bluuebunny/crossref_metadata_2025 huggingface dataset:
The Junction Between the Left Atrium and the Pulmonary Veins
Authors: NATHAN H. , Eliakim M.
Published: June 2012

Some anatomic features of the posterior wall of the left atrium, the atrial-pulmonary venous junctions, and the myocardial sleeves extending over the pulmonary veins, as observed in 16 human hearts, are described.

Different patterns of direction of the myocardial fibers of the atrial wall were found in the different specimens. The atrial wall between the upper pulmonary veins was consistently thicker than that between the lower ones. Similarly, the sphincter-like structures of the atrial-pulmonary venous junctions were generally more conspicuous, and the myocardial venous sleeves better developed in the superior than in the inferior pulmonary veins. The physiological and pathological implications of these findings are discussed.
Evaluation of the Left Ventricle in Patients with Mitral Stenosis
Authors: FEIGENBAUM HARVEY , CAMPBELL RICHARD W. , WUNSCH CHARLES M. , STEINMETZ EDWARD F.
Published: June 2012

In an attempt to objectively evaluate the status of the left ventricle in 32 patients with mitral stenosis, a modified form of supine leg exercise was done during simultaneous left and right heart catheterization. Besides measuring the usual hemodynamic parameters, a ratio of mitral valve flow (MVF) or diastolic left ventricular volume change (Δv/Δt) and the slope of the rise of left ventricular diastolic pressure (Δp/Δt) was calculated at rest and during exercise (Δv/Δp). The results of these measurements were compared with those obtained on nine patients with either innocent functional heart murmurs or hemodynamically insignificant stenotic valvular lesions.

None of the nine control patients had left ventricular end-diastolic pressures (LVEDP) greater than 12 mm Hg either at rest or with exercise. Exercise also did not appreciably alter the Δv/Δp ratio. Among the patients with mitral stenosis eight patients had distinctly elevated (greater than 14 mm Hg) LVEDP with exercise and 19 patients, including the eight with abnormal LVEDP, decreased the Δv/Δp ratio with exercise.

The difficulties and limitations associated with this type of study are discussed. However, there is a distinct possibility that these results are indicative of an abnormal left ventricle in some patients with mitral stenosis. It is further suggested that this abnormality may be related in some way to decreased left ventricular compliance. In addition, a close statistical correlation between Δv/Δp and cardiac output implicates this left ventricular abnormality as a possible etiological factor in the reduced cardiac output seen in many patients with mitral stenosis.
Familial Congenital Heart Disease
Authors: GERMAN JAMES , EHLERS KATHRYN H. , ENGLE MARY ALLEN
Published: June 2012

The chromosomal complement was analyzed in 35 individuals, each selected because of proven cardiac anomaly in him and in one or more of his relatives. The study to date has also been extended to include chromosomal analyses of 29 other affected and 21 unaffected relatives, a total of 85 individuals. In four of the 35 index individuals a small chromosomal variant was found, and in each case it was shown to be familial; in all, variants were detected in 11 of the 85 persons examined.

The various aberrations detected-an enlarged short arm of a member of group 13-15 in two families; heteromorphic nos. 16 in one family; satellites on a no. 17 in one family -are known to exist in apparently normal individuals in the general population. Neither the biological significance of these variants nor their relation to the etiology of cardiac anomalies can be established at present. However, the following working hypothesis has been developed: Small chromosomal variations in structure are transmitted in phenotypically normal individuals in the general population and constitute the chromosomal
structural load
; when the relatively infrequent but inevitable genetic imbalance of an embryo occurs as the consequence of such a chromosomal polymorphism, it may cause embryonic maldevelopment. By this mechanism, the structural load would become responsible for a proportion of birth defects.
Potassium-Sparing Effects of Triamterene in the Treatment of Hypertension
Authors: SPIEKERMAN RALPH E. , BERGE KENNETH G. , THURBER DELORAN L. , GEDGE STAFFORD W. , MCGUCKIN WARREN F.
Published: June 2012

Triamterene (2,4,7-triamino-6-phenylpteridine) was employed alone and in combination with hydrochlorothiazide in the treatment of patients with group 1 and 2 hypertension. In 21 patients, triamterene alone had an inconsistent antihypertensive effect on the systolic blood pressure, which was minimal in most patients. In 16 patients the combination of triamterene and hydrochlorothiazide (2:1 by weight) reduced the systolic blood pressure slightly more than did hydrochlorothiazide alone. Triamterene alone or in combination with hydrochlorothiazide produced an increase in the concentration of potassium in serum. Side effects due to triamterene were similar to those noted with thiazide diuretics. In addition, five patients had a decrease in blood hemoglobin concentration, and two patients had reversible alterations in liver function during triamterene therapy. Triamterene may be a useful adjunct for thiazidetreated hypertensive patients by decreasing the likelihood of complicating hypokalemia.
Ventricular Volume Studies in a Patient with Hypertrophic Subaortic Stenosis
Authors: RACKLEY CHARLES E. , WHALEN ROBERT E. , MCINTOSH HENRY D.
Published: June 2012

