bluuebunny/crossref_metadata_2025 huggingface dataset:
Cation Exchange Resin in the Treatment of Congestive Heart Failure
Authors: ELKINTON J. R. , SQUIRES R. D. , KLINGENSMITH W. C.
Published: June 2012

Electrolyte balances were measured in four edematous cardiac patients receiving cation exchange resin. It was found that such therapy would increase the fecal loss of sodium and, in some of the cases, would result in the loss of edema which had been refractory to other forms of therapy. In these cases the main route of sodium excretion was through the kidneys and not through the intestinal tract. The resin appeared to potentiate the renal action of simultaneously administered mercurial diuretics.
Revascularization of the Heart
Authors: HAHN RICHARD S. , KIM MAURICE
Published: June 2012

A free graft of vein was placed between the aorta and coronary sinus. Three weeks later the sinus was partially occluded at its ostium in the right auricle. Blood from the aorta was made available to the myocardium by way of the venous system. After these procedures were done a histologic study of the venous and arterial channels was carried out. The coronary sinus and its tributaries showed hyperplasia of the intima. The anterior cardiac veins showed dilatation with little or no hyperplasia of intima. None of the veins became occluded. Complete occlusion of major coronary arteries was done. These arteries distal to the occlusion showed medial sclerosis and atrophy. They did not show thrombosis. The myocardium distal to an occluded artery showed many vascular channels.
The Effects of Increased Intracranial Pressure on the Pulmonary Circulation in Relation to Pulmonary Edema
Authors: HARRISON WILLIAM , LIEBOW AVERILL A.
Published: June 2012

Sudden elevation of intracranial pressure raises not only the systemic but also the pulmonary intravascular pressures, on occasion, sufficiently to result in pulmonary edema. At least two mechanisms are concerned, that of bradycardia, and that of left ventricular failure. Evidence is presented that interruption of vagal inflow temporarily abolishes the first mechanism. These observations are considered in relation to the clinical problem of head injury.
A Study of Factors Related to Efects of Quinidine in Experimental Auricular Flutter
Authors: BROWN BARBARA B.
Published: June 2012

Increasing doses of quinidine cause increased slowing of the auricular rate in flutter of circus movement origin, and maximally tolerated doses cause reversion to sinus rhythm. Quinidine lengthens conduction time in the nonfluttering auricle, and the effect increases as the dose is increased. Refractory period is lengthened equally by small and large doses. Experimental results suggest that the effects of quinidine on the auriculoventricular conducting mechanisms are of three types, (1) direct depressant, (2) vagal block, and (3) reflex sympathetic stimulation, and that these effects are manifest to different degrees depending upon dose and the state of innervation to the heart.
Studies Utilizing the Portable Electromagnetic Ballistocardiograph
Authors: MANDELBAUM HARRY , MANDELBAUM ROBERT A.
Published: June 2012

Persons who have failed to habituate to the cardiovascular effects of nicotine will demonstrate changes in their ballistocardiogram after smoking. These ballistocardiographic changes produced by smoking are of more abnormal quality and are found more frequently in patients with coronary artery and hypertensive heart disease than in normal subjects. The ballistocardiograph provides an accurate objective means of determining whether nicotine has a deleterious effect upon the myocardial function of a patient. In a significant proportion of patients with heart disease who demonstrated an abnormal ballistocardiographic response to smoking, clinical improvement was obtained after a period of tobacco abstention.
Nutritional Factors in Hemodynamics
Authors: LEE RICHARD E. , TANAKA SACHIKO , HOLZE ELIZABETH A.
Published: June 2012

Albino rats treated with pteroylglutamic acid (PGA) developed a significant increase in blood pressure, as compared with litter mate controls of the same sex. The hypertension was associated with wedge-shaped fibroblastic renal cortical lesions. Factors possibly important etiologically in the elevation of blood pressure are discussed in relation to certain of the metabolic roles of pteroylglutamic acid.
The Measurement of Total "Sodium Space" and Total Body Sodium in Normal Individuals and in Patients with Cardiac Edema
Authors: WARNER GEORGE F. , DOBSON ERNEST L. , RODGERS CAROLINE E. , JOHNSTON MURIEL E. , PACE NELLO
Published: June 2012

Total sodium space and total body sodium contents were determined in four groups of individuals with the aid of radiosodium
24
. There appears to be an increase in these values with age, but the presence of well compensated cardiovascular disease in the older age group does not significantly alter the magnitude of these measurements. When congestive failure with edema occurs, there is a marked increase in total sodium space and total body sodium. The increase in total sodium space shows a good correlation with the clinical degree of edema.
Detection of Hypokinesis by a Quantitative Analysis of Left Ventricular Cineangiograms
Authors: LEIGHTON RICHARD F. , WILT SHARON M. , LEWIS RICHARD P.
Published: June 2012

A method for detecting left ventricular hypokinesis is proposed. It involves superimposition of left ventricular silhouettes traced from 30 degree right anterior oblique cineangiograms, correcting for thoracic cage motion, descent of the aortic valve and rotation of the apex. Normal values for the percent of systolic motion of seven endocardial segments have been established from measurements in 20 patients, permitting a statistical definition of hypokinesis. The use of this quantitative method has been compared with visual inspection of ventriculograms (qualitative method), resulting in differences in definition of hypokinetic segments by the two methods in 13 of 16 patients with coronary heart disease. When the quantitative method was used, only one hypokinetic segment was found which did not correspond to an obstructive coronary lesion while six such segments were defined using the qualitative method. In four patients segments thought to be hypokinetic (qualitative method) appeared to be akinetic (quantitative method). In six patients with cardiomyopathy, thought to have diffuse hypokinesis, all seven left ventricular segments were hypokinetic in only three patients. The use of a quantitative method appears to be essential to the proper interpretation of left ventricular wall motion and particularly to the detection of hypokinetic segments.
Effect of Valvular Surgery on Antibody to the Group A Streptococcal Carbohydrate
Authors: AYOUB ELIA M. , TARANTA ANGELO , BARTLEY THOMAS D.
Published: June 2012

