bluuebunny/crossref_metadata_2025 huggingface dataset:
Left Heart Volume and Mass Quantification in Children with Left Ventricular Pressure Overload
Authors: GRAHAM THOMAS P. , LEWIS BARNETT W. , JARMAKANI M. M. , CANENT RAMON V. , CAPP M. PAUL
Published: June 2012

This investigation was designed to quantify left ventricular and left atrial volume, volume change, systolic output, and ventricular mass in 31 patients with isolated left ventricular pressure overload secondary to aortic stenosis (AS, n = 14) or coarctation of the aorta (n = 17). These parameters were compared with normal standards and with data from a group of nine patients with a combined pressure and volume overload due to aortic stenosis plus aortic or mitral insufficiency (AS + AI or MI). Volumes were calculated from biplane cineangiocardiograms exposed at 60 frames/sec. Left ventricular end-diastolic volume (LVEDV) was significantly lower than normal in patients with AS (57 ± 11 cc/m
2
), but was normal (73 ± 12 cc/m
2
) in patients with coarctation. An increase in the ejection fraction (LVEF) was found in both groups averaging 0.73 ± 0.12 in AS patients and 0.69 ± 0.09 in coarctation patients. Patients with AS + aortic or mitral insufficiency (AI or MI) showed elevated LVEDV (103 ± 29 cc/m
2
), but had a normal ejection fraction. The LV mass was significantly increased in all groups: normal, 82 ± 10 g/m
2
; AS, 126 ± 41 g/m
2
; coarctation, 130 ± 44 g/m
2
; and AS + AI or MI, 168 ± 42 g/m
2
. The left ventricular systolic index and left atrial maximal volume were both normal in patients with pure pressure overload but were significantly increased in patients with combined pressure and volume overload. The low LVEDV in patients with AS as well as the normal volume in patients with coarctation occurred in the presence of elevated LV end-diastolic pressure and indicates a decrease in LV diastolic distensibility in patients responding to an isolated LV pressure overload by significant muscular hypertrophy without dilatation.
Arterial Sodium Content in Experimental Congestive Heart Failure
Authors: ZELIS ROBERT , DELEA CATHERINE S. , COLEMAN HENRY NEAL , MASON DEAN T.
Published: June 2012

This study sought to determine whether the electrolyte content of peripheral arteries is altered in experimental congestive heart failure (CHF) and whether such change, if present, would help to explain the abnormal vascular stiffness seen in human CHF. The concentrations of sodium (Na
+
) and potassium (K
+
) were determined in samples of aorta (Ao) and femoral arterial branches (FA) of 17 dogs. Six had ascites due to CHF produced by rapid ventricular pacing (left ventricular end-diastolic pressure [LVEDP] 26.2 mm Hg and maximal velocity of myocardial shortening [V
max
] 2.39 circumferences/sec). In the 11 animals in the control group pacing was stopped prior to the onset of CHF or the animals were not paced (LVEDP, 8.8 mm Hg and V
max
, 2.98 circumferences/sec). In CHF, mean Ao Na
+
was 38.0 ± 2.3 mEq/100 g dry weight and FA Na
+
was 44.2 ± 3.2 mEq/100 g. These were significantly higher than similar samples taken from the 11 normal dogs (Na
+
, 31.9 ± 1.6 [
P
< 0.05] and 31.9 ± 1.8 [
P
< 0.01] mEq/100 g, respectively). Although the water content tended to be higher and K
+
tended to be lower in animals with CHF, these values were not significantly different from normal.
Serial Hemodynamics after Renal Allotransplantation in Man
Authors: KOUNTZ SAMUEL L. , TRUEX GARY , EARLEY LAURENCE E. , BELZER FOLKERT O.
Published: June 2012

Serial measurements of glomerular filtration rate (GFR), independent and simultaneous clearances and extractions of para-aminohippurate (PAH), radiohippuran, and iodopyracet (Diodrast) were made in 11 adults and one child who received renal transplants from living donors. Measurements were made within 3 hours and repeated two to four times during the following 14 days. Immediately after transplantation, PAH clearance averaged 385 ml/min (range, 218 to 510), GFR averaged 54 ml/min (range, 22 to 87), renal plasma flow (RPF) averaged 672 ml/min (range, 309 to 1424), and marked vasodilatation was present with an average renal blood flow (RBF) of 979 ml/min (range, 435 to 2,114). As observed in other studies, immediate diuresis and natriuresis but no glycosuria occurred. Extraction ratios for PAH (
E
PAH) were below normal, ranging from 0.59 to 0.94, and those for
125 (or 131)
I-hippuran, and
131
I-Diodrast were even lower. Extraction ratio for PAH to radiohippuran averaged 1.43 in 17 simultaneous studies. However, RPF measured simultaneously with these agents was the same, indicating a true difference in transport of these substances. The low extraction ratio for PAH,
131 (or 125)
I-hippuran and
131
I-Diodrast was not related to depression of the maximal tubular transport of PAH and may have been a consequence of vasodilatation and increased RBF. Another observation made on these kidneys was a low filtration fraction which averaged 0.089. These hemodynamic changes did not appear to relate to circulating factors in the anephric recipient since they persisted throughout the 13-day study period in eight patients. In four patients showing transient rejection, GFR and the clearance of PAH and
131
I-hippuran decreased proportionately more than RBF. It is concluded that marked vasodilatation and a low filtration fraction are characteristic of uncomplicated renal allotransplantation in man, and that early rejection is expressed by measurable decreases in the clearances of PAH and inulin despite maintenance of RBF. These changes were present prior to clinical evidence of rejection.
Direct Blood Pressure Measurements in Brachial and Femoral Arteries in Children
Authors: PARK MYUNG K. , GUNTHEROTH WARREN G.
Published: June 2012

