAN JACQUELINE , LEATHERS JAMES E. , QUIGLEY MERVYN B.
Published: June 2012

Obstruction within pulmonary arteries is a well-known cause of pulmonary hypertension in patients with congenital heart disease, but dilatation of the pulmonary vessels is less well understood. The present report has shown that the technique of microradiography is well suited to the study of dilation of the pulmonary microcirculation because (1) vessels as small as capillaries are resolved, (2) whole capillary networks are seen in relation to the arteries feeding them and to the alveoli, and (3) the radiographed tissue may [See Figure in the PDF File] then be sectioned and stained for direct comparison of the histological and microradiographic aspects. The present study demonstrated the technique in a case of normal lungs, one of pulmonary hypertension and a high pulmonary blood flow, and in one of pulmonary hypertension and high pulmonary vascular resistance. Dilated capillaries were demonstrated in both patients with pulmonary hypertension. Greater distortion of the microvascular pattern was seen in the patient with high vascular resistance. Correlation of radiographic and histological examination provides an additional tool for study of the normal and abnormal pulmonary circulation.
Atrial Rhythm in Ventricular Tachycardia Occurring During Cardiac Catheterization
Authors: KISTIN A. D. , TAWAKKOL A. , MASSUMI R. A.
Published: June 2012

The atrial rhythm was studied in 38 patients during runs of tachycardia of five or more beats in sequence which occurred during cardiac catheterization and whose ventricular site of origin could be established with considerable confidence. Simultaneous esophageal and other leads were recorded. The most frequent mechanism was retrograde conduction to the atria with varying degrees of V-A (ventriculo-atrial) block which occurred in 26 of the 38 patients. Runs of ventricular tachycardia with one-to-one V-A conduction occurred in 13 patients. Runs with an independent atrial rhythm (A-V dissociation) occurred in nine patients. Varying atrial mechanisms during different runs of tachycardia occurred in 11 patients. The minimum QRS-to-retrograde P intervals in 24 of 35 patients with V-A conduction were within 0.03 sec of P-R interval. The briefest QRS-to-retrograde P interval observed was 0.09 sec. Reciprocal beats occurred in eight of 35 patients with V-A conduction.
Measurement of Mitral Regurgitation in Man by the Upstream Sampling Method Using Continuous Indicator Infusions
Authors: FRANK MARTIN J. , NADIMI MANOUCHEHR , HILMI KHALDOON I. , LEVINSON GILBERT E.
Published: June 2012

The upstream sampling method for measuring mitral regurgitation was evaluated in 19 patients during retrograde left ventricular and transseptal left atrial catheterization. Measurements obtained by using continuous infusions of indicator were compared, in all patients, with those obtained by using sudden single injections and, in 14 patients, with semiquantitative estimates by mitral valvulography. The mean values for regurgitant flow, total flow, and the regurgitant fraction did not differ significantly for the two dilution techniques. However, measurements of forward flow following sudden injections into the left ventricle were significantly larger than those following sudden injection into the pulmonary artery, while the latter differed insignificantly from measurements during continuous infusions into the left ventricle. Although neither technique had excellent reproducibility, the continuous-infusion method was clearly superior in this respect. The authors concluded that (1) a single measurement of mitral regurgitation by upstream sampling has a probability of large error, (2) continuous infusions in place of sudden injections give more reliable estimates, but (3) continuous infusion measurements are reliable only for mean values from replicate determinations.
Normal First Heart Sounds with Nonfunctional Tricuspid Valve or Right Ventricle
Authors: LUISADA ALDO A. , KURZ HARRY , SLODKI SHELDON J. , MACCANON DONALD M. , KROL BERNARDO , Harvey I.
Published: June 2012