Because previous studies revealed that high levels of antibody to the group A streptococcal carbohydrate (A-antibody) persist in the serum of patients with chronic rheumatic valvular disease, the effect of valvular surgery on the level of this antibody was examined in the present study. Streptococcal antibody titers (ASO, anti-DNAse B, and A-antibody) were determined on 73 patients admitted for cardiac surgery: 36 with chronic rheumatic valvular disease and 37 with nonrheumatic cardiac or coronary disease. While the ASO and anti-DNAse B presurgical titers were similar in rheumatic and nonrheumatic individuals, the levels of A-antibody were significantly higher in rheumatic patients. The effect of blood perfusion during cardiac surgery was reflected by reversion of antibody titers towards the mean value for a normal population. A trend toward a rise in all antibodies was seen in all patients two to seven weeks after surgery. However, after an interval of eight weeks or more following surgery, a significant decline in the A-antibody occurred in rheumatic patients who had undergone excision and replacement of the affected valve, but not in those who had experienced a simple commissurotomy. These findings provide additional evidence to support a relationship between valvular disease and A-antibody level in rheumatic patients.
The First Heart Sound in Complete Heart Block
Authors: BURGGRAF GARY W. , CRAIGE ERNEST
Published: June 2012

Eight subjects with complete atrioventricular heart block were studied with simultaneous echocardiography and phonocardiography to investigate the role of the mitral and tricuspid valves in the genesis of the first heart sound (S
1
). Mitral valve motion was studied in all cases and tricuspid patterns in three. At P-R intervals less than 0.20 sec, mitral leaflet closure was completed by ventricular systole. Below P-R values of 0.20 sec there was an inverse relationship between P-R and S
1
amplitude. With P-R between 0.20 and 0.50 sec atrial systole closed the mitral valve without recordable sound. Beyond P-R intervals of 0.50 sec there was reopening of the mitral valve and secondary closure initiated by ventricular systole which was coincident with S
1
. The extent of mitral leaflet separation at the onset of ventricular systole correlated with S
1
amplitude. Pre-ejection period was not related to S
1
intensity. Over a wide range of P-R intervals in two subjects with a split S
1
, tricuspid valve closure was simultaneous with the second S
1
component. It was concluded that atrioventricular valve closure is a necessary event in the production of S
1
and that at least in some individuals tricuspid valve closure is related to its second high frequency component.
Multiple Crystal Echocardiographic Evaluation of Endocardial Cushion Defect
Authors: SAHN DAVID J. , TERRY RICHARD W. , O'ROURKE ROBERT , LEOPOLD GEORGE , FRIEDMAN WILLIAM F.
Published: June 2012

A prototype multiple crystal echocardiographic system developed by Bom and associates was used to evaluate cross-sectional cardiac anatomy in real time in twenty infants and children with endocardial cushion defect (ECD). The findings were compared to fifty normal infants and children and nineteen patients with normal mitral valve anatomy but right ventricular enlargement (RVE). Three standard transducer positions for evaluation of sagittal and transverse cardiac cross-sections are outlined and the normal group and RVE subgroup described. Studies in patients with ECD demonstrated several distinctive abnormalities, consisting of multiple echoes in the mitral valve area, anterior mitral leaflet - septal apposition in diastole with reduced posterior motion in systole, and reduced excursion of the anterior mitral leaflet. In patients with complete atrioventricular (A-V) canal defects, the anterior leaflet was often observed passing across the plane of the ventricular septum into the right ventricle during diastole, and in some of these patients the anterior mitral leaflet was related to the tricuspid annulus. Multiple crystal cardiac ultrasonography allows a more precise determination of intra- and extracardiac spatial relationships and is easier to perform than single crystal echo. The new technique provides clinical information helpful in evaluating patients with possible ECD and gives some indication of the severity of the defect.
Appraisal of Antihypertensive Drug Therapy
Authors: CHASIS HERBERT
Published: June 2012

Four completed prospective studies of drug-treated and control hypertensives utilizing double blind randomized protocols are reviewed for the purpose of evaluating the evidence on which the present therapeutic crusade is based. Patients studied were predominantly male, observed for short period, had complications or died at young age, had high incidence of previous target organ vascular disease, and did not include those whose blood pressure fell to normal with hospitalization alone. Incidence of complications associated with coronary artery disease was the same in control and treated patients. The rapidly progressive disease observed in these patients differs from that described in other natural history studies. Population screening for hypertension for the purpose of instituting drug therapy is premature because the value of antihypertensive drug treatment for the general hypertensive population has not been established.
Echocardiographic Assessment of Left Ventricular Function
Authors: QUINONES MIGUEL A. , GAASCH WILLIAM H. , ALEXANDER JAMES K.
Published: June 2012

The concept of "normalized velocity" has been applied in this study to the echocardiographic (echo) assessment of left ventricular (LV) function in 87 patients. The following normalized velocities were calculated from the ultrasound recording of LV wall motion: 1) the mean circumferential fiber shortening rate (mean V
CF
), 2) the mean normalized posterior wall velocity (V
PW
), and 3) the mean normalized interventricular septal velocity (V
IVS
). Systolic ejection fraction (SEF), and mean (non-normalized) posterior wall velocity (PWV) were also determined. There were 19 patients with normal LV function, 5 with atrial septal defect (mean V
CF
, V
IVS
and SEF were not calculated in these patients), 16 with LV volume overload, 29 with myocardial disease, 6 with hypertrophic cardiomyopathy and 12 with coronary artery disease (CAD). Single plane cineangiographic (angio) determinations of mean V
CF
and SEF were obtained in 50 of the 87 patients (including all 12 patients with CAD).