Intra-arterial pressure in the brachial artery was compared with that in the femoral artery in children. There were no significant differences in systolic, diastolic, or mean pressures. The average auscultatory systolic pressure in the arm, obtained with a cuff 20% wider than the limb, was identical to the average direct systolic pressure in the brachial and femoral arteries. The auscultatory systolic pressure in the leg, using the same criterion for cuff width, was 11 mm Hg higher than the direct pressures. The discrepancy could represent (1) a systematic error in cuff size of inadequate width or length or (2) additional systolic amplification between the femoral and popliteal arteries. Since the femoral pressure is widely used in cardiac catheterization, this pressure is suggested as the standard for calibrating auscultatory technics. For leg blood pressure measurements a cuff at least 25% wider than the average leg diameter and long enough to encircle the limb is recommended.
Skeletal Muscle Capillaries in Nondiabetics
Authors: VRACKO RUDOLF
Published: June 2012

To evaluate the variations of capillary calibers and those of basal lamina (BL), pericytes, endothelium, and lumen within a sample of skeletal muscle and among samples from different anatomic sites, areas occupied by total capillary cross sections, by the lumen, endothelium, pericytes, and BL were measured on electron micrographs. Twenty capillary cross sections from each of the 41 specimens of skeletal muscle from 23 nondiabetic males were used.

For all parameters, a marked variation was noted within each specimen, between specimens from identical sites of different individuals, and between different anatomic sites of the same individuals. In general, the capillaries are largest in the lower leg and foot muscles; the lumen is smallest at the levels of mid-thigh and lower leg; the capillaries of the lower extremity have a greater investment of BL, endothelium, and pericytes than the capillaries of the trunk and hand muscles. The areas occupied by endothelial cytoplasm, pericyte cytoplasm, and by BL are larger in bigger capillaries apparently owing to greater circumference. In addition, the capillaries of the leg, particularly those of the lower leg, have an absolutely greater investment of BL than capillaries from proximal sites. Reasons for these regional differences in the overall size of capillaries and in the investment of BL are not known.
Coronary Arteriographic Appearances in Patients with Left Bundle-Branch Block
Authors: LEWIS C. MICHAEL , DAGENAIS GILLES R. , FRIESINGER GOTTLIEB C. , ROSS RICHARD S.
Published: June 2012

Left bundle-branch block (LBBB) was found to be associated with an unusually short left main coronary artery in 11 of 12 patients studied by selective coronary arteriography. The average length of the left coronary artery in this group of 12 patients with LBBB was 4.5 ± 1.7 mm as compared to 12.8 ± 0.8 mm in a control group. Four of the 12 had evidence of ischemic heart disease, one had mild aortic regurgitation, one had myocardiopathy, and one had a patent ductus arteriosus. No etiology was discovered for the LBBB in the remaining five patients. Mechanical and hemodynamic explanations for this association of a particular pattern of coronary anatomy with LBBB are proposed.
Study of Nailfold Capillaries in Hypertriglyceridemia (Types III and IV Hyperlipoproteinemia)
Authors: KUO PETER T. , FENG LOUISE Y. , PAMINTAUN JOSÉ
Published: June 2012

Reflected light nailfold capillaroscopy was used to discover micro-angiopathy in atherosclerotic patients with hypertriglyceridemia (types III and IV hyperlipoproteinemia). In comparison with healthy normolipemic controls, 51 of a series of 64 patients were found to have beds of dilated, congested, elongated, and tortuous capillary venular limbs and loops; and 29 of these with capillary abnormalities were found to have either fresh or old hemorrhages. Serial studies revealed that capillary hemorrhages tended to subside shortly after the hyperlipoproteinemia was controlled by a low carbohydrate diet, while the morphologic abnormalities showed little or no change for 8 to 21 months.
Morphology of the Human Mitral Valve
Authors: LAM J. H. C. , RANGANATHAN N. , WIGLE E. D. , SILVER M. D.
Published: June 2012

Chordae tendineae from 50 normal mitral valves were studied. Four main types can be distinguished by their mode of insertion. Commissural chordae insert into and define the commissures between the anterior and posterior leaflets. Rough zone chordae insert into the ventricular aspect of the distal rough portion of the anterior and posterior leaflets. Such rough zone chordae typically split into three cords before inserting into the leaflet. Two of the anterior leaflet rough zone chordae are thicker than the others and are called strut chordae. They insert at 4 and 8 o'clock positions on the semicircular anterior leaflet. Cleft chordae insert into and define the clefts between the scallops of the posterior leaflet. Basal chordae are single strands that arise from the posterior ventricular wall and insert into the basal zone of the posterior leaflet. This classification permits a clear definition of mitral valve anatomy and forms a sound basis for functional studies of chordae tendineae.
Morphology of the Human Mitral Valve
Authors: RANGANATHAN N. , LAM J. H. C. , WIGLE E. D. , SILVER M. D.
Published: June 2012

Fifty normal mitral valves from adults were studied. Commissures, identified by commissural chordae tendineae and the tips of papillary muscles, partition the mitral valvular tissue into anterior and posterior leaflets. This definition incorporates into the posterior leaflet the structures formerly regarded as accessory leaflets. The posterior leaflet is further divided into scallops by clefts in its tissue. Cleft chordae provide a guide to these interscallop indentations or clefts. Partitioned this way, the posterior leaflet was tri-scalloped in 46 hearts. In 42, a large middle scallop was present with two smaller scallops on either side. Rough and clear zones can be defined on the anterior leaflet and rough, clear, and basal zones on the posterior leaflet.
Congenital Absence of the Left Pericardium
Authors: NASSER WILLIAM K. , HELMEN CHARLES , TAVEL MORTON E. , FEIGENBAUM HARVEY , FISCH CHARLES
Published: June 2012

Until the past decade, the diagnosis of congenital absence of the pericardium, partial or complete, had rarely been made prior to postmortem examination or thoracotomy.