Left ventricular volume studies were performed on a patient with hypertrophic subaortic stenosis utilizing cineangiocardiography. During the injection of contrast material the patient had a premature ventricular contraction followed by sinus rhythm. The ventricular volume measurements were made during the post PVC beat and subsequent sinus beats. The volume studies revealed normal end-diastolic volumes and small end-systolic volumes with an increased ejection fraction. Although the left ventricular stroke volume was greater during the post PVC beat than during subsequent beats, the simultaneous arterial systolic and pulse pressure did not rise. The elevated diastolic filling pressure, the normal end-diastolic volumes, and the failure of the end-diastolic volume to increase with a longer diastolic filling period are compatible with diastolic restriction in hypertrophic stenosis.
Left Ventricular Performance During Muscular Exercise in Patients with and without Cardiac Dysfunction
Authors: ROSS JOHN , GAULT JAMES H. , MASON DEAN T. , LINHART JOSEPH W. , BRAUNWALD EUGENE
Published: June 2012

The LVEDP, cardiac output, and V

o
o2

were measured before and during supine muscular exercise in 38 patients. The normal pattern, established in seven patients without left ventricular dysfunction, consisted of an exercise factor [see Equation in PDF File], an LVEDP during exercise of less than 12 mm Hg, and little change or a decrease in LVEDP, which was accompanied in most instances by an increase in the stroke volume. In the majority of 31 patients with various cardiac lesions, but without valvular regurgitation, measurement of the LVEDP before and during exercise permitted the definition of normal or abnormal left ventricular function when the status of the left ventricle could not have been ascertained from other measurements. Thus, in most of the patients with mitral stenosis and abnormal resting hemodynamics, the pattern of left ventricular function during exercise was considered to be normal. Among the patients with aortic stenosis or left ventricular myocardial disease and elevated resting LVEDP, two types of abnormal performance of the left ventricle were identified. In some patients, an increase in LVEDP was accompanied by an increase in stroke volume, and this response was termed "abnormal left ventricular dynamics"; in the remaining patients, an increase in LVEDP and no change or a fall in stroke volume occurred and this response was termed "depressed left ventricular function." It is concluded that determination of the LVEDP before and during exercise adds importantly to measurements of the changes in cardiac output and O
2
consumption in characterizing left ventricular performance. The method employs standard catheterization techniques and appears to provide a practical and useful means for evaluating the functional status of the left ventricle in patients with and without myocardial dysfunction.
Validity of Indicator-Dilution Determination of Cardiac Output in Patients with Aortic Regurgitation
Authors: SAMET PHILIP , CASTILLO CESAR , BERNSTEIN WILLIAM H.
Published: June 2012

Indicator-dilution determinations of cardiac index were performed in 298 catheterization studies in three groups of patients, many with aortic regurgitation. The absence of physiologically significant differences between the two sampling sites, the pulmonary artery and systemic artery after right atrial injection, demonstrates that even severe aortic regurgitation does not vitiate the indicator-dilution determination of cardiac output after right heart injection and systemic arterial sampling if the downstroke of the primary dilution curve permits a straight-line semilogarithmic extrapolation.
Atrioventricular Junctional Premature and Escape Beats with Altered QRS and Fusion
Authors: KISTIN ALBERT D.
Published: June 2012

The interval between an ectopic QRS and a retrograde P wave measured in simultaneous esophageal and other leads may help to identify beats which originate in the atrio-ventricular (A-V) junction. In six cases beats which seem to originate in the A-V junction are associated with a QRS which differs in configuration from the QRS of sinus origin, and in each case atrial premature systoles which give rise to normal QRS complexes occur in tracings which contain the A-V junctional beats also. Comparison of the QRS of the atrial premature systoles with the QRS of the A-V junctional beats with respect to the time of occurrence in the cardiac cycle and the duration of the preceding cycle makes it seem unlikely that the altered QRS of the A-V junctional beats can be explained by aberrant conduction during incomplete recovery. In five of the cases, fusion QRS complexes occur, suggesting activation of the ventricles partly by an impulse of sinus origin and partly by the impulse of A-V junctional origin. These observations support the interpretation previously made by others that impulses of A-V junctional origin may reach the ventricles by pathways other than the usual A-V pathway. If such beats as are described here occur at all frequently, then the diagnostic value of fusion, heretofore considered an almost conclusive criterion of a ventricular focus, may be impaired.
Furosemide
Authors: STASON WILLIAM B. , CANNON PAUL J. , HEINEMANN HENRY O. , LARAGH JOHN H.
Published: June 2012

The physiological effects of furosemide, a new diuretic agent chemically related to thiazide diuretics, have been evaluated in seven normal subjects and in 39 patients with edema of varied origin.

The compound exhibited an unusually broad dose-response curve so that increasing diuresis could be induced with oral doses of from 40 mg once daily to 600 mg three times daily. At the higher dosages furosemide was significantly more effective than conventional thiazide diuretics and exhibited an order of potency which can be achieved with ethacrynic acid.

In many of its diuretic properties furosemide resembled thiazide agents. The natriuresis and diuresis which it produced was associated with a disproportionate loss of chloride and potassium and the consequent production of degrees of hypokalemic alkalosis.

However, physiological studies indicate that furosemide is qualitatively and quantitatively more similar to ethacrynic acid than to thiazide agents. Thus, furosemide, like ethacrynic acid and unlike thiazide diuretics acted to interfere with both urinary concentration (T
c

H
H2
O

) during antidiuresis and to block urinary dilution (C

H
H2
O

) during water diuresis. It also caused a negative urinary hydrogen balance during diuresis.