Mean V
CF
and SEF done by echo correlated very well with mean V
CF
and SEF done by angio in the patients without CAD (
r
= 0.94 and 0.91, respectively). Mean V
CF
(by echo or by angio) adequately separated normal from abnormal LV function. Although correlation between mean V
CF
and SEF was good, mean V
CF
was reduced while SEF was well preserved in several patients. In spite of LV asynergy, most of the patients with CAD had good correlation between echo and angio measurements of mean V
CF
and SEF. Although PWV correlated with echo and angio mean V
CF
in the patients without CAD, the overlap of normal and abnormal values made PWV an unreliable index of LV function. In contrast, V
PW
proved to be a reliable indicator of LV performance in patients without LV asynergy. Agreement between V
PW
and mean V
CF
(by echo or angio) was seen in 94% of the patients; in the presence of CAD, however, greater discrepancy was seen between these two measurements. Agreement between V
IVS
and V
PW
was present in 90% of the patients without CAD, but in only 58% of the patients with CAD.

The analysis of LV wall motion by echocardiography utilizing the "normalized velocity" concept appears to be a rational and practical method for evaluation of LV performance. In the absence of asynergy, V
PW
provides a reliable index of LV performance which may be of particular value when abnormal septal motion precludes the determination of SEF and mean V
CF
. In the presence of asynergy, however, mean V
CF
, V
PW
and V
IVS
may reflect only the performance of the visualized segment of myocardium.
A Method for Evaluating Computer Programs for Electrocardiographic Interpretation
Authors: BAILEY JAMES J. , ITSCOITZ SAMUEL B. , GRAUER LEONARD E. , HIRSHEFELD JOHN W. , HORTON MARTHA R.
Published: June 2012

A previously described method for evaluating computer programs for electrocardiographic (ECG) interpretation was applied to Version D of the Public Health Service (PHS) program and to the Mayo Clinic program of 1968. Staff cardiologists found agreement with the results of the PHS program in 45.5% of 1150 unselected tracings. Clinically significant disagreements based strictly on application of different criteria occurred in 29%, while disagreements based on program errors were found in 25.5%. The corresponding results for the Mayo Clinic program are: agreement in 47%, disagreements due to criteria differences in 30.9%, and disagreements due to program errors in 22.1%.

Both programs had serious deficiencies, particularly in the diagnostic categories of myocardial infarction and cardiac arrhythmias. PHS program errors resulted primarily from mismeasurements and deficient program logic, while Mayo Clinic program errors more frequently resulted from pattern recognition failures. Neither program appears suitable for routine clinical use at the present time.
Sustained Effects of Nitroglycerin Ointment in Patients with Angina Pectoris
Authors: REICHEK NATHANIEL , GOLDSTEIN ROBERT E. , REDWOOD DAVID R. , EPSTEIN STEPHEN E.
Published: June 2012

Cutaneous absorption of nitroglycerin is a well-documented phenomenon which may have unique advantages for the sustained prophylaxis of angina pectoris. Therefore, we have examined the effects of nitroglycerin ointment and placebo on exercise capacity in 14 patients with angina pectoris. Nitroglycerin ointment produced a significant increase in exercise capacity which persisted for at least three hours. Concomitant sustained changes in systolic blood pressure and resting heart rate were observed. Electrocardiographic evidence of myocardial ischemia was significantly reduced. Chronic administration in six patients did not reduce the effects of either nitroglycerin ointment or sublingual nitroglycerin. Nitroglycerin ointment appears to be a truly long-acting nitrate. While evidence of nitrate toxicity or tolerance was not observed in the present study, additional information is required before the widespread use of this agent can be recommended.
Starr-Edwards Mitral Valve Failure Ten Years After Replacement Surgery: Chronic Fibrous Obstruction of the Prosthesis Frustrum Area
Authors: SEYFER ALAN E. , HEYDORN WILLIAM H. , NELSON WILLIAM P. , SPICER MELVIN J. , STREVEY TRACY E.
Published: June 2012

A case of malfunction of a Starr-Edwards caged-ball mitral prosthesis occurring ten years after implantation is presented. The possibility of late malfunction must be suspected in any patient who redevelops symptoms after valve replacement. Preservation of normal prosthetic opening and closing clicks does not prove that the device is functioning normally. The diagnosis is difficult, with cardiac catheterization and demonstration of mitral obstruction providing the most valuable information. Once the diagnosis of prosthesis obstruction is made, reoperation and replacement is mandatory.

