bluuebunny/crossref_metadata_2025 huggingface dataset:
Subacute Effusive-Constrictive Pericarditis
Authors: HANCOCK E. W.
Published: June 2012

Clinical and hemodynamic observations are reported in 13 patients who demonstrated a distinct pathophysiologic form of compressive pericardial disease characterized by effusion into a free pericardial space associated with constriction of the heart by the visceral pericardium. The pericardial disease was idiopathic (nine patients) or subsequent to radiotherapy (four patients), with a maximal duration of symptoms of 16 months. Enlarged heart shadow, prominent paradoxical pulse, predominant systolic dip in the venous pressure pulse, and absence of atrial fibrillation were features that tended to distinguish the effusive-constrictive cases from those with noneffusive chronic constrictive pericarditis. The value of pressure measurements during combined cardiac catheterization and pericardiocentesis is emphasized in the differentiation of effusive-constrictive pericarditis from cardiac tamponade without constriction. Four patients were observed to progress through an effusive-constrictive phase to noneffusive constrictive pericarditis. Corticosteroids, pericardiocentesis, and other medical therapy produced some benefit but did not relieve constriction. The results of surgery were generally satisfactory.
Straddling and Displaced Atrioventricular Orifices and Valves with Primitive Ventricles
Authors: LIBERTHSON RICHARD R. , PAUL MILTON H. , MUSTER ALEXANDER J. , ARCILLA RENÉ A. , ECKNER FRIEDRICH A. O. , LEV MAURICE
Published: June 2012

Fourteen cases of straddling or displaced atrioventricular (A-V) orifices and valves are presented. There are three types: (1) straddling tricuspid orifice entering both primitive ventricles with the mitral valve entering the left ventricle (nine cases), (2) displaced tricuspid orifice into the primitive left ventricle, with no A-V orifice in the primitive right ventricle (three cases), and (3) displaced tricuspid orifice with straddling mitral valve, in which the mitral valve has connections in both primitive ventricles, with the tricuspid entering the primitive left ventricle (two cases). Pathologically, these hearts are not single ventricle since there is a primitive right ventricle containing a portion of sinus as well as conus. Embryologically, however, these hearts are related to single ventricle, all being due to insufficient or no passage of the atrial canal region to the right during the process of absorption of the bulbus. Selective angiocardiography may differentiate straddling A-V orifices from single ventricle by showing immediate filling of both ventricles by injection into the right or left atrium.
Pacing-Induced Changes in Stroke Volume in the Evaluation of Myocardial Function
Authors: LINHART JOSEPH W.
Published: June 2012

For characterization of left ventricular function using changes in heart rate, we performed right atrial pacing in 16 patients during right and left heart catheterizations. Hemodynamic data was obtained before pacing (B), during pacing (D), and immediately after (A) the sudden interruption of pacing, for assessment of the consequences of rapid changes in stroke volume. In 10 patients with normal left ventricular function, as heart rate (HR) changed from 81 ± 4
sem
(B) to 125 ± 6 (D) to 77 ± 5 beats/min (A), left ventricular end-diastolic pressure (LVEDP), from 8 ± 1 (B) to 3 ± 1 (D) to 9 ± 0.5 mm Hg (A), and stroke volume, from 74 ± 9 (B) to 46 ± 4 (D) to 77 ± 9 ml/beat (A), changed linearly. No change occurred in cardiac output (5.7 ± 0.5 liters/min) or in arterial pressure. In six patients with myocardial disease, HR changed similarly (from 86 ± 5 (B) to 126 ± 8 (D) to 90 ± 3 beats/min (A)), but LVEDP, cardiac output (CO), and stroke volume (SV) values were significantly different in comparison to the corresponding values for the subjects with normal function (LVEDP was 21 ± 3 (B), 8 ± 2 (D), and 25 ± 3 mm Hg (A),
P
= 0.001; CO was 4.1 ± 0.5 liters/min (B, D, and A),
P
= 0.01; SV was 48 ± 4 (B), 32 ± 5 (D), and 47 ± 4 ml/beat (A),
P
= 0.02). When pacing ventricular function curves were constructed relating left ventricular stroke work (SW) to LVEDP, normal patients exhibited a steep curve, while those with myopathies had flat responses. When the change (Δ) in SW was related to ΔLVEDP (ΔSW/ΔLVEDP), the value for normal subjects was 5.6 ± 1, and that for patients with myopathies, 0.6 ± .2 (
P
= 0.001). Atrial pacing may be used for characterization of left ventricular function, and permits a separation of normal and abnormal responses.
Long-term Results of Aortopulmonary Anastomosis for Tetralogy of Fallot
Authors: COLE ROGER B. , MUSTER ALEXANDER J. , FIXLER DAVID E. , PAUL MILTON H.
Published: June 2012

A review of 340 patients with tetralogy of Fallot undergoing aortopulmonary anastomosis of the Potts-Smith type (descending aorta to pulmonary artery) has been made for assessment of the complications and long-term results (1946-1969) of this procedure. There were 30 operative deaths (9%) and 52 late medical deaths (20%) The symptomatic improvement has remained impressive in the survivors even up to 20 years after shunt surgery, with 85% of the patients having a functional classification of I or II.

