bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Cardiac Defects: A Physician's Guide for Evaluation and Management
Authors: WHITTEMORE RUTH , GLENN FRANK , BLOUNT S. GILBERT , LAMBERT EDWARD C. , BLUMENTHAL SIDNEY , TAUSSIG HELEN B.
Published: June 2012

This report was designed primarily for the physician who is not a cardiologist but who encounters, in the course of his practice, patients with congenital malformations of the heart. It will help him decide whether and when such patients should have special studies done in a cardiac center or by a cardiologist familiar with these problems. It is divided into three parts: one on infants, one on children and adults, and the last on management. The first two parts are designed to assist the physician in the selection of patients for special studies, the last to aid him in the management of patients under his care. A special section in part III is devoted to care of the pregnant woman with a congenital defect. The decision as to which studies are needed and when they should be performed should be left to the cardiologist or center to which the patient is referred.
Cor Triloculare Biatriatum
Authors: HEATH DONALD
Published: June 2012

Cor triloculare biatriatum is a rare form of congenital heart disease that needs to be considered in the differential diagnosis of the important group of patients with cyanotic congenital heart disease with pulmonary hypertension. The clinical and pathologic features of an example of this disease are reported and discussed in a review of previously reported cases. The small pulmonary blood vessels showed some features of hypertensive pulmonary vascular disease and evidence of an increased bronchial arterial collateral circulation to the lung. An interpretation of these histologic changes relating them to the abnormal pulmonary physiology in cor triloculare biatriatum is suggested.
Shoulder-Hand Syndrome Following Myocardial Infarction with Special Reference to Prognosis
Authors: EDEIKEN JOSEPH
Published: June 2012

Shoulder-hand syndrome occurs in approximately 10 to 15 per cent of patients following acute myocardial infarction. Sympathectomy, sympathetic block, cortisone, and various other therapies have been advocated. In the present communication the results of simple measures such as local heat, analgesics, and the regimen of active use of the affected extremity are described in treating 47 attacks in 42 patients with acute myocardial infarction.
Design of an Ultra Low Frequency Force Ballistocardiograph on the Principle of the Horizontal Pendulum
Authors: REEVES T. J. , JONES W. B. , HEFNER L. L.
Published: June 2012

A low frequency ballistocardiographic system based on the principle of the horizontal pendulum is described. By increasing the coupling of the body to the bed and by the use of an extended frequency range accelerometer, ballistocardiograms having clearly defined high frequency components were recorded. The physical principles of such a system are briefly reviewed.
Anomalous Connection of Right Pulmonary Veins to Superior Vena Cava with Interatrial Communications
Authors: SWAN H. J. C. , KIRKLIN JOHN W. , BECU LUIS M. , WOOD EARL H.
Published: June 2012

Anomalous connection of the right pulmonary veins to the superior vena cava associated with an interatrial communication in an unusually cephalad location has been diagnosed at cardiac catheterization in 8 patients. These patients had the clinical features seen in patients who have atrial septal defects in the region of the fossa ovalis. Differentiation was accomplished by (1) the roentgenographic position of the catheter in the right superior pulmonary vein, (2) demonstration of an abnormally high oxygen saturation of the blood in the superior vena cava, (3) the presence of a small right-to-left shunt from the superior vena cava and the absence of such a shunt from the inferior vena cava, and (4) demonstration of similar drainage of blood from the right superior pulmonary vein and superior vena cava. The syndrome is considered to be an anomaly of pulmonary venous development while the atrial septum forms normally.
Myocardial Sarcoidosis
Authors: PEACOCK ROBERT A. , LIPPSCHUTZ EUGENE J. , LUKAS AGNES
Published: June 2012

Systemic sarcoidosis frequently involves the heart and is usually diagnosed at autopsy, often as a single granuloma. An extensive review of the literature was prompted by a very interesting clinical problem of etiology in the frequent syncope and Stokes-Adams attacks in an otherwise apparently healthy young girl. The pathologic findings and therapeutic dilemmas are reviewed in detail.
Electrocardiographic Abnormalities in Epidemic Hepatitis
Authors: SANGHVI L. M. , MISRA S. N.
Published: June 2012

Myocarditis has been reported in patients dying with viral hepatitis. With the increasing incidence of the disease, recognition of myocardial involvement is apparently important. The nature of the abnormalities suggested several factors including ischemia and local electrolyte disturbance of myocardium. The incidence of abnormalities was greater in the out-patients and in those with tachycardia, and greatest at the peak of the epidemic. Abnormalities showed no relation to the severity of the jaundice or of the illness or to the serum protein levels.
Serum Lipid Levels in Normal Persons
Authors: LEWIS LENA A. , OLMSTED FREDERICK , PAGE IRVINE H. , LAWRY ELEANOR Y. , MANN GEORGE V. , STARE FREDRICK J. , HANIG MARTIN , LAUFFER MAX A. , GORDON TAVIA , MOORE FELIX E.
Published: June 2012

Measurements of S
f
12-20, S
f
20-100, and total serum cholesterol made on 10,690 men and 3,404 women are reported and the relation of lipid level to race, source, age, sex, blood pressure, and weight is described. Distributions for men 40 to 59 are reported in detail.