A case of Ebstein's malformation of the tricuspid valve with persistent foramen secundum and right bundle-branch block is presented. Preoperative tracings revealed three distinct components of the first sound with normal intervals between them. After resection of a single floating tricuspid leaflet, closure of the septal defect, and insertion of a Starr-Edwards valve, the phonocardiogram again showed three normal components of the first heart sound, followed by a loud closing snap of the prosthetic tricuspid valve. This case demonstrates the occurrence of the three normal components of the first heart sound independently of right ventricular contraction and of tricuspid closure or tensing. In five dogs left ventricular phonocardiograms, made after right heart bypass and destruction of the free ventricular wall, revealed three normal components of the first heart sounds in three animals, and of the first two components, separated by normal intervals in two others. These experiments exclude any participation of the right ventricle or tricuspid valve in the mechanism of origin of the first heart sound. The authors conclude that the three normal components of the first heart sound are of left-sided origin and that the designation "tricuspid" for the second component should be abandoned.
Correlation of Vectorcardiographic Criteria for Myocardial Infarction with Autopsy Findings
Authors: GUNNAR ROLF M. , PIETRAS RAYMOND J. , BLACKALLER JORGE , DADMUN STEWART E. , SZANTO PAUL B. , TOBIN JOHN R.
Published: June 2012

One hundred eight patients who had had vectorcardiograms and electrocardiograms recorded were followed to autopsy, and their hearts were carefully studied postmortem. Vectorcardiographic criteria previously proposed using the Frank corrected lead system were tested against the anatomic findings. These criteria correctly predicted the presence of infarction in 49 (92%) of 53 hearts and correctly localized the infarct in 39 (74%). In four hearts (8%) infarction could not be identified. In 18 (32%) of 55 hearts in which infarcts were not present, these criteria falsely indicated infarction. The reasons for the false positive predictions are discussed. The criteria tested will prove useful in the diagnoses and localizations of myocardial infarcts when the pitfalls of deformities of the vectorcardiogram produced by ventricular hypertrophy and bundle-branch block are avoided.
Direct Determinations of Aortic Blood Flow in Patients with Aortic Regurgitation
Authors: BRAWLEY ROBERT K. , MORROW ANDREW G. , Seipp Harry W. , Cobb David E.
Published: June 2012

Instantaneous ascending aortic blood flow and left ventricular and central aortic pressure were determined at the time of operation in nine patients with severe aortic regurgitation. In six, the heart rate was controlled and increased by electrical stimulation between 50 and 170 beats/min. The relative duration of diastole decreased, and that of systole increased at faster heart rates. The mean systolic ejection rate fell, and regurgitant flow rates remained relatively constant. Thus, the per cent regurgitation was not reduced at faster rates. Following isoproterenol administration, the faster heart rate lengthened the relative duration of systole, abbreviated that of diastole, and increased the systolic ejection rate. Net result was an increased total forward flow and a reduced per cent regurgitation, but when the heart rate was held constant, the total forward stroke volume was ejected more rapidly, but the total forward and regurgitant flows per beat and per minute, and consequently the per cent regurgitation did not change. Assessments of left venticular function also were made in two patients.
Effects of Nitroglycerin on Hemodynamics During Rest and Exercise in Patients with Coronary Insufficiency
Authors: NAJMI MOOSA , GRIGGS DOUGLAS M. , KASPARIAN HRATCH , NOVACK PAUL
Published: June 2012

Twenty-three patients exhibiting coronary insufficiency on exercise have been studied at rest and at exercise prior to and following sublingual administration of nitroglycerin. The most consistent and marked effect of nitroglycerin was the reduction in pulmonary artery pressure, total pulmonary resistance, and right ventricular work at rest and during exercise. Our patients were grouped according to the degree of left ventricular failure as indicated by the abnormality of rise in pulmonary artery pressure during exercise. It became evident that nitroglycerin improved left ventricular function in terms of increased output and lessened pulmonary artery pressure in cases in which failure was most severe.
The Distribution of Intrarenal Blood Flow in Normal and Hypertensive Man
Authors: LOWENSTEIN JEROME , STEINMETZ PHILIP R. , EFFROS RICHARD M. , DEMEESTER MICHEL , CHASIS HERBERT , BALDWIN DAVID S. , GOMEZ DOMINGO M.
Published: June 2012

Observations were made on eight normotensive subjects and on 12 patients with essential hypertension to determine whether the intrarenal distribution of blood flow is altered in essential hypertension. Dye-dilution curves were recorded across the renal vascular bed and a set of integral transformations, developed by Gomez, was used to determine distribution of blood flow per unit renal blood volume across the renal vascular bed from dye-dilution curves. Observations also were made on two hypertensives and two normotensives during administration of norepinephrine. The distribution of specific blood flow and the functional renal blood volume in the right kidney of patients with essential hypertension were comparable to those in normal subjects, but the mean specific blood flow was reduced in essential hypertension. Failure to demonstrate altered distribution of specific blood flow in essential hypertension indicated an absence of focal reductions in renal blood flow and that blood flow is reduced uniformly throughout the renal vascular bed in essential hypertension. This reduction in specific renal blood flow is attributed to arteriolar vasoconstriction.
Effect of a Simple Deconditioning Procedure on the Diuretic and Natriuretic Response of Hypertensive Patients to a Hypertonic Salt Load
Authors: WELNER A. , GROEN J. J.
Published: June 2012