Since 1963, the condition has been recognized during life in six patients at this institution. Of these six patients, two had partial absence of the left pericardium and four had complete absence of the left pericardium. Characteristic roentgenologic findings were present in all six patients. Associated heart lesions were not present in either patient with a partial pericardial defect. Two of the remaining four had associated heart lesions. One patient had surgical repair of an atrial septal defect. Surgical repair of the pericardial defect was not attempted in any of the six patients. Hemodynamic determinations at rest were normal in all six patients. The two patients with partial pericardial defects, however, had elevation of the pulmonary artery and left ventricular end-diastolic pressures during mild exercise in the recumbent position which suggests that this type of defect is not totally innocuous. In view of the unusual and extreme cardiac mobility in this condition, it is conceivable that a portion of the heart could herniate and transiently incarcerate through the partial defect during exercise. It is suggested that partial pericardial defects may warrant surgical repair. Small defects or complete absence of the left pericardium, however, are apparently without lethal potential and do not require surgical intervention.
Dynamics of Interatrial Shunting in Children with Obstruction of the Tricuspid and Pulmonic Valves
Authors: LEVIN AARON R. , SPACH MADISON S. , CANENT RAMON V. , BOINEAU JOHN P.
Published: June 2012

The interatrial pressure-flow dynamics in patients with right-to-left shunting at the atrial level in the presence of right heart obstruction were studied. In tricuspid atresia most of the right-to-left gradient occurred during right atrial systole. This gradient, as well as the cineangiocardiograms, indicated that almost all systemic venous return was transferred from the right to the left atrium through the interatrial communication during right atrial contraction. Cine studies also suggesed that right atrial systole (1) contributed significantly to left ventricular filling and (2) produced regurgitant venous flow, especially into the hepatic veins.

In two patients with secundum atrial defect and associated marked pulmonic valve stenosis, bidirectional shunting at the atrial level was defined by pressure gradient and cine and dye-dilution curve technics. The right-to-left gradient and shunt occurred during ventricular diastole with accentuation of this gradient by atrial contraction; the left-to-right interatrial flow and gradient occurred during ventricular systole when both A-V valves were closed. These studies indicate that, in the presence of an interatrial communication, increasing degrees of right heart obstruction not only produce right-to-left shunting but (1) do so primarily by right-to-left flow across the interatrial communication during ventricular diastole and (2) with complete right atrial obstruction, right atrial contraction plays a dominant role in the transfer of systemic venous return to the left atrium.
Morphologic Findings in Human Cardiac Allografts
Authors: MILAM JOHN D. , SHIPKEY FREDRICK H. , LIND CARL J. , NORA JAMES J. , LEACHMAN ROBERT D. , ROCHELLE DONALD G. , BLOODWELL ROBERT D. , HALLMAN GRADY L. , COOLEY DENTON A.
Published: June 2012

Morphologic findings in human cardiac allografts from 13 patients are presented. In the acutely rejected cardiac allograft there was a cellular infiltrate consisting of large lymphocytes and varying numbers of polymorphonuclear leukocytes, eosinophils, and histiocytes in the myocardium and arterial intima. The coronary arteries frequently exhibited degeneration, acidophilia, and vacuolation of the tunica media. In the cases with chronic cardiac allograft rejection there was obliterative fibrous thickening of the arterial intima with medial necrosis. Focal areas of myocardial necrosis and fibrosis were present along with a myocardial infiltrate of mononuclear cells. In most patients who died of causes other than rejection, there was evidence of an immunologic response. Rejection has not been regarded as an "all or none" phenomenon. There was indication in this series that survival was related to histocompatibility.
Effects of Glucagon on Myocardial Oxygen Consumption and Coronary Blood Flow in Man and in Dog
Authors: MANCHESTER JOEL H. , PARMLEY WILLIAM W. , MATLOFF JACK M. , LEIDTKE A. JAMES , LARAIA PAUL J. , HERMAN MICHAEL V. , SONNENBLICK EDMUND H. , GORLIN RICHARD
Published: June 2012

The effects of intravenous administration of glucagon (50 µg/kg) on left coronary blood flow and myocardial oxygen consumption were studied in nine patients during diagnostic cardiac catheterization and in six open-chested anesthetized dogs. Coronary blood flow was measured with the
133
Xe washout technic in man, and with an electromagnetic flowmeter placed around the left anterior descending coronary artery in the dogs. In the patients, glucagon produced a 31% increase in coronary blood flow and a 29% increase in myocardial oxygen consumption, with no change in coronary arteriovenous (A-V) O
2
difference across the heart. In the dogs glucagon produced a 114% increase in coronary blood flow and a 131% increase in myocardial oxygen consumption, again with no change in coronary A-V O
2
difference. Thus glucagon is a secondary coronary vasodilator in both man and dog. The modest chronotropic and inotropic effects of glucagon observed in man were only half as great as those observed in the dog. Part or all of this difference in dose-response relationship between the two species may be related to the different experimental conditions of the study.
Identification of Ultrasound Echoes from the Left Ventricle by Use of Intracardiac Injections of Indocyanine Green
Authors: FEIGENBAUM HARVEY , STONE JOHN M. , LEE DON A. , NASSER WILLIAM K. , CHANG SONIA
Published: June 2012