The groups studied, while not selected as representative of the population at large, were remarkably similar in their lipid levels. The lipid levels of only 2 of the 33 groups—Los Angeles and the prisoners—differed significantly from the average. No convincing explanation for either of these exceptions was discovered.

The data in this study were mainly from a white population. Data for nonwhites came primarily from 2 aberrant groups and were too meager to allow a clear characterization of lipid levels. The levels for nonwhites from these 2 sources were closer to those of the white members of these groups than to the levels of the general population.

Cholesterol levels for men and women were found to be about the same at age 20. For both sexes the level rises with age but at first the rise is much greater for men than women. Above age 50, however, the level is higher for women than men and the level for women continues to rise after that age—at least within the age series for this study. The level for men reaches a peak at age 55, after which it declines. The relation of age and sex with lipid level for S
f
12-20 and S
f
20-100 appeared to be similar to that for cholesterol.

Correlations of lipid levels with blood pressure and weight were positive but very low. Hypertension or obesity, however, is associated with some elevation of lipid levels.

S
f
20-100 was found to be the most sensitive of the 3 lipid measures to sex and race differences. In the age group 40 to 59 it was the only one that exhibited a definite race and sex differential. In addition, it had the highest correlation with weight and with blood pressure.
Aneurysmal Dilatation of the Aortic Sinuses in Marfan's Syndrome
Authors: STEINBERG ISRAEL , MANGIARDI JOSEPH L. , NOBLE WILLIAM J.
Published: June 2012

Aneurysmal dilatation of the aortic sinuses in identical twins, aged 2 years, was disclosed after angiocardiography. Knowledge of the association of aortic sinus aneurysms and Marfan's syndrome led to the discovery of bilateral dislocated lenses; these, plus mildly arched palates, dolichocephaly, and slender fingers established the diagnosis of arachnodactyly. Right heart catheterization proved to be normal. A patent foramen ovale in 1 twin permitted pressure measurements in the left atrium and ventricle. Significant mitral insufficiency and aortic stenosis were excluded by the character of the left atrial and ventricular pressures. Aortic sinus dilatation is due to medial degeneration, a common finding in Marfan's syndrome. Endocardial or subendocardial (myxomatous) involvement of the left ventricle is probably the cause of the left ventricular hypertrophy.
The Problem of Bioassay and Comparative Potency of Diuretics
Authors: FORD RALPH V. , SPURR CHARLES L. , MOYER JOHN H.
Published: June 2012

Oral diuretic agents are widely used with but little information concerning their relative diuretic and toxic effects. A method is reported here for the bioassay of oral diuretic agents so that their comparative potency may be established. Four carbonic anhydrase inhibitors are compared by this method.
Brucella abortus
Endocarditis
Authors: HUDSON RAYMOND A.
Published: June 2012

The diagnosis and successful treatment of a case of bacterial endocarditis due to
Brucella abortus
is described. Therapy consisted of the combination of aureomycin and streptomycin.
Successful Surgical Repair of a Ruptured Aneurysm of the Sinus of Valsalva
Authors: MORROW ANDREW G. , BAKER R. ROBINSON , HANSON HANS ERIK , MATTINGLY THOMAS W.
Published: June 2012

A patient is described in whom an aneurysm of the right coronary sinus of Valsalva ruptured into the right atrium. A new method of surgical closure is presented along with pertinent physiologic data obtained before and after operation.
Combined Mitral and Pulmonic Stenosis
Authors: SHUBIN HERBERT , LEVINSON DAVID C. , ROSENFELD MAURICE H.
Published: June 2012

A case of combined pulmonic and mitral stenosis with cardiac catheterization studies is presented. A modification of the formula for calculating pulmonic valvular resistance is discussed. The importance of calculating cardiac output on the basis of the systolic ejection phase is noted.

The pulmonic valvular resistance by this modified formula was 210 dynes seconds cm.
-5
The pulmonary vascular resistance was 250 dynes seconds cm.
-5
The pulmonic valvular resistance tended to protect against the development of pulmonary edema, much as a high pulmonary vascular resistance protects against pulmonary edema.

The right ventricular output, which was 1.6 L. per minute, was limited by the pulmonic stenosis. Other mechanisms that might mechanically limit right ventricular output are significant tricuspid stenosis or limb tourniquets. In situations of impending pulmonary edema, any one of these factors that decrease right ventriccular output may be advantageous.
Main-Stem Extrasystoles
Authors: MARRIOTT HENRY J. L. , BRADLEY SAMUEL M.
Published: June 2012

Extrasystoles arising in the main stem of the bundle of His are generally regarded as very rare; only 7 examples have been published since their original description by Lewis in 1911 and 2 of these fail to satisfy rigid criteria for diagnosis. Four further examples, encountered in a relatively small series of tracings, are here presented and it is concluded that such extrasystoles are not so much rare as they are overlooked.
Chest Pain with Inverted T Waves, Predominantly in Precordial Leads, as the Only Electrocardiographic Abnormality
Authors: CUTTS FRANK B. , MERLINO FRANK , EASTON FREDERIC W.
Published: June 2012