This clinical pattern will be seen with increasing frequency as patients with artificial valves are followed over longer periods of time.
Differences in Distribution of Myocardial Abnormalities in Patients with Obstructive and Nonobstructive Asymmetric Septal Hypertrophy (ASH)
Authors: MARON BARRY J. , FERRANS VICTOR J. , HENRY WALTER L. , CLARK CHESTER E. , REDWOOD DAVID R. , ROBERTS WILLIAM C. , MORROW ANDREW G. , EPSTEIN STEPHEN E.
Published: June 2012

Previous studies have shown that abnormal cellular morphology is present in the ventricular septum of patients with asymmetric septal hypertrophy (ASH). The present study was undertaken to determine whether these morphologic abnormalities are limited to the ventricular septum of patients with ASH or are more diffusely distributed throughout the heart, and whether different patterns of distribution of the cellular abnormalities exist in patients with and patients without left ventricular outflow obstruction. Myocardium was obtained at operation or necropsy from 22 patients, including 14 with obstructive and eight with non-obstructive ASH, and studied by both light and electron microscopy. Many hypertrophied, bizarrely shaped, and abnormally arranged cardiac muscle cells, presumably a morphologic manifestation of the genetically transmitted myocardial defect in ASH, were present in the ventricular septum of all patients. In patients with obstructive ASH, these abnormalities were either absent or rarely found in muscle from the left and right ventricular free walls. This observation suggests that functional limitation in these patients is due largely to left ventricular outflow obstruction. In contrast, numerous disorganized cells were extensively distributed in the left and right ventricular feee walls from seven of eight symptomatic patients with non-obstructive ASH, suggesting that these abnormalities probably contribute importantly to functional impairment in such patients.
Postoperative Follow-Up of Patients with Ventricular Septal Defect
Authors: ALLEN HUGH D. , ANDERSON RAY C. , NOREN GEORGE R. , MOLLER JAMES H.
Published: June 2012

This study deals with 341 patients who underwent operative correction of ventricular septal defect at the University of Minnesota Hospitals from 1954 to 1960. Seventy-one patients (21%) died during operation or in the immediate postoperative period; another 30 patients (9%) died following discharge from the hospital and as late as 14 years after operation. One hundred-forty patients had postoperative cardiac catheterizations, 28 of whom were catheterized more than five years after operation. Postoperative hemodynamic data were compared with available preoperative data and show no significant change in total pulmonary resistance. Although the majority of our survivors are asymptomatic, we believe that periodic postoperative clinical and laboratory evaluation is important to the continued well-being of the patient.
Average Coronary Blood Flow Per Unit Weight of Left Ventricle in Patients With and Without Coronary Artery Disease
Authors: KLOCKE FRANCIS J. , BUNNELL IVAN L. , GREENE DAVID , WITTENBERG STEPHEN M. , VISCO JOHN P.
Published: June 2012

Average left ventricular flow per unit mass (F/W) has been evaluated at rest in 20 normal individuals and 26 patients with arteriographically proven, advanced coronary artery disease, using inert gas techniques modified to take into account methodological problems presented by heterogeneous perfusion within the ventricle. Preliminary studies in a canine model in which corornary flow could be measured directly before and after coronary occlusion indicated (1) that inert gas techniques utilizing venous sampling are suitable for abnormal situations when appropriately long periods of saturation and desaturation, and careful resolution of prolonged venous-arterial differences, are employed; and (2) that traditional inert gas methods are not adequate when F/W is abnormally heterogeneous. Using helium as a tracer, coronary disease patients showed a systematic reduction, in comparison to normal individuals, in average left ventricular F/W at rest (54 ± 11 vs 70 ± 13 ml/min/100 g,
P
< 0.01). Simultaneous studies with traditional nitrous oxide and krypton techniques did not show this difference because of the methodological limitations of these techniques in the presence of abnormally heterogeneous F/W. We conclude: (1) that useful, accurate measurements of F/W can be obtained in coronary disease if appropriate methodological precautions are taken; and (2) that appreciable portions of the left ventricle have an abnormally low F/W, even at rest, in patients with advanced coronary disease.
The Use of Heparinization to Prevent Arterial Thrombosis after Percutaneous Cardiac Catheterization In Children
Authors: FREED MICHAEL D. , KEANE JOHN F. , ROSENTHAL AMNON
Published: June 2012

Thrombosis at the site of arterial puncture is a common and serious complication of percutaneous cardiac catheterization in children. A double-blind study was therefore designed to test the efficacy of heparin administered during catheterization in reducing this complication. One hundred and sixty-one unselected children over one year of age were studied. Prior to catheterization, the pulse amplitudes were measured in both legs using a Pulse Volume Recorder (a standardized oscillometer). Immediately after arterial cannulation, heparin, 1 mg/kg, or a placebo was administered. On the morning following catheterization, the pulse amplitude in both legs was remeasured and a pulse volume index calculated using the uncatheterized leg as a control. Patients in whom the catheterized leg was cold, with poor capillary filling and absent arterial pulses four hours after the completion of catheterization, were started on intravenous infusion of heparin. If no improvement occurred within 48 hours, embolectomy was performed.