The data suggest that furosemide acts to block sodium chloride reabsorption in the ascending limb of Henle's loop and in more cortical distal diluting segments. The magnitude of its effects suggests that it also may interfere with proximal sodium chloride reabsorption. Ion exchange sodium reabsorptive mechanisms appear unaffected and become overactive during drug administration thereby accounting for the observed increases in potassium and hydrogen ion excretions.

Because of its properties furosemide was especially useful intravenously as an adjunct in the treatment of acute pulmonary edema and for oral maintenance therapy in the treatment of difficult or refractory edematous patients, many of whom exhibit associated electrolyte derangements or azotemias. In these difficult situations, for maximum diuresis and to avoid problems associated with K
+
, H
+
and Cl
-
depletion, intermittent therapy added to a maintenance schedule which utilizes aldosterone antagonists or chloride and potassium supplements appears advisable.

Furosemide, also like ethacrynic acid, was capable of adding to the natriuretic action of all other types of diuretic agents. This observation provides additional evidence for the existence of a number of different tubular transport processes located at different sites in the nephron which can participate in sodium conservation.
Cardiovascular Disease, Diabetes Mellitus, and Anthropometric Evaluation of Polynesian Males on the Island of Niihau-1963
Authors: BASSETT DAVID R. , ROSENBLATT GERALD , MOELLERING ROBERT C. , HARTWELL ALFRED S.
Published: June 2012

A study of 30 adult Polynesian males living on the isolated Hawaiian island of Niihau was conducted in October 1963. These relatively pure Polynesians were distinctly overweight, had a high prevalence of diabetes, and were hypertensive. Hematocrit values and whole blood viscosity were elevated. Serum uric acid levels were normal. Though Hawaiians generally have a high mortality rate from coronary heart disease, the average serum cholesterol level for this group was 30 to 40 mg% lower than in most populations having a high prevalence of coronary heart disease.
Left Atrial Volume and Its Changes in Heart Disease
Authors: HAWLEY RICHARD R. , DODGE HAROLD T. , GRAHAM THOMAS P.
Published: June 2012

Left atrial volume and volume change during the heart cycle were determined and compared with left ventricular stroke volume and forward, or effective, stroke volume in 57 patients who were grouped as follows: normal, primary cardiomyopathy, aortic valve disease, predominant mitral insufficiency, predominant mitral stenosis, and combined aortic and mitral valve disease.

In this study left atrial cyclic volume change averaged 41% of the left ventricular stroke volume and was in no case more than 72% of the left ventricular stroke volume, regardless of the type of heart disease. Some patients with aortic valve disease or primary cardiomyopathy have left atrial maximum volumes as large as those seen in many patients with mitral stenosis. Three features of left atrial volume and volume change per heart beat were observed in patients with mitral insufficiency: (1) a large left atrial volume (all patients with a left atrial volume greater than 365 ml had mitral insufficiency), (2) a large left atrial cyclic volume change, and (3) a left atrial volume change per beat equal to or greater than the forward, or effective, left ventricular stroke volume. It was also demonstrated that the left atrial cyclic volume change in patients with atrial fibrillation may be large and in this study showed no significant difference from values observed in patients with normal rhythm.
Circulation Time End Points
Authors: PIERSON RICHARD N. , GRIECO MICHAEL , SWINTON NEIL , DUBIN MICHAEL
Published: June 2012

Ideal measurements are both simple and precise. The subjective circulation time has provided more simplicity than precision to three generations of physicians attempting to analyze cardiac function. Other more complex and less available measurements have displaced the circulation time from its prior vogue, probably because of the wide ranges of normal circulation time values. Yet, no other bedside measurement of cardiac function reflects both cardiac output and central blood volume with a single result.

The peripheral arrival characteristics of radioisotope-labeled albumin are described in 15 normal subjects and in 13 patients with heart failure. These circulation-times are compared with the taste end point of the saccharin indicator simultaneously injected.

Taste threshold, a variable not dependent on cardiac status, determines a significant proportion of the circulation time in both normal and failing circulations.

The wide availability of instruments which measure radioactivity, dye density, or thermal change as a function of time could reinvest the circulation time with a new precision, in return for a modest loss of simplicity. Bypass of the noncardiac variable taste threshold may be added to the other well-described advantages of an objective circulation-time measurement by use of the time of half-peak concentration as the end point in recording the circulation time.
Significance of an Atrial Gallop Sound in Mitral Regurgitation
Authors: COHEN LAWRENCE S. , MASON DEAN T. , BRAUNWALD EUGENE
Published: June 2012

The incidence of atrial gallop sounds was studied in 51 patients with pure mitral regurgitation of sufficient severity to require operative treatment. Seventeen patients were in sinus rhythm. Nine of them had atrial gallop sounds and mitral regurgitation secondary to ruptured chordae tendineae, while six without atrial gallop sounds had primary valvular disease. The degrees of disability or the hemodynamic findings did not differ among the patients with ruptured chordae tendineae and those with primary valvular disease and sinus rhythm. However, the duration of symptoms and the history of a heart murmur were much shorter and the left atrium tended to be smaller in patients with ruptured chordae tendineae than in those with primary valvular disease. Sinus rhythm in a symptomatic patient with severe mitral regurgitation, therefore, should suggest the diagnosis of ruptured chordae tendineae. If, in addition, an atrial gallop sound is found the diagnosis of ruptured chordae tendineae is even more likely.
Epicardial Excitation of the Ventricles in a Patient with Wolff-Parkinson-White Syndrome (Type B)
Authors: DURRER D. , ROOS J. P.
Published: June 2012