Sixty-nine hospitalized patients, who gave a history of "coronary" type chest pain appearing at rest and lasting at least 15 minutes, and whose electrocardiographic changes were limited to deeply inverted T waves predominantly in the precordial leads, were selected from a large series of patients. The hospital course and electrocardiographic changes of these patients were studied. After an average follow-up period of 4 years, approximately half the patients were still able to work. Postmortem studies on 11 patients revealed extensive sclerosis of the coronary arteries in all.
Pathophysiology of Rheumatic Fever
Authors: AIKAWA JERRY K.
Published: June 2012

Radioisotopic technics were used to explore physiologic aberrations that may characterize individuals with acute rheumatic fever. No significant changes were noted in serial measurements of the blood volume or serum sodium and potassium concentrations. Most of the individuals with severe disease showed an initial value for radiosodium space of more than 330 ml./Kg. of body weight, with no evidence of edema. The exchangeable sodium content of the body correlated well with the radiosodium space. These changes are difficult to explain solely on the basis of extracellular edema, and are interpreted as suggesting that the intracellular content of sodium or that in bone is increased during acute rheumatic fever. An intracellular increase in sodium may be due to an alteration in the permeability of cell membrane induced by an immune mechanism.
Tetralogy of Fallot
Authors: MCCORD MALCOM C. , VAN ELK JACK , BLOUNT S. GILBERT
Published: June 2012

The considerable body of clinical and physiologic data in patients with the tetralogy of Fallot that has been accumulated over the past 15 years now indicates that the original concept of the lesion as a single, fairly narrowly limited entity is no longer valid. The tetralogy can now be demonstrated to occupy a broad spectrum in the field of congenital cardiac anomalies, representing widely varying forms. While the entity has been termed a tetralogy, only 2 features, namely the pulmonary stenosis and the ventricular septal defect, are essential in the determination of the clinical and physiologic pattern that patients with this defect portray.
Interference Dissociation
Authors: MILLER RALPH , SHARRETT RICHARD H.
Published: June 2012

Contradirectional interference results when 2 stimuli arising in different foci in any part of the heart spread in opposite directions toward each other. Interference dissociation is defined as that type of dissociation which is due to repetitive contradirectional interference.

The electrocardiograms of 12 cases have been selected for analysis to illustrate many of the important features of interference dissociation.

The various centers between which dissociation may theoretically occur are listed for reference. This series includes examples of dissociation due to interference between the following pairs of rhythms: Normal sinus rhythm and A-V nodal rhythm, normal sinus rhythm and multifocal idioventricular rhythms, sinus tachycardia and paroxysmal ventricular tachycardia, paroxysmal atrial tachycardia with block and idioventricular rhythm, simultaneous dissociated paroxysmal A-V nodal and ventricular tachycardias, and normal sinus rhythm and A-V nodal rhythm in the presence of the Wolff-Parkinson-White syndrome.

Interference may occur at any level between the points of origin of the 2 rhythms, and the most common sites of interference are illustrated diagrammatically.

Interference at the upper end of the A-V junction is of particular importance, and a clear understanding of isolated interference in this region is of help in resolving some of the more difficult problems of dissociation. For this reason the concept of the zone of potential interference is introduced. This is the time interval in the cardiac cycle during which interference between an A-V nodal, or ventricular, and oncoming S-A beat may be anticipated. Certain important deductions are derived from theoretical considerations of the zone of potential interference.

The various mechanisms leading to the onset and termination of interference dissociation are described, and the rates of the dissociated rhythms are compared.

Aberrancy of the ventricular response to A-V nodal impulses is discussed. This phenomenon is ascribed to uneven spread of the excitation wave from an eccentrically located focus, due to the fact that in the A-V node longitudinal is faster than horizontal transmission.

Ventricular and atrial captures are considered in detail. Of particular interest is the occasional occurrence of both types of capture in the same case. This paradox is explained on the basis of either intermittent retrograde block or simultaneous bidirectional conduction through the A-V node in the presence of functional longitudinal dissociation. The relationship of other forms of heart block to interference dissociation is pointed out. Heart block predisposes to, and frequently complicates, interference dissociation.

A differential diagnosis between interference dissociation and other disturbances of rhythm is presented.

Interference dissociation is one of the most complex arrhythmias and familiarity with all its possible variations is essential to the correct interpretation of any given tracing.
Wolff-Parkinson-White Syndrome
Authors: FISCH CHARLES , PINSKY SHELDON T. , SHIELDS J. PAUL
Published: June 2012

It is the purpose of this communication to present a case of pre-excitation (Wolff-Parkinson-White syndrome) associated with various arrhythmias, some hitherto not described, and to stress the many features of this unusual case that support the bypass concept of the origin of this syndrome.
Diverticulum of the Pericardium
Authors: MAIER HERBERT C.
Published: June 2012

A diverticulum of the pericardium can often be confused with other lesions of the heart and great vessels as well as mediastinal cysts and other masses. Pericardial effusion, sometimes associated with heart lesions causing cardiac enlargement, is a frequent factor in producing diverticular formation. The mode of development of a pericardial diverticulum is better appreciated when certain features of the anatomic structure of the parietal pericardium are understood. Two cases of pericardial diverticulum that illustrate the etiologic, clinical, and roentgen features of the lesion are presented.
Study of the Hemodynamic Effects of the Aorto-Coronary Sinus Graft Operation in Patients with Coronary Artery Disease
Authors: MOIR T. W. , PRITCHARD W. H.
Published: June 2012