The increased diuretic and natriuretic response of hypertensive patients to an intravenous salt load was modified toward normal by a deconditioning procedure which consisted in repeated exposure to the external situation of the test without, however, infusing any fluid into the vein. After this deconditioning, ratios between amounts of urine and sodium excreted in the first and the second 90-minute period of the test and the total 3-hour quantity of urine excreted were significantly reduced, but blood pressure was not changed. The response of normotensive patients to the same deconditioning was modified in the same direction but to a much smaller extent. It is suggested that the increased diuretic and natriuretic responses of hypertensive patients to an intravenous salt load are similar to the hyperreactive pressor and diuretic responses of these patients when exposed to stimuli that seem threatening to them, and that these responses are caused (at least in part) by hyperreactivity of the central nervous system to the external situation of the test.
A Hemodynamic Comparison of Essential and Renovascular Hypertension
Authors: FROHLICH EDWARD D. , ULRYCH MILOS , TARAZI ROBERT C. , DUSTAN HARRIET P. , PAGE IRVINE H.
Published: June 2012

Systemic hemodynamic measurements were obtained in 15 normal subjects and 30 untreated hypertensive patients (15 with essential hypertension and 15 with fibrosing stenosis of renal arteries). The essential hypertensives were selected from a larger group solely on the basis of matching their mean arterial pressures and ages with those of the patients with renal arterial disease in matched pairs; cardiac index was consistently higher in patients with renovascular hypertension than in those with essential hypertension. The higher cardiac output was maintained in the group with renal arterial disease even when reduced by tilting the subjects to a 50° head-up position. Total peripheral resistance was increased in both hypertensive groups. The low cardiac indices and mean rates of left ventricular ejection found in essential hypertension may also implicate the heart in this form of hypertension. Hence, increased total peripheral resistance, long thought to be the hemodynamic hallmark of hypertension, may not be the sole systemic abnormality; cardiac output may be increased in renal arterial disease and even reduced in essential hypertension.
Observations on Changing Hemodynamics in Tricuspid Atresia Without Associated Transposition of the Great Vessels
Authors: GALLAHER MARIAN E. , FYLER DONALD C.
Published: June 2012

Three patients are discussed who, in early infancy, presented with mild cyanosis, cardiac decompensation, failure to thrive, and pulmonary congestion. These manifestations were associated with tricuspid atresia without transposition of the great vessels. The clinical course of these children, who in varying periods of time became progressively more cyanotic, with hearts becoming smaller, and with decreasing pulmonary blood flow, is unique. Cardiac catheterization and angiocardiographic studies were obtained at each end of the clinical spectrum in all of the children. Although a closing ventricular septal defect is thought to be the cause of the decreasing pulmonary flow, the studies were not conclusive. In all three patients, palliative systemic venous-to-pulmonary arterial anastomosis (Glenn procedure) relieved the symptoms of hypoxia.
Infradiaphragmatic Anomalous Pulmonary Venous Drainage
Authors: JEGIER W. , CHARRETTE E. , DOBELL A. R. C.
Published: June 2012

The pathological anatomy and hemodynamic effects of total anomalous pulmonary venous drainage of the infradiaphragmatic type are reviewed in nine infants examined from 1940 to 1965 in the pathology department. Two infants underwent corrective surgery in the period; one operation was unsuccessful. The other infant had normal hemodynamics 6 months postoperatively and continues to do well 2 years after operation. Surgical principles are discussed. Some patients undergoing an anastomosis between the common pulmonary venous trunk and the left atrium will not require a second operation either to ligate the venous trunk or to close the atrial septal defect.
Peripheral Lymphatico-Venous Anastomoses
Authors: KOEHLER P. RUBEN , SCHAFFER BURTON
Published: June 2012