Epicardial excitation was explored by means of an exploring electrode during operation on a patient with a large atrial septal defect of the secundum type, whose ECG indicated a Wolff-Parkinson-White syndrome of type B. Very early excitation occurred, 10 msec after the end of the P wave, at the right lateral border, near the atrioventricular sulcus, an area which is located a relatively large distance from the atrioventricular node. Because the epicardial region closest to this node did not show early excitation, it was concluded that in this heart the node was not involved, but that a muscular bypass between the right atrial muscle and the closely adjacent right ventricular surface was responsible. The location corresponds with that described in several extensive anatomic studies of hearts with a WPW syndrome. The right ventricle was activated predominantly or completely by an excitation wave originating in this area; the excitation pattern of the left ventricle did not differ significantly from the normal.
Human Heart Weight at High Altitude
Authors: HULTGREN HERBERT N. , MILLER HARRY
Published: June 2012

The weight of the right ventricle, left ventricle, and septum determined in 98 hearts of high altitude (12,300 feet) residents in Peru and in 86 hearts from sea level in the continental United States revealed that right ventricular hypertrophy is no greater at high altitude than at sea level in the stillborn-newborn infant heart. Right ventricular weight relative to total heart weight at high altitude exceeds that at sea level beginning about 30 days after birth and reaches a plateau at 56 days. Thereafter the degree of relative right ventricular hypertrophy changes only slightly through the adult years. No evidence was found of postnatal atrophy of the right ventricle either at sea level or high altitude nor of septal hypertrophy accompanying the right ventricular hypertrophy in high altitude. The degree of right ventricular hypertrophy was moderate and variable, and corresponded to the moderate, variable pulmonary hypertension previously demonstrated in high altitude residents. Since total heart weights are similar at high altitude and sea level and since high altitude subjects have a smaller body size, the heart weight/body weight ratio is probably greater in the high altitude subject.
Serum Lactate Dehydrogenase Elevation in Ambulatory Cardiac Patients
Authors: JORGENSEN CHARLES R. , ZIMMERMAN THEODORE S. , WANG YANG
Published: June 2012

Activity of total lactate dehydrogenase (LDH) and that of the heat-stable isozyme (LDH-1) was measured by the method of Strandjord and Clayson in the serum of 62 cardiac patients with congenital and valvular heart disease before and after cardiac catheterization and at follow-up examination after cardiac surgery. A universal elevation of both total and heat-stable LDH was found in patients with prosthetic heart valves of several types. Lesser degrees of abnormalities were seen in a number of the patients without prosthetic devices. Some patients had a small increase in serum enzyme activity the day after cardiac catheterization. The evidence presented implicates hemolysis in the production of these abnormalities. It is suggested that all patients with prosthetic valves and a significant percentage of patients with severe hemodynamic abnormalities have chronic, usually compensated, intravascular hemolysis secondary to mechanical damage to red blood cells. These findings must be kept in mind in interpreting serum LDH determinations in patients with valvular prostheses or congenital and valvular heart disease who present with complaints of chest pain.
Cardiovascular Function in Shock
Authors: CAREY JOSEPH S. , BROWN ROBERT S. , MOHR PATRICIA A. , MONSON DAVID O. , YAO SEE TAO , SHOEMAKER WILLIAM C.
Published: June 2012

Hemodynamic responses to volume loading with infusion of dextran-40 and myocardial stimulation with isoproterenol in 23 patients in shock from hemorrhage, trauma, or sepsis, and 10 healthy controls were studied. Responses of the control were moderate to dextran and marked to isoproterenol. Shock patients were divided into three groups according to the response of the cardiac index to dextran-40: group I, >50% increase; group II, 15 to 50% increase; group III, <15% increase or a decrease. The central venous pressure of patients who responded to dextran (group I) generally rose moderately and that of those who failed to respond (group III) increased without improvement of cardiac index or stroke index, suggesting myocardial failure. Group II showed cardiac improvement at the expense of marked increase in venous pressure, suggesting relative cardiac insufficiency.

Group I failed to respond to isoproterenol infusion, indicating that circulatory failure primarily resulted from failure of venous return. All group III patients responded markedly to isoproterenol. It is concluded that a significant number of patients in shock from hemorrhage, trauma, and sepsis exhibit signs of cardiac insufficiency. The ability of these hearts to respond to isoproterenol suggests that depletion or altered metabolism of endogenous catecholamines in part underlies this insufficiency. Further-more, it is suggested that cardiac insufficiency may contribute to the death of a significant number of patients with severe hemorrhagic and septic shock.
Correlation of Hemodynamic Data and Pulmonary Angiography in Mitral Stenosis
Authors: SIDD JAMES J. , DERVAN ROSEMARY A. , LELAND O. STEVENS , SASAHARA ARTHUR A.
Published: June 2012

The abnormalities of pulmonary arterial blood supply in mitral stenosis, consisting primarily of constriction of lower lobe vessels with resultant upper lobe preferential flow, was assessed by means of pulmonary angiography in 30 patients with mitral stenosis uncomplicated by other cardiac diseases. The abnormalities in blood flow correlated best with both the pulmonay artery pressure and the pulmonary arteriolar resistance, and only reasonably well with the area of the mitral valve and the pulmonary capillary wedge pressure. It is suggested that the reversal of the normal lower lung field preferential blood flow in mitral stenosis is primarily a function of pulmonary artery hypertension due to increased pulmonary arteriolar resistance.