A group of patients with coronary artery disease have been studied preoperatively and after surgical creation of an arteriovenous fistula between the descending aorta and coronary sinus (Beck II, revascularization operation). Preoperatively, basal studies of cardiac output and blood volume were done with radioisotope technics. Postoperatively, catheterization studies of cardiovascular function were obtained and abnormalities, including heart failure, were found in patients with functionally significant arteriovenous fistulas.
Current Concepts on the Management of Shock
Authors: WEIL MAX H.
Published: June 2012

In the handling of a patient with shock it is essential to identify the underlying cause in order to plan rational treatment. On the basis of information presently available, the specific causes of shock have been classified into 6 groups: hypovolemia, cardiac failure, bacteremia, hypersensitivity, neurogenic factors, and obstruction to blood flow. Treatment was discussed with reference to these groups.

Vasopressor agents are helpful in most instances of shock related to cardiac failure, bacteremia, and hypersensitivity. They usually are contraindicated in shock due to vascular obstruction and in hypovolemic shock until optimal replacement of fluid has been achieved. Recent studies have indicated that metaraminol may be the pressor amine of choice because it is therapeutically effective, simple to administer, without risk of injury to skin and subcutaneous tissues, and available for injection without additional fluid (thus especially suitable for patients with renal failure).

Rigorous attention to the fluid and electrolyte state is of special importance. In the presence of acidosis, the response to vasopressor agents is greatly diminished. The use of molar solution of sodium lactate to re-establish this responsiveness has met with limited success and seems worthy of trial in selected cases.

Adrenocortical hormones may be of striking benefit in shock due to bacteremia or hypersensitivity when an overwhelming response to inflammation threatens life. These drugs may be used also to augment the effectiveness of vasopressor drugs. Relatively little risk is involved, provided that the periods of employment are short and that antibiotics are used concurrently.

The indications for the use of digitalis glycosides in shock are the same as at other times, and their routine use is of no proved benefit and may be injurious. Atropine is of value when excessive vagal activity with bradycardia produces or complicates the hypotensive state.

Chlorpromazine is of no proved worth in the treatment of shock, and possible benefits achieved with anticoagulants are not established as yet. Preliminary observations suggest that hypothermia may be of some value. The head-down position provides only transient benefit in patients with shock, and its prolonged or routine use may delay recovery.
Clinical Problems Related to Surgical Repair of Intracardiac Defects with the Aid of an Extracorporeal Pump-Oxygenator
Authors: BURCHELL HOWARD B.
Published: June 2012

The medical problems in the selection of patients for direct-vision reconstructive operations utilizing the pump-oxygenator of the Gibbon type are discussed. The evaluation of the pulmonary vascular changes is one of the most important medical tasks in many cases. The operative risk for such lesions as ventricular septal defect with high pulmonary flow, tetralogy of Fallot, pulmonary stenosis with intact ventricular septum, and atrial septal defect of the partial atrioventricular canal type is constantly decreasing and is 15 per cent or less at the present time. Heart block and cardiac arrhythmias are still, on occasion, serious postoperative complications. During 1 period of 3 months, subacute bacterial endocarditis (
Pseudomonas
) occurred in 4 patients but it has not recurred since.
Echinococcus Disease of the Heart
Authors: DIGHIERO JORGE , CANABAL EDUARDO JOAQUIN , AGUIRRE CESAR V. , HAZAN JACOBO , HORJALES JOSÉ O.
Published: June 2012

The etiology, pathogenesis, pathology, and the clinical picture of uncomplicated and complicated echinococcus disease of the heart are discussed.

Cardiac location of the larval stage of
Taenia echinococcus
in human beings is not an uncommon disease in sheep-grazing countries. The authors put special emphasis on the methods helping to establish the diagnosis of the condition prior to the appearance of any one of its dreaded complications, which make treatment much more difficult and prognosis considerably poorer.
The Ballistocardiogram in Overweight Young Adults
Authors: STERN SAMUEL , Lipavsky Aja
Published: June 2012

The ability to record the mechanical function of the heart is the principal value of the ballistocardiogram. In young healthy individuals the ballistocardiogram is consistently normal. Since overweight is apparently an important factor in the development of degenerative heart diseases, a study was undertaken to correlate excess weight in otherwise healthy young students with their respective ballistocardiograms, obtained on a direct-body ballistocardiograph.
The Atrial Coronary Arteries in Man
Authors: JAMES THOMAS N. , BURCH GEORGE E.
Published: June 2012

An anatomic study of the atrial coronary arteries in 43 fresh normal human hearts is described. The implications of the findings are discussed for clinical problems facing the cardiologist and the cardiovascular surgeon.
Left Atrial Electrokymography in Mitral Insufficiency in Man
Authors: JUDGE RICHARD D. , FIGLEY MELVIN M. , SLOAN HERBERT E.
Published: June 2012

The relationship of the left atrial border movements to underlying pressure and volume changes was investigated in individual human subjects with proved mitral insufficiency. Based on these observations, criteria for the recognition of hemodynamically significant mitral insufficiency have been revised. Special emphasis is placed on a rapid inward movement of the atrial wall during the period of early diastolic emptying. Application of these criteria to a group of patients with surgically proved valvular lesions suggests that they are more reliable than those previously described.
Ventricular Precontracting Area in the Wolff-Parkinson-White Syndrome
Authors: BANDIERA GIULIO , ANTOGNETTI PIER FAUSTO
Published: June 2012