The major late complications have been related to anastomotic channels which were made or eventually became too large, resulting in congestive heart failure (20 late medical deaths) or in pulmonary hypertension with pulmonary vascular obstructive disease. These complications are not unique to the Potts operation, and may be anticipated in patients with excessively large ascending aorta to right pulmonary artery anastomoses. Careful patient follow-up is indicated and, in the event of congestive heart failure or evidence for pulmonary hypertension, an aggressive approach with either shunt take down and intracardiac repair or shunt revision should be considered.
Abnormal Responses of the Systolic Time Intervals to Exercise in Patients with Angina Pectoris
Authors: POUGET JEAN M. , HARRIS WILLARD S. , MAYRON BART R. , NAUGHTON JOHN P.
Published: June 2012

The effects of a 4-min exercise on the duration of the systolic time intervals were determined in 20 patients with angina and 20 age-matched normal controls. The pre-ejection period was shortened 26 msec in normal subjects and 35 msec in angina patients. In normal subjects, total electromechanical systole corrected for heart rate (Q

2
2c

) decreased 24 msec, while the left ventricular ejection time corrected for heart rate (LVET
c
) remained unchanged. In the angina group, by contrast, Q

2
2c

failed to change, while LVET
c
lengthened 23 msec. The angina patients developed similar abnormalities, without pain, after 2 min of exercise. Changes in arterial pressure, cardiac output, and stroke volume failed to explain these systolic temporal abnormalities. Similar abnormalities occurred in 12 patients with primary myocardial disease and heart failure, but not in seven noncardiac patients with nonanginal chest pain. Owing to impaired left ventricular performance and increased afterload, mild exercise prolongs left ventricular ejection in patients with angina. This abnormal prolongation contributes to the development of angina and has value in its diagnosis.
Mode of Action of Chlorophenoxyisobutyric Acid on Cholesterol Metabolism in Man
Authors: HORLICK L. , KUDCHODKAR B. J. , SODHI H. S.
Published: June 2012

In short-term trials chlorophenoxyisobutyric acid (CPIB) (Atromid-S) reduced the plasma cholesterol and triglyceride levels in eight subjects with type II and IV hyperlipidemias to an equal extent. In these subjects, who were maintained on constant solid food diets, CPIB administration resulted in increased excretion of fecal neutral and acidic sterols in the type II subjects only. There was an immediate increase in specific activity of plasma cholesterol in seven of the eight subjects, and a reduced rate of fall of specific activity in many of the subjects. It is suggested that CPIB inhibits the synthesis of cholesterol in vivo, and that the subsequent fall in plasma cholesterol is responsible for the release of cholesterol with higher specific activity from tissues into the plasma pool.
Morphology of the Human Tricuspid Valve
Authors: SILVER M. D. , LAM J. H. C. , RANGANATHAN N. , WIGLE E. D.
Published: June 2012

The morphology of 50 normal tricuspid valves was studied. The surface of the leaflets was divided into three zones: (1) the rough zone, into which most of the chordae tendineae are inserted, (2) the basal zone, and (3) the clear zone, which lies between the rough and basal zones.

Five types of chordae were distinguished by their morphology and mode of insertion: fan-shaped, rough zone, basal, free edge, and deep chordae. The last two types are unique to the tricuspid valve.

If fan-shaped chordae, used to define the commissures between the leaflets, are absent, other landmarks may be used for commissural definition. Once defined, all tissue between the commissures was regarded as part of the anterior, posterior, or septal leaflet. The recognition that the free edges of the anterior and septal leaflets contain notches, that rough zone chordae insert into them, and that the posterior leaflet has scallops further aids identification of a leaflet's components. Thus, structures formerly regarded as accessory leaflets were incorporated into one of the three leaflets.
The Austin Flint Murmur and the
a
Wave of the Apexcardiogram in Aortic Regurgitation
Authors: PARKER ELIZABETH , CRAIGE ERNEST , HOOD W. P.
Published: June 2012

Hemodynamic data from 45 patients with either aortic regurgitation (with and without the Austin Flint murmur) or aortic regurgitation and mitral stenosis were correlated with the
a
-wave percentage amplitude of the apexcardiogram. Changes in the
a
wave correlated well with corresponding changes in left heart pressures but not with variations in volume. Of 15 patients in whom the ratio of the
a
wave to the total excursion during systole (
a
/H ratio) was [See Equation in PDF file]13%, 11 had left ventricular end-diastolic pressures (LVEDP) >20 mm Hg. All patients with
a
/H ratios >15% had abnormal LVEDP. The converse was not true; 13 patients had elevated LVEDP with normal
a
/H ratios. Patients with aortic regurgitation and mitral stenosis had
a
/H ratios similar to those of normal subjects.

The Flint murmur showed a significant correlation with left ventricular volume changes. Its presence was valuable in prediction of a large regurgitant volume and a high left ventricular stroke volume. It was also present in association with elevated left atrial mean pressure and elevated LVEDP.

Thus, two ancillary findings in aortic regurgitation, a high
a
wave in the apexcardiogram and the Austin Flint murmur, are of value in anticipating alterations in left ventricular hemodynamics as determined by left-sided catheterization and volume studies.
Blood Flow in the Diabetic Leg
Authors: BARNER HENDRICK B. , KAISER GEORGE C. , WILLMAN VALLEE L.
Published: June 2012