Similarly, the width of the right main pulmonary artery as measured on pulmonary angiograms correlated well with both the pulmonary artery pressure and pulmonary arteriolar resistance and less well with the area of the mitral valve. Pulmonary artery size in mitral stenosis is most likely a function of the severity of the pulmonary arteriolar resistance as reflected in the pulmonary artery pressure.
Quantitation of Precordial Movement
Authors: SUTTON GEORGE C. , CRAIGE ERNEST
Published: June 2012

A method has been devised for calibrating and measuring aspects of displacement records of cardiac movement. Forty-five normal subjects have been studied using this method, and a normal range has been calculated for the heights of the a wave, systolic outward movement, rapid-filling wave, and the ratio of rapid-filling wave to duration. The consistency of the results obtained and factors producing variations are discussed.
Quantitation of Mitral Regurgitation by Constant Infusion of Xenon-133
Authors: MORCH JOHN E. , SMITH H. JAMES , MCGREGOR MAURICE
Published: June 2012

A method for the accurate quantitation of mitral regurgitation in man was described and tested in 23 patients. The technique involves a constant infusion of xenon-133 into the left ventricle for 2 minutes. Left atrial and arterial samples must be withdrawn after constant concentration is achieved and before recirculation reaches high values. It was shown that concentration of indicator at both sample sites was constant by 60 seconds from the onset of infusion and that at 60 and 120 seconds left atrial concentration would rise on the average to 2.3 and 4.3% arterial concentration, respectively, as a result of recirculation. It could be demonstrated by altering the left atrial sample site that error due to incomplete mixing in the left atrium might average 2% and would be unlikely to exceed 7%. Values for cardiac output and regurgitant flow and regurgitant fraction, measured between 60 and 120 seconds, were relatively constant in any one patient. Regurgitant fraction varied from 1 to 84% of blood leaving the left ventricle in systole in different patients and there was good correlation with clinical and angiocardiographic estimates of severity of regurgitation.
Histochemical Studies of the Myocardium and Conduction System in Acquired Iron-Storage Disease
Authors: SCHELLHAMMER PAUL F. , ENGLE MARY ALLEN , HAGSTROM JACK W. C.
Published: June 2012

The myocardium, all parts of the conduction system, and the S-A node contained iron in six patients with acquired iron-storage disease. The nerve fibers and ganglia contained negligible amounts. No correlation was demonstrated between the amount of histochemically demonstrated iron in the myocardium and conduction system, or the amount of transfused iron, or the amount of quantitatively analyzed myocardial iron and the presence of antemortem arrhythmias and conduction disturbances. The degree of scarring in the S-A node, A-V node, and bundle of His did not parallel the density of iron deposits in these structures.

These observations support the theory that factors other than iron alone are responsible for the cardiac rhythm and conduction abnormalities associated with iron-storage disease.
Arteriolar Abnormalities with Chronic Systemic Hypertension
Authors: NAEYE RICHARD L.
Published: June 2012

A quantitative study of arteriolar structure has been undertaken in 23 individuals with chronic hypertension and 18 normotensive controls. In the hypertensive individuals, some arterioles were found to have an increased, and others a subnormal, mass of medial smooth muscle. Both abnormalities often bear a definite relation to arteriolar sclerotic lesions, those arterioles proximal to sclerotic segments having an increased medial coat and those distal, an atrophic coat. Mean values for mass of arteriolar muscle were often normal in organs of the hypertensive patients. These anatomic features can be correlated with a variety of physiological and clinical observations in the disorder.
Digital Arteriography in Occlusive Arterial Disease and Clubbing of the Fingers
Authors: TAKARO TIMOTHY , HINES EDGAR A.
Published: June 2012

A study of transbrachial digital arteriography led to the development of a technique that includes the use of an intra-arterial vasodilator (tolazoline) measurement of circulation time, direct roentgenographic magnification and serial exposures of long (14 by 35-inch) films in cassettes. This technique permitted study of the fine details of digital arteriograms of 34 patients with clubbing of the fingers or peripheral occlusive arterial disease. The ulnar artery was nonopacified in 13 cases and segmental areas of nonopacification of digital arteries were seen in 17 of the entire group, in many instances in the absence of symptoms of occlusive arterial disease. The technique is recommended for more adequate study of the peripheral microangiopathies.
Early Results of Use of Homografts for Replacement of the Aortic Valve in Man
Authors: HOEKSEMA TAMMO D. , TITUS JACK L. , GIULIANI EMILIO R. , KIRKLIN JOHN W.
Published: June 2012