This study was designed to identify the ultrasound echoes originating from the left ventricle. Injections of indocyanine green and saline were made directly in the left ventricular cavity via a cardiac catheter in patients undergoing routine diagnostic cardiac catheterization. The injections produced a cloud of echoes that filled the left ventricular cavity and outlined the left side of the interventricular septum and the endocardial surface of the posterior left ventricular wall. The results of this study verified the origin of echoes that are vital to the ultrasound technics for the detection of pericardial effusion, left ventricular wall size, left ventricular cavity size, and left ventricular stroke volume. This study also provided ways of distinguishing between the true left ventricular wall echoes and intracavitary echoes that often cause confusion.
Aortic Valve Surgery as an Emergency Procedure
Authors: HUTTER ADOLPH M. , DE SANCTIS ROMAN W. , NATHAN MARTIN J. , BUCKLEY MORTIMER J. , MUNDTH ELDRED D. , DAGGETT WILLARD M. , AUSTEN W. GERALD
Published: June 2012

Twenty-three patients critically ill from aortic valvular disease underwent emergency aortic valve replacement as a life-saving measure. Sixteen patients (70%) survived hospitalization and 14 (61%) are presently living. Of eighteen patients who underwent solitary aortic valve replacement, there were four hospital deaths and two late deaths. Five patients required double valve surgery, with three hospital deaths and no late deaths. The survivors often had dramatic improvement and have done well during an average follow-up period of 9 months. The major factor contributing to mortality after surgery was irreversible myocardial damage particularly evident in patients with longstanding severe valvular disease. Valve replacement can be successfully accomplished in patients critically ill with aortic valve disease, especially if it occurs as an isolated lesion.
Peripheral Vascular Volumes and Whole Body Hematocrit During Human Heart Lung Bypass
Authors: GIANNELLI STANLEY , AYRES STEPHEN M. , FLEMING PETER , CONRAD WILLIAM , SCHWARTZ MELVIN S. , GOULD HOWARD
Published: June 2012

Indicator-dilution curves were obtained across the peripheral vascular bed in 15 patients soon after the beginning of heart lung bypass, and in eight of these persons they were repeated just prior to the conclusion of bypass. A bolus containing labelled red cells and albumin was injected into the arterial inflow line just proximal to the aorta. Serial blood samples were obtained at intervals of 1 second from the venous return line, just distal to the right atrium, and the radioactivity was measured. The interposed volume of blood in the pump oxygenator delayed recirculation, allowing extrapolation of the exponential downslope and calculation of flow rates and indicator distribution volumes by the Hamilton-Stewart equations.

The distribution volume of albumin (average, 56.3 ml/kg) was always greater than that of red cells (average, 44.8 ml/kg). The average ratio of whole body hematocrit to perfusate hematocrit was 0.873. The absence of significant differences between data obtained at the beginning and just prior to the end of bypass suggests that there were no alterations in venous tone or the volume relationships of large vessels to the microcirculation.
The First Derivative Thoracic Impedance Cardiogram
Authors: LABABIDI ZUHDI , EHMKE D. A. , DURNIN ROBERT E. , LEAVERTON PAUL E. , LAUER RONALD M.
Published: June 2012

When an alternating current of high frequency is applied to the thorax, the first derivative of the impedance to this current is affected by the cardiac cycle resulting in a characteristic wave form.

Phonocardiograms, electrocardiograms, and first derivative thoracic impedance cardiograms were recorded simultaneously in 91 subjects. The first derivative thoracic impedance cardiograms were found to have sharply demarcated points which occur synchronously with the first heart sound, aortic second sound, pulmonic second sound, mitral opening snap, third heart sound, and fourth heart sound. The first derivative thoracic impedance cardiogram may thus be used not only as a reference tracing to help identify heart sounds on the phonocardiogram, but also for directly timing the intervals within the cardiac cycle.
The Pre-Hospital Phase of Acute Myocardial Infarction
Authors: MOSS ARTHUR J. , GOLDSTEIN SIDNEY
Published: June 2012

A prospective interview study of the hospital arrival time (HAT) was obtained on 160 patients, aged 28 to 87 years, who were admitted with acute myocardial infarctions to cardiac care units in two Rochester hospitals. The median time between the onset of acute coronary symptoms and the patient's arrival in a hospital emergency department was 3½ hours. The distribution of the HAT was trimodal: group I (early arrivals), less than 4 hours from onset of symptoms, median, 2 hours, n = 89; group II (mid-arrivals), 4 to 14 hours, median, 6 hours, n = 45; group III (late arrivals), greater than 14 hours, median, 27 hours, n = 26. Three intervals were defined: a decision time, an unaccounted for time, and a transportation time. In the entire population, the decision time consumed the major portion (51%) of the HAT, and the unaccounted for time 35% of HAT. The transportation time, whether by ambulance or car, averaged 25 min (14% of HAT), and it made up a diminishing percentage of the HAT in the longer arrival groups. The HAT in groups I, II, and III and the decision time in groups I and II were scrutinized with regard to demographic data, past medical history, pre-hospital factors, and hospital course. The findings suggest that the psychologic makeup of the patient is a major factor in the decision making process and thus, in the duration of the HAT.
Variations in Maximal Oxygen Intake with Physical Activity in Middle-Aged Men
Authors: MCDONOUGH JOHN R. , KUSUMI FUSAKO , BRUCE ROBERT A.
Published: June 2012

Data on maximal exercise performance are presented for normal middle-aged men free of cardiovascular disease. Maximal oxygen intake, oxygen pulse, heart rate, and lactate levels all decrease with increasing age.