Femoropopliteal bypass grafting with reversed saphenous vein was performed in 47 nondiabetic and 27 diabetic extremities. Graft flow was measured with an electromagnetic flow probe before and after injection of 15 mg of papaverine into the graft. Basal flow (nondiabetic, 74 ± 6; diabetic, 76 ± 11 ml/min) was similar in the two groups. Peak flow was significantly higher in the nondiabetic group (217 ± 14 ml/min) than in the diabetic group (169 ± 18 ml/min,
P
< 0.05), and the outflow tract was significantly better in the nondiabetics (12.2 ± 0.5) than in the diabetics (8.6 ± 0.7,
P
< 0.001). When flow was related to the quality of the outflow tract, there was no significant difference between nondiabetics and diabetics. Diabetics with occlusive vascular disease have greater involvement of the tibial and peroneal arteries than do nondiabetics. Vascular reactivity is not significantly impaired, and arterial reconstruction should not be withheld on the basis of anteriolar-capillary involvement.
Diphenylhydantoin in the Prevention of Recurring Ventricular Tachycardia
Authors: STONE NEIL , KLEIN MICHAEL D. , LOWN BERNARD
Published: June 2012

The efficacy of diphenylhydantoin in preventing recurrent ventricular tachycardia was studied in ten patients, nine of whom had documented coronary heart disease. Prolonged continuous ECG monitoring of up to 72 hr was performed in each case. Oral and intravenous loading doses of 1000 to 1500 mg were given on the first day of therapy to insure rapid attainment of therapeutic blood levels. Diphenylhydantoin was uniformly ineffective in preventing recurrence of ventricular tachycardia despite the presence of what is regarded as adequate therapeutic plasma concentrations (greater than 19.0 µg/ml in five patients, 10.8-18.0 µg/ml in the remaining five) shortly after onset of ventricular tachycardia. Nystagmus was noted in eight patients, but plasma diphenylhydantoin levels varied widely (8.6-35.0 µg/ml) when this sign of neurotoxicity was first detected.
Significance of the Diagnostic Q Wave of Myocardial Infarction
Authors: HORAN LEO G. , FLOWERS NANCY C. , JOHNSON JENNIFER C.
Published: June 2012

Correlation between the QRS complex and postmortem ventricular anatomy was made in 1184 instances of normal conduction:

(1) Mechanical reliance on the sheer presence or absence of a Q wave greater than 0.03 sec in duration led to "correct" diagnosis of infarction or not in 79% of the series.

(2)With normal conduction, abnormal Q waves
isolated
to either the anteroseptal (V
l
-V
4
) or inferior (II, III,
a
V
F
) electrocardiographic zones were frequently false (46%). However, abnormal Q waves restricted to the lateral zone (V
5
-V
6
) or in a combination of more than one electrocardiographic zone, were rarely false predictors of the presence of infarction (4%).

(3) Classical localization of infarction with normal conduction was statistically relatively reliable as compared with bundle-branch block. The increased frequency of the anatomic pattern of lateral basal infarction in association with normal QRS complexes (but known infarction) suggests relative "electrical silence" of the laterobasal left ventricle in abnormal Q-wave genesis.

(4) Lesions confined to a given anatomic location in the left ventricle tended to place particular emphasis and limits on the spectrum of electrocardiographic expression but did not yield a uniform single pattern of Q-wave distribution.
V
max
as an Index of Contractile State in Man
Authors: FALSETTI HERMAN L. , MATES ROBERT E. , GREENE DAVID G. , BUNNELL IVAN L.
Published: June 2012

The maximal, no-load, velocity for the contractile element (V
max
) was estimated in 45 patients. The patients included: 17 with normal left ventricular dynamics; eight with volume overload, compensated; 11 with volume overload, decompensated; three with pressure overload; and six with cardiomyopathy. Contractile element velocity (V
CE
) during isovolumic contraction was estimated in two ways: (1) from left ventricular pressure data alone, where V
CE
=(1/28.8p) (dp/dt), and (2) pressure data combined with measurement of left ventricular geometry (right anterior oblique cine). V
max
obtained in these two ways agreed well for most patients (r = 0.82). In the normal patients, V
max
varied from 1.46 to 2.64 muscle lengths per sec; in contrast that of the patients with cardiomyopathy varied between 0.71 and 1.34 muscle lengths per sec.

Other indices of contractility (ejection fraction, peak dp/dt, peak velocity of circumferential fiber [peak V
CF
], peak V
CE
, and V
CE
at zero stress) were compared on the basis of statistical correlation and consistency of other clinical evidence (presence or absence of congestive failure). Good correlation was obtained between V
max
and peak V
SE
(r = 0.68). Ejection fraction and peak V
CF
were less sensitive. Neither the peak rate of pressure rise or V
CE
at peak stress show any significant correlation with V
max
or clinical state. Previous studies have shown that V
max
can be evaluated from pressure data alone; this study confirms this finding in patients with mitral regurgitation as well as in those with normal outflow impedance.
Left Ventricular Volumes and Ejection Fraction by Echocardiography
Authors: POMBO JOAQUIN F. , TROY BART L. , RUSSELL RICHARD O.
Published: June 2012

Left ventricular end-diastolic and end-systolic volume, stroke volume, and ejection fraction were determined by biplane angiocardiography and echocardiography in 27 patients suspected of having heart disease. Angiographic volumes were calculated by the area-length method and echocardiographic volumes, from the left ventricular dimension of the echograms. The angiographic minor diameter and the semilength correlated significantly with the echocardiographic left ventricular dimensions in diastole and systole. Left ventricular size over a wide range compared favorably by each technique, with a correlation coefficient of r = 0.97 for end-diastolic volume (range by angiography 80-585 ml,
see
± 27.76), r = 0.97 for end-systolic volume (range by angiography 24-485 ml,
see
± 23.64), r = 0.83 for total left ventricular stroke volume (range by angiography 35-229 ml,
see
± 25.45), and r = 0.80 for left ventricular ejection fraction (range by angiography 0.18-0.70,
see
± 0.09). These data indicate that left ventricular dimensions in systole and diastole can be reliably determined and left ventricular chamber size and ejection fraction can be quantitated in man by the noninvasive technique of echocardiography.
Use of Echocardiography in Patients with Prolapsed Mitral Valve
Authors: DILLON JAMES C. , HAINE CHARLES L. , CHANG SONIA , FEIGENBAUM HARVEY
Published: June 2012