Two cases of peripheral lymphatico-venous anastomoses are reported. These communications, which generally are only visualized in the presence of obstruction of the lymphatics, are of practical importance because of the potential danger of relative rapid transfer of oily contrast material into the pulmonary circulation. The existence and importance of these communications are discussed.
SPECIAL ARTICLE
Authors: KATZ LOUIS N.
Published: June 2012

The purposes of a physical training program are examined and the evidence for the general and circulatory benefits of physical fitness is discussed. While the proof of benefits is not established, there is sufficient evidence from current studies to justify encouragement of the exercise programs. The evidence that exercise lessens experimental atherogenesis is equivocal. The possibility that physical fitness alters the morbidity and mortality of coronary sclerosis remains conjectural. Whether a physical fitness program would (1) lessen the incidence of intravascular thrombosis or atheromatous ulceration, (2) increase the extent or rate of development of coronary collaterals in man although the evidence in animals is suggestive, (3) improve the performance capacity of the heart, (4) decrease the likelihood of arrhythmias, or (5) result in more efficient bodily responses to the stresses associated with myocardial infarction is not clear or has not been definitely ascertained because of lack of evidence.
Detection of Small Ventricular Septal Defects
Authors: CRAENEN JO , MOORE DOUGLAS , HOHN ARNO R. , LAMBERT EDWARD C.
Published: June 2012

The value of selective left ventricular cineangiography in the detection of small ventricular septal defects was assessed in 23 patients in whom no shunt was detected by blood oxygen saturation change. A comparison was made with selective indocyaninegreen indicator-dilution curves in 10 of these patients. A ventricular septal defect was demonstrated by both methods in 10. However, in one case, the indicator curve showed a left-to-right shunt whereas selective left ventricular cineangiography failed to demonstrate it. Conversely, in two other cases, selective left ventricular cineangiography demonstrated a small ventricular septal defect while a normal curve was obtained by indicator-dilution technique.

Comparing our experience with cineangiography with that of others, using hydrogen ion and indocyanine-green indicator-dilution techniques for the detection of small left-to-right intracardiac shunts, it seems there is little difference in the sensitivity of the three methods. Each is capable of detecting ventricular septal defects which cause left-to-right shunts too small to produce measurable blood oxygen saturation variations.
Studies on Anomalous Collateral Systemic-Pulmonary Circulation
Authors: TAMMELING G. J. , NIEVEEN J. , SLUITER H. J.
Published: June 2012

The circulatory status of four patients with anomalous systemic-pulmonary circulations has been studied by bronchospirometry, cardiac catheterization, angiography, and dye-dilution techniques. In three of these patients the affected lung was smaller than normal, and bronchography showed no abnormalities. On the affected side angiography failed to show filling of the pulmonary artery, and the oxygen uptake appeared to be zero or minimal. In two of the patients bronchospirometry revealed an effective collateral circulation, whereas the dye-dilution curves were almost normal. In the other patient there was anatomic evidence of both transpleural systemic-pulmonary arterial communication and occlusive disease of the pulmonary veins. Here the dye-dilution curves revealed considerable shunting of blood, whereas no effective collateral circulation could be demonstrated. The fourth patient has extensive unilateral bronchiectasis and illustrates the condition wherein neither pulmonary nor systemic blood flows through the pulmonary capillary bed.

The pathogenesis of the various pathways of collateral circulation is discussed, as well as some methodological and technical problems.
Cardiac Volume in Normal Children and Adolescents
Authors: NGHIEM QUANG X. , SCHREIBER MELVYN H. , HARRIS LEONARD C.
Published: June 2012

Cardiac volume was determined by a simplified Rohrer-Kahlstorf method in 305 healthy children and adolescents. The ages ranged from birth to 19 years. Height and weight were comparable with normal growth standards. Race, sex, age, height, weight, and body surface area were studied for their value in predicting cardiac volume. Cardiac volume was different in males and females (
p
< 0.005) and was more closely predicted by weight than by body surface area. In this study body weight has been used as a single predictor of cardiac volume for both sexes. Normal values are presented and the limitations of the technique discussed.

Serial cardiac volume plotted against weight and cardiothoracic ratio plotted against time were correlated with the clinical course in 27 children with pure rheumatic mitral insufficiency. Cardiac volume was found to be superior to the cardiothoracic ratio in reflecting the severity and prognosis of mitral insufficiency. After the cardiac volume had reached a level of 1,100 to 1,300 ml, the course was progressively downhill in 10 adolescents in the absence of evidence of rheumatic activity in most cases.