The first 50 cases at the Mayo Clinic of insertion of an aortic valvular homograft after excision of the aortic valve are reported. The hospital mortality rate was 6%. An aortic diastolic murmur was noted in 17% of the surviving patients just prior to their dismissal from the hospital. In none was there evidence of hemodynamically significant aortic valvular incompetence. At follow-up examination 3 to 12 months postoperatively, an aortic diastolic murmur was audible in 44% of the traced patients. Only one patient had hemodynamically significant aortic valvular incompetence. The patients were not given anticoagulant therapy, and there were no thromboembolic complications.
Work Capacity and Efficiency of the Autotransplanted Heart
Authors: DAGGETT WILLARD M. , WILLMAN VALLEE L. , COOPER THEODORE , HANLON C. ROLLINS
Published: June 2012

Total extrinsic denervation of the heart was accomplished in six animals by cardiac autotransplantation. The work capacity and efficiency were studied in the postoperative period, when there was depletion of catecholamine stores. The left ventricular oxygen consumption (VO
2
) of these six cardiac autotransplants (average body weight, 13.6±0.6 kg) and six normal dogs (average body weight, 14.0±0.4 kg) were compared with a right-heart bypass at similar heart rates, mean arterial blood pressures, and systemic flows. The two groups of animals achieved comparable levels of stroke work (17.3 g-m) over the same range of filling pressures. Average maximum rates of left ventricular pressure development were also similar (autotransplants 2455±278 mm Hg/sec, versus 2267±209 mm Hg/sec for normal dogs). At VO
2
/100 g left ventricle, autotransplants averaged 9.54±0.97 cc/min and normal dogs 9.62±0.76 cc/min. However, left ventricular weights in the autotransplant group were significantly greater (110.9±6.2 g) than in the normal dogs (96.7±3.4 g), and represented a significantly greater percentage of body weight (8.2±0.5% versus sus 6.6±0.3%). Total left ventricular VO
2
was greater in autotransplants during performance of comparable levels of external work and at comparable degrees of contractility. No systematic difference in handling of glucose, lactate, or pyruvate was noted between the groups. Respiratory quotients were 1.0 or greater. The normal dogs showed no net change in circulating catecholamines across the coronary bed, whereas autotransplants always showed a net uptake of catecholamines. Myocardial mitochondria were enlarged in electron micrographs of the ventricular myocardium of the autotransplants.

The totally extrinsically denervated cardiac autotransplant can achieve a level of performance similar to that of a normal heart, but is less efficient in doing so. Alterations in utilization of circulating catecholamines may aid the hemodynamic adaptation to the cardiac denervation.
Measurement of Bronchial Blood Flow in Tetralogy of Fallot
Authors: NAKAMURA TAKASHI , KATORI RYO , MIYAZAWA KOZUI , ODA JUNSHI , ISHIKAWA KINJI
Published: June 2012

Bronchial blood flow was measured in nine patients with tetralogy of Fallot and in two of these cases after radical operation also. The study was made of simultaneous recording of dye-dilution curves from the left atrium and the ear following dye injection into the aortic root. A method of calculating the bronchial blood flow was devised by combining the dye-dilution method with the Fick principle. The bronchial blood flow was increased in all cases. The mean value was 0.46±0.31 L/min, with a range from 0.14 to 1.27 L/min; this is equivalent to 15.3% of the pulmonary artery flow on the average. This study showed no definite relationships among pulmonary artery blood flow, pulmonary artery pressure, arterial oxygen saturation, severity of disease, and patient's age. The postoperative measurement revealed no significant change in bronchial blood flow though its ratios to the pulmonary artery or aortic blood flows were considerably decreased.
Coronary Artery-Right Ventricular Communication Associated with Pulmonary Atresia and Ventricular Septal Defect
Authors: BAKER WILLIAM P. , VOGEL JOHN H. K. , BLOUNT S. GILBERT
Published: June 2012

A case of pulmonary atresia and right ventricular-left coronary artery fistulae with an associated ventricular septal defect is described. Hemodynamic findings like those reported in similar cases, but with an intact ventricular septum are also described. The implications of these observations in the genesis of right ventricular-coronary artery fistulae are discussed.
Anomalous Attachment of Mitral Valve Causing Subaortic Atresia
Authors: JUE KENNETH L. , EDWARDS JESSE E.
Published: June 2012

In a newborn female infant with persistent common atrioventricular canal, subaortic atresia resulting from attachment of the anterior mitral leaflet to the ventricular septum was observed. The cavity of the left ventricle was hypoplastic, while the wall was hypertrophied. The case illustrates the most severe degree of subaortic obstruction that may result from anomalous attachment of the mitral valve to the ventricular septum. Also present were multiple spleens, and other cardiovascular anomalies. The last included junction of a persistent left superior vena cava with the left atrium, absence of the coronary sinus, absence of the limbi of the fossa ovalis, and an anomalous connection of the right pulmonary veins to the right atrium.
Prosthetic Replacement of the Mitral Valve
Authors: MORROW ANDREW G. , OLDHAM H. NEWLAND , ELKINS RONALD C. , BRAUNWALD EUGENE
Published: June 2012