There was no evidence of arterial compromise to the catheterized extremity to any patient older than 10 years. Of 77 children ten years of age or younger, systemic heparinization postcatheterization was required for a pulseless extremity in 40% (15/37) of those in the placebo group and 8% (3/40) in the heparin group (
P
= 0.003). Only 5% (2/40) of children in the heparinized group had a pulse volume index of less than 50%, compared to 27% (10/37) in the placebo group (
P
= 0.003). Embolectomy was performed in seven of the 37 children in the placebo group and none of 40 in the heparin group (
P
= 0.01). No complications related to the use of heparin were found. We conclude that heparin administered during percutaneous catheterization is effective in preventing arterial thrombosis in children ten years of age or younger and should be routinely administered unless a specific contraindication to its use exists.
Anomalous Origin of One Pulmonary Artery from the Ascending Aorta
Authors: KEANE JOHN F. , MALTZ DAVID , BERNHARD WILLIAM F. , CORWIN ROBERT D. , NADAS ALEXANDER S.
Published: June 2012

Six patients with origin of one pulmonary artery from the ascending aorta are presented. Two are alive: a 21-year-old female, unoperated, with bilateral pulmonary vascular obstructive disease (PVO) and a 4-year-old girl who underwent successful correction at age 5 months. In addition, the data are reviewed from previous reports of 44 patients with this anomaly. Among the total of 50 patients, 42 had congestive heart failure in infancy. The right pulmonary artery arose anomalously in 44. A patent ductus arteriosus was present in 38 cases. At cardiac catheterization, pressure in both pulmonary arteries was generally at systemic level and the diagnosis was confirmed by aortography. Histologically, no significant PVO was observed in the majority of 18 infants who died, while significant changes, mainly in the "systemic" lung, were observed in 6 of 10 older children.

Twenty-two patients have been operated on with 13 survivors. Anastomosis of the aberrant pulmonary artery to the main pulmonary artery directly or using a graft has been successful in 12 of 18 children. Corrective tive surgery should be performed as early as possible to prevent PVO.
Complications of Cardiac Catheterization of Neonates, Infants, and Children
Authors: STANGER PAUL , HEYMANN MICHAEL A. , TARNOFF HAROLD , HOFFMAN JULIEN I. E. , RUDOLPH ABRAHAM M.
Published: June 2012

In order to assess the influence of recent modifications in cardiac catheterization technique and patient management, a prospective study of all complications in a series of 1160 cardiac catheterizations of neonates, infants, and children was performed. Thirty-four major and 136 minor complications were recorded. Fatal complications were rare in all age groups (0.26%); however, postcatheterization deaths not attributable to the procedure were common in critically ill neonates with nonremediable lesions.

Arrhythmias and arterial complications accounted for 78% of all complications. Although the incidence of arrhythmias was high (8.3% of all cases), particularly in infants, almost all responded to simple therapeutic measures. Five arrhythmias resulted in clinical deterioration and two contributed to death.

The incidence of arterial complications varied considerably with the method of arterial entry. Percutaneous catheterization by the sheath method was associated with fewer complications than with the Seldinger technique, arteriotomy, or insertion of a teflon cannula into an exposed artery. Complications were particularly common after brachial arteriotomy in patients with coarctation of the aorta (16.1%).

Complications of contrast media and perforation of the heart were infrequent, each occurring once.

Although the total number of major complications was only moderately less frequent than in patients of comparable age in the Cooperative Study on Cardiac Catheterization,
1
there was a considerable reduction in the most severe complications and deaths. The changes in catheterization technique and patient management that contributed to decreased mortality and morbidity are discussed.
Passive Elasticity of the Human Left Ventricle
Authors: FESTER ARIEH , SAMET PHILIP
Published: June 2012

Pressure-volume (PV) and stress-strain relationships (σ-ε) were utilized for evaluation of stiffness changes in the human left ventricle. A total of 45 patients were studied with data available from routine cardiac catheterization. They were divided into eight groups from which five were chosen for statistical comparison. These were the groups of normal, idiopathic hypertrophy without obstruction (IH), congestive heart failure in severe coronary artery disease (CHF-CAD
1
), moderate to severe CAD
2
, and mild to moderate CAD
3
. Utilizing precise pressure volume relationships, the natural elastic stiffness (dσ
sp.
/dε
2
) for a spherical model and the stiffness constant K
2
were evaluated. In addition, stress-strain relationships for ellipsoid model were utilized for evaluation of the diastolic stiffness and the stiffness constants b
1
and K
3
as obtained for the modified Lagrangian strain (L-L
1
)/L
1
, and the natural strain Loge(L/L
o
), respectively. The constants K
2
, b
1
and K
3
were 20.3 ± 1.5, 15.0 ± 2.4 and 15.8 ± 2.3 for eight normal patients; 34.5 ± 7.9, 18.3 ± 3.4 and 19.0 ± 3.5 for seven patients with idiopathic hypertrophy; 101.2 ± 24.2, 61.0 ± 13.0 and 62.3 ± 13.0 for six patients with severe CAD and CHF (CHF-CAD
1
); 59.5 ± 9.2, 32.7 ± 3.9 and 33.2 ± 3.9 for six patients with moderate to severe CAD (CAD
2
) and 35.5 ± 7.3, 24.8 ± 6.3 and 25.4 ± 6.3 for nine patients with mild to moderate CAD (CAD
3
). The end-diastolic passive elastic stiffness E
2
ed (sphere-natural) and E
3
ed (ellipsoid-natural) were 402 ± 55 g/cm
2
and 526 ± 95 g/cm
2
for the normals, 519 ± 250 and 555 ± 250 g/cm
2
for the IH group, 2420 ± 437 and 3142 ± 680 g/cm
2
for the CHF-CAD, group, 500 ± 166 and 525 ± 140 g/cm
2
for the CAD
2
group, and 352 ± 93 and 506 ± 180 g/cm
2
for the CAD
3
group. The results indicate that: 1) all stiffness constants correlated with each other very well and all are sensitive to the magnitude of the damage to the individual myocardium caused by a given disease state; 2) the ellipsoid-natural strain equation as developed in this study, which is more appropriate for biological materials, has the advantage of being the simplest of all other equations; 3) stiffness constants depend upon the quality of a given thick wall and not upon the thickness per se; 4) end-diastolic elastic stiffness may remain normal due to opposing effects of compliance, dilatation and hypertrophy; 5) the exponential part of the diastolic stress-strain curve describes only a partial mechanism by which resting force of the intact heart is explained.
Phenylephrine (Neo-synephrine) Terminated Ventricular Tachycardia
Authors: WAXMAN MENASHE B. , DOWNAR EUGENE , BERMAN NEIL D. , FELDERHOF CLARENCE H.
Published: June 2012