That the course of rheumatic mitral insufficiency is essentially volume-dependent is a phenomenon of great interest which may be used to assess the severity of mitral regurgitation and its future course.
Study of 200 Consecutive Patients with Abdominal Aneurysms Diagnosed by Intravenous Aortography Comparative Longevity with and without Aneurysmectomy
Authors: STEINBERG ISRAEL , TOBIER NINA
Published: June 2012

Statistical analysis, with special reference to longevity, is presented for a series of 200 consecutive patients diagnosed by means of intravenous abdominal aortography. During a follow-up period of 6 years, 104 patients underwent aneurysmectomy; 96 did not have resection of the aneurysm because operation was contraindicated, laparotomy disclosed a nonresectable aneurysm, or operation was refused by the patient. At the end of the study, 31% of the group having resection and 51% of the group not treated surgically had died. The majority of deaths in the surgically treated group occurred within 2 months after operation. In the other group the greatest number of deaths occurred from 6 to 12 months after diagnosis. Thus, although the immediate mortality was much higher for the group undergoing aneurysmectomy, the overall mortality rate for the 6-year period was significantly lower for this group than for the other group. In both groups, myocardial infarction and cancer accounted for more deaths than the operation or rupture of the aneurysm. Therefore, the associated diseases of the age group are determinants of the prognosis, rather than the resection alone.
Correlations of the Orthogonal Electrocardiogram and Vectorcardiogram with Constitutional Variables in 518 Normal Men
Authors: PIPBERGER HUBERT V. , GOLDMAN MERVIN J. , LITTMANN DAVID , MURPHY GEORGE P. , COSMA JOHN , SNYDER JAMES R.
Published: June 2012

Correlations were computed between 333 different electrocardiographic measurements and constitutional variables of 518 normal men. The variables consisted of age, body weight, height, chest configuration, race, and deviations from ideal weight according to height. The most significant correlations were encountered with age. With every decade of life, QRS amplitude measurements decreased at an average rate of 6.5%. Although less in absolute voltage terms, amplitude decreases with age were even more significant for the ST-T complex where the average decline was 9.75% for each decade. Comparison of records from white and Negro subjects revealed marked differences. Most amplitude measurements were higher in the latter group. Furthermore, configurations of leads X and Y differed significantly, with smaller Q/R ratios in Negroes. These findings strongly suggest reevaluation of diagnostic criteria according to race both for recognition of ventricular hypertrophies and myocardial infarcts. Correlations with chest configuration revealed a large number of differences but their significance level was relatively low. Body weight appeared to exert a stronger influence upon the ECG. Obesity led to decreases in amplitude and QRS rotations in superior and anterior directions. Correlations with deviations from ideal weight, calculated according to body height, did not exceed the significance level of those obtained with weight only. Body height appeared to exert the least influence upon the electrocardiogram. The results of the correlations emphasize the need for stratification of ECG data according to constitutional variables, particularly for age, race, and body weight. Use of this information will lead to enhancement of diagnostic ECG differentiation and serve as a basis for epidemiological investigations, particularly studies on aging.
Familial Myocardial Disease with and without Obstruction to Left Ventricular Outflow
Authors: NASSER W. K. , WILLIAMS J. F. , MISHKIN M. E. , CHILDRESS R. H. , HELMEN C. , MERRITT A. D. , GENOVESE P. D.
Published: June 2012

Right and left heart catheterization, including selective cineangiocardiography, was performed in 20 of the 33 patients examined in a large Negro family. Fifteen had features compatible with the diagnosis of idiopathic hypertrophic subaortic stenosis. Sudden death has not occurred in this family. Many of the patients were young and were totally unaware of the heart disease, although 11 had symptoms of dyspnea on exertion. A large number of individuals in this family were found to be affected by a familial form of heart disease with similar clinical manifestations, but with a wide spectrum of hemodynamic and cineangiocardiographic abnormalities ranging from no obstruction to ventricular outflow and only mild indentation of the ventricular cavity to obstruction and marked narrowing of both ventricular outflow tracts. The patients with obstruction of the left ventricular outflow tract were older than those without obstruction. Therefore, this study provides further evidence that in families with myocardial disease, the presence or absence of outflow tract obstruction is merely a different manifestation of the same basic cardiac disease. This study has also demonstrated distinct left ventricular abnormalities quite early in life suggesting that the disease may be of congenital origin and that obstruction may be a function of the duration of the disease.
Distensibility Characteristics of the Human Pulmonary Vascular Bed
Authors: YU PAUL N. , MURPHY GERALD W. , SCHREINER BERNARD F. , JAMES DOUGLAS H.
Published: June 2012