Mitral valve replacement was carried out in 100 patients with acquired mitral valvular disease. Preoperatively, two patients were in functional class II (NYHA), 64 in class III, and 34 in class IV. Fifty patients had predominant mitral stenosis, and 50 predominant mitral regurgitation. All were studied before operation by right and left heart catheterization, and the clinical and hemodynamic abnormalities were defined in detail and related to the valvular malformation. Seventeen patients died at or shortly after operation; seven others died in the late postoperative period. Operative methods employed, causes of death, and incidence and significance of nonfatal complications are presented. The 76 surviving patients have been followed for intervals of 15 months to 5 years; 47 are asymptomatic (class I), 26 are in class II, and three in class III. Postoperative hemodynamic assessments uniformly demonstrated regression of pulmonary hypertension, and intracardiac pressures and cardiac index were usually normal at rest. Hemodynamic responses to muscular exercise, however, were abnormal in most patients. Mitral valve replacement provides gratifying symptomatic and hemodynamic improvement in patients with mitral regurgitation or calcific mitral stenosis. Because prosthetic valves presently available are responsible for a significant number of late deaths and serious complication, operation is indicated only in severely disabled patients in whom life expectancy is limited.
Use of Ultrasound to Measure Left Ventricular Stroke Volume
Authors: FEIGENBAUM HARVEY , ZAKY ADIB , NASSER WILLIAM K. , Haine Charles L.
Published: June 2012

Several empirical observations made during ultrasound examinations for pericardial effusion have led to the possibility that this diagnostic technique might be used to measure left ventricular stroke volume in man. The hypothesis that left ventricular stroke volume was proportional to the amplitude of an echo originating from a portion of the left ventricle near the mitral ring (MREa) times the distance between the echoes from the anterior and posterior ventricular walls (LVD) has been validated.

Ultrasound examinations were performed simultaneously with cardiac output determinations using the direct Fick method on 16 patients proven to have competent mitral and aortic valves. Correlation between the two methods of measuring left ventricular stroke volume was excellent (r = 0.973;
P
< 0.001). When ultrasound measurements were used in the regression equation to predict stroke volume, the calculated values were within 11 ml or 15% of those determined by the Fick method.

The fact that an ultrasound examination is simple, can be done as a bedside determination in a matter of minutes, and is totally harmless to the patient make it a promising diagnostic procedure. The measurement of left ventricular stroke volume represents another addition to the growing list of medical uses for this intriguing technique.
The Frank Vectorcardiogram and the Electrocardiogram in Duchenne Progressive Muscular Dystrophy
Authors: FITCH CHARLES W. , AINGER LORIN E.
Published: June 2012

Electrocardiograms and Frank vectorcardiograms from 44 patients with classical childhood progressive muscular dystrophy (Duchenne type) were analyzed. Seventy-seven per cent had definite electrocardiographic abnormalities. All had one and usually several vectorcardiographic abnormalities. Abnormalities in orientation, magnitude, or both, of the planar and spatial ventricular gradients were the most consistent of the vectorcardiographic abnormalities and were observed in 95% of the patients. This finding is of significance if this vector theoretically reflects diffuse myocardial disease at the cellular level. QRS changes, in general, reflected the relatively greater loss of posterior ventricular force with consequent exaggeration of anterior ventricular force. There was no demonstrable relationship between the electrocardiographic and vectorcardiographic abnormalities with the age of the patient and the severity and rapidity of clinical progression of the disease in patients less than 16 years of age. This study suggests that the vectorcardiogram may be a useful diagnostic adjunct to the standard electrocardiogram in the study of the cardiomyopathy of progressive muscular dystrophy in childhood.
The Electrophysiological Properties of Diphenylhydantoin Sodium as Compared to Procaine Amide in the Normal and Digitalis-Intoxicated Heart
Authors: HELFANT RICHARD H. , SCHERLAG BENJAMIN J. , DAMATO ANTHONY N.
Published: June 2012

The effects of diphenylhydantoin sodium (Dilantin) on ventricular automaticity, intraventricular conduction, atrioventricular (A-V) conduction, and sinus rate have been determined in the digitalis-intoxicated and normal heart. These effects have been compared with procaine amide. Diphenylhydantoin sodium depresses ventricular automaticity and enhances A-V conduction while having little or no effect on intraventricular conduction or sinus rate. Procaine amide differed from diphenylhydantoin sodium in that it caused depression of both A-V and the intraventricular conduction, as well as slowing of the sinus rate.

The results indicate that the electrophysiological properties of diphenylhydantoin sodium make it superior to procaine amide in the treatment of digitalis toxicity. Both diphenylhydantoin sodium and procaine amide can suppress digitalis arrhythmias due to enhanced automaticity, but procaine amide may promote "re-entry" arrhythmias by potentiating the intraventricular conduction defect caused by the glycoside. In addition, diphenylhydantoin sodium appears to antagonize the action of digitalis on the A-V node, while procaine amide increases the digitalis-induced A-V block. It is concluded that the electrophysiological properties of diphenylhydantoin sodium make it an excellent agent in treating digitalis-induced arrhythmias.
Assessment of Aortic Valvular Stenosis from the Aortic Pressure Pulse
Authors: ARANI DJAVAD T. , CARLETON RICHARD A.
Published: June 2012