Physical activity defined by habitual running of any amount had a highly significant effect on maximal oxygen consumption. The enhanced effect of physical activity was found equivalent to nearly 10 years of age effect on maximal aerobic capacity.

Multivariate analysis revealed significant association between maximal oxygen intake and several coronary risk factors; specifically, physical activity, vital capacity, cigarette smoking, and body weight. Notably lacking in significance were other known risk factors, serum cholesterol, and blood pressure.

Data for maximal oxygen intake on healthy men aged 40 to 70 years are presented by age group and physical activity class; and regression equations are provided for estimation of maximal oxygen intake from age, physical activity status, and duration of the multistage treadmill test. These data should prove useful as normal standards for assessment of aerobic capacity in middle-aged men until such time as larger numbers of data on maximal exercise testing become available.
Quantitative Angiocardiography
Authors: KENNEDY J. WARD , YARNALL STEPHEN R. , MURRAY JOHN A. , FIGLEY MELVIN M.
Published: June 2012

Quantitative angiocardiographic methods have been used to determine left ventricular volume and left ventricular mass (LVM) in 100 patients with isolated mitral valve disease. Thirty-six patients had mitral stenosis (MS), 29 had mitral regurgitation (MR), and 35 had combined stenosis and regurgitation (MS + MR). Data on volume and LVM from these patients are presented and are related to standard flow and intracardiac pressure determinations and compared with normal values. In patients with MS, the mean end-diastolic volume per square meter of body surface area (EDV/m
2
) was 72 ml/m
2
and was increased to 148 ml/m
2
in those with MR. EDV/m
2
correlated closely with the severity of regurgitation and less well with LV end-diastolic pressure. The mean LV stroke volume was slightly smaller than normal in patients with MS (38 ml/m
2
) and was greatly increased in those with MR (88 ml/m
2
). The LV stroke volume correlated closely with the severity of regurgitation, r = 0.928. The ejection fraction (EF) was low in 37% of patients with MS and in 22% of those with MS + MR and MR alone. Left atrial volume was larger than normal in all patients and, although generally larger in those with regurgitation, did not correlate with its severity. In contrast, cyclic left atrial volume change was correlated with the severity of mitral regurgitation, r = 0.785. The data are presented with cumulative distribution curves suitable for reference standards.
Open Heart Surgery in Infective Endocarditis
Authors: MANHAS DEV R. , HESSEL EUGENE A. , WINTERSCHEID LOREN C. , DILLARD DAVID H. , MERENDINO K. ALVIN
Published: June 2012

Fourteen patients with bacterial endocarditis had open heart surgery. Thirteen were operated upon because of congestive heart failure, and in one the indication for surgery was persistent infection. The aortic valve alone was involved in six patients; two patients had both aortic and mitral valve endocarditis. Five patients had infection of the mitral valve, and one patient had tricuspid valve involvement. All the patients received preoperative antibiotics for a variable period.

Ten patients left the hospital and four died in the hospital. Of the 10 patients discharged, one died 9 months later of congestive heart failure. Seven patients developed valvular leaks either through the suture line or the homograft, and two deaths resulted. Nine patients are alive and in good functional status. Antibiotics were given for 5 to 10 days postoperatively; one patient, however, received antibiotics for 49 days.

Early open heart surgery is recommended in bacterial endocarditis if heart failure is progressive. Shorter postoperative antibiotic therapy is proposed once the source of residual infection is removed.
Fusion of the Left Aortic Cusp to the Aortic Wall with Occlusion of the Left Coronary Ostium, and Aortic Stenosis and Insufficiency
Authors: WAXMAN MENASHE B. , KONG YIHONG , BEHAR VICTOR S. , SABISTON DAVID C. , MORRIS JAMES J.
Published: June 2012

The case of a 16-year-old girl with a unique anomaly of the coronary arterial tree is presented. This report concerns the first known case of isolated adherence of the left coronary aortic valve cusp to the aortic wall. This produced total obstruction of the left coronary artery ostium, angina pectoris, syncope, aortic stenosis, and aortic insufficiency. Freeing the adherent cusp from the aortic wall restored patency of the left coronary artery, relieved the aortic insufficiency, and resulted in disappearance of the angina pectoris and syncope. This case adds to the growing spectrum of nonatherosclerotic coronary abnormalities which are capable of producing myocardial ischemia.
Intermittent Claudication
Authors: KANNEL WILLIAM B. , SKINNER JOHN J. , SCHWARTZ MELVIN J. , SHURTLEFF DEWEY
Published: June 2012

A general population sample of adult men and women was followed biennially over 14 years during which time 79 men and 46 women developed initial symptoms of intermittent claudication. A detailed examination of the incidence of this manifestation of atherothrombosis in comparison to that of coronary heart disease and atherothrombotic brain infarction was undertaken.