The echocardiographic findings are described for five patients who had the prolapsed mitral valve syndrome, proven by cardiac catheterization and angiocardiography. In all five patients, the echocardiograms demonstrated posterior displacement of the posterior mitral leaflet during systole. In four of the patients there was also posterior displacement of the anterior leaflet. Four of the five patients had mitral insufficiency, demonstrated by cineangiography. These four patients demonstrated echocardiographic separation of the anterior and posterior leaflets of the mitral valve in late systole. The fifth patient did not show this separation, and she had no mitral insufficiency by selective cineangiography. Two patients were given amyl nitrite during the echocardiographic examination, and the echogram showed earlier separation of the anterior and posterior leaflets as well as lengthening of the murmur. Echocardiography should be a very useful noninvasive, yet direct, method for diagnosing, studying, and following patients with prolapse of the mitral valve.
Comparison of the Vectorcardiogram with the Electrocardiogram in the Prediction of Left Ventricular Size
Authors: VINE DONALD L. , FINCHUM R. NEWELL , DODGE HAROLD T. , BANCROFT WILLIAM H. , HURST DAVID C.
Published: June 2012

The vectorcardiogram has been suggested as an alternative to the electrocardiogram in the diagnosis of left ventricular enlargement. In 107 patients, precordial QRS voltage measurements were compared with vectorcardiographic spatial magnitude measurements in their relationship to angiocardiographically determined left ventricular mass and volume.

Sensitivity, specificity, and linear correlations obtained with instantaneous spatial QRS magnitude measurements were similar to those obtained with selected precordial voltage measurements suggested by Sokolow and Grant. Multiple regression analysis incorporating time-strength integrals of the spatial QRS correlated more closely with left ventricular mass (R = 0.75) and total volume (R = 0.80) than did similar analysis using precordial voltages (R = 0.71). These differences are statistically significant (
P
= <0.01) but reduce the remaining variability of the electromotive-left ventricular size relationship by only 7 to 14% and leave 30 to 40% of the total variability unexplained. These findings do not support a large practical advantage for the vector-cardiogram over the electrocardiogram in the prediction of left ventricular size.
Ascending Aorta-Right Pulmonary Artery Shunt in Infants and Older Patients with Certain Types of Cyanotic Congenital Heart Disease
Authors: BERNHARD WILLIAM F. , JONES JIMMY E. , FRIEDBERG DAVID Z. , LITWIN S. BERT
Published: June 2012

A side-to-side anastomosis between the ascending aorta and the right pulmonary artery was created in 80 infants (less than 1 year of age) and in 61 older children with a variety of cyanotic cardiac abnormalities in which there is pulmonary stenosis or atresia. Seventy-one per cent of the infant group and 90% of patients over 1 year of age were long-term survivors (up to 6 years).

Tetralogy of Fallot was the most commonly encountered anomaly in all 141 patients (66%); transposition of the great vessels and pulmonary stenosis occurred in 18%; and tricuspid atresia with pulmonary stenosis in 10%.

The presence of an excessively large shunt anastomosis (55% of deaths) and additional (unrecognized) other anomalies (26%) were major causes of postoperative deaths.

In patients in whom a systemic-pulmonary artery anastomosis is required, this operation is the procedure of choice in infants under 1 year of age. It is also of value in older patients if a Blalock-Taussig shunt cannot be performed.
Mitral Insufficiency Resulting from "Overshooting" of Leaflets
Authors: EDWARDS JESSE E.
Published: June 2012

Mitral insufficiency may result from abnormal degrees of upward extension of valvular tissue, a condition which may be termed "overshooting."

This condition may result either from rupture of elements in the papillary musclechordal mechanism or from inadequate support of leaflets without rupture. The latter may occur in myocardial infarction or in instances of intrinsic weakness of connective tissues of leaflets and/or chordae tendineae.
Clinical and Circulatory Effects of Isosorbide Dinitrate
Authors: GOLDSTEIN ROBERT E. , ROSING DOUGLAS R. , REDWOOD DAVID R. , BEISER G. DAVID , EPSTEIN STEPHEN E.
Published: June 2012

In order to resolve current controversies on isosorbide dinitrate (ISDN), we employed a particularly sensitive testing protocol to evaluate effects of sublingual ISDN and nitroglycerin on the exercise capacity of patients with angina. Ten minutes after ISDN 21 of 23 patients exercised longer (average 2.7 minutes,
P
< 0.001) than after placebo. Benefit was evident in only a minority of patients tested one hour and in none tested two hours after either ISDN or nitroglycerin. A given amount of exercise resulted in lower mean blood pressure (average 13 mm Hg,
P
< 0.001), higher heart rate (average 10 beats/min,
P
< 0.001), and shorter ejection time (average 0.04 second,
P
< 0.001) after ISDN. Similar changes were seen after nitroglycerin. The product of blood pressure, heart rate, and ejection time, an index of myocardial O
2
consumption, was unchanged at angina after ISDN or nitroglycerin despite the increased exercise capacity, suggesting that clinical improvement after these drugs may be due to circulatory changes causing decreased myocardial O
2
demand. We conclude that sublingual ISDN closely resembles nitroglycerin in its alteration of circulatory responses to exercise and in the duration of the resultant improvement in exercise capacity.
Abnormalities of Left Ventricular Contraction Induced by Beta Adrenergic Blockade
Authors: HELFANT RICHARD H. , HERMAN MICHAEL V. , GORLIN RICHARD
Published: June 2012

To understand better the hemodynamic effects caused by propranolol, its effect on the geometry of left ventricular contraction was studied in ten subjects, four with angiographic evidence of coronary artery disease and six without demonstrable heart disease. Heart rate was controlled in four subjects with right atrial pacing. After 5 mg of intravenous propranolol, there were decreases in heart rate and cardiac index in most subjects with a variable effect on left ventricular end-diastolic pressure.