In a search for an indirect estimate of severity, data from 40 patients with pure aortic stenosis have been analyzed. Calculated aortic valvular areas ranged from 0.5 cm
2
to 2.4 cm.
2
Both aortic systolic upstroke time and the rate of aortic pressure rise were significantly altered by aortic stenosis; neither permitted reliable estimates of severity of the stenosis. An estimate of arterial compliance, stroke volume divided by pulse pressure, has been used in conjunction with the first derivative of rising aortic pressure to obtain an index of aortic stenosis. This index correlates well with calculated aortic valvular area (r = 0.912) and permits estimates of the severity of aortic stenosis when the left ventricle cannot be entered.
Coronary Disease in Familial Hypercholesterolemia
Authors: JENSEN JULIUS , BLANKENHORN DAVID H. , KORNERUP VALDEMAR
Published: June 2012

A report of 20 years' experience with coronary disease in 11 Danish families with hypercholesterolemia and normal serum triglycerides is given. A significantly higher death rate was found in family members who inherited the trait of hypercholesterolemia than in those who did not. The death rate of hypercholesterolemic family members was significantly higher than that found in all other persons of their age and sex living from 1943 to 1964 in Denmark; the death rate for the normocholesterolemic families was not. Most hypercholesterolemic family members died from coronary disease and at an earlier age than is usual for persons with coronary disease in Denmark. There was nothing to indicate that increase in triglycerides rather than increase in cholesterol is related to coronary disease in these families. No environmental factor was found to account for the higher death rate among the members with hypercholesterolemia.
Myocardial Blood Flow in Man as Measured by a Coincidence Counting System and a Single Bolus of
84
RbCl
Authors: KNOEBEL SUZANNE B. , MCHENRY PAUL L. , STEIN LEON , SONEL AHMET
Published: June 2012

Utilizing a coincidence counting system for the measurement of myocardial uptake of an 84-rubidium indicator, resting coronary blood flow (CBF) was measured in 33 normal subjects. The average CBF was 269 ± 61 ml/min/total heart. This represented 5.2 ± 1.6% of the simultaneous cardiac output. Fourteen normal subjects had resting and exercising CBF measurements. The change in CBF with exercise was statistically significant (0.005 >
P
> 0.001). The characteristics of the method are discussed in relationship to possible clinical applications for the measurement of CBF.
The Exercise Test in Diabetic Patients as Studied by Radioelectrocardiography
Authors: BELLET SAMUEL , ROMAN LAURIAN
Published: June 2012

Pathological, clinical, and epidemiological studies have shown that in diabetic subjects, the incidence of coronary heart disease is higher than in a nondiabetic population. In a group of 85 diabetic subjects free of clinical evidence of heart disease and exhibiting no significant abnormality in the resting electrocardiogram, an exercise electrocardiographic test was performed. In 22.3% results of the exercise test were positive; in similar studies of nondiabetic subjects, using the same technique and criteria, the incidence of positive electrocardiographic exercise tests ranged from 8 to 12%. Since a positive exercise test is usually associated with latent coronary artery disease, such findings would be considered of importance in the diagnosis and for following the evolution of this disease. It is suggested that the exercise test be performed routinely in diabetic subjects. By this means, coronary heart disease may be detected in the asymptomatic stage; this is particularly important for diabetic subjects, in whom even advanced coronary heart disease may be clinically silent.
Paroxysmal Ventricular Tachycardia with Rate-Dependent Coupling Intervals
Authors: SCHAMROTH LEO , DOLARA ALBERTO
Published: June 2012

A case of repetitive ventricular tachycardia is reported in which the duration of the coupling interval of the first ectopic beat of each paroxysm is related to the duration of the preceding R-R interval. Long coupling intervals are preceded by relatively long R-R intervals, and vice versa. The postulate is presented that this phenomenon may be due to varying conduction times of the extrasystolic impulse through the ectopic-ventricular junction.
Increased Survival with Prophylactic Quinidine After Experimental Myocardial Infarction
Authors: HURST VICTOR W. , MORRIS JAMES J. , ZEFT HOWARD J. , HACKEL DONALD B. , MCINTOSH HENRY D.
Published: June 2012

Experimental myocardial infarction was produced in 60 farm pigs by gradual coronary occlusion with an Ameroid constrictor placed around the left anterior descending coronary artery. Twenty animals were treated with 10 mg/kg/6 hr of quinidine, 10 with 5 mg/kg/6 hr, and 10 with 2.5 mg/kg/6 hr for a total period of 72 hours. Twenty animals served as controls. Serum quinidine levels were measured at 6-hour intervals. Significantly increased survival, when compared to controls, were observed in those animals treated with 5 and 10 mg/kg/6 hr of quinidine, but not in those receiving 2.5 mg/kg/6 hr. Under the described experimental conditions, designed to cause a reproducible, consistent infarction, quinidine treatment in nontoxic and well-tolerated doses significantly increased survival. Furthermore, there is a dose level below which this effect is lost. Whether the results of this study are applicable to man in preventing sudden death is unknown.
Postpartum Death with Maternal Congenital Heart Disease
Authors: NAEYE RICHARD L. , HAGSTROM JACK W. C. , TALMADGE BRUCE A.
Published: June 2012

Four women, with congenital heart disease, who died following parturition are presented. All had advanced pulmonary arterial lesions before delivery. In the intrapartum or early postpartum period widespread fibrin and platelet thrombi occluded already narrowed pulmonary arterial channels increasing right-to-left cardiac shunts. The etiology of the preterminal thrombotic disorder has not been established in any of the cases.