As for coronary heart disease (CHD), the incidence of intermittent claudication increased with age. Women lagged behind men by 10 years in incidence. Atherothrombotic brain infarction in contrast exhibited no male predominance and after the early sixties the women actually surged ahead.

Uncomplicated angina, surprisingly, resembled brain infarction more than intermittent claudication in the age-sex trend.

A pronounced increase in risk of intermittent claudication was noted for persons with CHD in general and angina in particular, suggesting a common underlying basis for claudication and coronary disease. The principal hazard for subjects with claudication appeared to derive from an increased propensity to cardiovascular morbidity and mortality rather than from the consequences of impaired circulation to the limb. Risk of death was twofold for those with claudication as compared to those without.
Banding of the Pulmonary Artery for Transposition of the Great Arteries and Ventricular Septal Defect
Authors: STARK JAROSLAV , TYNAN MICHAEL , TATOOLES CONSTANTINE J. , ABERDEEN EOIN , WATERSTON DAVID J.
Published: June 2012

The palliative procedures for TGA with VSD and pulmonary hypertension include pulmonary artery banding, atrial septostomy, and, when necessary, ligation of a patent ductus arteriosus. This paper presents the surgical results and physiological consequences of the palliative approach. The overall mortality was 12% (4 of 33 patients).

It was possible to lower the Pp to below 45 mm Hg in all 15 infants with pulmonary artery banding. Ten infants recatheterized after the operation had no evidence of progressive pulmonary vascular disease. In 6 of 18 children older than one year, the Pp remained higher than 45 mm Hg distal to the band. In six children recatheterized, the pulmonary flow had decreased from preoperative levels, and the calculated Rp/Rs ratio had not changed significantly. The arterial oxygen saturation was decreased after banding of the pulmonary artery in 16 of 20 patients in whom it was measured.

These data suggest that pulmonary artery banding can prevent the development of pulmonary vascular disease in infants. In children older than one year, pulmonary vascular disease can be arrested at the stage that it had reached at the time of banding the pulmonary artery.
Total Correction of Transposition of the Great Arteries Following Balloon Atrioseptostomy
Authors: WALDHAUSEN J. A. , PIERCE W. S. , RASHKIND W. J. , MILLER W. W. , FRIEDMAN S.
Published: June 2012

Twelve patients with isolated d-TGA have undergone total correction by an interatrial baffle technique. Ten of these patients had been palliated in infancy by the BAS technique, while two patients had atrial septectomy by the Blalock-Hanlon technique. Operation was facilitated if the patient had not had a previous thoracotomy. All patients survived operation and were discharged from the hospital considerably improved. While the mean preoperative arterial oxygen tension in room air bad been 27 mm Hg, the mean postoperative tension in room air was 49 mm Hg (
P
< 0.001). The most common complications were fluid retention, treated with diuretics, and arrhythmias, which in most instances were not of clinical importance. All patients eventually had an atrial pacemaker with normal atrioventricular conduction. Six patients had life-threatening complications, which included technical complications resulting in a late death, one case of postoperative intrathoracic bleeding, six pulmonary complications, two infections, one low cardiac output syndrome, one stroke, and one bleeding ulcer. All patients except one have done well since discharge, as evidenced by weight gain and further increase in arterial oxygen tension (mean 67 mm Hg).

The use of the BAS technique as the sole method of palliation for TGA, combined with several technical modifications of baffle placement, have minimized postoperative complications and provided excellent results.
Surgical Treatment of the Subelavian Steal Syndrome
Authors: RESNICOFF SETH A. , DEWEESE JAMES A. , ROB CHARLES G.
Published: June 2012

From an experience with 16 patients exhibiting a symptomatic subclavian steal syndrome, the following conclusions were reached:

1. Prompt and lasting relief from transient ischemic episodes can be provided by operative intervention.

2. When the right subclavian artery is involved, endarterectomy through a cervical approach is the procedure of choice.

3. Involvement of the left subclavian artery is best handled by employing a carotid-subclavian bypass or ligating the left vertebral artery.

4. Vertebral ligation on either side is particularly effective in the poor-risk patient in whom it can be performed under local anesthesia.

5. Concurrent significant stenosis of an internal carotid artery should be repaired at the time of correction of the subclavian steal, with the latter procedure performed after the carotid endarterectomy.
Cardiac Tamponade Following Open-Heart Surgery
Authors: ENGELMAN RICHARD M. , SPENCER FRANK C. , REED GEORGE E. , TICE DAVID A.
Published: June 2012

A review of 310 consecutive cardiac operations with cardiopulmonary bypass for acquired valvular and congenital heart disease found eight cases of late tamponade, 8 to 30 days after operation, and four cases of early tamponade, within 36 hours after operation. Early tamponade, associated with postoperative bleeding, was easily recognized and treated, but late tamponade was often misdiagnosed as cardiac failure or pulmonary embolism. In the eight late cases, six were associated with anticoagulation and hemorrhage, while two developed a bloody effusion with a pericardiotomy syndrome.

Tamponade produced an elevated right atrial pressure, low central or mixed venous oxygen tension, oliguria, hypotension, and tachycardia. A severe metabolic acidosis was a late finding.