Left ventricular end-diastolic volume increased in the majority of instances with a reduction in both volume ejected and per cent circumferential fiber shortening of the left ventricle. Furthermore, after propranolol the left ventricle assumed a more elongated shape. Propranolol either induced or exaggerated asynergy in five subjects, three of whom had coronary heart disease. These changes provide a morphologic basis for some of the cardiac hemodynamic effects of propranolol.
Interruption of the Atrioventricular Bundle with Congenital Atrioventricular Block
Authors: LEV MAURICE , CUADROS HUGO , PAUL MILTON H.
Published: June 2012

Two cases of congenital heart block were studied in which comprehensive serial section study of the conduction systems showed disruption of the penetrating portion of the atrioventricular (A-V) bundle. In one case, the branching portion of the A-V bundle was present together with the bundle branches. In the other case, the branching portion of the A-V bundle and the main left bundle branch were absent. The right bundle branch was interrupted after it gave off a tenuous connection to the septum; it began again, and finally terminated in the myocardium. In the latter case the electrocardiogram showed broad and notched QRS complexes. It is suggested that interruption of the A-V bundle may be related to abnormality in the mitral and tricuspid extensions of the central fibrous body or of the pars membranacea. This malformation of the conduction system is not related to any one type of congenital anomaly.
Localization and Sequence of Development of Atherosclerotic Lesions in the Carotid and Vertebral Arteries
Authors: SOLBERG LARS A. , EGGEN DOUGLAS A.
Published: June 2012

The distribution of fatty streaks, fibrous plaques, complicated lesions, and calcified lesions were determined for each of five segments in the common carotid arteries, each of five segments of internal carotid arteries, and for each of seven segments of vertebral arteries in specimens from 961 autopsied cases in Oslo, Norway, and Guatemala. The pattern of distribution of the lesions along the length of the arteries is characteristic for the different arteries. This pattern seems to be independent of sex, age group, type of lesions, and geographic location.

Fatty streaks and fibrous plaques have the same pattern of distribution within each artery at all ages. This close topographic association is consistent with the hypothesis that fibrous plaques are derived from fatty streaks. The early atherosclerotic lesions are located at the same sites where stenotic and occlusive lesions have been reported. Thus, it is likely that the early atherosclerotic lesions and the stenotic or occlusive lesions are pathogenetically closely associated with each other.
Radiologic Notes in Cardiology
Authors: BARON MURRAY G.
Published: June 2012

Detection of postinfarction aneurysms of the left ventricle has become increasingly important with the development of surgical techniques for the treatment of this lesion. Although the diagnosis can be established in some cases from chest films and cardiac fluoroscopy, angiocardiography is required for adequate preoperative evaluation. If surgery to excise the aneurysm is contemplated, coronary angiography should also be performed.
What Percentage of Patients with Angina Pectoris Are Candidates for Bypass Grafts?
Authors: GLASSMAN EPHRAIM , SPENCER FRANK C. , TICE DAVID A. , WEISINGER BARBARA , GREEN GEORGE E.
Published: June 2012

Of 63 patients evaluated for chest pain, 54 were found to have severe angina pectoris and major coronary arterial obstruction. Operation was considered feasible in 52 patients. Neither the angiographic demonstration of distal patent segments nor the apparent size of such segments was significant in selecting surgical candidates.
Balloon Closure of Ventricular Septal Defect
Authors: MILLS NOEL L. , VARGISH THOMAS , KLEINMAN LEONARD H. , BLOOMFIELD DENNIS A. , REED GEORGE E.
Published: June 2012

A prototype double-lumen cardiac catheter with an inflatable disc balloon for interim closure of left-to-right shunts through the ventricular septum is described. Five clinical fatalities following ventricular septal rupture in the early postmyocardial infarction period were seen at New York University Medical Center from October, 1968 to March, 1970.

Ventricular septal defects were made in nine acute dog experiments. Shunt sizes ranged from 2.2:1 to 4.8:1. Absence of shunting after balloon occlusion was confirmed by oxygen saturations, phonocardiography, and the hydrogen electrode method. Left ventricular angiography confirmed cardiac catheter positions.

The feasibility of ventricular shunt occlusion in patients who are deteriorating from early postinfarction septal rupture is discussed.
Humoral Antibody in Canine Cardiac Allograft Rejection
Authors: GOLDMAN BERNARD S. , SHUMAK KENNETH H. , CARTIER JEAN , SILVER MALCOLM D. , BIGELOW WILFRED G. , CROOKSTON JOHN H.
Published: June 2012

The antibodies formed in response to cardiac allografts were studied in four groups of dogs receiving one of the following: (1) no immunosuppressive treatment; (2) azathioprine and prednisone; (3) acetylsalicylic acid; (4) antilymphocyte serum.