By means of the analytic method of roentgenkymography of Cignolini, 11 typical cases of Wolff-Parkinson-White syndrome were studied. Comparison of the kymographic tracings with the synchronously registered electrocardiogram demonstrated precocious contraction of a limited ventricular area, situated in the left ventricle in the A type and in the right ventricle in the B type.
Anatomic Studies of the Cardiac Conduction System in Congenital Malformations of the Heart
Authors: REEMTSMA KEITH , COPENHAVER W. M.
Published: June 2012

A frequent and serious complication of certain intracardiac procedures is heart block, produced by operative injury to the conduction pathways. The anatomic relationship of the conduction system to cardiac defects has previously been studied only in isolated cases of heart block. This report deals with a study, by means of serial sections and reconstructions, of the relationships of the atrioventricular node and bundle to a variety of congenital defects in the area of the membranous ventricular septum.
The Nitrous Oxide Test
Authors: MORROW ANDREW G. , SANDERS RICHARD J. , BRAUNWALD EUGENE
Published: June 2012

The diagnosis of a left-to-right shunt generally depends upon the demonstration of significant differences in oxygen content among the venae cavae, the chambers of the right heart, and the pulmonary artery. The inconclusive or misleading results sometimes obtained with this method have stimulated interest in improved technics. The wide arteriovenous difference that normally exists during the inhalation of nitrous oxide has been studied in the development of a more accurate diagnostic approach. The superiority of the nitrous oxide test over the oxygen method is demonstrated.
Anesthesia in Patients with Heart Disease
Authors: VANDAM LEROY D. , BURNAP THOMAS K.
Published: June 2012

Anesthesia for the patient with heart disease has become increasingly safer with the passage of years due to a better knowledge of the physiology of heart disease and of the pharmacologic action of anesthetic agents themselves. There are few statistics to support the clinical impression that patients with cardiac disease tolerate anesthesia and surgery well but reports are not lacking. The difficulty in gathering statistics lies in an inability to compare results in comparable groups of patients. Anesthesia is but a small part of the total operative experience. The patient with serious heart disease usually undergoes a relatively long period of preoperative preparation. When ready, he is given preanesthetic medication and is subjected to the administration of an anesthetic. The surgical operation is superimposed on these preliminary events. Subsequently, convalescence with its many physiologic adjustments completes the surgical experience.

Anesthetic problems may originate in any of the aforementioned phases of the operative experience. These problems have been briefly reviewed. The most important factor in minimizing the problems of anesthesia itself is the skill and knowledge with which the anesthetic agents are chosen and administered rather than the actual pharmacologic and physiologic effects of the agents themselves. On a background of thorough medical preperation safe anesthesia for the patient with heart disease consists of the careful selection of preanesthetic medication, flawless technic, and use of minimal quantities of anesthetic agents and adjuncts. Despite the attainment of these goals, circulatory and respiratory problems will be encountered. These may be related to the heart disease itself, to medical preparation, pharmacologic side effects, and to a multitude of undesirable respiratory and circulatory reflexes. The latter in turn reside in anesthetic and surgical manipulation. Knowledge of these factors enables the internist to understand the problems of anesthesia and to prepare the patient for the operative experience.
Intravenous Drug Therapy of Stokes-Adams Disease
Authors: ZOLL PAUL M. , LINENTHAL ARTHUR J. , GIBSON WILLIAM , PAUL MILTON H. , NORMAN LEONA R.
Published: June 2012

In the treatment of Stokes-Adams disease emergency resuscitation from cardiac arrest can be effected by external electric stimulation or countershock. For the acute problems of persistent ventricular standstill and frequently recurrent seizures, which often appear immediately after resuscitation, intrinsic ventricular pacemakers must be aroused, accelerated, and maintained. In the treatment of these problems the effects of drugs on ventricular rhythmicity and atrioventricular conduction were evaluated. We have found the slow intravenous administration of dilute solutions of sympathomimetic amines to be an effective and safe technic. Epinephrine and isoproterenol were the most useful agents and were comparable in efficacy and toxicity.
Infradiaphragmatic Total Anomalous Pulmonary Venous Connection
Authors: JOHNSON ARNOLD L. , WIGLESWORTH F. W. , DUNBAR J. S. , SIDDOO SARJIT , GRAJO MARIA
Published: June 2012

A study of 4 cases of uncomplicated total anomalous pulmonary venous drainage, in which the connection with the systemic circuit is in the region of the porta hepatis, revealed similar clinical and radiologic findings, so that in the fourth case the diagnosis was suspected and confirmed by angiocardiographic study. Mainly due to the obstruction of pulmonary venous outflow, this form of total anomalous pulmonary venous drainage forms a distinct entity and the physiologic disturbance is quite different from those anomalies of the venous return in which the connection with the systemic circulation is above the diaphragm.
Blood Supply of the Human Interventricular Septum
Authors: JAMES THOMAS N. , BURCH GEORGE E.
Published: June 2012