Five cases of recurrent, wide QRS complex tachycardia which could be terminated with phenylephrine are presented. These cases fulfilled all accepted criteria for ventricular tachycardia. Carotid sinus massage with and without edrophonium hydrochloride had no effect on the ventricular activity but selectively slowed the atrial rate in cases of atrioventricular (A-V) dissociation, or blocked retrograde conduction in cases of A-V association. The mechanism of action of phenylephrine remains unclear.

These cases have many possible implications. Two of the most important are: 1) phenylephrine may be useful in terminating certain cases of ventricular tachycardia; 2) termination of an unknown, regular, wide QRS complex tachycardia by phenylephrine, and possibly other pressors, can no longer be taken as proof of a supraventricular mechanism.
Detection of Residual Myocardial Function in Coronary Artery Disease Using Post-extra Systolic Potentiation
Authors: DYKE STEPHEN H. , COHN PETER F. , GORLIN RICHARD , SONNENBLICK EDMUND H.
Published: June 2012

Improved global or segmental wall motion following revascularization suggests potential reversibility of ischemic left ventricular dysfunction in coronary artery disease (CAD). This study evaluates the effectiveness of post-extra systolic potentiation (PESP) to detect latent residual contractile function. Quantitative left ventriculography was performed in 15 patients with CAD (including seven with significant asynergy) and in three normal controls. During the ventriculogram, a single extra-systole was introduced by an R-wave coupled stimulator (R-stimulus interval averaged 398 msec, with an average mA of 2.4). PESP improved segmental axis shortening in 51 of 55 normal axes and 15 of 17 hypokinetic or akinetic axes. It also increased both ejection fraction and mean rate of circumferential fiber shortening in 17 of 18 patients. No significant arrhythmia occurred with this technique. A single interposed beat with PESP in one ventriculogram is a safe, effective method to detect residual potential contractile function in myocardium that may be hypokinetic or akinetic under conditions of the study.
Quantitative Determination of Regional Left Ventricular Wall Dynamics by Roentgen Videometry
Authors: DUMESNIL JEAN G. , RITMAN ERIK L. , FRYE ROBERT L. , GAU GERALD T. , RUTHERFORD BARRY D. , DAVIS GEORGE D.
Published: June 2012

The use of roentgen videometry as a means of studying regional left ventricular wall dynamics and performance was evaluated in 32 patients undergoing coronary arteriography. Nine patients had normal coronary arteriograms and hemodynamic findings (group 1), 8 patients had generalized decrease in left ventricular contraction and abnormal hemodynamic findings (group 2), and 15 patients with coronary artery disease had regional wall dynamics abnormalities (group 3). Sixty-per-second determinations of wall thickness were performed in selected sites of the left ventricle. Measurements performed included end-diastolic wall thickness (EDTw), mean and peak rates of systolic wall thickening (m and p dTw/dt), and fractional systolic increase in wall thickness (ΔTw/EDTw). In patients with uniformly performing ventricles (groups 1 and 2), these parameters correlated well with other parameters of ventricular function. Best distinction between the "normal" group (group 1) and the "abnormal" group (group 2) was achieved when the rates of thickening (m and p dTw/dt) were utilized (
P
< 0.001). In patients of group 3, three types of abnormal regional wall dynamics could be determined and quantified objectively: hypokinesia (decreased p dTw/dt), akinesia (p dTw/dt = 0), and dyskinesia (p dTw/dt < 0). The severity of the abnormality of the wall dynamics correlated well with the presence or absence of a previous infarction on the electrocardiogram, and the anatomic location was strongly correlated with the distribution and severity of coronary artery lesions within a given ventricle.
The Effect of Collateral Circulation on Segmental Left Ventricular Contraction
Authors: CARROLL ROBYN J. , VERANI MARIO S. , FALSETTI HERMAN L.
Published: June 2012

The anatomy of the coronary circulation was correlated with left ventricular segmental contractile motion in 162 patients: 43 with normal coronary arteriograms, 119 with significant (> 75%) obstruction of the right coronary artery and/or left anterior descending coronary artery. Collateral vessels were identified in 69% of the patients with coronary artery disease (82/119). The cases with collaterals were graded poor, fair, or good according to the number of vessels and the quality of opacification. Segmental contractile motion was determined angiographically by the percent shortening of each of the six chords of the left ventricle in the right anterior oblique projection. The range of normal shortening (mean ± one standard deviation) for each chord was established in the 43 normal patients as follows:

[See Equation in PDF File]

Patients were grouped according to the site of coronary artery obstruction and quality of collateral circulation to the area supplied by the obstructed coronary artery. The percent shortening and number of abnormal segments were determined for each patient; there was no consistent difference in segmental contraction between patients with and without collaterals. The quality of collateral vessels did not correlate with either the number of abnormal segments or the percent of chord shortening.