Only azathioprine-prednisone treatment was effective in reducing antibody formation, although the histological changes of rejection were modified in each of groups 2, 3, and 4. Hearts transplanted in the presence of "donor-specific" lymphocytotoxic antibodies were not hyperacutely rejected, despite the fixation of antibodies to the sarcolemma within minutes or a few hours of transplantation.
Rat Heart Allograft Survival with Donor Pretreatment
Authors: FREEMAN JAN S. , CHAMBERLAIN E. , REEMTSMA KEITH , STEINMULLER DAVID
Published: June 2012

Heterotopic rat heart transplants from Ag-B compatible Fischer strain donors to Lewis recipients were monitored by daily ECG. The median survival time (MST) of control grafts was 12.8 days. Pretreatment of donors with whole-body radiation, cyclophosphamide, or antilymphocyte serum resulted in MST of 19.7, 18.0, and 17.8 days, respectively. Local irradiation of the heart alone did not prolong survival beyond control values, whereas whole-body irradiation with the heart shielded did, indicating that the prolongation achieved by donor pretreatment with radiation, at least, was a systemic rather than local effect. Only slight prolongation was achieved by donor radiation in the Ag-B incompatible BN to Lewis strain combination, demonstrating the importance of histocompatibility matching for the effectiveness of donor pretreatment.
Effects of a Hyperosmotic Perfusate on Extended Preservation of the Heart
Authors: LEVITSKY SIDNEY , MULLIN EDWARD D. , SLOANE ROBERT E. , FERRANS VICTOR J. , BUJA L. MAXIMILIAN , WILLIAMS WILLIS H. , MORROW ANDREW G.
Published: June 2012

Twelve canine hearts were preserved for 18 hours with filtered plasma, with and without added dextran, passed through a Kolobow membrane oxygenator at 8 to 10 C. Active and passive length-tension curves (LTC) were obtained with an isovolumetric balloon after rewarming to 37 C with blood pumped from a support animal. Nine additional control hearts were similarly evaluated immediately after removal. The active LTC was unchanged for all three groups. Diastolic compliance was moderately decreased in all the perfused hearts. Interstitial edema was present in varying degrees in all hearts preserved with filtered plasma without dextran but was absent in the dextran-plasma group. These data indicate the advantages of using a hyperosmotic perfusate for extended cardiac preservation.
Rehabilitation Following Cardiac Surgery
Authors: FINCHUM R. NEWELL
Published: June 2012

Of 120 vocational rehabilitation clients having cardiac surgery between July, 1966 and December, 1968, seven were lost to follow-up, and the operative and late mortality totaled 14%. Ninety-six patients were seen for voluntary outpatient evaluation with a mean postoperative evaluation time of 22 months. Two-thirds of the patients had acquired heart disease and were in functional class III or IV preoperatively. After surgery 76 were in functional class I or II with 20 in functional class III. The electrocardiogram and radiographic heart size had returned toward normal in over 50%, and 76% of those having preoperative exercise tests demonstrated improved exercise capacity postoperatively.

The rehabilitation effort was successful in 83% of those surviving surgery and 77% of the entire series. Medical and surgical physical factors were found to be more important than psychosocial factors in determining the vocational outcome after surgery. The duration of unemployment was the most important preoperative variable in predicting the rehabilitation result. The importance of medical follow-up after cardiac surgery is emphasized by the detection of a significant number of residual medical problems.
Intracardiac Surgery in Neonates and Infants Using Deep Hypothermia with Surface Cooling and Limited Cardiopulmonary Bypass
Authors: BARRATT-BOYES BRIAN G. , SIMPSON M. , NEUTZE JOHN M.
Published: June 2012

In an attempt to achieve safe intracardiac surgery in severely ill babies with congenital heart defects, a technique of deep hypothermia with surface cooling and limited bypass has been used. Under halothane anesthesia, these infants were cooled to a nasopharyngeal temperature of 26 C on a circulating water blanket and the temperature was lowered further to 22 C by a short period of total body perfusion. After a period of circulatory arrest which averaged 48 minutes at 22 C, during which the intracardiac repair was carried out, rewarming to 32 C was achieved by 20 minutes of total body perfusion and final rewarming to 36 C by surface means.

Thirty-three of 37 infants under 10 kg in weight, with correctable lesions, survived this procedure, including 25 aged 8 days to 12 months. Conditions corrected were transposition (13), tetralogy of Fallot (9), total anomalous pulmonary venous connection (6), ventricular septal defect (6), and atrioventricular canal (3). The technique gave ideal operating conditions and is believed to have wide application in the neonatal and infant group.
Total Correction of Tetralogy of Fallot in Adolescents and Adults
Authors: BEACH P. MAYNARD , BOWMAN FREDERICK O. , KAISER GERARD A. , MALM JAMES R.
Published: June 2012

Sixty-four cyanotic patients over 15 years of age with tetralogy of Fallot have undergone total correction. Fifty-one patients had previous shunting procedures. The established intracardiac technique for total repair was used throughout. In 11% (7 of 64) of patients reconstruction of the pulmonary outflow tract was required. Follow-up extends from six months to ten years. Operative mortality was 6.25% (4 of 64). There was one late death. All deaths were technically related and none could be correlated with patient age. Bilaterally functioning Blalock shunts and Potts anastomoses contributed significantly to operative mortality. Abundant collateral circulation exists in older patients with tetralogy of Fallot, and increased bleeding in this series was reflected in a 20.3% (13 of 64) reoperation rate. Survivors represent 92.2% (59 of 64) of the group and all are completely asymptomatic. Approximately one-half of the surviving patients have undergone postoperative catheterization. Of those patients studied, 93.4% (29 of 31) have a good to excellent hemodynamic result following correction. All patients with outflow-tract patches subsequently developed pulmonary insufficiency and right-heart failure. These patients were easily managed on a cardiotonic regimen, however, and digitalis was discontinued in each case by the end of the third postoperative month. These mortality and survivor figures parallel those obtained in our total experience of 250 tetralogy repairs. We believe all patients with tetralogy of Fallot should undergo total correction. Advanced age is no contraindication to surgery. Shunting procedures, when indicated, are to be considered only a preliminary to full correction.
Detection of Tricuspid Valvular Regurgitation with a Catheter Velocitometer
Authors: NOLAN STANTON P. , BOTERO LUIS M. , INOCENCIO EDDIE C. , RAWITSCHER ROBERT E. , LEE ROBERTO J.
Published: June 2012