The changes in pulmonary blood flow, pressure, and volume during supine exercise are studied in seven patients without cardiovascular abnormality, 12 patients with aortic valve disease, 13 patients with mitral valve disease, and five patients with primary myocardial or pericardial disease. The degree of distensibility of the pulmonary vascular bed is assessed by the simultaneous changes in the magnitude of the pulmonary distending pressure (average of pulmonary artery and left atrial pressure) and of the pulmonary blood volume.
Adjustable Prosthesis for Pulmonary Artery Banding
Authors: SHANE RAMON A. , KIMMELL GARMAN O. , JAQUES WILLIAM E. , CAMPBELL GILBERT S.
Published: June 2012

An adjustable, stainless-steel "ball and saddle" prosthesis has been devised for banding the main pulmonary artery in dogs. Comparisons were made between this prosthesis and circumferential cotton umbilical and Teflon tape banding in 20 dogs. The vessel lumen and pressure gradient across the banded area returned to normal after release of the ball and saddle band, but not after release of the circumferential tape bands. However, microscopic damage to the banded artery was noted in all dogs, with attenuation of the media being most evident in dogs with the steel ball and saddle prosthesis.
Combined Prosthetic Replacement of the Mitral and Aortic Valves
Authors: MASON DEAN T. , ROSS JOHN , GAULT JAMES H. , BRAUNWALD EUGENE , MORROW ANDREW G.
Published: June 2012

Detailed preoperative and postoperative hemodynamic studies were carried out in 12 patients with severe aortic and mitral valve disease in whom replacement of both valves with ball-valve prostheses was carried out. Replacement of both valves resulted in restoration to normal, or nearly normal, the resting values of cardiac output, left ventricular end-diastolic pressure (LVEDP), pulmonary arterial pressure, and pulmonary vascular resistance. However, studies of left ventricular function during muscular exercise revealed abnormalities in the relationships between cardiac output and oxygen consumption in six of seven patients, and in no patient was the left ventricular response to exercise normal when assessed by the relation between LVEDP and stroke volume. It appears likely, therefore, that underlying myocardial disease or coronary arterial disease contributed to the preoperative disability in these patients, and may limit complete symptomatic recovery following operation. The residual impairment of myocardial performance observed in these patients appears to be more pronounced than that previously demonstrated in patients in whom isolated replacement of either the mitral or aortic valve had been performed.
"Demand" and Internal Mammary Artery Implantation
Authors: MALETTE WILLIAM G. , SCHNEIDER BARRY , TAIT IVAN B.
Published: June 2012

The results with internal mammary artery implantation in the myocardium after chronic, slow constriction of the left anterior descending coronary artery did not differ from the same implantation done with a normal coronary system. Patency rates, flow through the implanted vessel, cineangiographic appearances, and anatomical patterns were the same in both groups. Pulse pressure patterns were variable.

We conclude that ischemic demand in this preparation has little to do with final flow rate, anatomical collateral pattern, or patency. The reason for this lack of correlation is still obscure.
Surgical Significance of Angiographic Patterns in Coronary Arterial Disease
Authors: DIETHRICH EDWARD B. , LIDDICOAT JOHN E. , KINARD SAMUEL A. , GARRETT H. EDWARD , LEWIS JOHN M. , DEBAKEY MICHAEL E.
Published: June 2012

A review of 313 selective cine coronary arteriograms performed in patients with angina pectoris is presented. Classification of coronary arterial disease by location and severity of stenosis has established certain patterns of disease. Significant disease (greater than 75% stenosis of at least one major vessel) occurred in 270 of 313 (89%) patients. Significant single-vessel disease occurred in only 58 of 270 (23%) patients, while the occurrence of significant multiple-vessel disease was: double, 110 of 270 (40%) patients; triple, 78 of 270 (29%) patients; and quadruple, 24 of 270 (9%) patients. The distribution in 191 arterial occlusions was: right coronary, 101 of 191 (53%); anterior descending, 64 of 191 (33%); and circumflex, 26 of 191 (14%). Anterior and anterior-lateral myocardial ischemia occurred in 80 of 270 (29%) patients, isolated posterior myocardial ischemia in 46 of 270 (18%) patients, and equal anterior and posterior ischemia in 144 of 270 (53%) cases. The angiographic studies were correlated with clinical history and electrocardiographic findings.