The blood supply of the interventricular septum has been studied in 43 normal human hearts, from patients dying of noncardiac causes. The specimens were prepared by injection of vinylite into the coronary arteries. Description is made of the normal vascular anatomy of this area, and its clinical importance is discussed.
Bronchial Obstruction Due to Pulmonary Artery Anomalies
Authors: CONTRO STEPHEN , MILLER ROBERT A. , WHITE HARVEY , POTTS WILLIS J.
Published: June 2012

In a previous publication attention was drawn to the occurrence of pulmonary artery anomalies as conditions causing tracheobronchial obstruction. In the present report 2 infants are presented in whom a large aneurysm of the pulmonary artery pressed upon the walls of the left bronchus, producing severe respiratory symptoms.
Postpericardiotomy Syndrome Following Surgery for Nonrheumatic Heart Disease
Authors: ITO TOMIKO , ENGLE MARY ALLEN , GOLDBERG HENRY P.
Published: June 2012

Widespread intracardiac surgery of rheumatic heart disease has brought to medical attention a puzzling postoperative complication, usually designated the "postcommissurotomy syndrome" and often considered to represent reactivation of rheumatic fever. Herein are reported instances of an identical complication following intrapericardial surgery of congenital heart disease. It is suggested that the delayed febrile pleuropericardial reaction represents a traumatic pericarditis and that a preferable name for it is the postpericardiotomy syndrome.
Angiocardiographic and Physiologic Correlations in Mitral Stenosis
Authors: LUKAS DANIEL S. , MAHRER PETER R. , STEINBERG ISRAEL
Published: June 2012

With the use of the technics of angiocardiography and cardiac catheterization the relation of specific hemodynamic abnormalities to alterations in cardiovascular anatomy in mitral valvular disease was investigated in 56 patients.
Pressor Polypeptides Formed in Vivo and in Vitro as Mediators of Renal Hypertension
Authors: BRAUN-MENÉNDEZ E. , PALADINI A. C.
Published: June 2012

During the purification of hypertensin formed in vitro, evidence of heterogeneity of the pressor activity was obtained by counter current distribution. Pepsitensin shows a similar heterogeneity. These facts lead to the hypothesis that other proteolytic enzymes may also be present in the tissues and may hydrolyze hypertensinogen with the formation of pressor polypeptides of the hypertensin or pepsitensin type. Thus, substances similar to hypertensin may be formed in the organism by the action of proteolytic enzymes other than renin and may, if produced locally, exert a vasoconstrictor action or, if they enter the circulation, cause an increase in blood pressure.
Evidence for Renotrophin as a Causal Factor in Renal Hypertension
Authors: BRAUN-MENÉNDEZ E.
Published: June 2012

Most of the methods used for the production of experimental renal hypertension involve a reduction in the amount of functional renal tissue. According to the renotrophin hypothesis, the blood pressure of animals with experimental hypertension should be reduced or normalized if the rate of production of renotrophin is reduced (hypophysectomy, thyroidectomy, low protein diet) or if the functional renal mass is increased (kidney transplant, parabiosis). Conversely, the blood pressure should rise to higher levels or hypertension develop if the rate of production of renotrophin is increased (thyroid hormones, somatotrophin, testosterone, thyrotrophin, gonadotrophin in males, protein-rich diets) or if the functional renal mass is further reduced (sensitizing actions of unilateral nephrectomy, etc.). Experimental evidence to be presented conforms with the renotrophin hypothesis and its 4 corollaries.
Carotid Sinus Participation in Experimental Renal Hypertension
Authors: MCCUBBIN J. W.
Published: June 2012

Using direct electroneurographic technics, it is shown that the carotid sinus baroceptor reflexes adapt or reset to the higher pressure levels of chronic renal hypertension. They remain functional at the higher pressure level and thus act to maintain rather than to oppose it. This provides a satisfactory explanation for the presence of significant neurogenic vasoconstriction in chronic hypertension. Experiments on acutely hypertensive dogs indicate that the resetting process starts quite early but seems to lag behind the rise in arterial pressure.
Reliability of Subjective Circulation Time Determinations
Authors: MAHL MURRAY M. , LANGE KURT
Published: June 2012

When the fully objective dermofluorographic method of measurement of circulation time was compared with the subjective Decholin and saccharin methods, it was found that the values obtained with the subjective methods were often unreliable. The error was unpredictable in magnitude and occurrence, and was maximal in patients with failure.
Venous-Arterial Admixture in the Lungs in Primary and Secondary Polycythemia
Authors: LILLEHEI JAMES P. , JOHNSON ROBERT L. , WU NANCY , HALDEN E. RICHARD , SPROULE BRIAN J.
Published: June 2012

By use of a polarographic technic for measuring arterial oxygen tension, venous-arterial shunting in the lungs was investigated in patients with primary and secondary polycythemia before and after treatment and in nonpolycythemic normal and emphysematous subjects.
Radiologic Aspects of Operable Heart Disease
Authors: STRAUSS PHILIP , ABRAMS HERBERT L. , ROBINSON SAUL
Published: June 2012

The preoperative and postoperative radiologic findings in 71 patients with patent ductus arteriosus treated surgically were investigated. The purpose of the study was to determine the magnitude, character, and rapidity of the changes observed, as well as the relationship of the postoperative change to complicating cardiovascular lesions. Serial examinations were compared with the preoperative studies and with each other, including an analysis of over-all heart size, individual chamber size, the pulmonary vessels, and the aortic silhouette. The results were tabulated and their significance was evaluated.
Transposition of the Pulmonary Veins
Authors: GUNTHEROTH WARREN G. , NADAS ALEXANDER S. , GROSS ROBERT E.
Published: June 2012

The seriousness of incomplete transposition of the pulmonary veins has probably been underestimated in the past.