The preoperative diagnosis of tricuspid valvular regurgitation (TVR) is unreliable, and definitive diagnosis is usually made by the surgeon at the time of operation. In preliminary studies of a new electromagnetic catheter velocitometer used in dogs undergoing thoracotomy, pressures in the right atrium and ventricle were recorded simultaneously with the velocity of vena caval blood flow through a competent tricuspid valve and following surgical production of TVR. Normal and chronic TVR dogs were studied by catheterization. A systolic to diastolic (S/D) ratio was derived by measuring the areas beneath the recorded vena caval velocity curves that coincided with ventricular systole and diastole. In both normal and TVR dogs, heart rate varied from 60 to 240/min, and mean right atrial pressure varied from 2.5 to 15 mm Hg. Results indicated that patterns of velocity clearly distinguished normal from regurgitant tricuspid valves; velocity pattern of TVR was the reciprocal of the normal pattern; vena caval S/D ratio in normal animals was 2.0 ± 0.3 but never less than 1.0, and S/D ratio in TVR was 0.6 ± 0.15 but always less than 1.0. Under conditions similar to clinical cardiac catheterization, the patterns of velocity and the S/D ratio obtained with the velocitometer provided a highly reliable assessment of the presence or absence of TVR in dogs.
Obstruction of Tricuspid Ball-Valve Prostheses
Authors: VANDER VEER JOSEPH B. , RHYNEER GEORGE S. , HODAM ROBERT P. , KLOSTER FRANK E.
Published: June 2012

Obstruction of Starr-Edwards tricuspid prostheses occurred in seven patients from 2 to 52 months after surgery. Four patients were taking anticoagulants. Three patients presented with acute right-heart failure, three were asymptomatic, and one died suddenly. Of the six who were examined, all had high-pitched tricuspid diastolic murmurs and elevated jugular venous pressure, five had hepatomegaly, and three had peripheral edema. Cardiac catheterization in four patients revealed elevated right atrial pressure in all and large transvalvular pressure gradients in three. Angiography showed impaired flow across the valve in all cases. In six cases, impingement of a prosthesis strut on the ventricular myocardium was the underlying mechanism of obstruction. Two patients died without reoperation. Four of the remaining five patients survived reoperation and were improved.

Tricuspid ball-valve obstruction is a potentially lethal complication that may develop with minimal symptoms. A characteristic diastolic murmur and elevated systemic venous pressure have uniformly been present. Confirmatory hemodynamic studies should be followed by early reoperation.
Aortic Debridement-Long-term Follow-up
Authors: ENRIGHT LEE P. , HANCOCK E. WILLIAM , SHUMWAY NORMAN E.
Published: June 2012

The clinical and hemodynamic data available in the five-to eight-year follow-up of 45 patients who underwent aortic debridement for aortic stenosis are presented. Eight patients (18%) remain in follow-up (average duration 6.4 years) with excellent clinical results. Twenty-seven (60%) of these patients have undergone a second operative procedure for correction of aortic stenosis, having achieved an average of 4.3 years of palliation prior to the second operative procedure. Including the operative deaths occurring with the second procedure and the subsequent follow-up of these patients, 29 patients are alive with average follow-up period of 5.7 years. Two of these deaths were not due to cardiovascular disease. Substantial residual aortic gradients were compatible with excellent periods of palliation, provided a reduction of the gradient for the particular patient was achieved. We feel that operative debridement for aortic stenosis, when technically feasible, is a realistic approach to this disease state. Although reoperation may eventually be necessary in the course of the patient's disease, a significant period of palliation with limited morbidity is gained by the patient.
Appraisal of Surgical Atrial Septectomy for Transposition of the Great Arteries
Authors: LITWIN S. BERT , PLAUTH WILLIAM H. , JONES JIMMY E. , BERNHARD WILLIAM F.
Published: June 2012

The results of surgical atrial septectomy alone, septectomy with pulmonary artery banding, and septectomy with shunting procedures in 105 patients are reported. There were 82 survivors with eight deaths directly related to surgery, seven related to specific preoperative complications, and eight resulting from associated cardiac malformations. Excellent improvement in arterial oxygen saturation was achieved and maintained over an extended period of time in the majority of survivors.

Although balloon septostomy has proved to be a helpful palliative maneuver in patients with TGA, 34 children who had this procedure later required surgical septectomy.