Treatment in the presence of bleeding was uniformly effective if thoracotomy and drainage were promptly instituted. Pericardiocentesis sufficed only in the patients with a pericardiotomy syndrome. Three deaths occurred in the late group from a delay in diagnosis (37.5% mortality).
Circulatory Effects of Carotid Sinus Nerve Stimulation in Dogs with Reference to Coronary Flow and Resistance
Authors: FALICOV RAUL E. , RESNEKOV LEON , KOCANDRLE VLADIMIR , KING SHEILA , KITTLE C. FREDERICK
Published: June 2012

The effects of electrical stimulation of the carotid sinus nerves upon heart rate, myocardial function, circulatory dynamics, and coronary flow were studied in the anesthetized, open-chest dog. Carotid sinus nerve stimulation produced a transient profound bradycardia, which was abolished by vagotomy, and a more sustained, less marked, slowing of the heart, which became less marked after propranolol. The effects on cardiac output were variable. Significant drops in aortic pressure and systemic resistance were observed. Anterior descending coronary arterial flow also decreased significantly, but the changes in calculated coronary vascular resistance were variable. A disproportionate reduction in coronary blood flow was observed relative to the decrease in myocardial oxygen consumption.

Under the conditions of our experiment, carotid sinus nerve stimulation significantly decreased cardiac work, arterial pressure, and myocardial contractility, and probably produced some coronary vasoconstriction secondary to the reduction in myocardial oxygen demand.
Fatal Malfunction of Edwards Low-Profile Mitral Valves
Authors: HORSLEY HOWARD T. , RAPPOPORT WILLIAM J. , VIGODA PHILIP S. , VOGEL JOHN H. K.
Published: June 2012

Three of nine patients in whom the Edwards low-profile valve was placed in the mitral position have shown serious valve malfunction. Two of these expired despite emergency valve replacement. The third valve was replaced semielectively, with a good outcome.

The valve malfunction has resulted from pannus formation on the uncovered metal struts, with severe limitation of motion and cocking of the valve disc. It is felt that careful serial evaluation of signs, symptoms, and valve cinefluorography is mandatory in patients with this valve. Should one or more of these parameters indicate valve malfunction, especially if serial observations indicate progressive worsening, valve replacement with another type of prosthesis should be very seriously considered. Serial cinefluorographic observation of the disc motion is indicated even in a setting of clinical well being.
Internal Mammary Artery Implantation: Effect on Myocardial Lactate Utilization
Authors: KEMP HARVEY G. , MANCHESTER JOEL H. , AMSTERDAM EZRA A. , TAYLOR WARREN J. , GORLIN RICHARD
Published: June 2012

Twenty-three subjects with angiographically documented coronary heart disease were studied by means of arterial and coronary sinus catheterization before and one year after internal mammary artery implantations. The pre- and postoperative patterns of lactate extraction at rest and after isoproterenol stress have been determined and correlated with clinical improvement and angiographic patency of the implant. In group I 13 subjects had implants that were angiographically seen to fill some portion of the coronary circulation. Eight of 11 who produced lactate preoperatively reverted to normal lactate extraction. Two extracted lactate at both studies. All but two had clinical improvement. No deaths occurred over a mean follow-up period of 40 months (range 20 to 64). In group II ten subjects bad implants with no visible connection to the coronary circulation. Only one subject had reversion of lactate production to extraction and two from extraction to production. Seven of ten did not improve clinically. Three deaths occurred over a mean follow-up period of 39 months (range 17 to 53). Agreement has been found between reversion to normal lactate metabolism, angiographic patency, and clinical improvement following internal mammary artery implantation.
Immediate Revascularization of the Heart
Authors: ADAM MAURICE , MITCHEL BEN F. , LAMBERT CARY J.
Published: June 2012

The surgical treatment of myocardial ischemia demands immediate revascularization. In 70 patients this demand was met by the use of 114 aorta-to-coronary artery saphenous vein bypass grafts. Thirty-four single, 28 double, and 8 triple bypass grafts were used. They were taken to the right coronary artery (38 times), to the left anterior descending coronary artery (60 times), and to the circumflex coronary artery (16 times). There were 28 patients with three-vessel coronary disease (stenosis greater than 75%) and 15 with two-vessel disease. In spite of this, the operative mortality was only 10% (7 of 70), and four patients died of their disease while awaiting surgery. Relief of symptoms, which occurs without delay, has continued in 81% of the patients (57 of 70).

The use of aorta-to-coronary artery saphenous vein bypass grafts "jump grafts" is proposed as being widely applicable, very effective, and the safest procedure available for the surgical treatment of coronary artery occlusive disease. More observations on longterm results are still needed.
Comparative Survival of Transplanted Heart and Skin in Inbred Rats
Authors: FREEMAN JAN S. , REEMTSMA KEITH , STEINMULLER DAVID
Published: June 2012

Skin, kidney, and heart allografts are all rejected acutely by inbred rats when the donor and recipient strains are incompatible at the
Ag-B
or major rat histocompatibility locus. In contrast, in
Ag-B
compatible strain combinations, kidney allografts usually survive indefinitely even though skin allografts are still rejected acutely. Unfortunately, matching at major loci may not insure the prolonged survival of organ as opposed to skin allografts in general because heart allografts in the
Ag-B
compatible Fischer to Lewis strain combination are rejected acutely, like skin.