The frequency of severe posterior myocardial ischemia, either alone or in conjunction with severe anterior ischemia, indicates the need for selective posterior or total myocardial ischemia, either alone or in conjunction of patients are to benefit from myocardial revascularization.
Application of Gas Endarterectomy to Atherosclerotic Peripheral Vessels and Coronary Arteries
Authors: SAWYER P. N. , KAPLITT M. J. , SOBEL S. , DIMAIO D.
Published: June 2012

A new technique of endarterectomy is described. It uses carbon dioxide gas, under pressure, to dissect the diseased inner layers of blood-vessel wall from the more normal outer layer. It has been utilized in 89 patients. It remains to be seen what the 5- and 10-year patency rates will be. This must, in large degree, relate to the patient's vascular disease. Finally, we hope that a series of coronary endarterectomies can be done to indicate the applicability of the technique to coronary revascularization.
Operative Therapy for Femoral-Popliteal Arterial Occlusive Disease
Authors: KOUCHOUKOS NICHOLAS T. , LEVY JEROME F. , BALFOUR JOHN F. , BUTCHER HARVEY R.
Published: June 2012

One hundred ninety-four patients underwent 222 operations for femoral-popliteal arterial occlusive disease between 1957 and 1965. The results of operative therapy employing synthetic bypass grafts, thromboendarterectomy, and autogenous saphenous veins were assessed by determining the accumulative patency rates for the three operative methods, the incidences of subsequent major amputations, and the degree of symptomatic relief (fig. 1, tables 9 and 10).

The 2-year accumulative patency rates for synthetic bypass grafts, thromboendarterectomy, and saphenous vein bypass grafts were 28%, 50%, and 63%, respectively (table 8). Subsequent major amputations were performed in 37%, 27%, and 12% of the extremities in the three groups. Improvement in symptoms occurred in 33%, 48%, and 73% of the patients in the respective groups.

When grouped according to severity of presenting symptoms and signs and the status of the arterial outflow by arteriography, patency rates were highest in the vein graft group and lowest in the synthetic graft groups. The patency rates after endarterectomy in those extremities with severe symptoms and poor arterial outflow tracts were similar to those of the synthetic graft group.
Follow-up Studies of Acute Dissecting Aortic Aneurysms Managed with Antihypertensive Agents
Authors: HARRIS P. D. , MALM J. R. , BIGGER J. T. , BOWMAN F. O.
Published: June 2012

Twelve patients with acute dissecting aneurysms have been treated with antihypertensive medications. These patients all presented with chest or back pain and had systolic blood pressures of greater than 160 mm Hg. They responded to drug-induced hypotension with loss of pain and stabilization of their general condition. Two patients died during the initial phase of therapy. In both these cases there was inadequate control of the blood pressure on an altered medication regime. Ten patients have now been followed for periods ranging from 1 month to 1 year. There has been no evidence either symptomatically or roentgenographically that these patients have had progression of their disease process.
Exercise Tolerance and Hemodynamic Studies After Replacement of Canine Mitral Valve With and Without Preservation of Chordae Tendineae
Authors: RASTELLI G. C. , TSAKIRIS ANASTASIOS G. , FRYE ROBERT L. , KIRKLIN JOHN W.
Published: June 2012