A late fall in arterial oxygen saturation was often indicative of diminishing pulmonary blood flow on the basis of increasing pulmonary stenosis or pulmonary vascular obstructive disease.
Five-Year Experience with Magovern Aortic Prostheses
Authors: REED GEORGE E. , CLAUSS ROY H. , TICE DAVID A. , ACINAPURA ANTHONY J.
Published: June 2012

Experience with 105 patients in whom the Magovern aortic valve prosthesis was employed and who were followed for up to five years is presented and analyzed. Twenty-eight patients had a second valve repaired or replaced, four had triple valve disease, and four had aneurysms of the ascending aorta in addition to the aortic valve disease. The ages of these patients ranged from 21 to 74 years with 23 patients in the seventh and eighth decades of life. There were eight operative deaths (8%) and 17 late deaths (17%). Four late deaths were due to embolization or bleeding. Seventeen patients (16%) suffered emboli, and eight (8%) had significant bleeding complications for a total of 25 complications from these causes. Permanent heart block occurred in 9% of the patients and was as common late after operation as early. Although two patients required reoperation because of leaks, in no instance did the prosthesis work loose if it was properly sized and properly positioned.
Clinical Experience with the Unidirectional Dual-Chambered Intra-aortic Balloon Assist
Authors: BREGMAN DAVID , KRIPKE DAVID C. , COHEN MARTIN N. , LANIADO SHLOMO , GOETZ ROBERT H.
Published: June 2012

A dual-chambered balloon mounted on a single-lumen catheter is described, consisting of a distal spherical occluding balloon and a narrower cylindrical pumping balloon. This balloon, in contrast to the conventional single-chambered balloon, pumps blood unidirectionally toward the aortic root in diastole, effecting a 66 to 100% greater increase in coronary blood flow. The implications of this concept are discussed, with particular reference to cardiogenic shock. Significant improvement in all measurable indices of ventricular work are demonstrated both clinically and experimentally. Results in patients are summarized.
Renal Vascular Response to Salt Restriction in Normal Man
Authors: HOLLENBERG NORMAN K. , ADAMS DOUGLASS F. , RASHID ABDUR , EPSTEIN MURRAY , ABRAMS HERBERT L. , MERRILL JOHN P.
Published: June 2012

The role of the sympathetic nervous system in the renal vasoconstriction induced by sodium restriction has been assessed in normal man in balance on a 10-mEq sodium intake. Renal blood flow was measured with radioxenon injected into the renal artery. Phentolamine infused into the renal artery at rates of up to 3 mg/min did not increase net renal perfusion or alter its intrarenal pattern. That dose of phentolamine was at least 30 times the threshold for significant blockade of the renal vascular effects of a large dose of epinephrine injected intra-arterially. The results suggest strongly that neither circulating catecholamines nor the sympathetic nerves play a central role in the renal vascular response to salt restriction in normal man.
Clinicopathologic Correlations
Authors: CARTER JOHN B. , SETHI SURENDRA , LEE GERALD B. , EDWARDS JESSE E.
Published: June 2012

Among the various anatomic classes of aortic valvular insufficiency is that associated with prolapse of one or several cusps of the valve. A number of etiologic factors come into play, including intrinsic weakness or excessive cuspid tissue, trauma, infection, inadequate support of the aorta as in certain ventricular septal defects, and loss of commissural support from laceration of the ascending aorta. The latter condition may result from trauma, cystic medial necrosis, inflammation, or hypertension. The lacerated aorta may either be associated with typical dissecting aneurysm or there may be little intramural dissection of blood.

In some instances wherein prolapse of one or more cusps causes aortic insufficiency, the functional disturbance may be overcome by correcting the basic problem while preserving the natural aortic valve.
Prevention of Rheumatic Fever
Authors: DENNY FLOYD W. , AYOUB ELIA M. , DILLON HUGH C. , DISNEY FRANK A. , KAPLAN EDWARD L. , MOODY MAX D. , PATERSON PHILIP Y. , TARANTA ANGELO
Published: June 2012

Rheumatic fever is a recurrent disease which frequently can be prevented. Infection with group A streptococci precipitates both initial and recurrent attacks; therefore, prevention of rheumatic fever and rheumatic heart disease depends upon the control of streptococcal infections. This may be accomplished by (1) prevention of streptococcal injections in rheumatic subjects, and (2) early and adequate treatment of streptococcal infections in all individuals.

Bacterial endocarditis may result from dental and other surgical procedures in patients with rheumatic or congenital heart disease. When such procedures are undertaken, these patients should be protected by administration of antibiotics in therapeutic doses.
Hemodynamic Effects of Angiotensin in Normal and Environmentally Stressed Monkeys
Authors: FORSYTH RALPH P. , HOFFBRAND BARRY I. , MELMON KENNETH L.
Published: June 2012

Simultaneous regional blood flow and resistance measurements were made in 21 organs in 11 supine unanesthetized rhesus monkeys before and during two different doses of intravenously infused angiotensin II or saline. Systemic arterial pressure and total peripheral resistance significantly increased at both infusion rates in the six experimental monkeys, compared with changes in five control monkeys; cardiac output decreased at the high dose level. Among major organs, the kidneys, skin, liver (hepatic artery), and mesentery had reductions in the fraction of cardiac output they received and, thus, the greatst increase in resistance and decrease in blood flow. No organ had a significant increase in its blood flow; however, skeletal muscle and bone were normally perfused due to increases in the fraction of cardiac output they received.

Four other monkeys received continuous intravenous angiotensin infusions at initially subpressor rates for periods of 26 to 30 days. There were steady increases of systemic arterial blood pressure due to a rise in total peripheral resistance which reached a plateau in about 5 days. Avoidance schedules or other environmental stresses in these angiotensin-infused monkeys produced much more marked pressor episodes than those which occur in noninfused monkeys. These observations support the hypothesis that small amounts of angiotensin can potentiate sympathetic mediated vasomotor activity.