Data on 11 patients is presented, including 10 with associated atrial septal defects. Common symptoms were dyspnea, fatigability, and frequent respiratory infections. Examination revealed no cyanosis, widely split second sound, soft systolic murmur and middiastolic murmur at the apex. One third demonstrated a presystolic murmur of medium pitch. The electrocardiographic and radiographic features were characteristic of atrial septal defects. There were no specific vascular shadows in any of our patients. Catheterization data were also characteristic of atrial septal defects. There was an inverse relationship between the right atrial pressure and systemic index. Anomalous pulmonary veins were entered during the right heart catheterization in 6 of the 10 patients catheterized.

Seven patients have had atrioseptopexy to close the septal defect and to direct the blood from the anomalously draining veins into the newly enlarged left atrium. An eighth patient had repair and shift of the atrial septum by means of open heart surgery through a pump oxygenator. This approach will probably prove optimal for future operations.
Some Evidence for Active Constriction in the Human Pulmonary Vascular Bed
Authors: PATEL DALI J. , LANGE RAMON L. , HECHT HANS H.
Published: June 2012

Continuous infusion of norepinephrine in man caused a rise in pulmonary arteriolar resistance as measured by pulmonary artery-pulmonary wedge pressure differences. Since no change in flow occurred during the procedures, the data suggest active constriction of the pulmonary vascular bed under these circumstances.
Serum Glutamic Oxaloacetic Transaminase in Dissecting Aneurysm of the Thoracic Aorta
Authors: TREDWAY JOHN B. , KEMBLE EDWARD E.
Published: June 2012

The behavior of serum glutamic oxaloacetic transaminase level in cases of dissecting aneurysm of the thoracic aorta is reported. Certain clinical and laboratory observations suggest that intrapericardial hemorrhage is the responsible factor when the titer of serum glutamic oxaloacetic transaminase is elevated.
Relationship of Degree of Atherosclerosis of Internal Carotid System in the Brain of Women to Age and Coronary Atherosclerosis
Authors: WINTER MALCOLM D. , SAYRE GEORGE P. , MILLIKAN CLARK H. , BARKER NELSON W.
Published: June 2012

Cerebral infaretion currently is the third leading cause of death in the United States. Since atherosclerosis of the cerebral arteries is the basis for the majority of strokes, the authors undertook to define more accurately the distribution of such atherosclerosis, its relation to coronary atherosclerosis, and its relation to such other factors as hypertension, obesity, and cerebral infarction. The results of their study are presented here.
Movements and Forces of the Human Heart
Authors: HARRISON T. R. , LOWDER JOHN A. , HEFNER LLOYD L. , HARRISON DONALD C.
Published: June 2012

Precordial movements starting after P and before Q have been studied. Right atrial contraction appears to cause a forward-rightward motion and left atrial contraction a backward movement of the precordium. The latter is exaggerated in most patients with mitral stenosis and in some patients with myocardial failure.
Comparative Severity of Atherosclerosis in Costa Rica, Guatemala, and New Orleans
Authors: TEJADA CARLOS , GORE IRA , STRONG JACK P. , MCGILL HENRY C.
Published: June 2012

The present study is concerned with the comparative severity of aortic atherosclerosis in specimens obtained from 941 necropsies performed in low-income Costa Ricans, Guatemalans, and New Orleans whites. The findings indicate geographic differences in the severity of atherosclerosis after the age of 30 years. The dietary habits, serum cholesterol, and lipoprotein patterns of similar populations are compared with the present pathologic findings.
Observations on the Delayed First Heart Sound in Mitral Stenosis and Hypertension
Authors: WEISSLER ARNOLD M. , LEONARD JAMES J. , WARREN JAMES V.
Published: June 2012

The measurement of the time between the onset of ventricular depolarization and the first heart sound, the Q-1 interval, has been employed in the phonocardiographic evaluation of patients with rheumatic heart disease. Prolongation of this interval has been noted frequently in patients with mitral stenosis and may be used as evidence in weighing the advisability of operation. In the present study, delayed appearance of the first heart sound was often noted in patients with hypertensive vascular disease as well. The mechanism for these changes as well as their significance in the phonocardiographic evaluation of patients with combined valvular disease and hypertension is discussed.
A Correlative Study of Postmortem, Electrocardiographic, and Spatial Vectorcardiographic Data in Myocardial Infarction
Authors: BURCH G. E. , HORAN L. G. , ZISKIND JOSEPH , CRONVICH J. A.
Published: June 2012