In summary, the development of collateral vessels is not associated with the restoration of normal segmental wall motion in patients with coronary artery disease.
Acute Rheumatic Fever in a South Florida County Hospital, 1967-1971
Authors: TAMER DOLORES M.
Published: June 2012

It has been previously reported that the incidence of acute rheumatic fever (ARF) in South Florida is less than in other metropolitan areas of the United States. It has been suggested that when acute rheumatic fever does occur the morbidity and mortality are significantly decreased. A five-year retrospective study of hospitalized cases revealed 98 episodes of ARF in 95 patients. The clinical manifestations paralleled data from recent surveys in two northern cities and included arthritis in 78 episodes, carditis in 54, chorea in two, and erythema marginatum and subcutaneous nodules in one case each. There were three deaths due to malignant pancarditis. Clinical, laboratory, and demographic data were also similar for this group and indicate rheumatic fever in Miami is not unlike the pattern of illness in other endemic areas of this country.
Anomalous Origin of the Left Circumflex Coronary Artery
Authors: PAGE HARRY L. , ENGEL H. JURGEN , CAMPBELL W. BARTON , THOMAS CLARENCE S.
Published: June 2012

Anomalous origin of the circumflex coronary artery from the proximal right coronary artery or right sinus of Valsalva was recognized in 20 of 2996 patients undergoing selective coronary arteriography (0.67%). The relative frequency of this anomaly demands a high level of anticipation during the performance of selective coronary arteriography to assure that an adequate study has been obtained. Failure to recognize and properly demonstrate the anomaly can be hazardous to patient management.

Two angiographic signs have proved reliable in recognizing the anomalous artery before its selective demonstration. These signs are a profile view of the artery behind the aortic root during left ventriculography (the "aortic root sign") and recognition of absent arterial inflow to a significant area of the posterior lateral left ventricle during selective injections of the main left coronary artery (the "sign of non-perfused myocardium"). These angiographic signs are described and the clinical implications of proper demonstration of the anomalous circumflex coronary artery are discussed.
Echocardiographic Assessment of Ductus Arteriosus Shunt in Premature Infants
Authors: SILVERMAN NORMAN H. , LEWIS ALAN B. , HEYMANN MICHAEL A. , RUDOLPH ABRAHAM M.
Published: June 2012

Echocardiograms were performed on premature infants with a patent ductus arteriosus (PDA) in order to assess the magnitude of the left-to-right shunt. Ten of 14 infants with a hemodynamically significant PDA required ligation because of intractable cardiac failure. Twenty infants served as controls. These consisted of seven infants without heart disease, ten infants who were examined echocardiographically after surgical ligation of a PDA, and three infants who were considered to have closed the PDA spontaneously prior to echocardiographic examination. We measured the left atrial (LA) and aortic root (Ao) diameters and an LA/Ao ratio was used to assess left atrial size.

The LA/Ao ratio was 1.28 ± 0.23 (
sd
) in the group with PDA and 0.86 ± 0.10 in the control group. Infants who required surgical ligation all had an LA/Ao ratio above 1.15 (mean 1.38 ± 0.19). After ligation of the PDA the ratio returned to normal levels (0.87 ± 0.12).

Sequential studies performed on seven infants demonstrated the usefulness of the LA/Ao ratio in following the changes in left-to-right ductus shunting and left ventricular failure as well as the effects of medical and surgical therapy. The LA/Ao ratio is helpful in differentiating infants with respiratory distress due to ductus shunting and left ventricular failure from intrinsic pulmonary disease.
Echocardiographic Diagnosis of Aortic Valve Vegetations in Candida Endocarditis
Authors: GOTTLIEB STUART , KHUDDUS SHAIK A. , BALOOKI HOOSHANG , DOMINGUEZ ALBERTO E. , MYERBURG ROBERT J.
Published: June 2012

Similar echocardiographic findings in two patients with surgically confirmed Candida endocarditis of the aortic valve are described. It is suggested that echocardiography performed early in the clinical course of evaluation of drug abuse patients with suspected endocarditis, particularly in the presence of negative blood cultures and systemic emboli, may help establish the diagnosis. Once the diagnosis has been suggested by echocardiography, further steps for confirmation of the diagnosis of Candida endocarditis and therapeutic intervention may be undertaken with minimal time lag.
Recurrent Ventricular Tachycardia Due to Resectable Cardiac Tumor
Authors: ENGLE MARY ALLEN , EBERT PAUL A. , REDO S. FRANK
Published: June 2012

Repeated attacks of paroxysmal rapid heart action and the occurrence of severe cardiac failure during such an episode led to hospitalization of two otherwise healthy two-year-old boys. After conversion of the tachycardia and relief of the cardiac failure, the chest roentgenogram showed an unusual bulge in the region of the left ventricle, and the electrocardiogram indicated an abnormality there. This combination of symptoms and signs suggested the diagnosis of left ventricular tumor, and cardiac catheterization with contrast visualization verified the diagnosis. The tumor was discrete and resectable in both instances. It was characterized as myofibroma or rhabdomyofibroma. Both children have remained free of symptoms on follow-up, which for one child has been ten years.
Altered Sedimentation Behavior and Ultrastructure of Platelets in Hyperlipidemia
Authors: SALEH JEAN W. , HASHIM SAMI A.
Published: June 2012