The effect of the mitral Starr-Edwards ball-valve prosthesis on cardiac function was investigated in the dog. Fifteen dogs were studied for the first 48 hours after replacement of the mitral valve (the chordae tendineae [see Figure in the PDF file] had been totally resected, partially resected, or preserved). The cardiac output and left atrial pressure were similar in these three groups of animals and in two animals subjected to sham operation. Ten dogs (five with intact chordae and five with excised chordae) were studied two months after the insertion of a Starr-Edwards prosthesis. In these animals normal hemodynamic values were obtained at rest and during infusion of acetylcholine, except for a marked (liastolic gradient across the prosthesis, which developed at high cardiac output and heart rate. Six dogs were able to complete a standard test of substantial, unrestrained, graded exercise and gave a normal heart rate response. Heart rate increased and was maintained during maximal efforts, to levels of about 300 beats/min, demonstrating that heart rate need not be a limit of cardiac performance. No evidence of left ventricular dysfunction or of a decrement in cardiac performance could be demonstrated in dogs early or late after replacement of the mitral valve with a Starr-Edwards prosthesis. The presence or absence of chordae tendineae was irrelevant to cardiac performance.
A Nonthrombogenic, Nonanticoagulant-Dependent Mitral Valve Prosthesis
Authors: PALMER TREVELYAN E. , LAUTSCH ELIZABETH V. , SANMARCO MIGUEL E. , DAVILA JULIO C.
Published: June 2012

Thromboembolism stems from incompletely covered foreign body which is in physical continuity with tissue. Cardiac valve prostheses which remain partially exposed show, at the tissue-to-prosthesis junction, incomplete healing which is characterized by continuing granulation and proliferating immature unstable scar tissue, from which thrombosis originates and propagates.

The principle of complete encapsulation with healthy granulation tissue, maturation into stable fibrous tissue without inflammation, covered by a normal antithrombogenic endothelial surface, is a more logical approach than [see Figure in the PDF file] methods which attempt to prevent thrombosis by altering the character of the surface of the exposed foreign body or the blood coagulation mechanism. A valve is described which functions eminently satisfactorily as a replacement for the calf mitral valve.
Conservative Management of Tricuspid Regurgitation in Patients Undergoing Mitral Valve Replacement
Authors: BRAUNWALD NINA S. , ROSS JOHN , MORROW ANDREW G.
Published: June 2012

Among 100 consecutive patients undergoing mitral valve replacement, 28 had clinically and hemodynamically significant tricuspid regurgitation without tricuspid stenosis. In 21 patients the mitral valve was regurgitant, and in eight it was stenotic. The characteristic murmur of tricuspid regurgitation was present in 27 patients; 25 had abnormal venous distention, 14 peripheral edema, and seven ascites; and in 27 the liver was enlarged more than 4 cm below the costal margin. The mean right atrial pressure was abnormally high in every patient (average 11 mm Hg), and 25 had severe pulmonary hypertension (average systolic pressure 75 mm Hg). At the time of mitral replacement, 25 patients had no operative procedure on the tricuspid valve, and three had a tricuspid annuloplasty. Four patients died, a mortality rate (14%) not different from that in the patients without tricuspid regurgitation.

Twenty-four patients were reassessed at postoperative intervals of one to four years (average 30 months). All evidenced symptomatic improvement; 16 observed no dietary restriction of sodium, six ate regular diets without added salt, and only two limited sodium intake more stringently. Postoperatively, mean right atrial pressures averaged 5 mm Hg and systolic pulmonary arterial pressures 39 mm Hg.

In many patients with advanced mitral valve disease, associated tricuspid regurgitation is of a functional nature and secondary to right ventricular hypertension and dilatation of the tricuspid annulus. The present results indicate that in such patients tricuspid regurgitation will improve or disappear after mitral replacement and that tricuspid valve replacement is seldom necessary.
Influence of Rhythm and Anticoagulation upon the Incidence of Embolization Associated with Starr-Edwards Prostheses
Authors: YEH THOMAS J. , ANABTAWI ISAM N. , CORNETT VICTOR E. , ELLISON ROBERT G.
Published: June 2012

The incidence of embolism following aortic and mitral valve replacement with Starr-Edwards prostheses has been analyzed and correlated with cardiac rhythm and anticoagulation. No embolism occurred in the aortic valve replacement group, regardless of use or nonuse of Coumadin. In the mitral group, the incidence of embolism during atrial fibrillation was approximately 1.7 times that during sinus rhythm. Coumadin prophylaxis was extremely effective. The incidence during non-anticoagulation was 40 times that during adequate anticoagulation, and seven times that during inadequate anticoagulation. Embolism occurred as late as 21 months after surgery, often shortly after termination of anticoagulation. Three of the four patients with emboli associated with bacterial endocarditis died. All nine patients with emboli not associated with infection survived, half without permanent sequelae.