The spatial vectorcardiograms (sVCG) and electrocardiograms were studied with respect to the gross and microscopic data in 59 instances of myocardial infarction. Besides the early abnormalities in the QRS sÊ-loop frequently associated with the electrocardiographic Q of infarction, there were recognizable alterations in the sVCG associated with the anatomic location of the infarction: lateral wall infarcts shortened vectors in mid-QRS sÊ-loop, and posterior lateral basal infarction altered the terminal portion distinctively. The myocardial lesions included fresh infarcts, solid scars, scattered fibrosis, and scar with interwoven intact muscle fibers. Where many normal-appearing fibers were present in the lesion, the previously recorded ECG or sVCG frequently failed to show the diagnostic signs of infarction. However, by presenting the depolarization complex in greater detail, the sVCG supplemented the ECG, improving the accuracy of diagnosis of infarction, especially among the smaller, less solid lesions.
Persistent Right Jugular Lymph Sac Simulating Cervical Tumor
Authors: STEINBERG ISRAEL S.
Published: June 2012

A patient who had had trauma to the right shoulder and upper chest complained of a right supraclavicular mass. Examination revealed a cystic tumor made larger by performance of the Valsalva maneuver. Angiocardiography demonstrated that there was partial stenosis of the terminal end of the right innominate vein. This and the Valsalva maneuver were responsible for the filling of a right persistent jugular lymph sac that simulated a cervical tumor.
Perforation of the Heart during Cardiac Catheterization and Selective Angiocardiography
Authors: ESCHER DORIS J. W. , SHAPIRO JEROME H. , RUBINSTEIN BERTA M. , HURWITT ELLIOTT S. , SCHWARTZ SIDNEY P.
Published: June 2012

Perforation of the myocardium is rare during cardiac catheterization. The precautions to be exercised, particularly in regard to clinical management, are delineated in this communication.
Lipid Keratopathy and Atheroma
Authors: COGAN DAVID G. , KUWABARA TOICHIRO
Published: June 2012

Lipid plaques in corneas of patients with lipid keratopathy, in corneas of hypercholesteremic rabbits and in the arteries of man and the hypereholesteremic rabbit are described. An interesting and thought-provoking analogy is drawn between the plaques that can be seen and followed in the eye during life with the more occult plaques of blood vessels in atheromatosis.
Constrictive Pericarditis: Serial Hemodynamic Studies with an Explanation for Reversible Congestive Phenomena
Authors: MURPHY TIMOTHY R. , MEYER JULIUS M. , CHASE JULES
Published: June 2012

A new explanation for certain instances of acute reversible congestive phenomena in constrictive pericarditis is offered on the basis of 6 patients studied clinically and by right heart catheterization. In 2 cases intermittent tamponade in the presence of a rigid pericardium accounted for the reversibility of the congestive state, as contrasted with 4 cases presenting the chronic progressive course of classical constrictive pericarditis. The diagnosis in the 6 cases was proved by surgery or autopsy.
The Pathology of Hypertensive Pulmonary Vascular Disease
Authors: HEATH DONALD , EDWARDS JESSE E.
Published: June 2012

Progressive histologic changes occur in the pulmonary arteries and arterioles, as a complication of chronically elevated pulmonary arterial blood pressure, in patients with congenital septal defects of the heart. This progression is so stereotyped as to allow a division of the structural effects into 6 grades. The histologic features of each grade are described in detail in this communication. These results afford a basis for comparing the magnitude of these changes to the clinical findings.
The Electrocardiographic Findings in Small, Atypical Myocardial Infarcts
Authors: CLAGETT A. HENRY
Published: June 2012

Others have described mild or atypical myocardial infarction as a clinical condition in which the pain is of short duration and the evidence of tissue damage is slight. It occurs in otherwise healthy individuals and is characterized by complete recovery and the absence of complications. In this study the electrocardiograms of 359 patients with myocardial infarction were divided according to the QRS complexes; one group showing normal QRS complexes and the other showing typical Q waves. The clinical features of the patients in these two groups were compared.
Results of Surgery for Congenital Pulmonary Stenosis
Authors: HANSON JOHN S. , IKKOS DANAE , CRAFOORD CLARENCE , OVENFORS CARL-OLOF
Published: June 2012

Clinical and physiologic data before and after operation are presented in 2.5 patients who underwent surgical correction of congenital pulmonary stenosis with intact ventricular septum. Sixteen patients were operated on by the transventricular approach, 7 by the transarterial route, and 2 had infundibulectomies. Postoperative changes in the clinical status, phonocardiogram, electrocardiogram, x-rays, and right heart catheterization values are discussed. Comparison is made of the 2 major operative technics both in the present group and in cases gathered from a review of the literature.
Electrocardiographic Changes in Acute Subendocardial Infarction
Authors: COOK RODERICK W. , EDWARDS JESSE E. , PRUITT RAYMOND D.
Published: June 2012

The electrocardiographic consequences of subendocardial infarction will find their most evident and characteristic expression in the acute has of a large lesion. Five cases of this kind are presented here and the associated electrocardiographic changes are described. At what level in the myocardium between the endocardium and epicardium do the electrocardiographic expressions of subendocardial infarction give way to those of transmural infarction Data in 6 cases of large nontransmural infarction are presented for comparison with findings in the 5 cases of subendocardial infarction.
The Ballistocardiogram in Juvenile Diabetes Mellitus
Authors: RAKEL ROBERT E. , SKILLMAN THOMAS G. , BRAUNSTEIN JOHN R.
Published: June 2012

Ballistocardiographic studies were made in 41 patients; with diabetes since childhood. A high incidence of abnormalities was observed. The possible diagnostic and prognostic implications are discussed.