The influence of hyperlipidemia on platelet sedimentation behavior and ultrastructure was studied in samples of plasma obtained from 22 normal subjects, 7 patients with Type II and 12 patients with Type IV hyperlipoproteinemia, all fasting; also from 11 normal subjects prior to and at intervals up to 6 hours following ingestion of a meal containing 65 g of fat. Platelet counts were made on mixed platelet rich plasma after centrifugation of whole blood at 1,000 rpm, on top plasma layers after high speed centrifugation (10,000 rpm), and on the sediments resuspended in imidazole buffer. The mean ±
se
number of platelets per mm
3
in top layer among normal, Type II and Type IV plasmas were 4,090 ± 405; 9,000 ± 70, and 21,500 ± 1,950, respectively. The rise and subsequent fall in plasma triglycerides in response to fat ingestion in normal subjects paralleled those of platelets in the top layers. No such correlation was found with plasma cholesterol. The presence of platelets in the top layers of plasma was demonstrated further by electron microscopy. The buoyant platelets revealed the presence of osmophilic (lipid) particles within their open canalicular system, and pseudopod formation. The sedimented platelets from normal subjects had a smooth contour, whereas those from patients with hyperlipidemia displayed a striking formation of pseudopods. The data suggest that the sedimentation behavior of platelets and their normal structure are altered significantly as they interact with abnormal concentrations of plasma lipoproteins.
The Effects of Operation on the Echocardiographic Features of Idiopathic Hypertrophic Subaortic Stenosis
Authors: BOLTON MERLE R. , KING JAMES F. , POLUMBO RALPH A. , MASON DEAN , PUGH DAVID M. , REIS ROBERT L. , DUNN MARVIN I.
Published: June 2012

Simultaneous cardiac catheterizations and echocardiograms were performed before and 6-12 months following ventriculoseptomyectomy in 10 patients with idiopathic hypertrophic subaortic stenosis (IHSS) to define the effects of operation on the echocardiographic features of IHSS. Preoperatively, the resting peak systolic gradient ranged from 40-125 mm Hg and averaged 81 mm Hg. Postoperatively no gradient was present in nine patients and one patient had a 15 mm Hg residual gradient. Echocardiographic obstruction index averaged 54 msec/mm (range 35-85) preoperatively and was reduced to 12 msec/mm (0-67) postoperatively. The markedly abnormal systolic anterior motion (SAM) of the anterior mitral leaflet present in all preoperatively was diminished or absent following operation. The preoperative left ventricular outflow tract dimension, calculated by echocardiogram at peak SAM, averaged 1.4 mm (range 0-5) and increased to 15 mm (3-25) following operation. Ventricular septal width averaged 18 mm (range 14-21) and posterior wall thickness averaged 11 mm (range 7-13) and were unchanged following operation. Mitral valve diastolic closing velocity, measured echocardiographically was not altered by operation (average 35 mm/sec before and after operation), suggesting that significant changes in left ventricular compliance did not occur. The echocardiogram in patients after ventriculoseptomyectomy demonstrates more normal mitral valve motion and increased left ventricular outflow tract dimension. In some patients uneven mitral leaflet-septal contact may produce significantly abnormal areas of SAM without obstruction.
The Conducting Tissues in Congenitally Corrected Transposition
Authors: ANDERSON ROBERT H. , BECKER ANTON E. , ARNOLD ROBERT , WILKINSON JAMES L.
Published: June 2012

The histopathological findings are reported in 11 cases of congenitally corrected transposition. For the purposes of this investigation, only hearts with a well-formed septum separating two ventricular sinuses were classed as corrected transposition. We did not, therefore, study any examples of single ventricle with inverted outlet chamber. Five of the cases formed the basis of a preliminary report, in which the distribution of conducting tissues in the anomaly was shown to differ from that reported in previous investigations. The six new cases confirmed this distribution. Thus, in all cases, the connecting atrioventricular node was anteriorly situated in the right atrium at the lateral junction of pulmonary and mitral valves. An anteriorly situated bundle descended into the morphologically left ventricle (right-sided) and encircled the anterolateral quadrant of the pulmonary outflow tract before descending on the anterior septum and bifurcating. The bundle branches were inverted. This distribution was observed in specimens with intact septa (three cases) and in specimens with ventricular septal defects (eight cases). In the latter cases the conducting tissues were related to the anterior quadrants of the defects. One case was of particular interest since the posterior node in the position of the normal atrioventricular node also made contact with the ventricles via a posterior bundle. In all other specimens this node was hypoplastic and did not have ventricular connections. It is considered that this finding provides a link with previous descriptions of posterior conducting tissue in congenitally corrected transposition. The findings are discussed with relation to the development of complete heart block in this anomaly.
Instant Electrocardiography
Authors: CANTWELL JOHN D. , FLETCHER GERALD F.
Published: June 2012

Instant electrocardiograms before and after physical activity were recorded three times per week for three to six months in ten patients with postmyocardial infarction angina pectoris who engaged in a physical training program. Four patients developed ST-segment depressions of over 2 mm following exercise and one of the four had associated ventricular ectopia. Three other patients had asymptomatic runs of ventricular tachycardia. Two of the latter subsequently developed ventricular fibrillation during moderate physical activity and one subsequently died suddenly at home while engaged in yardwork.

Instant electrocardiography represents a simple way to screen for patients prone to exercise-induced arrhythmias. It is felt that the latter should be on antiarrhythmic drugs and be limited to rather light physical activity such as certain flexibility exercises, noncompetitive team sports, and moderately brisk walking.