Evidence that donor pretreatment of rat heart allografts with leukocidal agents can prolong graft survival suggests that the degree of immunogenicity of grafts may be related in part to their leukocyte content.
Pathogenesis of Rejection of Canine Cardiac Allografts
Authors: SHUMAK K. H. , GOLDMAN B. S. , SILVER M. D. , BIGELOW W. G. , CROOKSTON J. H.
Published: June 2012

Cardiac rejection was studied in 25 mongrel dogs receiving heterotopic abdominal cardiac allografts from unrelated donors. Seventeen recipients were not given immunosuppressive therapy; the other eight were treated with antilymphocyte serum. Antibodies cytotoxic to dog lymphocytes were detected in the serum of five dogs after transplantation. Immunofluorescence studies showed the presence of IgG deposits on the sarcolemma of hearts undergoing rejection. In addition, there were focal IgG deposits on many of the recipients' own hearts, including five which showed changes of focal myocarditis when stained with hematoxylin and eosin. In the dogs treated with antilymphocyte serum, rejection was delayed, and the histological changes were modified. However, the development of lymphocytotoxic antibody and the deposition of IgG were unaffected.
The Clinical Value of Frequency Analysis of the First Heart Sound in Myocardial Infarction
Authors: ADOLPH ROBERT J. , STEPHENS JOHN F. , TANAKA KUMEO
Published: June 2012

A sensitive technic for frequency analysis of the first heart sound (S
1
) during isovolumic contraction time (ICT) was developed. Recorded heart sounds were filtered with a dynamic analyzer. Amplitudes of frequencies between 30 and 70 cps were plotted as a percentage of peak total energy of S
1
against frequency. A consistent and reproducible frequency "fingerprint" was obtained in 74 normal subjects. Frequencies of S
1
were shown to be directly proportional to ventricular elasticity (VE) and inversely proportional to combined ventricular mass (VM). VM is constant during ICT. Amplitude at 40 cps was less than at 30 cps because of reduced VE (myocardial infarction), increased VM (athletes), or combined reduction in VE and increased VM (myocardiopathy). Normal patterns were found in aortic insufficiency (increased VE and VM). Diagnostic patterns were found in 21 of 24 patients with acute myocardial infarction (MI) but were similar to patterns found in patients with healed infarcts and myocardiopathy and athletes. Acute pulmonary embolism could be differentiated from MI.
Distribution of Pulmonary Blood Flow after Myocardial Ischemia and Infarction
Authors: KAZEMI HOMAYOUN , PARSONS EDWARD F. , VALENCA LAERCIO M. , STRIEDER DENISE J.
Published: June 2012

Regional distribution of pulmonary blood flow and ventilation was determined with the
133
xenon technic in the erect position at the bedside in 15 patients an average of 6 days after uncomplicated myocardial infarction (MI) and in five patients with severe angina in the same coronary care unit. Follow-up studies were repeated within 3 to 25 weeks on six of the patients with MI.

There was marked reduction in perfusion to the lung base after myocardial infarction. Patients with severe angina showed some underperfusion of the lower lung zones, but to a much less degree than those with acute MI. The pattern of pulmonary perfusion reverted toward that seen in angina in the follow-up studies of patients with MI. Distribution of ventilation was normal in all patients.

The results of the study suggest that there are probably chronic changes in the pulmonary vasculature of patients with arteriosclerotic heart disease which lead to redistribution of pulmonary blood flow toward the apex, and that the marked under-perfusion of the lung base demonstrated following acute myocardial infarction reflects an acute increase in the pulmonary venous and interstitial pressures most likely due to occult left ventricular failure.
The Role of Left Atrial Transport in Aortic and Mitral Stenosis
Authors: STOTT DONALD K. , MARPOLE DEREK G. F. , BRISTOW J. DAVID , KLOSTER FRANK E. , GRISWOLD HERBERT E.
Published: June 2012

The relationship of left atrial contraction to ventricular filling was studied in 24 patients. Eight patients had aortic stenosis, eight had mitral stenosis, and eight others served as a control group. All had normal sinus rhythm. Cineangiocardiographic volumetric determinations of the left ventricle were done throughout the cardiac cycle, and the rate of left ventricular filling before and during left atrial contraction was calculated.

In the group with aortic stenosis 39% of the left ventricular stroke volume entered the ventricle during left atrial contraction; in the group with mitral stenosis 24% was contributed during left atrial contraction, and in the control patients, 26%.

The rate of left ventricular filling more than doubled during left atrial contraction in aortic stenosis, while no consistent change in the rate of filling occurred during left atrial contraction in mitral stenosis and in the control group.

The character of the resistance to left ventricular filling in aortic stenosis and mitral stenosis is discussed. An important contribution by left atrial contraction to left ventricular performance in aortic stenosis is suggested.
Anomalous Left Coronary Artery from Pulmonary Artery
Authors: PERRY LOWELL W. , SCOTT LEWIS P.
Published: June 2012

Anomalous origin of the left coronary artery from the pulmonary artery has been noted in 11 patients at Children's Hospital of the District of Columbia from 1946 to 1969. Four of our cases plus 40 in the literature have been reported with complete catheterization data. These 44 infants and children can be divided into three groups (A, B, and C) according to the magnitude of the shunt at pulmonary artery level.

The type of treatment in infants and children with anomalous left coronary artery and increased oxygen saturation in the pulmonary artery at the time of catheterization (group A) appears to be immaterial, as all have survived. Mortality rates in patients with left-to-right shunts not large enough to be detected by oxygen studies (group B) indicate no significant difference in those treated medically or surgically; hence, if possible, surgery should be delayed in this group until after 1 to 2 years of age when surgical mortality is negligible. In patients with filling of the left coronary artery from the pulmonary artery (group C), direct anastomosis of the anomalous left coronary artery to the aorta seems to be the only therapeutic recourse.

To date, there are insufficient data to indicate the efficacy of direct anastomosis of the anomalous left coronary artery to the aorta in the sick infant.